scholarly journals EP.WE.46Stentolith as an uncommon complication of loss to follow up after endoscopic biliary stenting

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Sherwin Ng ◽  
Mark Lam ◽  
Nina Gill ◽  
Awad Shamali
Keyword(s):  
De Novo ◽  
Stone Disease ◽  
Plastic Stents ◽  
Endoscopic Stenting ◽  
Biliary Stenting ◽  
Common Procedure ◽  
Stent Occlusion ◽  
Endoscopic Biliary Stenting ◽  
Lost To Follow Up

Abstract Introduction Endoscopic biliary stenting is a common procedure, with indications from malignant obstruction to benign stone disease. We discuss a patient who re-presented after endoscopic stenting having been lost to follow up, with a large ‘stentolith’ requiring open CBD exploration. Case Presentation A 56-year-old female presented in 2013 with obstructive jaundice and a 2-week history of abdominal pain. She was a smoker, but otherwise had no past medical, surgical, or relevant family history. After initial workup, ERCP with sphincterotomy and pigtail stent placement was performed with interval laparoscopic cholecystectomy in 2014. Post-operative follow up was not arranged, the patient subsequently re-presented in 2020 with fatigue. MRCP confirmed a proximal CBD stone and linear artefact. Open exploration facilitated removal of the stone-stent complex. Discussion Complications of stenting include cholangitis, stent occlusion and migration. Stenting for failed biliary stone extraction is considered a temporary measure, with removal or exchange at three months. However, patients may be lost to follow up and return with non-specific symptoms. A rare cause is de novo formation of a gallstone calculus encasing the stent, a phenomenon termed “stentolith”. Proposed pathophysiology is through promotion of bacterial proliferation by the stent, with biofilm formation and calcium bilirubinate precipitation. Variation in formation has been described, with plastic stents developing circumferential stones, due to potential space between the wall and stent. Conclusion This highlights the importance of robust inter-disciplinary working, careful patient follow up and implementation of a mandatory registry at all hospitals for stented patients.

scholarly journals 106 Stentolith As an Uncommon Complication of Loss to Follow Up After Endoscopic Biliary Stenting

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
S Ng ◽  
M Lam ◽  
N Gil ◽  
A Shamali
Keyword(s):  
De Novo ◽  
Stone Disease ◽  
Plastic Stents ◽  
Endoscopic Stenting ◽  
Biliary Stenting ◽  
Common Procedure ◽  
Stent Occlusion ◽  
Endoscopic Biliary Stenting ◽  
Lost To Follow Up

Abstract Introduction Endoscopic biliary stenting is a common procedure, with indications from malignant obstruction to benign stone disease. We discuss a patient who re-presented after endoscopic stenting having been lost to follow up, with a large ‘stentolith’ requiring open CBD exploration. Case Presentation A 56-year-old female presented in 2013 with obstructive jaundice and a 2-week history of abdominal pain. She was a smoker, but otherwise had no past medical, surgical, or relevant family history. After initial workup, ERCP with sphincterotomy and pigtail stent placement was performed with interval laparoscopic cholecystectomy in 2014. Post-operative follow up was not arranged, and the patient subsequently re-presented in 2020 with fatigue. MRCP confirmed a proximal CBD stone and linear artefact. Open exploration facilitated removal of the stone-stent complex. Discussion Complications of stenting include cholangitis, stent occlusion and migration [2]. Stenting for failed biliary stone extraction is considered a temporary measure, with removal or exchange at three months (1). However, patients may be lost to follow up and return with non-specific symptoms. A rare cause is de novo formation of a gallstone calculus encasing the stent, a phenomenon termed “stentolith” [4]. Proposed pathophysiology is through promotion of bacterial proliferation by the stent, with biofilm formation and calcium bilirubinate precipitation [6]. Variation in formation has been described, with plastic stents developing circumferential stones [12-25], due to potential space between the wall and stent. Conclusions This highlights the importance of robust inter-disciplinary working; careful patient follows up and implementation of a mandatory registry at all hospitals for stented patients.

