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

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.

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

Endoscopy International Open ◽

10.1055/a-0754-2290 ◽

2018 ◽

Vol 06 (12) ◽

pp. E1417-E1422 ◽

Cited By ~ 10

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.

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Clinical and echocardiographic trends in percutaneous balloon mitral valvuloplasty

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01442-w ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Ofir Koren ◽

Asaf Israeli ◽

Ehud Rozner ◽

Nassem Darawshy ◽

Yoav Turgeman

Keyword(s):

Heart Failure ◽

Medical Center ◽

Success Rates ◽

Mitral Valvuloplasty ◽

Percutaneous Balloon Mitral Valvuloplasty ◽

Developing Heart ◽

Percutaneous Balloon ◽

Study Population ◽

Procedural Success ◽

Over Time

Abstract Background The prevalence of Rheumatic Mitral Stenosis (MS) has significantly changed over the last decades. We intend to examine patient demographics, Echocardiographic characteristics, procedural success rates, and complications throughout 30-years. Methods We conducted a single-center descriptive observational study. The study population consists of patients undergone percutaneous balloon mitral valvuloplasty (PBMV) at Emek Medical Center in Israel from January 1990 to May 2019. Results Four hundred seventeen patients underwent PBMV during the study period and were eligible for the study. Age did not change significantly over time (p = 0.09). The prevalence of Male and patients who were smoking and had multiple comorbidities such as hypertension, dyslipidemia, ischemic heart disease, and chronic kidney disease became increases over time (p = 0.02, p = 0.02, p = 0.001, p = 0.01, p = 0.02, and p = 0.001, respectively). Wilkins score and all its components increased over time, and the total score was higher in females (p = 0.01). Seventy-nine (18.9%) patients had complications. The rate of complications did not change over decades. Patients with Wilkins score > 8, post-procedural MR of ≥2, and post-procedural MVA < 1.5 had the highest risk for the need of Mitral valve replacement (MVR) surgery in 2 years following PBMV (3.64, 4.03, 2.44, respectively, CI 95%, p < .0001 for all). The median time in these patients was 630 days compared to 4–5 years in the entire population. Patients with Post-procedural MR of ≥2 and post-procedural MVA < 1.5 had ten times risk for developing heart failure (HR 9.07 and 10.06, respectively, CI 95%, P < .0001). Conclusion Our research reveals trends over time in patients’ characteristics and echocardiographic features. Our study population consists of more male patients with multiple comorbidities and more complex and calcified valvular structures in the last decade. Wilkins score > 8, post-procedural MR of ≥2, and post-procedural MVA < 1.5 cm2 were in-depended predictors for the time for surgery and heart failure hospitalization.

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Percutaneous transhepatic drainage is safe and effective in biliary obstruction—A single-center experience of 599 patients

PLoS ONE ◽

10.1371/journal.pone.0260223 ◽

2021 ◽

Vol 16 (11) ◽

pp. e0260223

Author(s):

Bálint Kokas ◽

Attila Szijártó ◽

Nelli Farkas ◽

Miklós Ujváry ◽

Szabolcs Móri ◽

...

Keyword(s):

Success Rate ◽

Extrahepatic Bile Duct ◽

Treatment Algorithm ◽

Success Rates ◽

Technical Success ◽

Tertiary Referral Center ◽

Technical Success Rate ◽

Percutaneous Transhepatic Drainage ◽

First Choice ◽

Transhepatic Drainage

Background Historically, surgical bilioenteric bypass was the only treatment option for extrahepatic bile duct obstruction, but with technological advancements, percutaneous transhepatic drainage (PTD) and endoscopic solutions were introduced as a less invasive alternative. Endoscopic methods may lead to a decreasing indication of PTD in the future, but today it is still the standard treatment method, especially in hilar obstructions. Methods In our retrospective data analysis, we assessed technical success rate, reintervention rate, morbidity, mortality, and the learning curve of patients treated with PTD over 12 years in a tertiary referral center. Results 599 patients were treated with 615 percutaneous interventions. 94.5% (566/599) technical success rate; 2.7% (16/599) reintervention rate were achieved. 111 minor and 22 major complications occurred including 1 case of death. In perihilar obstruction, cholangitis were significantly more frequent in cases where endoscopic retrograde cholangiopancreatography had also been performed prior to PTD compared to PTD alone, with 39 (18.2%) and 15 (10.5%) occurrences, respectively. Discussion The results and especially the excellent success rates demonstrate that PTD is safe and effective, and it is appropriate for first choice in the treatment algorithm of perihilar stenosis. Ultimately, we concluded that PTD should be performed in experienced centers to achieve low mortality, morbidity, and high success rates.

