Endoscopic treatment of Zenkerʼs diverticulum by complete septotomy: initial experience in 19 patients

Abstract Background and study aims Endoscopic treatment of Zenker’s Diverticulum (ZD) using a flexible endoscope and a diverticuloscope consists of myotomy of the cricopharyngeus muscle, sparing the lower part of the diverticular septum. However, recurrence occurs in up to 54 % of patients at 4 years. We assessed the feasibility and safety of a complete septotomy in endoscopic treatment of ZD. Patients and methods We conducted a retrospective analysis of a prospectively collected database at a single referral center. All consecutive patients treated by complete resection of the diverticular wall were included. The endoscopic technique used a distal attachment cap and division of the ZD septum using a Dual Knife or a Triangle Tip knife in endocut mode, until the esophageal muscularis propria was seen and no residual diverticulum remained. Symptoms were evaluated using the Augsburger questionnaire. Results Nineteen patients, 10 of whom were men with mean age 79 ± 12 years, were treated by complete septotomy for a symptomatic ZD with a median size of 2.5 cm (range 1–5 cm). The clinical success rate was 100 % and the complication rate was 10 % (one pneumonia and one atrial fibrillation). Median hospital stay was 2 days (range 1–3 days). On Day 1 esophagogram, no extraesophageal contrast leakage was seen, periesophageal CO2 was still visible in two patients, and complete ZD regression was seen in 63 % of patients. The 6-month clinical success rate was 100 %, with two patients lost to follow-up, and a median symptom score of 0 (range 0–4). After a mean ± SD follow-up of 9 ± 5 months, the clinical success rate was 94 % (16/17). Conclusion Complete endoscopic septotomy is a feasible and safe therapeutic modality in patients with symptomatic ZD that does not require use of a diverticuloscope, and with good short-term efficacy. The complete regression of the diverticulum observed on Day 1 in 63 % of patients could be a marker of long-term clinical success.

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Tract dilation to salvage failing buttonholes in arteriovenous dialysis fistulae

The Journal of Vascular Access ◽

10.1177/1129729818804996 ◽

2018 ◽

Vol 20 (3) ◽

pp. 290-300

Author(s):

Eyal Barzel ◽

John W Larkin ◽

Allen Marcus ◽

Marta M Reviriego-Mendoza ◽

Len A Usvyat ◽

...

Keyword(s):

Arteriovenous Fistula ◽

Success Rate ◽

Clinical Success ◽

Clinical Success Rate ◽

Technical Success ◽

Technical Success Rate ◽

Sharp Recanalization ◽

Tract Dilation ◽

Lost To Follow Up

Introduction: Hemodialysis patients with an arteriovenous fistula can use buttonhole techniques for cannulation. Although buttonholes generally work well, patients may report difficult and painful cannulation, and buttonholes may fail over time. We aimed to assess the effectiveness of tract dilation in treatment of failing buttonholes. Methods: We retrospectively analyzed data from patients treated with buttonhole tract dilation at an outpatient vascular access center between January 2013 and August 2015. Results: Data from 23 patients were analyzed. There were 51 tract dilation procedures during 36 encounters for failing arteriovenous fistula buttonhole tract(s). The technical success rate for established tract dilation with “blunt-recanalization” was 90% (n = 46). The five remaining buttonholes had “sharp-recanalization” to create and dilate new tract through the buttonhole. For 46 buttonholes treated with “blunt-recanalization,” there was an 85% clinical success rate at one week (39 buttonholes), and one was lost to follow-up; there was a 70% clinical success rate after one month (32 buttonholes). In the five buttonholes with “sharp-recanalization,” there was only one clinical success with p < 0.05 for difference in success rate compared to “blunt-recanalization” at both one week and one month. There was one complication from “sharp-recanalization” requiring abandonment of the buttonhole tract. Discussion: Buttonhole tract dilation is a useful method to treat difficult cannulation and painful cannulation and has the potential to extend the life of failing buttonholes.

