scholarly journals Usefulness of the “newly designed” short-type single-balloon enteroscope for ERCP in patients with Roux-en-Y gastrectomy: a pilot study

2018 ◽  
Vol 06 (12) ◽  
pp. E1417-E1422 ◽  
Author(s):  
Yuki Tanisaka ◽  
Shomei Ryozawa ◽  
Masafumi Mizuide ◽  
Masanori Kobayashi ◽  
Akashi Fujita ◽  
...  
Keyword(s):  
Pilot Study ◽  
Success Rate ◽  
Median Time ◽  
Primary Outcome ◽  
Success Rates ◽  
Force Transmission ◽  
Endoscopic Retrograde ◽  
Surgically Altered Anatomy ◽  
Procedural Success ◽  
Single Balloon

Abstract Background and aims In recent years, the short single-balloon enteroscope (SBE) has been used during endoscopic retrograde cholangiopancreatography (ERCP) for patients with surgically altered anatomy and has been reported to be useful. However, difficulties remain, and the procedures and devices need improvements. We assessed the usefulness and superiority of a new short SBE equipped with passive bending and high-force transmission by comparisons with outcomes using the conventional short SBE. Methods This study evaluated short SBE-assisted ERCP-related procedures for Roux-en-Y gastrectomy between September 2011 and October 2017. Outcomes including the procedural success rate, which was the primary outcome, were assessed to compare the conventional short SBE (SIF-Y0004 [prototype]) and the new short SBE (SIF-H290S). Results Of 74 procedures performed in 61 patients, 51 procedures in 39 patients involved the SIF-Y0004, and 23 procedures in 22 patients involved the SIF-H290S. The procedural success rates were 70.6 % for SIF-Y0004, and 95.7 % for SIF-H290S, representing better results for the new short SBE (P = 0.02). The new short SBE also had a superior diagnostic success rate (P = 0.047) and median time to reach the blind end (P < 0.001). Conclusions Roux-en-Y gastrectomy patients treated with the new short SBE had better outcomes than those treated with conventional short SBE. More cases need to be studied; however, the new short SBE has the potential to improve ERCP outcomes in patients with surgically altered anatomy.

Short midline catheters: High success rates for antibiotic therapy in children with cystic fibrosis

2021 ◽  
pp. 112972982110353
Author(s):  
Judith Glazner ◽  
Kate Steinfort ◽  
Yanhong Jessika Hu ◽  
William Browne ◽  
Ian Smith ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Antibiotic Therapy ◽  
Success Rate ◽  
Median Time ◽  
Primary Outcome ◽  
Outcome Data ◽  
Time To Failure ◽  
Success Rates ◽  
Device Failure ◽  
A Prospective Study

Objective: Short midline catheter use in paediatric populations appears to be increasing, however data on success rates and efficacy are sparse. This study aims to describe the success rate when midline venous catheters are employed as a single device for intravenous antibiotic therapy in paediatric patients with cystic fibrosis. Methods: A retrospective cohort study was performed in a single institution, retrieving electronic medical record data from July 2017 through March 2020. The primary outcome was device success, defined as a catheter that remained functional until the end of antibiotic therapy. Reasons for device failure were categorized in a standard fashion. Results: Primary outcome data were available for 116 catheter insertions, involving 49 patients and 55 proceduralists. The success rate was 84% ( n = 98). Median age at insertion was 15 years (range 4–19) and median weight 52 kg (13–81). Soft, polyether block amide, Arrow® Seldinger Arterial Catheters were employed. Only 16 patients (14%) required general anaesthesia. Median time to failure was 6 days, and median time to successful completion of treatment was 13 days. Six of 18 failures occurred within 48 h and were likely insertion complications. The most common reasons for device failure were occlusion, extravasation, phlebitis and dislodgement. More than half of patients (56%) received antibiotic therapy at home. Conclusion: There is a high single device success rate when inserting short midlines for 13-day intravenous pulmonary antibiotic therapy in children with cystic fibrosis. These results should be confirmed with a prospective study.