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A Comparison of Calcium Hydroxyapatite and Dextranomer/Hyaluronic Acid for the Endoscopic Treatment of Vesicoureteral Reflux

Advances in Urology ◽

10.1155/2013/263602 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

Tin C. Ngo ◽

Ilene Yi-Zhen Wong ◽

William A. Kennedy

Keyword(s):

Hyaluronic Acid ◽

Learning Curve ◽

Success Rate ◽

Endoscopic Treatment ◽

Single Injection ◽

Statistical Significance ◽

Case Series ◽

Calcium Hydroxyapatite ◽

Success Rates ◽

Single User

Purpose. Minimal data exists comparing dextranomer/hyaluronic acid (Dx/HA) and calcium hydroxyapatite (CaHA) for the endoscopic treatment of VUR in the hands of a single user.Materials and Methods. We reviewed our consecutive single-user case series of 27 children (42 ureters) receiving endoscopic treatment with CaHA and 21 children (33 ureters) who received Dx/HA injection. Children receiving CaHA injections were divided into two groups of 13 and 14 patients (Coaptite I and II) to assess the learning curve effects. Postoperatively, RBUS and VCUG were performed. Multiple regression analysis was performed to assess statistical significance of success rates.Results. The total CaHA group had a per-ureter success rate (Grade 0) of 52% after one injection. When separated into two cohorts, the single injection per-ureter success rates were 43% for Coaptite I and 62% for Coaptite II. In contrast, the Dx/HA series had a single injection per-ureter success rate (Grade 0) of 78%.Conclusions. Our consecutive case experience shows improved results for Dx/HA compared to CaHA, though the learning curve effects and evolution of injection technique likely played a role in the improved outcomes in the Dx/HA cohort. A randomized controlled multicenter trial would provide the most accurate data comparing these two agents.

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Learning Curve for Endovascular Abdominal Aortic Aneurysm Repair: Evaluation of a 277-Patient Single-Center Experience

Journal of Endovascular Therapy ◽

10.1177/152660280200900302 ◽

2002 ◽

Vol 9 (3) ◽

pp. 262-268 ◽

Cited By ~ 31

Author(s):

Armando C. Lobato ◽

Julio Rodriguez-Lopez ◽

Edward B. Diethrich

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Learning Curve ◽

Success Rate ◽

Operative Mortality ◽

Time Interval ◽

Abdominal Aortic ◽

Contrast Volume ◽

Operative Complications ◽

Procedural Success

Purpose: To determine the minimum number of stent-graft deployments that an interventional team with endovascular skills must do to be considered well trained in endovascular abdominal aortic aneurysm (AAA) exclusion. Methods: The records of 277 consecutive patients (236 men; median age 73 years, range 49–91) undergoing endovascular AAA repair at a single institution between 1994 and 1998 were reviewed. Information was collected on procedural success, conversion, time interval between procedures, operative complications, operative mortality, contrast volume, blood loss, intensive care unit (ICU) length of stay (LOS), and hospital LOS. A first-order differential equation was used to calculate a learning curve based on the success rate. Patients were subsequently divided into 5 sequential groups of 55 patients (the last group had 57 patients). Results: Analyzing the pattern of procedural success to failures, a sharp change in the slope was observed between 50 and 65 trials. The number 55 was arbitrarily chosen to represent the point after which the incremental change in the success rate never exceeded 0.01 (<1 failure per 100 attempts). In the intergroup comparisons, success rate (p<0.04), conversion rate (p<0.0001), and procedural frequency (p<0.0001) were statistically significant when the first 55-patient group was compared to the others. Operative complications (p=0.08) and operative mortality (p=0.16) were numerically but not significantly different. Contrast volume was significantly reduced for the last group (p<0.0001). A Cox regression model identified only procedural frequency (p=0.03) and procedural volume (p=0.04) as predictive of technical success. Performing endovascular AAA repairs at a ≤10-day interval was associated with a >80% success rate. Conclusions: This study shows that not only is the number of procedures important to outcome, but also the frequency with which they are performed. Based on our team's performance data, 55 cases would appear to be the minimum volume and 1 case every 10 days the minimum frequency to obtain good operative results with aortic endografting.