scholarly journals Long-term outcomes of fully covered self-expandable metal stents versus plastic stents in chronic pancreatitis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Sang Hoon Lee ◽  
Yeon Suk Kim ◽  
Eui Joo Kim ◽  
Hee Seung Lee ◽  
Jeong Youp Park ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Clinical Efficacy ◽  
De Novo ◽  
Plastic Stents ◽  
Metal Stents ◽  
Plastic Stent ◽  
Sems Group ◽  
Spontaneous Migration

AbstractChronic pancreatitis (CP) related main pancreatic duct (MPD) stricture has been a challenge for endoscopists. Fully covered self-expandable metal stents (FC-SEMS) has been tried in CP patients, but the efficacy and safety are still controversial. Thus, we aim to compare the long-term clinical efficacy of FC-SEMS vs. plastic stent placement in persistent MPD strictures secondary to CP. Between 2007 and 2018, 80 chronic pancreatitis patients (58 males, median age 49 years), who underwent endoscopic placement of FC-SEMS (n = 26) and plastic stent (n = 54) for persistent MPD strictures after at least 3 months of initial single plastic stenting, were retrospectively analyzed during a median follow-up duration of 33.7 months. As a result, MPD stricture resolution rate was statistically higher in FC-SEMS group (87.0% vs. 42.0%, p < 0.001). Although immediate complications occurred similarly (38.5% vs. 37.0%, p = 0.902), spontaneous migration (26.9%) and de novo strictures (23.1%) were pronounced delayed complications in FC-SEMS group. Pain relief during follow-up was significantly higher in FC-SEMS group (76.9% vs. 53.7%, p = 0.046). The total procedure cost was similar in both groups ($1,455.6 vs. $1,596.9, p = 0.486). In comparison with plastic stent, FC-SEMS placement for persistent MPD strictures had favorable long-term clinical efficacy, with its typical complications like spontaneous migration and de novo strictures.

Autologous Transplantation in De Novo Non-Promyelocytic Acute Myeloid Leukemia (AML) Patients in First Complete Remission (CR1) with Peripheral Blood Stem Cell (PBSC) Collection Following Consolidation with High-Dose Cytarabine and Etoposide: A Single Institution Experience

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4461-4461
Author(s):  
Eugene Choi ◽  
Lingyi Chen ◽  
Srikanth Nagalla ◽  
Vamshi Kaveti ◽  
Regina Mullaney ◽  
...  
Keyword(s):  
De Novo ◽  
Disease Free Survival ◽  
High Dose ◽  
Free Survival ◽  
Kaplan Meier ◽  
Cd34 Cells ◽  
High Dose Cytarabine ◽  
Lost To Follow Up ◽  
Disease Free

