scholarly journals Third-Space Endoscopy: Recent Updates

2021 ◽  
Vol 12 (03) ◽  
pp. 160-166
Author(s):  
Zaheer Nabi ◽  
D Nageshwar Reddy
Keyword(s):  
Third Space ◽  
Gastrointestinal Diseases ◽  
Pneumatic Dilatation ◽  
Promising Alternative ◽  
Achalasia Cardia ◽  
Esophageal Myotomy ◽  
Therapeutic Procedures ◽  
Long Term Follow Up ◽  
Endoscopic Myotomy

AbstractThird space or submucosal space is a potential space which on expansion allows the endoscopist to execute a multitude of therapeutic procedures for various gastrointestinal diseases like achalasia, subepithelial tumors, Zenker’s diverticulum, and refractory gastroparesis. Third space was first utilized for performing endoscopic myotomy in cases with achalasia cardia about a decade ago. Since then, the field of submucosal endoscopy has witnessed an exponential growth. The present review focuses on recent advances in the field of third-space endoscopy. With regard to per-oral endoscopic myotomy (POEM) in achalasia cardia, several recent studies have evaluated the long-term outcomes of POEM, compared endoscopic myotomy with pneumatic dilatation (PD) and surgical myotomy, and evaluated the outcomes of short- versus long-esophageal myotomy. In addition, the utility of multiple dose antibiotic prophylaxis to prevent infections after POEM has been questioned. Overall, the results from these studies indicate that POEM is a durable treatment modality, equally effective to Heller’s myotomy and superior to PD. With regard to gastric-POEM (G-POEM), recent studies suggest only modest efficacy in cases with refractory gastroparesis. Therefore, quality studies are required to identify predictors of response to optimize the outcomes of G-POEM in these cases. Another third-space endoscopy procedure that has gained popularity is endoscopic division of septum in cases with esophageal diverticula including Zenker’s POEM and epiphrenic diverticula POEM (Z-POEM and D-POEM, respectively). The technique of diverticulotomy using the principles of submucosal endoscopy appears safe and effective in short term. Data on term outcomes are awaited and comparative trials with flexible endoscopic myotomy required. Per-rectal endoscopic myotomy (PREM) is the most recent addition to third space endoscopy procedures for the management of short-segment Hirschsprung’s disease. Limited data suggest that PREM may be a promising alternative surgery in these cases. However, quality studies with long-term follow-up are required to validate the outcomes of PREM.

A novel third space endoscopic procedure, per-rectal endoscopic myotomy, for Hirschsprung’s disease: Medium and long-term outcomes

Endoscopy ◽  
2020 ◽  
Author(s):  
Amol Bapaye ◽  
Parag Dashatwar ◽  
Vishnu Biradar ◽  
Shital Biradar ◽  
Rajendra Pujari
Keyword(s):  
Hirschsprung's Disease ◽  
Hirschsprung’S Disease ◽  
Third Space ◽  
Stool Frequency ◽  
Segment Length ◽  
Anal Stenosis ◽  
Current Standard ◽  
Aganglionic Segment ◽  
Endoscopic Myotomy

Introduction Hirschsprung’s disease (HSCR) is congenital aganglionosis affecting hindgut and presents with constipation. Surgical pull-through is current standard but has morbidity. Per-rectal endoscopic myotomy (PREM) is a novel third space endoscopy technique for treating SS-HSCR. Methods Retrospective series of SS-HSCR patients diagnosed on history, contrast enema, rectal biopsies, anorectal manometry and treated by PREM. Aganglionic segment mapped pre-PREM. PREM performed using third space endoscopy principles. Objective – to compare stool frequency and unit laxative (UL) usage pre and post-PREM. Results N = 9; duration 4-years. Mean age – 7.5 (± 5.2) years; 7 males. Mean aganglionic segment length – 6.3 (± 4.4) cm. Mean procedure time – 96.1 (±37.9) minutes. Mean LOS – 2.5 (±0.7) days. Median follow-up –17 months (9 – 58). Stool frequency – pre – 1/4.4 (±1.5) vs. post – 1/1.2 (±0.4) days (p = 0.0004). Mean UL usage – pre – 5.4 (±4.9) vs. post – 0.4 (±0.7) units (p = 0.0002). No laxatives in 6 (66%). Single AE (anal stenosis) – dilatation. Conclusions PREM is a safe and effective minimally invasive procedure for SS-HSCR and provides long-term response.