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EUS-guided intrahepatic biliary drainage: a large retrospective series and subgroup comparison between percutaneous drainage in hilar stenoses or postsurgical anatomy

Endoscopy International Open ◽

10.1055/a-1264-7511 ◽

2020 ◽

Vol 08 (12) ◽

pp. E1782-E1794

Author(s):

Giuseppe Vanella ◽

Michiel Bronswijk ◽

Geert Maleux ◽

Hannah van Malenstein ◽

Wim Laleman ◽

...

Keyword(s):

Percutaneous Drainage ◽

Biliary Drainage ◽

Clinical Success ◽

Success Rates ◽

Median Hospital Stay ◽

Tertiary Referral Center ◽

Surgically Altered Anatomy ◽

Fatal Adverse Events ◽

Management Algorithms

Abstract Background and study aims Endoscopic ultrasound-guided intrahepatic biliary drainage (EUS-IBD) struggles to find a place in management algorithms, especially compared to percutaneous drainage (PTBD). In the setting of hilar stenoses or postsurgical anatomy data are even more limited. Patients and methods All consecutive EUS-IBDs performed in our tertiary referral center between 2012 – 2019 were retrospectively evaluated. Rendez-vous (RVs), antegrade stenting (AS) and hepatico-gastrostomies (HGs) were compared. The predefined subgroup of EUS-IBD patients with proximal stenosis/surgically-altered anatomy was matched 1:1 with PTBD performed for the same indications. Efficacy, safety and events during follow-up were compared. Results One hundred four EUS-IBDs were included (malignancies = 87.7 %). These consisted of 16 RVs, 43 ASs and 45 HGs. Technical and clinical success rates were 89.4 % and 96.2 %, respectively. Any-degree, severe and fatal adverse events (AEs) occurred in 23.3 %, 2.9 %, and 0.9 % respectively. Benign indications were more common among RVs while proximal stenoses, surgically-altered anatomy, and disconnected left ductal system among HGs. Procedures were shorter with HGs performed with specifically designed stents (25 vs. 48 minutes, P = 0.004) and there was also a trend toward less dysfunction with those stents (6.7 % vs. 30 %, P = 0.09) compared with previous approaches. Among patients with proximal stenosis/surgically-altered anatomy, EUS-IBD vs. PTBD showed higher rates of clinical success (97.4 % vs. 79.5 %, P = 0.01), reduced post-procedural pain (17.8 % vs. 44.4 %, p = 0.004), shorter median hospital stay (7.5 vs 11.5 days, P = 0.01), lower rates of stent dysfunction (15.8 % vs. 42.9 %, P = 0.01), and the mean number of reinterventions was lower (0.4 vs. 2.8, P < 0.0001). Conclusions EUS-IBD has high technical and clinical success with an acceptable safety profile. HGs show comparable outcomes, which are likely to further improve with dedicated tools. For proximal strictures and surgically-altered anatomy, EUS-IBD seems superior to PTBD.

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Learning Curve in External DCR – A Trainee’s Perspective

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v9i2.19255 ◽

2018 ◽

Vol 9 (2) ◽

pp. 121-127 ◽

Cited By ~ 2

Author(s):

Karan Bhatia ◽

Sabyasachi Sengupta ◽

Madhu Bhadauria

Keyword(s):

Learning Curve ◽

Success Rate ◽

Uttar Pradesh ◽

Complication Rates ◽

Entire Study ◽

External Dacryocystorhinostomy ◽

Sac Syringing ◽

Anatomical Success ◽

Over Time ◽

External Dcr

Purpose: The aim of this study is to determine the success rate over time in patients undergoing External Dacryocystorhinostomy (DCR) with acquired naso-lacrimal duct obstruction (NLDO), when done by a trainee ophthalmologist.Methods: The study was Prospective Observational study and was conducted in Tertiary Eye Hospital, Uttar Pradesh, India. One hundred and fourteen consecutive adult patients underwent external DCR for acquired complete NLDO by a trainee with less than 3 years of experience in ophthalmology between November 2011 and March 2013. Postoperative anatomic success rate was determined at 6 months on the basis of the patency of lacrimal sac syringing and patients were asked to subjectively evaluate improvement of their epiphora using a questionnaire.Results: Anatomical success rate across the entire study period was 93.7% and this improved from 87% in the first tertile of 38 patients to 94% in the second tertile and 100% in the final tertile of cases (p<0.05). Overall complication rate was 16.67% and reduced from 29% in the first tertile to 8% in the final tertile (p<0.05). Loss of anterior nasal flap was the commonest complication (10 cases) during the training period.Conclusion: External DCR, as a primary procedure for acquired NLDO, even when operated by trainee ophthalmologists, has a relatively high success rate that improves over time. As the learning curve improves, complication rates reduce significantly. Financial Disclosure: No author has any financial or proprietary interest in the material or method mentioned.

