scholarly journals The EDGI new take on EDGE: EUS-directed transgastric intervention (EDGI), other than ERCP, for Roux-en-Y gastric bypass anatomy: a multicenter study

2019 ◽  
Vol 07 (10) ◽  
pp. E1231-E1240 ◽  
Author(s):  
Matthew R. Krafft ◽  
William Hsueh ◽  
Theodore W. James ◽  
Thomas M. Runge ◽  
Todd H. Baron ◽  
...  
Keyword(s):  
Gastric Bypass ◽  
Retrospective Study ◽  
Adverse Events ◽  
Multicenter Study ◽  
Clinical Success ◽  
Endoscopic Biopsy ◽  
Success Rates ◽  
Moderate Severity ◽  
Excluded Stomach ◽  
Heterogenous Group

Abstract Background and study aims Indications for accessing the duodenum, and/or excluded stomach in Roux-en-Y gastric bypass (RYGB) patients extend beyond diagnosis and treatment of pancreaticobiliary maladies. Given the high technical and clinical success of EUS-directed transgastric ERCP (EDGE) in RYGB anatomy, we adopted this transgastric (anterograde) approach to evaluate and treat luminal and extraluminal pathology in and around the excluded gut in RYGB patients. EUS-directed transgastric intervention (“EDGI”), other than ERCP, is the terminology we have chosen to describe this heterogenous group of transgastric diagnostic and/or interventional endoscopic procedures (transgastric interventions) performed via a lumen-apposing mental stent (LAMS) in select patients with RYGB. Patients and methods A multicenter (n = 4), retrospective study of RYGB patients with suspected luminal or extraluminal pathology, in or around the duodenum and/or excluded stomach, underwent EDGI using LAMS between December 2015 and January 2019. Results A total of 14 patients (78.6 % women; mean age, 55.7 + 12.4 years) underwent EDGI via LAMS. Technical and clinical success rates of EDGI were 100 %. The most common transgastric interventions were diagnostic EUS of extraluminal pathology (n = 6, 42.7 %) and endoscopic biopsy of gastroduodenal luminal abnormalities (n = 5, 35.7 %). Two moderate-severity adverse events due to LAMS maldeployment occurred during EUS-JG creation (14.3 %), and each instance was successfully rescued with a bridging stent. Conclusions A variety of gastroduodenal luminal and extraluminal disorders in RYGB patients can be effectively diagnosed and managed using EDGI via LAMS.

scholarly journals Randomized Double-Blind Study Comparing 3- and 6-Day Regimens of Azithromycin with a 10-Day Amoxicillin-Clavulanate Regimen for Treatment of Acute Bacterial Sinusitis

2003 ◽  
Vol 47 (9) ◽  
pp. 2770-2774 ◽  
Author(s):  
Dan C. Henry ◽  
Ernie Riffer ◽  
William N. Sokol ◽  
Naumann I. Chaudry ◽  
Robert N. Swanson
Keyword(s):  
Adverse Events ◽  
Multicenter Study ◽  
Clinical Success ◽  
Double Blind Study ◽  
Efficacy And Safety ◽  
Success Rates ◽  
Double Blind ◽  
Once Daily ◽  
Acute Bacterial Sinusitis ◽  
Amoxicillin Clavulanate

ABSTRACT A randomized, double-blind, multicenter study of adults with acute bacterial sinusitis (ABS) compared the efficacy and safety of two azithromycin (AZM) regimens, 500 mg/day once daily for 3 days (AZM-3) or 6 days (AZM-6) to the efficacy and safety of an amoxicillin-clavulanate (AMC) regimen of 500-125 mg three times daily for 10 days. A total of 936 subjects with clinically and radiologically documented ABS were treated (AZM-3, 312; AZM-6, 311; AMC, 313). Clinical success rates were equivalent among per-protocol subjects at the end of therapy (AZM-3, 88.8%; AZM-6, 89.3%; AMC, 84.9%) and at the end of the study (AZM-3, 71.7%; AZM-6, 73.4%; AMC, 71.3%). Subjects treated with AMC reported a higher incidence of treatment-related adverse events (AE) (51.1%) than AZM-3 (31.1%, P < 0.001) or AZM-6 (37.6%, P < 0.001). More AMC subjects discontinued the study (n = 28) than AZM-3 (n = 7) and AZM-6 (n = 11) subjects. Diarrhea was the most frequent treatment-related AE. AZM-3 and AZM-6 were each equivalent in efficacy and better tolerated than AMC for ABS.