scholarly journals Practical applications and learning curve for EUS-guided hepaticoenterostomy: results of a large single-center US retrospective analysis

2019 ◽  
Vol 07 (04) ◽  
pp. E600-E607 ◽  
Author(s):  
Theodore James ◽  
Todd Baron
Keyword(s):  
Learning Curve ◽  
Success Rate ◽  
Success Rates ◽  
Practical Applications ◽  
Tertiary Referral Center ◽  
Surgically Altered Anatomy ◽  
Procedure Duration ◽  
Procedural Success ◽  
Few Data ◽  
Over Time

Abstract Background and study aims Endoscopic ultrasound-guided hepaticoenterostomy (EUS-HE) is an effective method of endoscopic biliary drainage in cases where endoscopic retrograde cholangiopancreatography has failed or is deemed impossible. Indications for EUS-HE have expanded, resulting in increased interest by endoscopists to learn the procedure; however, few data exist on breadth of application or experience needed to develop proficiency. We describe utilization of EUS-HE for biliary decompression at a large tertiary referral center along with procedural learning curve. Patients and methods Retrospective evaluation of 60 consecutive patients who underwent attempted EUS-HE by one endoscopist from February 2016 through June 2018. Procedures were divided into chronological and summative experience quartiles. We compared procedural success rate, procedural utilization, and procedure duration over time. Results Sixty patients underwent attempted EUS-HE during the study period: 35 with surgically altered anatomy, 23 with malignant biliary obstruction, 35 outpatients, 35 females; median age, 66 years. The procedure was technically successful in 53 patients. Success rates by summative experience quartile were 80 %, 80 %, 93.3 % and 100 % respectively. Beginning at patient number 40, the remaining cases had a success rate of 100 %. Utilization increased from eight cases in the first chronological quartile to 28 in the fourth. There was no significant reduction in procedure duration over time. Conclusion For an experienced endoscopist, EUS-HE could be performed effectively and safely after the experience of 40 cases. Limitations of this study include a single endoscopist and heterogeneous patient population with variable anatomy that may affect procedural success. Future studies should include data from multiple centers and endoscopists.

scholarly journals Feasibility of balloon endoscope-assisted endoscopic retrograde cholangiopancreatography for the elderly

2020 ◽  
Vol 08 (09) ◽  
pp. E1202-E1211
Author(s):  
Ryunosuke Hakuta ◽  
Hirofumi Kogure ◽  
Yousuke Nakai ◽  
Tsuyoshi Hamada ◽  
Tatsuya Sato ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
The Elderly ◽  
Group Differences ◽  
Success Rates ◽  
Technical Success ◽  
Endoscopic Retrograde ◽  
Elderly Individuals ◽  
Technical Success Rate ◽  
Surgically Altered Anatomy

Abstract Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) for patients with surgically altered anatomy is challenging. Recently, balloon endoscopy has been shown to facilitate ERCP for this population with a high technical success rate, but adverse events (AEs) are not uncommon. Compared to non-elderly patients, elderly patients may be at higher risk of AEs due to underlying comorbidities. The current study aimed to evaluate the feasibility of balloon endoscope-assisted ERCP (BE-ERCP) for the elderly. Patients and methods We retrospectively identified patients who underwent BE-ERCP between January 2010 and September 2019. For patients who underwent multiple procedures during the study period, the first session was analyzed. Early AEs associated with BE-ERCP were compared between elderly (≥ 75 years) and non-elderly patients. Results A total of 1,363 BE-ERCP procedures were performed, and 568 patients (211 elderly and 357 non-elderly) were included for the analyses. Technical success rates were high in both the elderly and non-elderly groups (80 % vs. 80 %, respectively). The rates of early AEs were similar between the groups (12 % vs. 9.0 % in the elderly and non-elderly group, respectively; P = 0.31). The mltivariable-adjusted odds ratio for early AEs comparing elderly to non-elderly patients was 1.36 (95 % confidence interval, 0.74–2.51; P = 0.32). Specifically, we did not observe between-group differences in rates of gastrointestinal perforation (2.4 % vs. 2.8 % in elderly and non-elderly groups, respectively; P = 0.99) and aspiration pneumonia (1.9 % vs. 0.6 %, P = 0.20). Conclusions BE-ERCP is a feasible procedure for elderly individuals with surgically altered anatomy.

