scholarly journals Amplatzer occluders for refractory esophago-respiratory fistulas: a case series

2021 ◽  
Vol 09 (09) ◽  
pp. E1350-E1354
Author(s):  
Arthur Belle ◽  
Christine Lorut ◽  
Aurélie Lefebvre ◽  
Einas Abou Ali ◽  
Rachel Hallit ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Clinical Success ◽  
Case Series ◽  
Clinical Success Rate ◽  
Endoscopic Management ◽  
Vacuum Therapy ◽  
Short Term ◽  
Endoscopic Vacuum Therapy ◽  
Endoscopic Placement ◽  
Safe Treatment Option

Abstract Background and study aims Endoscopic management of esophagorespiratory fistulas (ERF) is challenging and currently available options (stents, double pigtail, endoscopic vacuum therapy) are not very effective. We report the feasibility and efficacy of endoscopic placement of Amplatzer cardiovascular occluders for this indication. Patients and methods This was a single-center, prospective study (June 2019 to September 2020) of all patients with non-malignant ERF persistent after conventional management with esophageal and/or tracheal stents. The primary outcome was the technical feasibility of Amplatzer placement. Secondary outcomes were clinical success defined by effective ERF occlusion and resolution of respiratory symptoms allowing oral food intake. Results Endoscopic placement of Amplatzer occluders was feasible in 83 % of patients (5/6), with a 50 % (3/6) clinical success rate at 9 months. The mortality rate was 33 % (2/6). Conclusions An Amplatzer cardiac or vascular occluder is a feasible and safe treatment option for refractory ERF, with a 50 % short-term clinical success.

Vacuum Therapy and Internal Drainage as the First-Line Endoscopic Treatment for Post-Bariatric Leaks: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 1-8
Author(s):  
Issaree Laopeamthong ◽  
Thanita Akethanin ◽  
Wisit Kasetsermwiriya ◽  
Suphakarn Techapongsatorn ◽  
Amarit Tansawet
Keyword(s):  
Systematic Review ◽  
Fixed Effects ◽  
Primary Outcome ◽  
Clinical Success ◽  
Evidence Synthesis ◽  
Meta Analysis ◽  
Data Availability ◽  
Vacuum Therapy ◽  
Internal Drainage ◽  
First Line

<b><i>Introduction:</i></b> Several endoscopic methods can be employed to manage post-bariatric leaks. However, endoluminal vacuum therapy (EVT) and endoscopic internal drainage (EID) are relatively new methods, and studies regarding these methods are scarce. We performed a systematic review of the literature and a meta-analysis to evaluate the efficacy of EVT and EID. <b><i>Methods:</i></b> Databases were searched for eligible studies. The clinical success of leak closure was the primary outcome of interest. A proportional meta-analysis was performed for pooling the primary outcome using a fixed-effects model. A meta-analysis or descriptive analysis of other outcomes was performed based on the data availability. <b><i>Results:</i></b> Data from 3 EVT and 10 EID studies (<i>n</i> = 279) were used for evidence synthesis. The leak closure rates (95% confidence interval [CI]) of EVT and EID were 85.2% (75.1%–95.4%) and 91.6% (88.1%–95.2%), respectively. The corresponding mean treatment durations (95% CI) were 28 (2.4–53.6) and 78.4 (50.1–106.7) days, respectively. However, data about other outcomes were extremely limited; thus, a pooled analysis could not be performed. <b><i>Conclusions:</i></b> Both EVT and EID were effective when used as the first-line treatment for post-bariatric leaks. However, larger studies must be conducted to compare the efficacy of the 2 interventions.

scholarly journals Endoscopic Self-Expandable Metallic Stent Insertion without Fluoroscopic Guidance Is Feasible and Safe for Acute Colonic Obstruction Caused by Colorectal Cancer

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Yadong Feng ◽  
Qian Yu ◽  
Ming Li ◽  
Wei Xu ◽  
Ye Zhu ◽  
...  
Keyword(s):  
Success Rate ◽  
Clinical Success ◽  
Colonic Obstruction ◽  
Clinical Success Rate ◽  
Metallic Stent ◽  
Fluoroscopic Guidance ◽  
Procedure Time ◽  
Technical Success ◽  
Short Term ◽  
Expandable Metallic Stent