Tocilizumab in Giant Cell Arteritis: A Multicenter Retrospective Study of 34 Patients

2016 ◽  
Vol 43 (8) ◽  
pp. 1547-1552 ◽  
Author(s):  
Alexis Régent ◽  
Serge Redeker ◽  
Alban Deroux ◽  
Pierre Kieffer ◽  
Kim Heang Ly ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Side Effects ◽  
Adverse Events ◽  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Multicenter Study ◽  
Efficacy And Safety ◽  
Severe Adverse Events ◽  
Retrospective Multicenter Study

Objective.To report the efficacy and safety of tocilizumab (TCZ) for giant cell arteritis (GCA).Methods.A retrospective multicenter study that included 34 patients receiving TCZ for GCA.Results.TCZ was effective in all but 6 patients, who still had mild symptoms. Mean glucocorticoid dose was tapered. One patient died and 3 patients had to stop TCZ therapy because of severe adverse events. Twenty-three patients stopped treatment; 8 of these experienced relapses after a mean of 3.5 ± 1.3 months.Conclusion.TCZ is effective in GCA. However, side effects occur. Whether this treatment has only a suspensive effect remains to be determined.

Practice patterns, techniques, and outcomes of flexible endoscopic myotomy for Zenker’s diverticulum: a retrospective multicenter study

Endoscopy ◽  
2020 ◽  
Author(s):  
Chetan Mittal ◽  
David L. Diehl ◽  
Peter V. Draganov ◽  
Laith H. Jamil ◽  
Ammara Khalid ◽  
...  
Keyword(s):  
Adverse Events ◽  
Practice Patterns ◽  
Clinical Success ◽  
Zenker’S Diverticulum ◽  
Success Rates ◽  
Zenker's Diverticulum ◽  
Submucosal Dissection ◽  
Significant Difference ◽  
Endoscopic Myotomy ◽  
Needle Knife

Abstract Background Flexible endoscopic myotomy has been increasingly performed for Zenker’s diverticulum using various endoscopic techniques and devices. The main aims of this study were to assess practice patterns and compare outcomes of endoscopic myotomy for Zenker’s diverticulum. Methods Procedures performed at 12 tertiary endoscopy centers from 1/2012 to 12/2018 were reviewed. Patients (≥ 18 years) with Zenker’s diverticulum who had dysphagia and/or regurgitation and underwent endoscopic myotomy were included. Outcomes assessed included technical success, clinical success, and adverse events. Results 161 patients were included. Traditional endoscopic septotomy was performed most frequently (137/161, 85.1 %) followed by submucosal dissection of the septum and myotomy (24/161, 14.9 %). The hook knife (43/161, 26.7 %) and needle-knife (33/161, 20.5 %) were used most frequently. Overall, technical and clinical success rates were 98.1 % (158/161) and 78.1 % (96/123), respectively. Adverse events were noted in 13 patients (8.1 %). There was no significant difference in technical and clinical success between traditional septotomy and submucosal dissection groups (97.1 % vs. 95.8 %, P = 0.56 and 75.2 % vs. 90.9 %, P  = 0.16, respectively). Clinical success was higher with the hook knife (96.7 %) compared with the needle-knife (76.6 %) and insulated tip knife (47.1 %). Outcomes were similar between centers performing > 20, 11 – 20, and ≤ 10 procedures. Conclusions Flexible endoscopic myotomy is an effective therapy for Zenker’s diverticulum, with a low rate of adverse events. There was no significant difference in outcomes between traditional septotomy and a submucosal dissection approach, or with centers with higher volume, though clinical success was higher with the hook knife.

scholarly journals Endoscopic Retrieval Technique of Proximally Migrated Pancreatic Stents: A Retrospective Study in a Tertiary Centre

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Yi Lu ◽  
Zheng Jin ◽  
Jia-chuan Wu ◽  
Li-ke Bie ◽  
Biao Gong
Keyword(s):  
Retrospective Study ◽  
Adverse Events ◽  
Pancreatic Duct ◽  
Clinical Information ◽  
Stent Migration ◽  
Point Of View ◽  
Pancreatic Stent ◽  
Success Rates ◽  
Tertiary Centre ◽  
Endoscopic Retrieval

