MESH REINFORCEMENT IN ANTIREFLUX SURGERY – ADVERSE EVENTS AND ENDOSCOPIC MANAGEMENT

Summary Esophageal foreign body impaction (EFBI) is a gastrointestinal emergency, mostly requiring endoscopic management. The aim of this study is to evaluate the epidemiology, adverse events, and outcomes of patients following the episode of EFBI. All esophagogastroduodenoscopy (EGD) reports of admitted patients for EFBI at the University of Kansas Medical Center between 2003 and 2018 were retrospectively reviewed. Of 204 patients, who met the inclusion criteria, 60% were male and the mean age was 54.7 ± 17.7 years. The encounter was the first episode of EFBI in 76% of cases. EGD in less than 24 hours of patients’ admission was required in 79% of cases. The distal esophagus was the most common site of impaction (44%). Push and pull techniques were used in 38 and 35.2% of cases, respectively, while 11% were managed by a combination of both techniques. Structural causes were the most common etiologic findings including benign strictures and stenosis in 21.5% of patients, followed by Schatzki’s ring (7.8%) and hiatal hernia (6.9%). Of all cases, 45% did follow-up in up to 1 year, and biopsy was done in 34% of cases. Out of 43 patients who had endoscopic findings suspicious for eosinophilic esophagitis (EoE), the diagnosis was confirmed by pathology in 37. The rate of recurrence EFBI was significantly higher in patients with EoE (P < 0.001). EFBI-related esophageal adverse events (AEs) occurred in 4.9% of cases. Cardiovascular and pulmonary AEs occurred in 1.5 and 2.9%, respectively. Logistic regression did not find any predictor for AEs occurrence. EFBI managed very well with endoscopic treatments. Despite the emerging data about the safety of the push technique, there are still concerns regarding its adverse events especially the risk of perforations. Our study shows no significant difference in adverse events between different types of techniques.

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Clinical outcomes of endoscopic removal of foreign bodies from the upper gastrointestinal tract

BMC Gastroenterology ◽

10.1186/s12876-021-01959-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Dong Ryeol Yoo ◽

Chang Bin Im ◽

Baek Gyu Jun ◽

Hyun Il Seo ◽

Jong Kyu Park ◽

...

Keyword(s):

Gastrointestinal Tract ◽

Adverse Events ◽

Clinical Outcomes ◽

Foreign Bodies ◽

Early Recognition ◽

Upper Gastrointestinal Tract ◽

Endoscopic Management ◽

Endoscopic Removal ◽

Foreign Objects ◽

Upper Gastrointestinal

Abstract Background Ingested foreign objects frequently require emergency removal. This study aimed to investigate the clinical outcomes of endoscopic removal of foreign bodies from the upper gastrointestinal tract and the risk factors for adverse events. Methods Adults (> 18 years) who underwent endoscopic management of ingested foreign bodies at two centers, one inland and one on the coast, between January 2008 and December 2017 were eligible. Clinical characteristics and procedure-related outcomes were retrospectively reviewed. Patients were divided into two groups, based on whether the foreign bodies were sharp or blunt in shape. Results A total of 853 patients aged 19–96 years were analyzed. Ingestion of fish bones was more common in the coastal area, whereas ingestion of food boluses was more common in the inland area. The duration of impaction ranged from 1 h to over 1 month and was significantly longer in patients who ingested blunt than sharp foreign bodies (15 vs. 5 h, p < 0.001). Most (98.9%) foreign bodies were successfully removed. Adverse events occurred in 31.2 % of patients, including ulcers (4.0%) and perforations (3.3 %). Multivariate analysis showed that age (odds ratio [OR] 1.015, p = 0.012), sharp foreign bodies (OR 5.133, p < 0.001), location in the esophagus (OR 2.723, p = 0.018), and duration of impaction (OR 1.431, p < 0.001) were factors associated with adverse events. Conclusions Early recognition and timely endoscopic removal of ingested foreign bodies, particularly in elderly patients and those with sharp foreign bodies, may improve clinical outcomes.

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OC.03.2 BILIOPANCREATIC ADVERSE EVENTS AFTER PANCREATICODUODENECTOMY: PRELIMINARY RESULTS OF ENDOSCOPIC MANAGEMENT WITH PEDIATRIC COLONOSCOPE

Digestive and Liver Disease ◽

10.1016/s1590-8658(21)00492-8 ◽

2021 ◽

Vol 53 ◽

pp. S102

Author(s):

M. Mutignani ◽

M. Bravo ◽

L. Dioscoridi ◽

F. Pugliese ◽

M. Cintolo ◽

...