Aims. Endoscopic self-expandable metallic stent (SEMS) insertion for acute colonic obstruction caused by colorectal cancer (CRC) is always performed under fluoroscopic guidance. This study evaluated the feasibility and safety of an endoscopic stenting procedure without fluoroscopic guidance. Methods. A total of 36 patients with an acute colonic obstruction caused by CRC underwent endoscopic SEMS insertion using a colonoscope without fluoroscopic guidance, followed by analyses of the technical and clinical success and short-term complications. Results. Total technical success rate and clinical success rate were 91.7% and 86.1%, respectively. The mean procedure time was 21.2±10.3 minutes. There was no stent dislodgement. One case of hematochezia and two cases of tenesmus occurred in patients with left-sided complete obstructions. No other short-term complications occurred. Procedure time, technical success, and clinical success rate were 16.3±9.4 minutes, 93.1%, and 89.6% for left-sided obstructions, respectively, and were 26.8±10.7 minutes, 85.7%, and 71.4% for right-sided obstructions, respectively. For complete obstructions, procedure time, technical success, and clinical success rate were 22.5±8.9 minutes, 90%, and 83.3%, respectively. In the incomplete cases, procedure time, technical success, and clinical success were 13.5±6.7 minutes, 100%, and 100%, respectively. Technical success, clinical success, and short-term complications were not differed between lesion locations and degrees. Conclusions. This simple technique is feasible and safe for palliation of acute colonic obstruction caused by CRC.

scholarly journals Palliative Endoscopic Ultrasound Biliary Drainage for Advanced Malignant Biliary Obstruction: Should It Replace the Percutaneous Approach?

2019 ◽  
Vol 13 (3) ◽  
pp. 385-397 ◽  
Author(s):  
C. Rinaldi A. Lesmana ◽  
Rino A. Gani ◽  
Irsan Hasan ◽  
Andri Sanityoso Sulaiman ◽  
Khek Yu Ho ◽  
...  
Keyword(s):  
Success Rate ◽  
Endoscopic Ultrasound ◽  
Biliary Drainage ◽  
Biliary Obstruction ◽  
Clinical Success ◽  
Case Series ◽  
Clinical Success Rate ◽  
Malignant Biliary Obstruction ◽  
Technical Success Rate ◽  
Case Series Study

Endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic biliary drainage (PTBD) are the standard of care in malignant biliary obstruction cases. Recently, endoscopic ultrasound-guided biliary drainage (EUS-BD) has been widely used after unsuccessful ERCP. However, the patient’s clinical impact of EUS-BD over PTBD is still not obvious. Therefore, this case series study aims to evaluate the clinical outcomes of patients with advanced malignant biliary obstruction who underwent EUS-BD after failed ERCP. A retrospective database study was performed between January 2016 and June 2018 in patients with advanced malignant biliary obstruction. Patients were consecutively enrolled without randomization. Treatment options consisted of ERCP and PTBD or EUS-BD if ERCP failed. Based on 144 biliary obstruction cases, 38 patients were enrolled; 24 (63.2%) were men. The patients’ mean age was 66.8 ± 12.36 years. The most common cause of malignant biliary obstruction was pancreatic cancer (44.7%). Biliary drainage was achieved by ERCP (39.5%), PTBD (39.5%), and EUS-BD (21.1%). The technical success rate was 86.7% by PTBD and 87.5% by EUS-BD (p = 1.000), while the clinical success rate was 93.3% by PTBD and 62.5% by EUS-BD (p = 0.500). The median survival in patients who underwent PTBD versus those wo underwent EUS-BD was 11 versus 3 months (log-rank p = 0.455). In conclusion, there is no significant advantage of EUS-BD when compared to PTBD in terms of clinical success and survival benefit in advanced malignant biliary obstruction.

scholarly journals Sealing the hole: endoscopic management of acute gastrointestinal perforations

2019 ◽  
Vol 11 (1) ◽  
pp. 55-61
Author(s):  
Ahmed Gabr
Keyword(s):  
Surgical Treatment ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Standard Of Care ◽  
Endoscopic Management ◽  
Anatomical Location ◽  
Gi Tract ◽  
Omental Patch ◽  
Endoscopic Closure ◽  
Number Of Factors

Acute perforations are one of the recognised complications of both diagnostic and therapeutic gastrointestinal (GI) endoscopy. The incidence rate varies according to the type of procedure and the anatomical location within the GI tract. For decades, surgical treatment has been the standard of care, but endoscopic closure has become a more popular approach, due to feasibility and the reduction of the burden of surgery. Various devices are available now such as through-the-scope clips, over-the-scope clips, endoscopic suturing devices, stents, bands and omental patch. All have been tested in studies done on humans or animal models, with a reasonable overall technical and clinical success rate, proving efficiency and feasibility of endoscopic closure. The choice of which device to use depends on the site and the size of the perforation. It also depends on availability of thee device and the endoscopist’s experience. A number of factors that could predict success of endoscopic closure or favour surgical treatment have been suggested in different studies. After successful endoscopic closure, patients are usually kept nil by mouth and receive antibiotics for a duration that varied between different studies.