Background. There were scarce trials concerning the treatments and outcomes of proximal pancreatic stent migration. Herein, we did a retrospective study to discuss this problem from an endoscopist’s point of view.Patients and Methods. From January 2009 to June 2014, patients with proximally migrated pancreatic duct stents were identified. Their clinical information was viewed. Retrieval techniques, success rates, and adverse events were analyzed.Results. A total of 36 procedures were performed in 34 patients; the median age of the patients was 53 years, with 17 males and 17 females. Eight patients’ pancreatic duct stents could still be seen in the major or minor papilla and were pulled out with a snare forceps or a grasping forceps; in the remaining 28 procedures, the management was somewhat thorny; the retrieval called for several devices. Final success was achieved in 31 patients. No adverse event was observed in the process of ERCP procedures, 5 patients developed post-ERCP pancreatitis (PEP), 1 patient got infection, and 1 patient had haemorrhage.Conclusions. Endoscopic retrieval of migrated pancreatic stent is safe and less invasive; nonetheless, attention should be paid so as to reduce the incidence and degree of related adverse events, especially PEP.

Safety of lumen-apposing stent with or without coaxial plastic stent for endoscopic ultrasound-guided drainage of pancreatic fluid collections: a retrospective study

Endoscopy ◽  
2018 ◽  
Vol 50 (10) ◽  
pp. 1022-1026 ◽  
Author(s):  
Manuel Puga ◽  
Claudia Consiglieri ◽  
Juli Busquets ◽  
Natàlia Pallarès ◽  
Lluis Secanella ◽  
...  
Keyword(s):  
Adverse Events ◽  
Endoscopic Ultrasound ◽  
Clinical Success ◽  
Success Rates ◽  
Plastic Stent ◽  
Frequent Adverse Event ◽  
Pancreatic Fluid Collections ◽  
Pancreatic Fluid ◽  
Transmural Drainage ◽  
Fluid Collections

Abstract Background The aim of this study was to evaluate whether the placement of a coaxial double-pigtail plastic stent (DPS) within a lumen-apposing metal stent (LAMS) may improve the safety of endoscopic ultrasound (EUS)-guided drainage of pancreatic fluid collections (PFCs). Methods This was a retrospective cohort study including patients with PFCs and an indication for transmural drainage. Two strategies (LAMS alone or LAMS plus DPS) were used at the endoscopist’s discretion. Results A total of 41 patients were treated (21 LAMS alone; 20 LAMS plus DPS). The characteristics of the PFCs, and the technical and clinical success rates did not differ between groups. The LAMS alone group had a significantly higher rate of adverse events than the LAMS plus DPS group (42.9 % vs. 10.0 %; P = 0.04). Bleeding was the most frequent adverse event observed. Conclusions The addition of a coaxial DPS to LAMS was associated with a lower rate of adverse events in EUS-guided drainage of PFCs.

Transcatheter arterial embolization for hemorrhage after gynecologic hysterectomy: a multicenter study

2021 ◽  
pp. 028418512110103
Author(s):  
Cheng Shi Chen ◽  
Young-Jong Cho ◽  
Ji Hoon Shin ◽  
Jeong Ho Kim ◽  
Suyoung Park ◽  
...  
Keyword(s):  
Multicenter Study ◽  
Transcatheter Arterial Embolization ◽  
Clinical Success ◽  
Arterial Embolization ◽  
Exploratory Laparotomy ◽  
Hemodynamic Instability ◽  
Active Bleeding ◽  
Success Rates ◽  
Contrast Extravasation ◽  
Anterior Division

Background Transcatheter arterial embolization (TAE) is not common for hemorrhagic complications after gynecologic hysterectomy. Purpose To evaluate the effectiveness and safety of TAE for hemorrhage after hysterectomy for gynecologic diseases. Material and Methods This is a retrospective, multicenter study, which investigated 11 patients (median age = 45 years) who underwent TAE for hemorrhage after gynecologic hysterectomy between 2004 and 2020. Results The median interval between surgery and angiography was one day (range = 0–82 days). Hemodynamic instability and massive transfusion were present in 6 (54.5%) and 4 (36.4%) patients, respectively. CT scans (n = 7) showed contrast extravasation (n = 5), pseudoaneurysm (n = 1), or both (n = 1). On angiography, the bleeding arteries were the anterior division branches of the internal iliac artery (IIA) (n = 6), posterior division branch (lateral sacral artery, n = 1), and inferior epigastric artery (n = 1) in eight patients with active bleeding. In the remaining three patients, angiographic staining without active bleeding foci was observed at the vaginal stump, and the feeders for staining were all anterior division branches of the IIA. Technical and clinical success rates were 100% and 90.9% (10/11), respectively. In one patient, active bleeding focus was successfully embolized on angiography, but surgical hemostasis was performed for suspected bleeding on exploratory laparotomy. Postembolization syndrome occurred in one patient. Conclusions TAE is effective and safe for hemorrhage after hysterectomy for gynecologic diseases. Angiographic findings are primarily active bleeding, but angiographic staining is not uncommon. A bleeding focus is possible in any branch of the IIA, as well as the arteries supplying the abdominal wall.

