Endoscopic ultrasonography-guided deployment of embolization coils and cyanoacrylate injection in gastric varices versus coiling alone: a randomized trial

Abstract Background Gastric variceal bleeding is a life-threating condition with challenging management. We aimed to compare the efficacy and safety of endoscopic ultrasonography (EUS)-guided coil embolization and cyanoacrylate injection versus EUS-guided coil embolization alone in the management of gastric varices. Methods A single-center, parallel-randomized controlled trial involving 60 participants with gastric varices (GOV II and IGV I) who were randomly allocated to EUS-guided coil embolization and cyanoacrylate injection (n = 30) or EUS-guided coil embolization alone (n = 30). The primary end points were the technical and clinical success rates of both procedures. The secondary end points were the reappearance of gastric varices during follow-up, along with rebleeding, the need for reintervention, and complication and survival rates. Results The technical success rate was 100 % in both groups. Immediate disappearance of varices was observed in 86.7 % of patients treated with coils and cyanoacrylate, versus 13.3 % of patients treated with coils alone (P < 0.001). Median survival time was 16.4 months with coils and cyanoacrylate versus 14.2 months with coils alone (P = 0.90). Rebleeding occurred in 3.3 % of patients treated with combined treatment and 20 % of those treated with coils alone (P = 0.04). With combined treatment, 83.3 % of patients were free from reintervention versus 60 % with coils alone (hazard ratio 0.27; 95 % confidence interval 0.095 – 0.797; P = 0.01). Conclusions EUS-guided coil embolization with cyanoacrylate injection achieved excellent clinical success, with lower rates of rebleeding and reintervention than coil treatment alone. Multicenter studies are required to define the most appropriate technique for gastric variceal obliteration.

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Comparison of different techniques for the management of venous steno-occlusive lesions during placement of peripherally inserted central catheter

Scientific Reports ◽

10.1038/s41598-021-89780-6 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Woo Jin Yang ◽

Danbee Kang ◽

Ji Hoon Shin ◽

Eun Ho Jang ◽

Seung Yeon Noh ◽

...

Keyword(s):

Clinical Success ◽

Alternative Pathway ◽

Transluminal Angioplasty ◽

Second Line ◽

Peripherally Inserted Central Catheter ◽

Central Catheter ◽

Success Rates ◽

Initial Attempt ◽

Technical Success Rate ◽

Occlusive Lesion

AbstractThe purpose of this study is to investigate strategies for peripherally inserted central catheter (PICC) placement in patients with venous steno-occlusive lesion (VSOL). We performed a retrospective cohort study in adults with central or peripheral VSOL who underwent PICC placement procedures from January 2015 to December 2018. Four different strategies [selecting alternative pathway/over the wire (SAP/OTW), percutaneous transluminal angioplasty (PTA), re-puncture in ipsilateral arm (RIA), and catheter placement in the contralateral arm (CICA)] were analyzed and we compared the clinical outcomes by strategy and compared the strategy between central and peripheral VSOLs. During 4 years, 258 PICC procedures performed in patients with VSOLs, 100 PICC were included in the analysis. The overall technical success rate of initial attempt with SAP/OTW was 32.2%. As a second-line technique, PTA was most frequently used in both central (100%) and peripheral (68.2%) VSOL groups. The clinical success rates within 2 months of SAP/OTW, PTA, RIA, CICA were 55.2%, 43.2%, 14.3%, and 33.3%, respectively (P = 0.24). In conclusion, when the SAP/OTW failed, the PTA can be preferred as a second-line technique for both central and peripheral VSOLs. When guidewire passage fails, the operator could adopt the RIA or CICA technique as an alternative method.

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SpyGlass DS-guided lithotripsy for pancreatic duct stones in symptomatic treatment-refractory chronic calcifying pancreatitis

Endoscopy International Open ◽

10.1055/a-0808-4499 ◽

2019 ◽

Vol 07 (02) ◽

pp. E99-E103 ◽

Cited By ~ 8

Author(s):

Christian Gerges ◽

David Pullmann ◽

Farzan Bahin ◽

Markus Schneider ◽

Peter Siersema ◽

...