Endovascular therapy of arterioureteral fistulas

VASA ◽  
2020 ◽  
pp. 1-9
Author(s):  
Anne Marie Augustin ◽  
Giulia Dalla Torre ◽  
Arkadius Kocot ◽  
Thorsten Alexander Bley ◽  
Charis Kalogirou ◽  
...  
Keyword(s):  
Iliac Artery ◽  
Clinical Success ◽  
Treatment Strategies ◽  
Case Series ◽  
Clinical Success Rate ◽  
Major Complication ◽  
External Iliac Artery ◽  
Pelvic Surgery ◽  
Oncologic Surgery ◽  
Segmental Artery

Summary: Background: Arterioureteral fistulas (AUFs) are severe pathologies of different origin and with increasing incidence frequently appear in patients with underlying extensive malignancy and after pelvic surgery. AUF therapy is challenging since symptoms are frequently non-specific and patients are often unsuitable surgical candidates due to comorbidities. Since experiences with endovascular treatment strategies are limited, the feasibility, effectiveness, and safety were evaluated in a consecutive case series. Patients and methods: A retrospective analysis of five patients with endovascular AUF exclusion was performed. Probable predisposing factors for an AUF included history of pelvic malignancy with oncologic surgery in four patients, radiotherapy in four patients, and indwelling ureteral stents in four patients. Clinical presentation, diagnostic management, and site of fistula were assessed. Furthermore, technical and clinical success as well as complications were evaluated. Results: All patients presented with gross haematuria. In four patients, haematuria occurred during endoscopic ureteral stent manipulation. Affected vessels were the internal pudendal artery in one, intrarenal segmental artery and external iliac artery in two, and internal iliac artery in another two patients. Treatment included coil embolisation (n = 2), plug embolisation (n = 3), particulate embolisation (n = 1), and covered stent implantation (n = 2). Technical success was achieved in all procedures. In two cases, re-intervention was necessary due to AUF recurrence, resulting in a clinical success rate of 60.0%. One major complication class D was documented. Conclusions: AUFs can be treated effectively and safely using endovascular techniques. Diagnostic and therapeutic management of this rare entity requires a high level of awareness for potential risk factors as well as an optimal multidisciplinary coordination.

scholarly journals Economic Burden of Endoscopic Vacuum Therapy Compared to Alternative Therapy Methods in Patients with Anastomotic Leakage After Esophagectomy

2021 ◽  
Author(s):  
Ann-Kathrin Eichelmann ◽  
Sarah Ismail ◽  
Jennifer Merten ◽  
Patrycja Slepecka ◽  
Daniel Palmes ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
Alternative Therapy ◽  
Patient Treatment ◽  
Endoscopic Management ◽  
Vacuum Therapy ◽  
Ivor Lewis ◽  
Icu Stay ◽  
Reduction Strategies ◽  
Endoscopic Vacuum Therapy ◽  
Mean Cost

Abstract Background Endoscopic vacuum therapy (EVT) has become a promising option in the management of anastomotic leakage (AL) after esophagectomy. However, EVT is an effortful approach associated with multiple interventions. In this study, we conduct a comparative cost analysis for methods of management of AL. Methods All patients who experienced AL treated by EVT, stent, or reoperation following Ivor Lewis esophagectomy for esophageal cancer were included. Cases that were managed by more than one modality were excluded. For the remaining cases, in-patient treatment cost was collected for material, personnel, (par)enteral nutrition, intensive care, operating room, and imaging. Results 42 patients were treated as follows: EVT n = 25, stent n = 13, and reoperation n = 4. The mean duration of therapy as well as length of overall hospital stay was significantly shorter in the stent than the EVT group (30 vs. 44d, p = 0.046; 34 vs. 53d, p = 0.02). The total mean cost for stent was €33.685, and the total cost for EVT was €46.136, resulting in a delta increase of 37% for EVT vs. stent cost. 75% (€34.320, EVT), respectively, 80% (€26.900, stent) of total costs were caused by ICU stay. Mean pure costs for endoscopic management were relatively low and comparable between both groups (EVT: €1.900, stent: €1.100, p = 0.28). Conclusion Management of AL represents an effortful approach that results in high overall costs. The expenses directly related to EVT and stent therapy were however comparatively low with more than 75% of costs being attributable to the ICU stay. Reduction of ICU care should be a central part of cost reduction strategies.

scholarly journals Endoscopic Management of Complicated High-Grade Vesicoureteral Reflux in the First Year of Life

2021 ◽  
Author(s):  
ALI TEKIN ◽  
Sibel Tiryaki ◽  
İsmail Yağmur ◽  
Özge Kılıç ◽  
Ali Avanoğlu ◽  
...  
Keyword(s):  
Success Rate ◽  
Vesicoureteral Reflux ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Endoscopic Management ◽  
First Year ◽  
High Grade ◽  
Initial Injection ◽  
Material Volume ◽  
First Year Of Life