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Modified Silicone Stent in the Treatment of Bronchopleural Fistula: Clinical Observation of 17 Cases

10.21203/rs.3.rs-61647/v1 ◽

2020 ◽

Author(s):

Junli Zeng ◽

Xuemei Wu ◽

Zhide Chen ◽

Meihua Zhang ◽

Mingyao Ke

Keyword(s):

Success Rate ◽

Clinical Success ◽

Bronchopleural Fistula ◽

Clinical Success Rate ◽

Stent Migration ◽

Left Heart Failure ◽

Silicone Stent ◽

Life Threatening ◽

Lost To Follow Up

Abstract Objective: Bronchopleural fistula is a rare but life-threatening event with limited therapeutic options. Aim of our study is to investigate the efficacy and safety of the modified silicone stent in patients with bronchopleural fistula.Method: Between March 2016 and April 2020, we retrospectively collected 17 patients with bronchopleural fistula and who underwent bronchoscopic placement of the modified silicone sten. The Y-shaped stent was tailored and sutured manually. The initial success, clinical success, the cured rate and complications were recorded. Results: Placement of the modified silicone stent was successful in 16 patients on first attempt (initial success rate was 94.1%). The median follow-up time was 107(rang, 5-431) days. The amelioration of respiratory symptoms was reported in all patients. There were 14 patients with empyema, the daily drainage was significantly decreased in 11 patients over time, and the purulent fluid completely disappeared in six patients. The clinical success rate was 76.5%. There were seven stents was removed during follow-up, four (26.7%) removed for cured fistula, two for the severe proliferation of granulation tissue and one for the dislocation of stent. No severe adverse events of stent migration and suture dehiscence happened. There were three cases were lost to follow-up and seven patients succumbed. The cause of death included progression of primary malignance, the uncontrolled infection, myocardial infarction and left heart failure.Conclusion: The modified silicone stent may be an effective and safe option for bronchopleural fistula patients in whom the conventional therapy is inappropriate and contraindicated.

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Ferric sulfate as pulpotomy agent in primary teeth: twenty month clinical follow-up

Journal of Clinical Pediatric Dentistry ◽

10.17796/jcpd.24.4.d7u6405nw1132705 ◽

2000 ◽

Vol 24 (4) ◽

pp. 269-272 ◽

Cited By ~ 28

Author(s):

Hamijeta Ibricevic ◽

Qumasha Al-Jame

Keyword(s):

Success Rate ◽

Primary Teeth ◽

Root Resorption ◽

Clinical Success ◽

Clinical Success Rate ◽

Ferric Sulfate ◽

Primary Molar ◽

Molar Teeth ◽

The Moment

Seventy primary molar teeth, carious exposed, symptom free, without any sign of root resorption in children aged from 3 to 6 years (main age 4.3yr) were treated with conventional pulpotomy procedures. Ferric sulfate 15.5% solution (applied for 15 second for 35 teeth) and formocresol solution (five minute procedure of Buckley's formula for next 35 teeth) have been used as pulpotomy agents. In both groups, pulp stumps were covered with zinc-oxide eugenol paste. Permanent restorations were stainless steel crowns. Clinical check up was every three-months and radiographic follow-up time was six and twenty months after treatment. Our results within this period revealed 100% clinical success rate in both groups. Radiographic success rate was in both groups 97.2%, while in 2.8% cases has shown internal root resorption. On the basis of these results, we can recommend ferric sulfate as a pulpotomy agent in primary teeth in substitution for formocresol at the moment.

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Long-Term Management of Recurrent Cholecystitis after Initial Conservative Treatment: Endoscopic Transpapillary Gallbladder Stenting

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2018/3983707 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7

Author(s):

Hideki Kamada ◽

Hideki Kobara ◽

Naohito Uchida ◽

Kiyohito Kato ◽

Takayuki Fujimori ◽

...