Keyword(s):

Pancreatic Duct ◽

Clinical Success ◽

Symptomatic Treatment ◽

Complication Rates ◽

Success Rates ◽

Technical Success Rate ◽

Extracorporeal Shock Wave ◽

Small Series ◽

Chronic Calcifying Pancreatitis ◽

Calcifying Pancreatitis

Abstract Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) and/or extracorporeal shock wave lithotripsy are first-line therapies for draining an obstructed pancreatic duct (PD) in painful chronic calcifying pancreatitis (CCP). Pancreaticoscopy has shown promising success rates in small series. Materials and methods This study was a retrospective analysis of a clinical database. Included were all digital single-operator digital video (SOV) pancreaticoscopy-guided interventions (n = 23) on CCP patients (n = 20) between 2015 and 2017. Success and complication rates were collected from the database. Clinical success was determined by assessing pain level score (NRS) and quality of life (QoL) using standardized questionnaires. Results Overall technical success rate (successful SOV-pancreaticoscopy and PD drainage) was 95 %. Adverse events occurred in 7 of 23 procedures (30 %) and included extravasation from the PD (n = 1), self-limiting post-sphincterotomy bleeding (n = 1) and post-ERCP pancreatitis (PEP) (n = 6). At 3- to 6-month follow-up, 95 % of patients reported improvement in symptoms and reduction in intake of analgesics. Mean NRS decreased from 5.4 (±1.6) to 2.8 (± 1.8) (P < 0.01). Clinical success was achieved in 95 % of patients. Conclusions Digital SOV-guided lithotripsy was found to be safe and effective in this highly selected population of CCP patients. PD decompression had a beneficial effect on pain reduction and QoL.

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Effectiveness of 4 Pulpotomy Techniques—Randomized Controlled Trial

Journal of Dental Research ◽

10.1177/154405910508401210 ◽

2005 ◽

Vol 84 (12) ◽

pp. 1144-1148 ◽

Cited By ~ 60

Author(s):

K.C. Huth ◽

E. Paschos ◽

N. Hajek-Al-Khatar ◽

R. Hollweck ◽

A. Crispin ◽

...

Keyword(s):

Calcium Hydroxide ◽

Clinical Success ◽

Controlled Trial ◽

Relative Effectiveness ◽

Estimating Equation ◽

Ferric Sulfate ◽

Primary Molars ◽

Healthy Children ◽

Success Rates ◽

Randomized Controlled

Pulpotomy is the accepted therapy for the management of cariously exposed pulps in symptom-free primary molars; however, evidence is lacking about the most appropriate technique. The aim of this study was to compare the relative effectiveness of the Er:YAG laser, calcium hydroxide, and ferric sulfate techniques with that of dilute formocresol in retaining such molars symptom-free. Two hundred primary molars in 107 healthy children were included and randomly allocated to one of the techniques. The treated teeth were blindly re-evaluated after 6, 12, 18, and 24 months. Descriptive data analysis and logistic regression analysis, accounting for each patient’s effect by a generalized estimating equation (GEE), were used. After 24 months, the following total and clinical success rates were determined (%): formocresol 85 (96), laser 78 (93), calcium hydroxide 53 (87), and ferric sulfate 86 (100). Only calcium hydroxide performed significantly worse than formocresol (p = 0.001, odds ratio = 5.6, 95% confidence interval 2.0–15.5). In conclusion, calcium hydroxide is less appropriate for pulpotomies than is formocresol.

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World’s First Experience Treating TASC II C and D Tibial Occlusive Disease Using the Selution SLR Sirolimus-Eluting Balloon: Six-Month Results From the PRESTIGE Study

Journal of Endovascular Therapy ◽

10.1177/15266028211007457 ◽

2021 ◽

pp. 152660282110074

Author(s):

Tjun Yip Tang ◽

Charyl Yap ◽

Shereen Xue Yun Soon ◽

Sze Ling Chan ◽

QingWei Shaun Lee ◽

...

Keyword(s):