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Rational guidewire use in the coronary chronic total occlusion interventions

The Egyptian Heart Journal ◽

10.1186/s43044-020-00115-8 ◽

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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Salvage Techniques for Difficult Biliary Cannulation: A Retrospective Study of 1021 Endoscopic Retrograde Cholangiopancreatography Cases in a Tertiary Referral Center

10.21203/rs.3.rs-1149043/v1 ◽

2021 ◽

Author(s):

Shikiko Maruta ◽

Harutoshi Sugiyama ◽

Sadahisa Ogasawara ◽

Chihei Sugihara ◽

Mayu Ouchi ◽

...

Keyword(s):

Success Rate ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Success Rates ◽

Endoscopic Retrograde ◽

Biliary Cannulation ◽

Tertiary Referral Center ◽

Treatment Processes ◽

Difficult Biliary Cannulation ◽

Needle Knife ◽

Event Rates

Abstract Although some salvage techniques have been developed to overcome difficult biliary cannulation in endoscopic retrograde cholangiopancreatography (ERCP), few reports analyzed the choice of techniques and their clinical outcomes in large cohorts. This study aimed to evaluate the outcomes of biliary cannulation in patients with initial treatment papillae. We retrospectively identified 1021 patients who underwent initial ERCP from January 2013 to March 2020. We investigated background factors, treatment details, success rates, and adverse event rates. Then we analyzed a series of treatment processes, including salvage techniques such as double guidewire technique (DGT), needle knife pre-cutting (NKP), and transpancreatic pre-cut papillotomy (TPPP). The initial ERCP success rate was 94.3%, and the eventual success rate was 98.3%. Salvage techniques were required in 380 of 1021 patients (37.2%), associated with long oral protrusion (OR, 2.38; 95% CI, 1.80–3.15; p < 0.001). A total of 503 cases (49.3%) had long oral protrusions, 47.5% of which required the salvage techniques, much higher than 27.5% of not-long cases. Patients with long oral protrusions had a higher frequency of NKP. In conclusion, patients with long oral protrusions frequently required salvage techniques. Appropriate strategies and salvage techniques may help to overcome many difficult biliary cannulation cases.

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The learning curve of retinal detachment surgery

Graefe s Archive for Clinical and Experimental Ophthalmology ◽

10.1007/s00417-021-05096-1 ◽

2021 ◽

Author(s):

Viola Radeck ◽

Horst Helbig ◽

Teresa Barth ◽

Maria-Andreea Gamulescu ◽

David Maerker ◽

...

Keyword(s):

Retinal Detachment ◽

Learning Curve ◽

Success Rate ◽

Learning Curves ◽

Successful Outcome ◽

Success Rates ◽

Retinal Detachment Surgery ◽

Primary Success ◽

Female Surgeons ◽

The Individual

Abstract Purpose To investigate the learning curve of vitreoretinal (VR) surgeons beginning training in retinal detachment (RD) surgery. Methods The files of all consecutive patients undergoing VR surgery for uncomplicated RD between Jan 2005 und Mar 2020 were retrospectively reviewed. Successful outcome was defined as no retinal redetachment within 3 months after surgery. Results Ten surgeons started their VR career during this period. Together, these 10 surgeons performed 3786 RD operations (mean 379; median 251; range 71–1053). Primary success rate after one operation was 90% (3420 of 3786). When starting to operate retinal detachments, VR surgeons had a primary success rate of about 80%. Redetachment rates steadily decreased and stabilized at just under 10% after about 200 operations. Beginners needed more than twice the time for the procedure compared to experienced surgeons. The individual learning curves varied widely. In our series, female surgeons seem to have a faster learning curve. Conclusion RD surgery performed by VR surgeons in training had acceptable results. With increasing experience, success rates continuously improve reaching stable levels after approximately 200 operations. The training of VR surgeons requires considerable resources.

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