Keyword(s):

High Risk ◽

Acute Cholecystitis ◽

Success Rate ◽

Clinical Success ◽

Clinical Success Rate ◽

Technical Success ◽

Technical Success Rate ◽

High Risk Patients ◽

Risk Patients

Background. Endoscopic transpapillary gallbladder stenting (ETGBS) is an effective procedure for treating high-risk patients with acute cholecystitis and severe comorbidities. However, the efficacy of ETGBS for recurrent cholecystitis (RC) remains unclear. This study aimed to explore its efficacy in patients with RC for whom cholecystectomy is contraindicated because of its high surgical risk.Methods. Data on 19 high-risk patients who had undergone ETGBS for RC after initial conservative therapy in our institution between June 2006 and May 2012 were retrospectively examined. The primary outcome was the clinical success rate, which was defined as no recurrences of acute cholecystitis after ETGBS until death or the end of the follow-up period. Secondary outcomes were technical success rate and adverse events (AEs).Results. The clinical success rate of ETGBS was 100%, the technical success rate 94.7%, and AE rate 5%: one patient developed procedure-related mild acute pancreatitis. The clinical courses of all patients were as follows: four died of nonbiliary disease, and the remaining 15 were subsequently treated conservatively. The median duration of follow-up was 14.95 months (range 3–42 months).Conclusions. ETGBS is an effective alternative for managing RC in high-risk patients with severe comorbidities.

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One-year results of gastric peroral endoscopic myotomy for refractory gastroparesis: a French multicenter study

Endoscopy ◽

10.1055/a-1205-5686 ◽

2020 ◽

Author(s):

Olivier Ragi ◽

Jérémie Jacques ◽

Julien Branche ◽

Sarah Leblanc ◽

Geoffroy Vanbiervliet ◽

...

Keyword(s):

Success Rate ◽

Multicenter Study ◽

Clinical Success ◽

Clinical Success Rate ◽

Peroral Endoscopic Myotomy ◽

Gastric Retention ◽

Endoscopic Myotomy ◽

Cardinal Symptom

Abstract Background: Data on the long-term outcomes of gastric peroral endoscopic myotomy (G-POEM) for refractory gastroparesis are lacking. We report the results of a large multicenter long-term follow-up study of G-POEM for refractory gastroparesis. Methods: This was a retrospective multicenter study of all G-POEM operations performed in seven expert French centers for refractory gastroparesis with at least 1 year of follow-up. The primary endpoint was the 1-year clinical success rate, defined as at least a 1-point improvement in the Gastroparesis Cardinal Symptom Index (GCSI). Results: 76 patients were included (60.5 % women; age 56 years). The median symptom duration was 48 months. The median gastric retention at 4 hours (H4) before G-POEM was 45 % (interquartile range [IQR] 29 % – 67 %). The median GCSI before G-POEM was 3.6 (IQR 2.8 – 4.0). Clinical success was achieved in 65.8 % of the patients at 1 year, with a median rate of reduction in the GCSI score of 41 %. In logistic regression analysis, only a high preoperative GCSI satiety subscale score was predictive of clinical success (odds ratio [OR] 3.41, 95 % confidence interval [CI] 1.01 – 11.54; P = 0.048), while a high rate of gastric retention at H4 was significantly associated with clinical failure (OR 0.97, 95 %CI 0.95 – 1.00; P = 0.03). Conclusions: The results confirm the efficacy of G-POEM for the treatment of refractory gastroparesis, as evidenced by a 65.8 % clinical success rate at 1 year. Although G-POEM is promising, prospective sham-controlled trials are urgently needed to confirm its efficacy and identify the patient populations who will benefit most from this procedure.

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Elective Percutaneous Coronary Interventions (PCI) in 100 Cases in a Centre Without On-site Cardiac Surgery Support

Medicine Today ◽

10.3329/medtoday.v24i1.14106 ◽

2013 ◽

Vol 24 (1) ◽

pp. 8-11

Author(s):

Md Nurul Afsar Badrul ◽

Kamal Ahmed ◽

Sufia Rahman

Keyword(s):