Renal Failure ◽

Clinical Success ◽

Target Lesion ◽

Lesion Length ◽

Success Rates ◽

Technical Success ◽

Free Survival ◽

End Stage Renal Failure ◽

Technical Success Rate ◽

End Stage

Purpose: The performance of sirolimus-coated devices has not been studied in patients with chronic limb-threatening ischemia patients. PRESTIGE aims to investigate the 6-month efficacy and safety profile of the Selution Sustained Limus Release (SLR) sirolimus-eluting balloon for treatment of TASC II C and D tibial occlusive lesions in patients with CLTI. Materials and Methods: PRESTIGE is a pilot prospective, nonrandomized, single-arm, multi-investigator, single-center clinical study. Endpoints were adverse event-free survival at 1 month, technical success rate, primary tibial patency at 6 months, limb salvage success, target lesion revascularization (TLR), and amputation free survival (AFS). Results: A total of 25 patients were included. There were 17 (68.0%) males; mean age, 63.7±9.73 years. CLTI severity was based on the Rutherford scale (R5=25/25; 100.0%). Significant comorbidities included diabetes mellitus (n=22; 88.0%) and end-stage renal failure (n=11; 44.0%). A total of 33 atherosclerotic lesions were treated (TASC II D=15 (45.5%)). Mean lesion length treated was 191±111 mm. Technical success was 100%. Primary tibial patency at 6 months was 22/27 (81.5%) and freedom from clinically driven TLR was 25/30 (83.3%). AFS was 21/25 (84.0%; 3 deaths and 1 major lower extremity amputation). Mean Rutherford score improved from 5.00 at baseline to 1.14±2.10 (p<0.05) at 6 months. There was a wound healing rate of 13/22 (59.1%) and 17/21 (81.0%) at 3 and 6 months respectively. Conclusions: Selution SLR drug-eluting balloon is a safe and efficacious modality in treating complex tibial arterial occlusive lesions in what is an otherwise frail cohort of CLTI patients, with a high prevalence of diabetes and end-stage renal failure. Technical and clinical success rates are high and 6-month target lesion patency and AFS are more than satisfactory.

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Outcomes of EUS-guided choledochoduodenostomy as primary drainage for distal biliary obstruction with covered self-expandable metallic stents

Endoscopy International Open ◽

10.1055/a-1161-8488 ◽

2020 ◽

Vol 08 (07) ◽

pp. E861-E868

Author(s):

Naosuke Kuraoka ◽

Kazuo Hara ◽

Nozomi Okuno ◽

Takamichi Kuwahara ◽

Nobumasa Mizuno ◽

...

Keyword(s):

Success Rate ◽

Clinical Success ◽

Clinical Success Rate ◽

Cancer Center ◽

Biliary Duct ◽

Metallic Stent ◽

Success Rates ◽

Stent Patency ◽

Technical Success Rate ◽

Drainage Technique

Abstract Background and study aims Endoscopic ultrasonography-guided choledochoduodenostomy (EUS-CDS) is an alternative therapy for percutaneous transhepatic biliary drainage. Outcomes of EUS-CDS for distal biliary tract obstruction with a covered self-expandable metallic stent (SEMS) as a primary drainage technique are unclear because there are few relevant reports. This study aimed to determine outcomes in patients undergoing EUS-CDS using SEMS as the primary drainage technique for malignant distal biliary duct obstruction. Patients and methods This retrospective study was conducted at Aichi Cancer Center Hospital, from January 2010 to July 2018, using data from our database. Results EUS-CDS was performed as a primary drainage technique for 92 patients. The technical success rate was 92.8 %, and the clinical success rate was 91.6 %. The overall incidence of adverse events was 15.7 %. The median stent patency time for the EUS-CDS was 396 days. Nineteen patients required re-intervention because of cholangitis or jaundice. Conclusion EUS-CDS as a primary drainage technique using SEMS has high technical and clinical success rates. It should be considered an effective drainage method with respect to long-term stent patency, low re-intervention rates, and absence of severe complications.

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Analysis of outcomes of endovascular embolisation: A cross-sectional two-center study on 46 visceral artery pseudoaneurysms

CVIR Endovascular ◽

10.1186/s42155-021-00248-0 ◽

2021 ◽

Vol 4 (1) ◽

Author(s):

Mohammad Koriem Mahmoud Omar ◽

Moustafa H M Othman ◽

Robert Morgan ◽

Abdelkarem Hasan Abdallah ◽

Hany Seif ◽

...

Keyword(s):