Keyword(s):

Adverse Events ◽

Endoscopic Management ◽

Preliminary Results

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A prospective study of fully covered metal stents for different types of refractory benign biliary strictures

Endoscopy ◽

10.1055/a-1111-8666 ◽

2020 ◽

Vol 52 (05) ◽

pp. 368-376 ◽

Cited By ~ 2

Author(s):

Tatsuya Sato ◽

Hirofumi Kogure ◽

Yousuke Nakai ◽

Kazunaga Ishigaki ◽

Ryunosuke Hakuta ◽

...

Keyword(s):

Adverse Events ◽

Prospective Study ◽

Endoscopic Management ◽

Metal Stents ◽

Biliary Strictures ◽

Surgically Altered Anatomy ◽

Anastomotic Strictures ◽

Benign Biliary Strictures ◽

Long Term Treatment ◽

Stricture Recurrence

Abstract Background While endoscopic management of benign biliary strictures (BBSs) is the standard of care, long-term treatment remains the issue in refractory cases, especially for anastomotic strictures after living-donor liver transplantation (LDLT) and hepaticojejunostomy anastomotic strictures (HJAS). The aim of this prospective study was to evaluate the safety and effectiveness of a fully covered self-expandable metal stent (FCSEMS) for patients with refractory BBSs. Methods Patients with BBSs that were unamenable to endoscopic plastic stent placement with a treatment period of more than 6 months were eligible. An FCSEMS was placed endoscopically and removed after 90 days. In patients with surgically altered anatomy, an FCSEMS was placed using a double-balloon endoscope. The primary outcome was stricture resolution at FCSEMS removal. The secondary outcomes included stricture recurrence and adverse events. Results A total of 30 patients were enrolled: the causes of their BBSs were anastomotic stricture after LDLT in 13, HJAS in 12, post-cholecystectomy in two, chronic pancreatitis in two, and post-hepatectomy in one. The technical success rate of FCSEMS placement was 100 % and all FCSEMSs were successfully removed. The rate of stricture resolution at FCSEMS removal was 96.6 % (91.7 % in the post-LDLT group and 100 % in the HJAS group). Stricture recurrence occurred in three HJAS patients (10.7 %) during a median follow-up period of 15.6 months. Adverse events were observed in 12.1 %: five cholangitis, one pancreatitis, and one perforation. Conclusion Temporary placement of an FCSEMS was a feasible and effective treatment option for refractory BBSs, especially for post-LDLT strictures and HJAS.

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Abstract 14190: Optimal Peri-endoscopic Management of Anti-thrombotic Therapy in Chinese Elderly Patients: A Retrospective Study

Circulation ◽

10.1161/circ.132.suppl_3.14190 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Hao Wang ◽

Tao Tao ◽

Hai-jun Wang ◽

Yu-tao Guo ◽

Yu-tang Wang

Keyword(s):

Adverse Events ◽

Elderly Patients ◽

Gastrointestinal Endoscopy ◽

Endoscopic Management ◽

Optimal Timing ◽

Low Molecular Weight ◽

Bleeding Events ◽

Bridging Therapy ◽

Chinese Elderly ◽

Study Population

Introduction: To investigate optimal timing of cessation and resumption of anti-thrombotic therapy (ATT) during gastrointestinal endoscopy in Chinese elderly patients. Methods: Between January 1st 2008 and December 31st 2014,at Chinese PLA General Hospital, 3747 patients (76.03±10.3 years) hospitalized for elective gastrointestinal endoscopy were retrospectively analyzed. The study population were predominately male(96.1%) and senile(age ≥60, 92.3%).Patients‘ peri-endoscopic management of ATT and adverse events (thromboembolism and bleeding) were recorded. RхC tables were used to compare the differences of peri-endoscopic adverse events among patients with different peri-endoscopic management of ATT. Results: the peri-endoscopic thromboembolic incidence in those with discontinuing ATT ≥7 days before procedure was significantly higher (8.12%). No difference of bleeding incidence was found among different cessation time before procedure. The peri-endoscopic thromboembolic incidence increased as the delaying of resuming ATT after procedure. However, the incidence of peri-endoscopic bleeding in patients with resuming ATT 2-7 days after procedure was lowest (0.63%). The reason why bleeding incidences in patients with resuming ATT >7 days, and those without resuming ATT were much higher than those with resuming ATT 2-7 days was that occurrence of bleeding urged physician to postpone or cancel resumption of ATT. When discontinuing ATT, the differences of peri-endoscopic thromboembolic or bleeding events between patients receiving low-molecular-weight heparin bridging therapy and those without bridging therapy were not significant. Conclusions: Cessation of ATT <7 days before endoscopic procedure and resumption of ATT in 2-7days after procedure were optimal peri-endoscopic ATT management strategy for Chinese elderly patients.Bridging therapy couldn’t protect elderly patients from peri-endoscopic thromboembolic events.