Success Rate ◽

Clinical Success ◽

Clinical Success Rate ◽

Hospital Death ◽

Percutaneous Coronary Interventions ◽

Vessel Disease ◽

Coronary Interventions ◽

Percutaneous Coronary ◽

The Mean

Since its introduction in 1977, Percutaneous Coronary Interventions (PCI) is an important tool in the treatment of coronary artery disease (CAD). It is a retrospective analysis of data of 100 cases (132 vessels). The mean age was 50.9 years (range 30-70) with 90 (90%) male and 10 (10%) female. Indication of PCI includes acute and old MI, Chronic stable angina and unstable angina were 48 (48%), 33 (33%) and 19(19%) respectively. Procedure done in total 132 vessels among 100 patients. most of the cases were single vessels disease (SVD) {68 (68%} followed by double vessel disease (DVD) {30(30%)} , triple vessel disease (TVD) {02 (02%)} and chronic total occlusion (CTO) {02 (02%)}.Cobalt chromium was commonly used stent (117 (88.6%) followed by drug illuting stent (DES) 12 (9.1%) and bare metal stent (BMS) 3 (2.3%). Among the site of the stent insertion left anterior descending (LAD) 62 (47%), right coronary lesion (RCA) 37 (28), left circumplex artery (LCX) 33 (25%).Maximum stent length was 35 mm, minimum 10mm. Maximum stent diameter was 3.5 mm whereas minimum diameter 2.5 mm. The mean pretreatment reference diameter was 2.55 ± 0.20 mm and post treatment diameter 2.70 ± 0.45 mm. Angiographic, procedural and clinical success rate were 100%, 98% and 98% respectively. Major adverse cardiovascular event (MACE) {periprocedural MI} occurred in 2 (02 %) cases. Minor cardiovascular complications revealed vascular haematoma 2 (02%), bleeding from access site in 1 (01%), transient ventricular fibrillation (VF) in 3 (03%) cases. There was no hospital death, emergency CABG before discharge from hospital. Angiographic, procedural and clinical success rate were excellent with a little MACE and event free survival within 30 days follow up. So, PCI is a safe and effective method of myocardial revascularization irrespective of lesion morphology and type of stents used at immediate and 30 days follow up. DOI: http://dx.doi.org/10.3329/medtoday.v24i1.14106 Medicine TODAY Vol.24(1) 2012 pp.8-11

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Modified silicone stent for the treatment of post-surgical bronchopleural fistula: A clinical observation of 17 cases

10.21203/rs.3.rs-61647/v3 ◽

2020 ◽

Author(s):

Junli Zeng ◽

Xuemei Wu ◽

Zhide Chen ◽

Meihua Zhang ◽

Mingyao Ke

Keyword(s):

Success Rate ◽

Clinical Success ◽

Bronchopleural Fistula ◽

Clinical Success Rate ◽

Massive Hemoptysis ◽

Left Heart Failure ◽

Silicone Stent ◽

Life Threatening ◽

Granulomatous Tissue

Abstract Background: Bronchopleural fistula is a rare but life-threatening event with limited therapeutic options. We aimed to investigate the efficacy and safety of the modified silicone stent in patients with post-surgical bronchopleural fistula.Methods: Between March 2016 and April 2020, we retrospectively reviewed the records of 17 patients with bronchopleural fistula and who underwent bronchoscopic placement of the Y-shaped silicone stent. The rate of initial success, clinical success and clinical cure, and complications were analyzed.Results: Stent placement was successful in 16 patients in the first attempt (initial success rate: 94.1%). The median follow-up time was 107 (range, 5-431) days. All patients achieved amelioration of respiratory symptoms. The clinical success rate was 76.5%. Of the 14 patients with empyema, the daily drainage was progressively decreased in 11 patients, and empyema completely disappeared in six patients. Seven stents were removed during follow-up: four (26.7%) for the cure of fistula, two for severe proliferation of granulomatous tissue and one for stent dislocation. No severe adverse events (i.e. massive hemoptysis, suture dehiscence) took place. Seven patients died (due to progression of malignancy, uncontrolled infection, myocardial infarction and left heart failure).Conclusions: The modified silicone stent may be an effective and safe option for patients with post-surgical bronchopleural fistula patients in whom conventional therapy is contraindicated.