Clinical Success ◽

Target Lesion ◽

Visceral Artery ◽

Complication Rates ◽

Endovascular Management ◽

Success Rates ◽

Cross Sectional ◽

Technical Success Rate ◽

Endovascular Embolisation ◽

Embolic Materials

Abstract Purpose Visceral artery pseudoaneurysms (VAPAs) are uncommon in clinical practice but may have serious clinical outcomes up to death. Endovascular management is a safe effective alternative option to traditional surgical procedures. This study assesses the outcome of different embolic materials and techniques used in the endovascular management of VAPAs. Materials and methods This is a two-center retrospective analysis of endovascular embolisation of 46 VAPAs, with a mean pseudoaneurysm size of 13 ± 11.35 mm, that were urgently managed between July 2018 and March 2020. Patients’ presentations were GIT hemorrhage, intrabdominal hemorrhage, hematuria, and abdominal pain in 34.78%, 30.43%, 23.91%, and 10.87% respectively. Management using coils only was done in 28/46 patients (60.87%), NBCA glue only in 16/46 patients (34.78%), combined coils and NBCA glue in 1/46 patient (2.17%), and Amplatzer plugs only in 1 patient (2.17%). The management techniques were sac packing in 9/46 patients (19.57%), inflow occlusion in 28/46 patients (60.87%) and trapping in 9/46 patients (19.57%). All patients were followed-up for 1 year after the procedure. Results The overall clinical success and periprocedural complication rates were 93.48%, and 15.22% respectively, and 30-day mortality was zero. Clinical success was 92.86% in the coil subgroup (n = 28), and 93.75% in the NBCA glue subgroup (n = 16). The technical success rate was 100%. Effectiveness of the procedures during the follow-up was 97.83%. Target lesion re-intervention rate was 2.17%. Conclusion Transarterial embolisation can provide high technical and clinical success rates with low periprocedural complication and re-intervention rates, as well as satisfactory procedure effectiveness in the management of VAPAs.

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Clinical Feasibility and Safety of Endoscopic Self-Expandable Metal Stent Placement for Upper Gastrointestinal Pathologies

International Surgery ◽

10.9738/intsurg-d-15-00169.1 ◽

2019 ◽

Vol 103 (11-12) ◽

pp. 605-612

Author(s):

Bünyamin Gürbulak ◽

Esin Kabul Gürbulak ◽

Hasan Bektaş ◽

İsmail Ethem Akgün ◽

Hızır Yakup Akyildiz ◽

...

Keyword(s):

Success Rate ◽

Stent Placement ◽

Clinical Success ◽

Clinical Success Rate ◽

Endoscopic Stenting ◽

Covered Stents ◽

Success Rates ◽

Endoscopic Stent ◽

Technical Success Rate ◽

Upper Gastrointestinal

We aimed to review our experiences to evaluate the practicality, safety, and effectiveness of endoscopic stent placement for the palliation of malignant obstructions of the upper gastrointestinal system (GIS) and the treatment of postoperative complications such as failure of anastomoses and fistulae. Endoscopic stent placement is increasingly used in the upper GIS for the management of both high grade malignancies causing obstruction and benign pathologies such as anastomosis failures, gastrointestinal fistulae, and strictures. Hospital records, clinical data, and endoscopy reports of 61 patients who had undergone endoscopic stenting between the years 2012 and 2015 were analyzed retrospectively. For all patients, self-expandable metal covered stents were used. Data involving technical and clinical success rates, complication, morbidity, and mortality rates of the endoscopic stenting procedure was collected and simple statistical analyses were made. Endoscopic stenting was successful in 60 of 61 patients (98.3%). Overall technical success rate was found to be 98.3%; clinical success rate, 86.6%; complication rate, 4.9%. No stent related mortality was observed in our series. Endoscopic stents can be effectively and safely used in the treatment of various lesions of the upper GIS.

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Plug-Assisted Retrograde Transvenous Obliteration

Digestive Disease Interventions ◽

10.1055/s-0038-1632364 ◽

2017 ◽

Vol 01 (04) ◽

pp. 293-301

Author(s):

Eung Kim ◽

Dong Gwon

Keyword(s):

Hepatic Encephalopathy ◽

Clinical Success ◽

Treatment Options ◽

Clinical Effectiveness ◽

Gastric Varices ◽

Gelatin Sponge ◽

Success Rates ◽

Endoscopic Injection ◽

Balloon Catheters ◽

Portosystemic Shunts

AbstractGastric fundal varices and portosystemic hepatic encephalopathy are major complications of portal hypertension in patients with liver cirrhosis. Many treatment options have been used for gastric varices, including endoscopic injection and transjugular intrahepatic portosystemic shunts (TIPS), but the clinical effectiveness of these treatments remains contentious. Today, balloon-occluded retrograde transvenous obliteration (BRTO) has become the treatment of choice because of its excellent clinical effectiveness and outcomes; however, the associated use of sclerosants and temporary indwelling balloon catheters can cause specific complications. Vascular plugs are another option that has been shown to be safe, feasible, and effective when used as an embolic material in vascular disease. Recently, a technique has been developed that uses such vascular plugs with a gelatin sponge to embolize gastrorenal shunts. This technique is known as plug-assisted retrograde transvenous obliteration (PARTO), and it is also associated with high technical and clinical success rates. Moreover, it appears to be a much safer and more feasible procedure than BRTO. In this review, we introduce PARTO and outline its strengths and potential for use as the treatment of choice in gastric varices and hepatic encephalopathy.