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Underwater cap-assisted Endoscopic Retrograde Cholangiopancreatography in patients with surgically altered anatomy: a pilot study

Endoscopy ◽

10.1055/a-1311-9779 ◽

2020 ◽

Author(s):

Alessandro Fugazza ◽

Andrea Anderloni ◽

Danilo Paduano ◽

Matteo Badalamenti ◽

Roberta Maselli ◽

...

Keyword(s):

Bile Duct ◽

Adverse Events ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Endoscopic Management ◽

Biliary Disease ◽

Bile Duct Stones ◽

Endoscopic Retrograde ◽

Promising Alternative ◽

Surgically Altered Anatomy ◽

Transparent Cap

Introduction Endoscopic retrograde cholangiopancreatography (ERCP) in surgically altered anatomy (SAA) pa-tients is technically challenging and associated with a significant number of failures. We examined the feasibility and efficacy of a novel technique for management of jaundice orcholangitis second-ary to bile duct stones (BDS), called underwater cap-assisted ERCP (u-ERCP). Methods Between June 2019 and February 2020 all patients with jaundice or cholangitis secondary to bile duct stones (BDS) with SAA who underwent u-ERCP were enrolled. The u-ERCP tecnnique combines the underwater advancement of a pediatric colonoscope with a transparent cap fitted on the tip of the endoscope. We evaluated the technical success, clinical suc-cess and adverse events associated with u-ERCP. Results We describe the technique itself and our first experience in 6 patients. A complete and successful procedure was carried out in all patients with no adverse events occurrence. None of the patients needed additional treatments for recurrence of symptoms during the follow-up period. Conclusions The u-ERCP can be considered as a promising alternative for successful endoscopic management of biliary disease in patients with SAA.

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The Efficacy of Argon Plasma Coagulation versus Carvedilol for Treatment of Portal Hypertensive Gastropathy

Digestion ◽

10.1159/000502814 ◽

2019 ◽

Vol 101 (6) ◽

pp. 651-658 ◽

Cited By ~ 1

Author(s):

Mohamed S. El Shahawy ◽

Zakarya M. Shady ◽

Abdullah Gaafar

Keyword(s):

Adverse Events ◽

Serum Ferritin ◽

Serum Iron ◽

Argon Plasma Coagulation ◽

Argon Plasma ◽

Deficiency Anemia ◽

Endoscopic Management ◽

Portal Hypertensive Gastropathy ◽

Plasma Coagulation ◽

Transfusion Requirements

Background/Aim: Several treatment options have been developed for portal hypertensive gastropathy (PHG); medications and endoscopic management. The aim of this study was to evaluate the efficacy and safety of argon plasma coagulation (APC) versus Carvedilol in treatment of a cohort of Egyptian patients with severe PHG. Methods: A total of 130 patients with severe PHG were enrolled; 10 patients were excluded due to death and failure to complete the treatment sessions accordingly, 120 patients were included. Patients were divided into 2 groups: Group A (n = 52) treated with APC; Group B (n = 68) treated with oral Carvedilol. Success was defined as stabilization of hemoglobin (Hb) over 100 g/dL or Hb increase >10% from pretreatment level and reduction of blood transfusion requirements over the following 3 months after the start of therapy. Upper gastrointestinal endoscopy was performed to assess the degree and site of PHG. APC was conducted to areas with mucosal ectatic vascular lesions. Results: PHG was mostly fundic (36.35%) in APC group and (36.76%) in Carvedilol group (p = 0.56). Throughout follow-up period, there was significant increase in Hb level, serum iron, and serum ferritin with a significant decrease in total iron-binding capacity (TIBC) in APC group as compared to Carvedilol group (p < 0.001). Additionally, there was gradual increase in the mean Hb, serum iron, and serum ferritin and gradual decrease of TIBC in Carvedilol group. Accordingly, there was an overall improvement of iron deficiency anemia (IDA) in both groups; however, it was significantly better in APC group than in Carvedilol group. No major adverse events were detected in both the groups. Conclusion: APC significantly improves IDA and decreases transfusion requirements in patients with severe PHG as compared to oral Carvedilol with small risk of adverse events. Furthermore, the combination of APC and Carvedilol unless contraindicated could have a synergistic effect in controlling severe PHG.

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