scholarly journals A136 LIVING ON THE EDGE: EUS-DIRECTED TRANSGASTRIC ERCP (EDGE) IN PATIENTS WITH ROUX-EN-Y GASTRIC BYPASS ANATOMY

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 121-122
Author(s):  
A Jain ◽  
R Barclay ◽  
F Donnellan
Keyword(s):  
British Columbia ◽  
Gastric Bypass ◽  
Adverse Events ◽  
General Hospital ◽  
Gallstone Pancreatitis ◽  
Gastric Fistula ◽  
Proximal Jejunum ◽  
Invasive Approach ◽  
Excluded Stomach ◽  
Victoria General Hospital

Abstract Background Roux-en-Y gastric bypass (RYGB) surgery imposes anatomic barriers to endoscopic retrograde cholangiopancreatography (ERCP). Potential options for biliary access in these patients include laparoscopic-assisted ERCP or balloon enteroscopy. However, these approaches require specialized equipment and/or operating room personnel and are associated with high rates of failure and adverse events compared to conventional ERCP. A recently described technique, EUS-directed transgastric ERCP (EDGE), is an entirely endoscopic approach which involves accessing the excluded stomach to facilitate conventional ERCP. Objectives To describe the results of EDGE procedures performed in two centres in British Columbia. Aims To describe the results of EDGE procedures performed in two centres in British Columbia. Methods Data were collected from five patient cases who had undergone an EDGE procedure at Victoria General Hospital (4) or Vancouver General Hospital (1) in British Columbia from 2019 to 2020. All patients had a history of RYGB bariatric surgery. In each of the procedures, a 20 mm diameter lumen-apposing metal stent (LAMS) was deployed under EUS-guidance to allow access from the gastric remnant or proximal jejunum to the excluded stomach. Subsequently, during a separate procedure 4 to 28 days later, a duodenoscope was passed through the LAMS to perform ERCP. Following ERCP, the LAMS was removed 0 to 38 days later and replaced with a double pigtail stent to facilitate controlled closure of the gastro-jejunal or gastro-gastric fistula. Results Of the five cases included in the case series, 4 patients underwent EDGE for treatment of choledocholithiasis and one patient underwent the procedure for gallstone pancreatitis. The technical success rate of the EDGE procedure in the five cases was 100%. Clinical success, defined by normalization of bilirubin and symptomatic relief, was observed in all of the cases. There were no adverse events related to the EDGE procedure in these five cases. Conclusions The results of this series support EDGE as a safe and minimally invasive approach to biliary access and therapy in patients with previous RYGB surgery. Funding Agencies None

scholarly journals An Open-Label Uncontrolled, Multicenter Study for the Evaluation of the Efficacy and Safety of the Dermal Filler Princess VOLUME in the Treatment of Nasolabial Folds

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Daisy Kopera ◽  
Michael Palatin ◽  
Rolf Bartsch ◽  
Katrin Bartsch ◽  
Maria O’Rourke ◽  
...  
Keyword(s):  
Hyaluronic Acid ◽  
Adverse Events ◽  
Multicenter Study ◽  
Dermal Filler ◽  
Nasolabial Fold ◽  
Efficacy And Safety ◽  
Open Label ◽  
Moderate Severity ◽  
Injection Site Reactions ◽  
Nasolabial Folds