Abstract INTRODUCTION: Autologous PBSC transplant is an important yet evolving treatment modality for patients with AML. However, the ideal mobilization regimen from which to collect PBSC remains in question. Previous reports have indicated that highdose cytarabine with etoposide is both safe and effective in terms of successful PBSC procurement, subsequent engraftment, and disease outcome. METHODS: At our institution from 1994 to 2007, 38 consecutive patients with de novo non-promyelocytic AML in first complete remission following conventional induction chemotherapy were consolidated with high-dose cytarabine (2000mg/m2 IV q12h × 8 doses, days 1–4) and etoposide (40mg/kg IV over 96h) followed by G-CSF 5 mg/kg subcutaneously starting d14 until completion of PBSC collection. Patients underwent myeloablative therapy with busulfan (1mg/kg po q6h × 16 doses, days –7 to -4) and etoposide (60 mg/kg IV over 10h, day -3) with PBSC infusion occurring on day 0 with daily G-CSF 5 mg/kg. Data regarding stem cell yield, engraftment and patient outcome was collected retrospectively. RESULTS: The average patient age was 44 years (range 19–70). Following consolidation, at least 2×106 CD34 cells/kg were isolated from all 38 patients with a median of 9.4×106 (range 2.2–43) CD34 cells/kg over a mean of 4 collections (range 1–11). Overall, 36 of 38 (95%) remained in CR and went onto PBSC transplant (one died from infectious complications during consolidation, one relapsed before transplant). The median number of stem cells infused was 8.8×106 CD 34 cells/kg (range 2.2–47). All 36 patients engrafted with the mean number of days to neutrophil recovery (ANC&gt;500) being 11 (range 8–17) and the mean number of days to platelet recovery (&gt;20,000) being 12 (range 8–19). Disease-free outcomes in patients undergoing PBSC transplant while in CR1 are presented in Figure 1. The 3y overall survival in all pts was 66%, and 56% at 5y. For good-risk cytogenetic patients, 3y OS was 78% and the 5y OS was 75%. For intermediate-risk cytogenetic patients, OS was 47% and 36% at 3y and 5y respectively. Three patients with poor cytogenetics were autulogously transplanted. One patient relapsed at day 111 and expired at day 450. The second patient remains in CR at day 246. The third patient relapsed at day 104 and expired at day 322. CONCLUSION: In patients with de novo non-promyelocytic AML in CR1, consolidation with high-dose cytarabine plus etoposide is safe and provides excellent yield of PBSCs upon growth factor accelerated hematological recovery. Subsequent engraftment after autologous transplanation is rapid. Our outcomes support the viability of this regimen in patients with good and intermediate-risk cytogenetics. Figure 1: Kaplan-Meier analysis of disease-free survival following autologous PBSC transplant. Cytogenetic analysis was unavailable in 5 patients, and 1 patient was lost to follow-up. Figure 1:. Kaplan-Meier analysis of disease-free survival following autologous PBSC transplant. Cytogenetic analysis was unavailable in 5 patients, and 1 patient was lost to follow-up.

scholarly journals CSF goes astray no matter what is in the way: occipital intradiploic pseudomeningocele and de novo syringomyelia following foramen magnum decompression for Chiari I malformation in a pediatric patient

2020 ◽  
Vol 25 (5) ◽  
pp. 529-534
Author(s):  
Arthur R. Kurzbuch ◽  
Shailendra Magdum
Keyword(s):  
Revision Surgery ◽  
De Novo ◽  
Foramen Magnum ◽  
Chiari I Malformation ◽  
Foramen Magnum Decompression ◽  
Dural Closure ◽  
First Case ◽  
Chiari I ◽  
Lost To Follow Up

Nontraumatic intradiploic pseudomeningoceles and de novo syringomyelia formation are very rare entities. The authors have previously reported the case of a 4-year-old girl who underwent foramen magnum decompression without dural closure for Chiari I malformation. Three years after the operation an intradiploic pseudomeningocele was documented, but the patient was lost to follow-up without undergoing revision surgery. Four years later, at the age of 11 years, the patient returned for treatment of intensifying symptoms. Radiological imaging then showed an increase in the size of the intradiploic pseudomeningocele and a new cervical syrinx. The patient underwent a first revision surgery in which a part of the internal layer of the occipital bone was removed and arachnoid scar lysis was performed. Two months later the syrinx had worsened, and in a second revision surgery a pseudomeningocele-peritoneal shunt was placed. Here, the authors describe what is to their knowledge the first case of an intradiploic pseudomeningocele and de novo syringomyelia formation following Chiari I decompressive surgery.

scholarly journals Newer Stents for Unresectable Malignant Distal Biliary Obstruction: Striving for Perfection!