CS.2.2 ENDOSCOPIC PNEUMATIC DILATATION IN STENOSING CROHN'S DISEASE: LONG-TERM FOLLOW-UP

2010 ◽  
Vol 42 ◽  
pp. S64
Author(s):  
S. Morini ◽  
R. Lorenzetti ◽  
C. Hassan ◽  
A. Zullo ◽  
S. Campo
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Pneumatic Dilatation ◽  
Long Term Follow Up

scholarly journals Pneumatic Balloon Dilatation for Achalasia Cardia: Outcome, Complications, Success, and Long-term Follow-up

2017 ◽  
Vol 7 (2) ◽  
pp. 138-141 ◽  
Author(s):  
Sudhir J Gupta ◽  
Nitin R Gaikwad ◽  
Amol R Samarth ◽  
Sonal R Gattewar
Keyword(s):  
Balloon Dilatation ◽  
Type I ◽  
Type Ii ◽  
Achalasia Cardia ◽  
Eckardt Score ◽  
Free Interval ◽  
Long Term Follow Up ◽  
Pneumatic Balloon Dilatation

ABSTRACT Background Achalasia is a chronic disease that can be managed with effective endoscopic modalities. Aim To evaluate the effectiveness of single setting of pneumatic balloon dilatation for achalasia and assess the long-term success and outcomes. Materials and methods This is a retrospective study of all achalasia patients who underwent pneumatic balloon dilatation at our institute. Patients who could be contacted were inquired regarding their symptoms and dysphagia-free interval after dilatation. Results A total of 72 patients were enrolled. Out of this, 14 patients lost to follow-up. Mean age of 58 patients was 45.02 ± 16.51 years. Male:female ratio was 13:16. Mean predilatation Eckardt score was 7.16 ± 0.834. Type I achalasia was present in 10 (17.2%), type II in 44 (75.9%), type III in 4 (6.9%). Predilatation basal integrated relaxation pressure (IRP) was 28.14 ± 14.76 mm Hg. Postdilatation Eckardt score was 2.40 ± 1.67. Postdilatation dysphagia-free interval was 17.28 ± 6.70 months. A total of 9 patients (15.51%) failed to respond to first dilatation and 49 (84.48%) patients benefited from single setting of pneumatic dilatation. Esophageal perforation occurred in 2/58 (3.44%). We did not find any significant difference in gender distribution, age of presentation, duration of symptom, pre- and postdilatation Eckardt score, type of achalasia, and basal IRP on manometry between type of achalasia. Postdilatation dysphagia-free interval in type II achalasia (18.09 ± 5.976 months) was more than types I and III achalasia cardia (p = 0.066), which showed trend toward significance. Conclusion Pneumatic balloon dilatation of achalasia cardia is a highly effective endoscopic procedure with minimal complications and mortality. Even the single setting of dilatation can have long-lasting dysphagia-free interval. How to cite this article Gupta SJ, Gaikwad NR, Samarth AR, Gattewar SR. Pneumatic Balloon Dilatation for Achalasia Cardia: Outcome, Complications, Success, and Long-term Follow-up. Euroasian J Hepato-Gastroenterol 2017;7(2):138-141.

scholarly journals P-P27 Long term follow-up after pancreatico-duodenectomy: A UK wide survey

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Mary Phillips ◽  
Denise Robertson ◽  
Kathryn Hart ◽  
Rajesh Kumar ◽  
Nariman Karanjia
Keyword(s):  
Quality Of Life ◽  
Nutritional Assessment ◽  
Gastrointestinal Diseases ◽  
Improve Quality ◽  
Exocrine Insufficiency ◽  
Clinician Experience ◽  
Long Term Follow Up

Abstract Background Pancreatico-duodenectomy (PD)  results in major anatomical changes that have an impact on nutritional status and quality of life. Issues such as pancreatic exocrine insufficiency (PEI), diabetes mellitus (DM), malnutrition, micronutrient deficiency, osteoporosis and other gastrointestinal diseases are common in the post-operative setting (1, 2). Appropriate treatment of these surgical consequences is associated with improved survival (3, 4), and should improve quality of life. The aim of this survey was to assess current practice and identify which disciplines were reviewing patients following PD, what format that review takes and the duration of follow up. Methods A UK wide electronic survey was developed using Qualtrics® software (SAP America Inc. USA) to capture all the nutritional aspects of follow up thought to be relevant in the long term. Markers of endocrine failure and malnutrition (weight, nutritional assessment and biochemical vitamin and mineral screens), smoking and alcohol cessation advice and the use of dual energy x-ray absorptiometry (DEXA) scans were included. The survey was piloted on 5 staff locally prior to being circulated through a professional network – the Pancreatic Society of Great Britain and Ireland (PSGBI). Data were analysed using Chi-Square tests in SPSS (Version 26). Results One hundred and one (23% response rate) clinicians completed the survey, with 83 useable data sets.  Surgeons and dietitians were most likely to reply to the questionnaire, 88% of respondents worked in tertiary centres, half (55%) had more than 10 years’ experience. There were highly significant variations in practice according to clinician experience, underlying pathology, and institution (p < 0.001 in all cases). Diabetes screening did not occur in 30% of cases. Lifelong follow up was offered by 24% of clinicians (17 surgeons, 3 dietitians, 1 nurse), in pre-malignant (n = 15), benign (n = 11) and malignant disease (n = 10) (P < 0.001). Conclusions Whilst this study may be biased towards those with an interest in follow up, we still demonstrated a need to improve the provision of long-term follow up for patients who have undergone PD, especially since provision of a comprehensive assessment appeared to be associated with clinician experience, and varies between institutions. More evidence for the benefits of long-term follow up and the optimal content is required to inform the development of clinical guidance. Early detection of clinical consequences may improve quality of life and reduce complications associated with poorly managed endocrine and exocrine failure.

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