scholarly journals Single Balloon Enteroscopy-Guided Endoscopic Retrograde Cholangiopancreatography in Surgically Altered Anatomy: Long vs. Short Type

2021 ◽  
Vol 26 (3) ◽  
pp. 181-185
Author(s):  
Chang-Hwan Park
Keyword(s):  
High Risk ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Clinical Studies ◽  
Endoscopic Retrograde ◽  
Balloon Enteroscopy ◽  
Surgically Altered Anatomy ◽  
Single Balloon ◽  
Single Balloon Enteroscopy ◽  
Foregone Conclusion ◽  
Short Type

Traditionally, enteroscopy-guided endoscopic retrograde cholangiopancreatography (ERCP) was considered as troublesome procedure with high risk of complications in patients with surgically altered anatomy (SAA). However, recent studies have suggested that it might not have to be a foregone conclusion. In addition, various enteroscopes have been used for enteroscopy-guided ERCP in patients with SAA showing promising results. Among them, long type single balloon enteroscopes (SBE) have mostly been used for enteroscopy-guided ERCP in Korea. Recently, short type SBE can come in handy all around. Two major points should be considered when to choose between long type and short type SBE in SAA. First, it is the figurative difference between the two types of SBE that effects on actual results of enteroscopy-guided ERCP. Second, it is clinical studies using short type and/or long type SBE for enteroscopy-guided ERCP in patients with SAA. Conclusively speaking, short type SBE should be considered at first for enteroscopy-guided ERCP in most patients with SAA.

scholarly journals Rational guidewire use in the coronary chronic total occlusion interventions

2020 ◽  
Vol 72 (1) ◽  
Author(s):  
Ahmet Karabulut ◽  
Sevket Gorgulu ◽  
Tanıl Kocagoz
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Statistical Analysis ◽  
Success Rate ◽  
Chronic Total Occlusion ◽  
Success Rates ◽  
Total Occlusion ◽  
Clinical Challenge ◽  
The Mean ◽  
Procedural Success

Abstract Background Procedures for coronary chronic total occlusion (CTO) are still a clinical challenge with relatively lower success rates. Recent advances in the biotechnology and introduction of CTO-dedicated guidewires have increased the procedural success rate of CTO interventions. Herein, we aimed to reveal the clinical and angiographic predictors of the crossability of the initial guidewire choice and rational guidewire usage in CTO interventions. A total of 177 patients with an indication for a coronary CTO procedure were included in this study. The use of 1–3 guidewires and crossing of the CTO lesion with the initial guidewire choice was defined as rational guidewire usage. The CTO lesions were classified according to the Japanese chronic total occlusion registry (J-CTO) and EuroCTO scores for evaluating the difficulty of the procedures. Then, a statistical analysis was performed to assess the initial guidewire choice, crossability, and contributors to rational guidewire usage. Results The mean J-CTO score was 1.42 ± 1.16, and the mean EuroCTO score was 1.44 ± 1.18. The success rate of the procedures was 90.4%. The initial guidewire choice crossed the lesion in 44.1% of the cases, in which 1–3 guidewires were used (82.1%). The crossability of the polymeric and moderate stiff tip guidewires was higher (82.1% and 64.1%, respectively), and the Pilot series was the most successful brand (36.2%). Logistic regression analysis confirmed that J-CTO score, procedural technique, guidewire type, and stiffness of the tip were the major predictors of rational guidewire usage. Conclusion Our analysis showed that the use of polymeric and moderate stiff tip guidewires, particularly the Pilot brand, were associated with rational guidewire usage in easy and intermediate difficulty CTO cases.

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