2021 ◽  
Vol 12 (01) ◽  
pp. 059-062
Author(s):  
Jimil Shah ◽  
Surinder Singh Rana
Keyword(s):  
Biliary Drainage ◽  
Biliary Obstruction ◽  
Drug Eluting Stents ◽  
Metal Stents ◽  
Biliary Stenting ◽  
Stent Occlusion ◽  
Endoscopic Biliary Stenting ◽  
Palliative Procedure ◽  
Drug Eluting ◽  
And Migration

AbstractEndoscopic biliary stenting is one of the most commonly used palliative procedure in patients with unresectable malignant distal biliary obstruction. Biliary stenting can be performed with either plastic or metallic stents. Stent occlusion and migration are important limitations of currently available stents. Variety of newer stents with varying designs and stent materials like stents with antimigratory properties, antireflux stents, drug-eluting stents, radioactive stents, and bioabsorbable stents are being developed to overcome the limitations of currently available stents. In this article, we are discussing two articles on the newer stent designs (plastic and metal stents) for biliary drainage in patients with unresectable malignant distal biliary obstruction.

scholarly journals Tonsillectomy in Adults: Analysis of Indications and Outcome in Sokoto, North Western Nigeria

2019 ◽  
pp. 1-7
Author(s):  
D. Aliyu ◽  
J. H. Solomon
Keyword(s):  
Histopathological Analysis ◽  
Recurrent Tonsillitis ◽  
Common Procedure ◽  
Female Ratio ◽  
Case File ◽  
Lost To Follow Up ◽  
Age Range ◽  
Male To Female ◽  
Adult Tonsillectomy

Background: Tonsillectomy is a well-established surgical procedure practiced commonly by otolaryngologist for removal of tonsils. Although being a relatively simple and common procedure, it is not without considerable complications. This study aimed to profile the indication and outcome of adult tonsillectomy in our region. Method: This was a retrospective study of all adults who had tonsillectomy in the department of Otorhinolaryngology, Usman Danfodiyo Teaching Hospital, (UDUTH) Sokoto, over a seven-year period from 1st January 2011 to 31st December 2017. All information was carefully retrieved from each patient’s case file and from the operation register. The data retrieved was subsequently analysed. Results: A total of 55 adults patients had tonsillectomy over the period of study. Age range was 18 to 45 years with a mean age of 26.3 years. There were 16 males (29.1%) and 39 females (70.9%) with a male to female ratio of 1:2.4.  Recurrent tonsillitis 28(50.9%) was the commonest indication; others include: post quinsy 13(23.6%), tonsillomegally 6(10.9%); suspected neoplasm 6(10.9%); recurrent otalgia secondary to tonsillomegally 2(3.6%) Five patients had unilateral tonsillectomy for suspected neoplasm while others had bilateral tonsillectomy. Cold dissection was used in 37 (67.2%) of the patients, while 18(32.7%)were by electro cautery (Bipolar diathermy). The commonest post-operative complication was pain in all patients, followed by otalgia (29.1%) and secondary post tonsillectomy bleed in two patients. No patient had blood transfusion. Hospital average stay was 3 days. Follow up was uneventful in 16 (29.1%) of patients while 4(7.3%) patients had squamous cell carcinoma and were refered to Oncologist. The remaining 35 patients were lost to follow up. Conclusion: The commonest indication for Adult tonsillectomy is chronic recurrent tonsillitis. Histopathological analysis of every tonsil specimen is advocated.

scholarly journals Problematic issues of endoscopic biliary stenting

2019 ◽  
Vol 86 (7) ◽  
pp. 13-17
Author(s):  
A. I. Dronov ◽  
I. L. Nastashenko ◽  
Yu. P. Bakunets ◽  
P. P. Bakunets ◽  
L. V. Levchenko
Keyword(s):  
Biliary Obstruction ◽  
Distal Part ◽  
Biliary Fistula ◽  
Plastic Stents ◽  
Biliary Duct ◽  
Biliary Stenting ◽  
Treatment Results ◽  
Endoscopic Biliary Stenting ◽  
Biliary Ducts