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Placebo-Controlled Trial of Intravaginal Clindamycin 2% Cream for the Treatment of Bacterial Vaginosis

Annals of Pharmacotherapy ◽

10.1177/106002809302701106 ◽

1993 ◽

Vol 27 (11) ◽

pp. 1343-1345 ◽

Cited By ~ 6

Author(s):

Gary E. Stein ◽

Sharon L. Christensen ◽

Nancy L. Mummaw ◽

David E. Soper

Keyword(s):

Bacterial Vaginosis ◽

Clinical Success ◽

Controlled Trial ◽

Signs And Symptoms ◽

Controlled Clinical Trial ◽

Success Rates ◽

Double Blind ◽

Treatment Groups ◽

Vaginal Cream

OBJECTIVE: To compare the safety and efficacy of intravaginal clindamycin 2% cream with placebo in nonpregnant women with bacterial vaginosis. DESIGN: A randomized, double-blind, placebo-controlled clinical trial. SETTING: Ambulatory patients in the general community. PATIENTS: Two hundred fifteen nonpregnant outpatients with a diagnosis of bacterial vaginosis were entered into this study. Of the 134 evaluable patients, 65 received clindamycin and 69 placebo. Demographic parameters were comparable between the two treatment groups. INTERVENTION: Study subjects were equally randomized to receive either 5 g of clindamycin 2% vaginal cream or placebo cream for seven nights. MAIN OUTCOME MEASURES: Clinical and microbiologic follow-up evaluations were scheduled for 5–10 days and 25–39 days posttreatment. Patients were interviewed about signs and symptoms, adverse events, and compliance. Diagnostic examinations were performed. RESULTS: Clinical success rates (cure and improvement) occurred in 50 of 65 patients who received clindamycin (77 percent) and 17 of 69 patients who received placebo (25 percent) by the first posttreatment visit (p<0.001). Microbiologic cures or improvement were observed in 59 of the 65 patients treated with clindamycin (91 percent) compared with 20 of 69 placebo-treated patients (29 percent) (p<0.001). At the end of the study, clinical and microbiologic cures or improvement were evident in 45 of 57 (79 percent) and 37 of 57 clindamycin-treated patients (65 percent), respectively, and 18 of 51 (35 percent) and 14 of 51 (28 percent) of the placebo-treated patients, respectively. The success rates with clindamycin 2% cream were statistically higher than those with placebo. The adverse-effect profiles in the two groups were similar and no serious adverse effects were reported. Patients who received clindamycin had a statistically higher incidence of nonbacterial vaginitis/cervicitis (18.5 vs. 7.5 percent, p=0.003). CONCLUSIONS: Intravaginal clindamycin 2% cream appears to be an effective and safe treatment of symptomatic bacterial vaginosis in nonpregnant women.

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CT-Guided Transhepatic Catheter Drainage of Deep Postoperative Collections: Initial Experience

Journal of Clinical Interventional Radiology ISVIR ◽

10.1055/s-0041-1740572 ◽

2021 ◽

Author(s):

Akhil Baby ◽

Danny Joy ◽

Nihar R. Dash ◽

Sujoy Pal ◽

Deep N. Srivastava ◽

...

Keyword(s):

Success Rate ◽

Clinical Success ◽

Clinical Success Rate ◽

Patient Positioning ◽

Success Rates ◽

Catheter Drainage ◽

Drainage Procedure ◽

Ct Guided ◽

Technical Success Rate ◽

Transhepatic Drainage

Abstract Introduction This article assesses the safety and utility of transhepatic drainage of deep seated postoperative intra-abdominal collections under computed tomography (CT) guidance in a short series. Materials and Methods This retrospective study included five patients (mean age: 45.8 years; 3 males, 2 females) who underwent CT-guided transhepatic drainage of postoperative abdominal abscess in our department between April 2019 and December 2020. The clinical and surgical details and the details of the transhepatic drainage procedure were evaluated along with success rates and complications. Results The surgical procedures were Whipple's pancreaticoduodenectomy in four patients and gastrectomy in one patient. Four out of five abscesses were drained through the right lobe of liver, while one was through the left lobe with a technical success rate of 100%. The mean total time for catheter drainage procedure including patient positioning and preparation was 29.2 minutes. None of the patients had procedure-related complications. Mean duration of catheter drainage was 12 days. All patients had complete resolution of symptoms after drainage and the clinical success rate was 100%. Conclusion Transhepatic approach is safe and effective for the drainage of inaccessible postoperative abdominal collections or abscesses where a standard percutaneous approach is not possible.

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