Sequential endoscopic drainage and clip closure of an intrathoracic esophagogastric anastomotic dehiscence

Oesophagectomy is being used in treatment of several oesophageal diseases, most commonly in treatment of oesophageal cancer. It is a major surgical procedure that may result in various complications. One of the most severe complications is anastomotic dehiscence between the gastric conduit and the oesophageal remnant. Anastomotic dehiscence after esophagectomy is directly linked to high morbidity and mortality. We propose a therapeutic algorithm of this complication based on published literature and our experience by retrospective evaluationof 164 patients who underwent oesophagectomy for oesophageal cancer. Anastomotic dehiscence was present in 29 cases.

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Novel multidisciplinary hub-and-spoke tertiary service for the management of severe acute pancreatitis

BMJ Open Gastroenterology ◽

10.1136/bmjgast-2020-000501 ◽

2021 ◽

Vol 8 (1) ◽

pp. e000501

Author(s):

Manu K Nayar ◽

Noor L H Bekkali ◽

David Bourne ◽

Sophie Young ◽

John S Leeds ◽

...

Keyword(s):

Acute Pancreatitis ◽

Severe Acute Pancreatitis ◽

Secondary Care ◽

Multiorgan Failure ◽

Tertiary Care ◽

Endoscopic Drainage ◽

Hub And Spoke ◽

Specialist Nurse ◽

Icu Stay

ObjectiveSevere acute pancreatitis (SAP) is associated with high mortality (15%–30%). Current guidelines recommend these patients are best managed in a multidisciplinary team setting. This study reports experience in the management of SAP within the UK’s first reported hub-and-spoke pancreatitis network.DesignAll patients with SAP referred to the remote care pancreatitis network between 2015 and 2017 were prospectively entered onto a database by a dedicated pancreatitis specialist nurse. Baseline characteristics, aetiology, intensive care unit (ICU) stay, interventions, complications, mortality and follow-up were analysed.Results285 patients admitted with SAP to secondary care hospitals during the study period were discussed with the dedicated pancreatitis specialist nurse and referred to the regional service. 83/285 patients (29%; 37 male) were transferred to the specialist centre mainly for drainage of infected pancreatic fluid collections (PFC) in 95% (n=79) of patients. Among the patients transferred; 29 (35%) patients developed multiorgan failure with an inpatient mortality of 14% (n=12/83). The median follow-up was 18.2 months (IQR=11.25–35.51). Multivariate analysis showed that transferred patients had statistically significant longer overall hospital stay (p<0.001) but less ICU stay (p<0.012).ConclusionThis hub-and-spoke model facilitates the management of the majority of patients with SAP in secondary care setting. 29% warranted transfer to our tertiary centre, predominantly for endoscopic drainage of PFCs. An evidence-based approach with a low threshold for transfer to tertiary care centre can result in lower mortality for SAP and fewer days in ICU.

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The Role of Nutritional Access in Malnourished Elderly Undergoing Major Surgery for Acute Abdomen: A Propensity Score-Matched Analysis

The American Surgeon ◽

10.1177/0003134820973719 ◽

2020 ◽

pp. 000313482097371

Author(s):

Shekhar Gogna ◽

David Samson ◽

James Choi ◽

Jorge Con ◽

Kartik Prabhakaran ◽

...

Keyword(s):

Propensity Score ◽

Abdominal Surgery ◽

Acute Abdomen ◽

Anastomotic Dehiscence ◽

The Elderly ◽

Major Surgery ◽

P Value ◽

Gastrointestinal Complications ◽

Group I

Background About 50% of the elderly undergoing emergency abdominal surgery are malnourished. The role of timely surgical nutritional access in this group of patients is unknown. Methods We analyzed the National Inpatient Sample database from 2009 through the first three-quarters of 2015 of patients aged ≥65 years who were malnourished and underwent major abdominal surgery for the acute abdomen within the first 2 days of hospital admission. Results Of 3 246 721 patients analyzed, 4311 patients met inclusion criteria. Of these, only 507 (11.8%) patients had surgical nutritional access (gastrostomy or jejunostomy) (group I), while 3804 patients (88.2%) did not (group II). In the propensity score-matched population, there were 482 patients in each group. The patients in group I had lower odds of mortality and postoperative gastrointestinal complications (paralytic ileus, anastomotic dehiscence, and intestinal fistulae) ( P-value <.01, respectively). Discussion Elderly who receive surgical nutritional access have lower rates of gastrointestinal complications and mortality.

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Endoscopic drainage of pancreatic pseudocysts

Practical Pediatric Gastrointestinal Endoscopy ◽

10.1002/9781119423492.ch38 ◽

2021 ◽

pp. 343-346

Author(s):

Mike Thomson

Keyword(s):

Pancreatic Pseudocysts ◽

Endoscopic Drainage

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Utility of endoscopic transpapillary pancreatic cyst drainage for intraductal papillary mucinous neoplasm infection

BMJ Case Reports ◽

10.1136/bcr-2021-242583 ◽

2021 ◽

Vol 14 (6) ◽

pp. e242583

Author(s):

Shunsuke Watanabe ◽

Masao Toki ◽

Junji Shibahara ◽

Tadakazu Hisamatsu

Keyword(s):

Intraductal Papillary Mucinous Neoplasm ◽

Cyst Wall ◽

Pancreatic Cyst ◽

Epigastric Pain ◽

Drainage Tube ◽

Endoscopic Drainage ◽

Endoscopic Retrograde Pancreatography ◽

Endoscopic Retrograde ◽

Mucinous Neoplasm ◽

Route Of Infection

A 61-year-old woman with intraductal papillary mucinous neoplasm (IPMN) infection, who was treated with antibiotics, developed IPMN reinfection with febrile epigastric pain and was febrile. CT showed that the diameter of the IPMN had grown and hardened, with thickening of the cyst wall. Endoscopic retrograde pancreatography was then performed and a nasopancreatic cyst drainage tube was placed into the cyst. Symptoms and inflammatory findings improved considerably 17 days after endoscopic drainage. Few reports and evidence have been found regarding IPMN infections, and the frequency of onset, route of infection and optimal drainage method remain unknown. This study indicated that endoscopic transpapillary pancreatic cyst drainage was effective and is highly recommended for IPMN infection.

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