Objective. To study the results of endoscopic biliary stenting (EBS) for biliary obstruction of various genesis to determine the problematic issues of the procedure and possibility of its efficacy raising. Materials and methods. Experience of conduction of 5748 endoscopic transpapillary interventions in 2010 - 2017 yrs was analyzed: endoscopic papillosphincterotomy was performed in 2919 (50.8%) observations, stenting of biliary ducts - in 379 (6.6%). In 296 (78.1%) observations plastic stents (PS) were introduced, while in 83 (21.9%) – the self-expanding metallic stents. Results. Of 208 patients, in whom primary temporary EBS was performed for tumoral biliary obstruction, using PS, in 153 (73.6%) the next stage of treatment have constituted elective  operation in 10 - 14 days after elimination of hyperbilirubinemia, signs of cholangitis, additional examination and determination of the intervention volume. Among these patients in 56 (36.6%) radical operations were performed, and in 97 (63.4%) – palliative operations. In 47 patients PS for closure of external biliary fistula (EBS) PS was introduced: in 13 (27.7%) – for tubular stenosis of distal part of common biliary duct, in 7 (14.9%) – for insufficiency of sutures of common biliary duct (after choledocholithotomy), in 14 (29.8%) – for intraoperative damages of extrahepatic biliary ducts, in 5 (10.6%) – for presence of Luschka channels, in 8 (17.0%) – for a state after hepatic resection, echinococectomy. Presence of concrements, which due to some reasons were not removed endocopically, in environment of purulent cholangitis have constituted the indication for performance of EBS in 24 (8.1%) observations, chronic pancreatitis, complicated by obturation jaundice – in 9 (3.0%). Correction of iatrogenic damages of biliary ducts with development of their partial strictures, EBF, using EBS with introduction of PS, were performed in 8 (2.7%) patients. Conclusion. The necessity exists to study the treatment results in patients, suffering biliary obstruction of various genesis, to determine problematic issues of the main procedures and possibilities of their efficacy raising.

Outcome of Relapsed AML Patients Aged between 50 and 70: The ALFA Group Experience (ALFA 9801 Study).

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 1857-1857
Author(s):  
F. Merabet ◽  
N. Boissel ◽  
O. Reman ◽  
Jean-Henri Bourhis ◽  
B. Quesnel ◽  
...  
Keyword(s):  
De Novo ◽  
High Dose ◽  
Conventional Dose ◽  
Investigational Drugs ◽  
Group 12 ◽  
First Remission ◽  
First Relapse ◽  
De Novo Aml ◽  
Lost To Follow Up