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Clinical success rate of fissure sealants: One-year follow-up

10.26650/eor.20200572 ◽

2020 ◽

Author(s):

Mine Koruyucu ◽

Dilara Bektaş ◽

Cengiz Aydınoğlu ◽

Pelin Barlak ◽

Figen Seymen

Keyword(s):

Success Rate ◽

Clinical Success ◽

Clinical Success Rate ◽

Fissure Sealants ◽

One Year

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Early endoscopic treatment of symptomatic pancreatic necrotic collections

Scientific Reports ◽

10.1038/s41598-021-03924-2 ◽

2022 ◽

Vol 12 (1) ◽

Author(s):

Mateusz Jagielski ◽

Jacek Piątkowski ◽

Marek Jackowski

Keyword(s):

Success Rate ◽

Endoscopic Treatment ◽

Clinical Success ◽

Late Phase ◽

Clinical Success Rate ◽

Endoscopic Drainage ◽

Endoscopic Intervention ◽

Average Total Number ◽

Group 2

AbstractEUS-guided transmural endoscopic drainage is commonly used in the treatment of WOPN in the late phase of ANP. The role of endoscopic intervention remains unclear in the early phase of ANP. This study aimed to prospectively evaluate early endoscopic treatment of ANCs compared with endoscopic drainage of WOPN. Overall, 71 patients with ANP who underwent transmural endoscopic drainage for necrotic collections were included. Endoscopic intervention was performed within the first four weeks of ANP in 25 (35.21%) patients with ANC (Group 1) and in 46 (64.79%) patients after four weeks since the onset of ANP with WOPN (Group 2). The overall mean age of patients was 49.9 (22–79) years and 59 of them were males. The mean time of active drainage and duration of total endoscopic treatment was 26.8 and 16.9 days (P = 0.0001) and 270.8 and 164.2 days (P = 0.0001) in Groups 1 and 2, respectively. The average total number of endoscopic interventions was 9.5 and 4.5 in Groups 1 and 2, respectively (P = 0.0001). The clinical success rate, frequency of complications of endoscopic interventions, long-term success rate, and recurrence rate were not significantly different between the groups (P > 0.05 for each). Transmural endoscopic drainage is effective method of treatment of early ANCs within the first four weeks of ANP. However, compared with endoscopic intervention in WOPN, more interventions and longer duration of drainage are required.

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Modified silicone stent for the treatment of post-surgical bronchopleural fistula: a clinical observation of 17 cases

BMC Pulmonary Medicine ◽

10.1186/s12890-020-01372-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Junli Zeng ◽

Xuemei Wu ◽

Zhide Chen ◽

Meihua Zhang ◽

Mingyao Ke

Keyword(s):

Success Rate ◽

Clinical Success ◽

Bronchopleural Fistula ◽

Clinical Success Rate ◽

Massive Hemoptysis ◽

Left Heart Failure ◽

Silicone Stent ◽

Life Threatening ◽

Granulomatous Tissue

Abstract Background Bronchopleural fistula is a rare but life-threatening event with limited therapeutic options. We aimed to investigate the efficacy and safety of the modified silicone stent in patients with post-surgical bronchopleural fistula. Methods Between March 2016 and April 2020, we retrospectively reviewed the records of 17 patients with bronchopleural fistula and who underwent bronchoscopic placement of the Y-shaped silicone stent. The rate of initial success, clinical success and clinical cure, and complications were analyzed. Results Stent placement was successful in 16 patients in the first attempt (initial success rate: 94.1%). The median follow-up time was 107 (range, 5–431) days. All patients achieved amelioration of respiratory symptoms. The clinical success rate was 76.5%. Of the 14 patients with empyema, the daily drainage was progressively decreased in 11 patients, and empyema completely disappeared in six patients. Seven stents were removed during follow-up: four (26.7%) for the cure of fistula, two for severe proliferation of granulomatous tissue and one for stent dislocation. No severe adverse events (i.e. massive hemoptysis, suture dehiscence) took place. Seven patients died (due to progression of malignancy, uncontrolled infection, myocardial infarction and left heart failure). Conclusions The modified silicone stent may be an effective and safe option for patients with post-surgical bronchopleural fistula patients in whom conventional therapy is contraindicated.

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