The dermal filler Princess VOLUME is a highly cross-linked, viscoelastic hyaluronic acid injectable gel implant used for aesthetic treatment. To evaluate the efficacy and safety of Princess VOLUME in the treatment of nasolabial folds, an open-label uncontrolled, multicenter study was conducted. Forty-eight subjects were recruited who had moderate to deep wrinkles, according to the Modified Fitzpatrick Wrinkle Scale (MFWS). Subjects received Princess VOLUME in both nasolabial folds at Day 0. Nasolabial fold severity was evaluated at 30, 90, 180, and 270 days after treatment, using the MFWS and the Global Aesthetic Improvement Scale (GAIS). Adverse events and treatment site reactions were recorded. Among the 48 subjects, 93.8% were female with a median age of 52 years. There were significant improvements(P<0.0001)in the MFWS scores at 30, 180, and 270 days after treatment compared with those at baseline, with a mean decrease of 1.484 (±0.408), 1.309 (±0.373), and 1.223 (±0.401), respectively; hence the primary endpoint was achieved and clinical efficacy demonstrated. Princess VOLUME was well tolerated, and most adverse events were injection site reactions of mild to moderate severity. Subject satisfaction (97.9%), subject recommendation of the treatment (93.6%), and investigators GAIS scores (97.9% improvement) were high.

scholarly journals Percutaneous cholecystostomy for biliary decompression in patients with cholangitis and pancreatitis

2018 ◽  
Vol 46 (10) ◽  
pp. 4120-4128 ◽  
Author(s):  
Jin Myung Park ◽  
Chang Don Kang ◽  
Minjong Lee ◽  
Sung Chul Park ◽  
Sung Joon Lee ◽  
...  
Keyword(s):  
Adverse Event ◽  
Adverse Events ◽  
Biliary Obstruction ◽  
Clinical Success ◽  
Adverse Event Rate ◽  
Serum Total Bilirubin ◽  
Percutaneous Cholecystostomy ◽  
Success Rates ◽  
Biliary Decompression ◽  
Significant Difference

Objective This study was performed to assess the effectiveness and safety of percutaneous cholecystostomy (PC) for biliary decompression. Methods We retrospectively analyzed our institution’s PC database from March 2015 to August 2017 and selected patients with biliary obstruction. The primary outcomes were the technical and clinical success rates. As secondary outcomes, adverse events and pain after PC were compared with those of patients who underwent PC for acute cholecystitis during the same period. Results Twenty patients underwent PC for biliary obstruction (cholangitis, 19; pancreatitis, 1). The technical and clinical success rates were 100%. The median serum total bilirubin level decreased considerably from 4.5 to 1.4 mg/dL after PC. An adverse event (catheter migration) occurred in 1 patient, and 17 patients developed pain after PC. During the same period, 104 patients underwent PC for cholecystitis. Adverse events occurred in 7 patients, and 62 developed pain. There was no significant difference in the adverse event rate between the cholangitis/pancreatitis and cholecystitis groups (5.0% vs. 6.7%, respectively), but pain occurred considerably more frequently in the cholangitis/pancreatitis group (94.4% vs. 63.9%, respectively). Conclusions PC is an effective and safe method for biliary decompression in selected patients. However, attention should be paid to postoperative pain.

scholarly journals Difference of Success Rates of Mineral Trioxide Aggregate Pulpotomies Performed Both by Undergraduate Dental Students and by an Expert Operator: A Retrospective Study

2017 ◽  
Vol 2017 ◽  
pp. 1-5
Author(s):  
Marco Pasini ◽  
Maria Rita Giuca ◽  
Roberto Gatto ◽  
Silvia Caruso
Keyword(s):  
Retrospective Study ◽  
Clinical Success ◽  
Test Group ◽  
Dental Students ◽  
Radiographic Evaluation ◽  
Primary Molars ◽  
Control Group ◽  
Second Primary ◽  
Success Rates ◽  
Significance Level

Aim. The aim of this retrospective study was to evaluate the clinical and radiographic success of pulpotomy on primary molars performed by dental students compared to that performed by an expert operator.Methods. The study was conducted on 142 second primary molars in 102 children. The patients were randomly selected from the available records. The test group (treated by dental students) included 51 subjects (28 males and 23 females, mean age:7.2±1) and the control group included 51 children (29 males and 22 females, mean age:7.4±1.2years). After pulpotomy, a clinical and radiographic evaluation after 12 months was performed. Chi-square test and odds ratio were calculated and significance level was set atp<0.05.Results. The success rate was significantly lower, 81.6% (p<0.05), in the test group than in the control group (93%). The test group showed less clinical and radiographic success (86% and 80%, resp.) compared to the control group (97.2% for clinical success and 93% for radiographic success).Conclusions. Pulpotomy with MTA is an effective method that ensures a good percentage of success. The clinical experience of the operator is a contributing factor.

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