Abstract Background: Outcome of relapsing AML pts aged &gt; 50 yrs is considered poor but remains incompletely studied and is important to analyse, especially with new therapeutic perspectives like targetted drugs and non myeloablative allogeneic SCT (ASCT). Methods: we analyzed the outcome of pts included in ALFA 9801 trial (reported in detail in another abstract) who had relapsed. This trial included, between 2001 and 2006, de novo AML aged 50 to 70 years, randomized for induction to conventional dose AraC and high dose DNR or IDA, followed by 2 courses of intermediate dose AraC with the same anthr, and finally randomization between no maintenance or 1 year of IL2. Results: 468 pts were included (median age: 60 years).360 (77%) achieved CR. With a median follow up of 40 months, 232 (64% of CR) pts had relapsed. Their median age was 60 years and M/F 132/100. Duration of first remission was ≤6 mo (41pts), &gt;6mo and ≤12 mo (102 pts), &gt;12 mo (89 pts). Treatment received for relapse was proposed at the discretion of physicians in charge of the patient: 97 (42%) pts received intensive chemotherapy (anthr-AraC, n=89, HD AraC n=5, FLAG, n= 3),) (IC group), 47 (20%) received Gemtuzumab (GO) alone (n= 25) or a GO containing regimen (n=22)(GO group), 12 patients (5%) received LD AraC, and 60 (28%) were treated with supportive care (SC). 8 pts were lost to follow up, 3 pts had CNS relapse, 1 pt received ASCT as relapse tratment, and 4 received investigational drugs. 52/110 pts aged &lt; 60 received IC or GO combining regimen versus 39/122 pts&gt; 60 (p&lt;0.01). 46/122 pts aged &gt; 60 were treated with SC versus 12/110 pts&lt;60 (p&lt;0.001). GO alone was given to 22/110 and 20/122 pts aged &lt; or &gt; than 60 (NS). 18 patients (median age 53 years) received allo SCT (13 “classical” and 5 non myeloablative SCT) in second CR, including only 1 pt aged &gt; 60. A second CR was obtained in 39%: 57% in the IC group, 59% in the GO group (60% for pts treated with GO alone), 25% in the LDAraC group and none in the SC group. Median duration of second CR was 260 days. Median overall survival of the 232 patients from first relapse was 233 days (IC95%:202–281). Age &lt; 60 years (p= 0.02), duration of first CR&gt; 12 months (median 451 d vs 205 d for 1st CR&lt; 12 months, p=0.001), salvage with IC or GO (median 340 days vs 140 for non IC +GO group, p&lt;0.001) predicted for longer survival. There was no difference in survival for pts in the intermediate (N:144) and defav (N:43) cytogenetic groups (according to results of cytogenetics at diagnosis). The 12 pts in the fav cytogenetic group had significant better outcome. Survival from first relapse was similar for pts with a duration of 1st remission &lt;6 months or 6 to 12 months. Of the 18 pts allografted in 2nd CR: 9 were alive in CR (4 + to 60 +: median:30 months). Conclusion: In this relatively old relapsing AML population (median age of 60), 62% of the 232 pts were able to receive intensive treatment for their relapse (chemotherapy and/or GO). 39% pts overall obtained a 2nd CR, including 57% of those treated intensively.17% of CR2 pts received allogeneic SCT, a proportion that may increase if more non myeloablative allo SCT are performed.

scholarly journals Long-Term Outcomes of Fully Covered Self-Expandable Metal Stents Versus Plastic Stents in Chronic Pancreatitis

2021 ◽  
Author(s):  
Sang Hoon Lee ◽  
Yeon Suk Kim ◽  
Eui Joo Kim ◽  
Hee Seung Lee ◽  
Jeong Youp Park ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Clinical Efficacy ◽  
De Novo ◽  
Plastic Stents ◽  
Metal Stents ◽  
Plastic Stent ◽  
Sems Group ◽  
Spontaneous Migration

Abstract Chronic pancreatitis (CP) related main pancreatic duct (MPD) stricture has been a challenge for endoscopists. Fully covered self-expandable metal stents (FC-SEMS) has been tried in CP patients, but the efficacy and safety are still controversial. Thus, we aim to compare the long-term clinical efficacy of FC-SEMS vs. plastic stent placement in persistent MPD strictures secondary to CP. Between 2007 and 2018, 80 chronic pancreatitis patients (58 males, median age 49 years), who underwent endoscopic placement of FC-SEMS (n=26) and plastic stent (n=54) for persistent MPD strictures, were retrospectively analyzed during a median follow-up duration of 33.7 months. As a result, MPD stricture resolution rate was statistically higher in FC-SEMS group (87.0% vs. 42.0%, p < 0.001). Although immediate complications occurred similarly (38.5% vs. 37.0%, p = 0.902), spontaneous migration (26.9%) and de novo strictures (23.1%) were pronounced delayed complications in FC-SEMS group. Pain relief during follow-up was significantly higher in FC-SEMS group (76.9% vs. 53.7%, p = 0.046). The total procedure cost was similar in both groups ($1,455.6 vs. $1,596.9, p = 0.486). In comparison with plastic stent, FC-SEMS placement for persistent MPD strictures had favorable long-term clinical efficacy, with its typical complications like spontaneous migration and de novo strictures.

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