Abstract Purpose:The treatment of high-grade vesicoureteral reflux in infants is controversial. Subureteric injection has been tried recently with its advantage of easy application and less invasiveness. In this study, we aimed to assess the efficacy of endoscopic sub-ureteric injection to correct high-grade reflux in infants with documented indications for anti-reflux surgery.Materials and Methods:Hospital records of high-grade (grade 4-5) VUR patients who had undergone endoscopic sub-ureteric injection in the first year of life with documented breakthrough infections, between 2009-2016 were reviewed. Radiologic success was defined as complete resolution of reflux in VCUG obtained at least three months after the injection and clinical success was defined as the downgrading of reflux degree below three and absence of urinary infection.Results:A total of 23 patients with 34 high-grade refluxing units were included in the study. The mean age at first injection was 6.3±1.8 months (1-11 months). Radiologic success rate with initial injection was 61.7% and increased to 85.2% after repeated injections. The overall clinical success rate at first injection was 70.6% and 97.1% after repeated injections. Mean injected material volume was 0.34±0.27 (0.1-1) ml per ureter. Conclusion:Endoscopic treatment is a successful alternative in infants with high-grade vesicoureteral reflux suffering breakthrough infections.

scholarly journals Two Ways of Immediate Rehabilitation of Edentulous Mandible with Dental Implants and Prostheses – Critical View on Brånemark System® Novum

2003 ◽  
Vol 46 (4) ◽  
pp. 205-212 ◽  
Author(s):  
Jiří Krug ◽  
Radek Mounajjed
Keyword(s):  
Detrimental Effect ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Radiographic Study ◽  
Prosthetic Rehabilitation ◽  
Marginal Bone Loss ◽  
Short Term ◽  
Critical View ◽  
Good Healing ◽  
Edentulous Mandible

With appropriate stabilization and occlusal loading, mandibular implants can be immediately loaded in a complete- arch configuration with no apparent detrimental effect on the rates of osseointegration. Ten patients were treated with the immediate loading protocols in completely edentulous mandible either with conventional one-stage implants and a provisional denture or with the Brånemark System® Novum and a definite restoration. A total of 42 implants were placed. One Novum implant was lost 1 month after placement. The clinical success rate of the immediately loaded implants at the time of the 6–month check-up was 97.6 %. Radiographic surveys completed by panoramic radiographs 6 months after the surgery revealed good healing of bone at implant interface. After the period, mean marginal bone loss was 0.4 mm (ranged from 0 mm to 1.5 mm). The results of this short-term clinical and radiographic study indicate that the precise surgical and prosthetic protocol allows successful prosthetic rehabilitation of mandibular edentulism and that the provisional or permanent fixed reconstruction can be provided to a patient on a day of fixture surgery. Finally, authors consider critical comments on Brånemark System® Novum.

An international study on the use of peroral endoscopic myotomy (POEM) in the management of esophageal diverticula: the first multicenter D-POEM experience

Endoscopy ◽  
2018 ◽  
Vol 51 (04) ◽  
pp. 346-349 ◽  
Author(s):  
Juliana Yang ◽  
Xianhui Zeng ◽  
Xianglei Yuan ◽  
Kenneth Chang ◽  
Omid Sanaei ◽  
...  
Keyword(s):  
Clinical Success ◽  
Case Series ◽  
Peroral Endoscopic Myotomy ◽  
Endoscopic Management ◽  
Distinct Advantage ◽  
Technical Success Rate ◽  
Dysphagia Score ◽  
Esophageal Diverticula ◽  
First Case ◽  
Endoscopic Myotomy

Abstract Background The aim of this study is to report a novel, multicenter experience with the diverticular peroral endoscopic myotomy (D-POEM) technique in the management of esophageal diverticula. Methods This is a multicenter, international, retrospective study involving three centers. D-POEM was performed using the principles of submucosal endoscopy. Results A total of 11 patients with an esophageal diverticulum (Zenker’s 7, mid-esophagus 1, epiphrenic 3) were included. The mean size of the esophageal diverticula was 34.5 mm. The overall technical success rate of D-POEM was 90.9 %, with a mean procedure time of 63.2 minutes. There were no adverse events. Clinical success was achieved in 100 % (10 /10), with a decrease in mean dysphagia score from 2.7 to 0.1 (P < 0.001) during a median follow-up of 145 days (interquartile range 126 – 273). Conclusion Endoscopic management of esophageal diverticula using the novel technique of D-POEM appears promising. This first case series on D-POEM suggests that the procedure is feasible, safe, and effective in the management of esophageal diverticula. D-POEM offers the distinct advantage of ensuring a complete septotomy. Larger studies are needed to confirm these intriguing results.

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