scholarly journals P-P25 Hot Axios stent removal following endoscopic pancreatic necrosectomy

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Owain Greaves ◽  
Ryan Baron ◽  
Jonathan Evans ◽  
Michael Raraty ◽  
Kulbir Mann ◽  
...  
Keyword(s):  
Pancreatic Pseudocysts ◽  
Surgical Removal ◽  
Distributed Data ◽  
Significant Morbidity ◽  
Endoscopic Stent ◽  
Stent Removal ◽  
Endoscopic Stents ◽  
Parametric Data ◽  
Walled Off Necrosis

Abstract Background Symptomatic pancreatic pseudocysts or walled off necrosis following pancreatitis can be drained via a stoma from the collection to the GI tract, this is typically facilitated by endoscopic stents. These stents are left in-situ until the area has drained, this can take several months. The stent is then ideally removed endoscopically. Little is known about the consequences of failed endoscopic stent removal or factors contributing to this failure.   Methods Retrospective analysis of prospective data at LUHFT between 1st January 2018 and 31st December 2019 of patients receiving at least one Hot Axios stent for management of pancreatic collection. Normally distributed data were compared using Student’s two tailed T test, with non-parametric data compared using Mann-Witney U test, categorical data were analysed using Chi2 test Results 131 patients were included in analysis, of which 74 were male with a median age of 56 years (IQR 46-66.5).  Failure of endoscopic removal (14 patients) was associated with a longer time to removal; 101 days (IQR 78-121) to first attempt vs. 49 days (IQR 19-104) to first endoscopic attempt where the stent was successfully retrieved endoscopically (p < 0.01). Surgical removal was undertaken in 6 patients, with significant morbidity in 2 of 6 patients. Overall 90-day mortality in patients undergoing Hot Axios stent placement was 8 of 131 (6%). Conclusions Endoscopic stent removal fails more frequently in patients where the stent has remained in situ for a long time before removal is attempted. Surgical removal of Hot Axios Stents is associated with significant morbidity, and this should be balanced against the as yet unknown consequences of leaving Hot Axios stent in-situ permanently.

scholarly journals A85 THE CLINICAL IMPACT OF COVID-19 DELAYS ON PLASTIC BILIARY STENT REMOVAL IN NOVA SCOTIA

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 54-56
Author(s):  
D R Lim ◽  
M Tsai ◽  
S E Gruchy ◽  
J Jones ◽  
G Williams ◽  
...  
Keyword(s):  
Survival Analysis ◽  
Nova Scotia ◽  
Stent Placement ◽  
Biliary Stent ◽  
Biliary Stents ◽  
Stent Occlusion ◽  
Stent Removal ◽  
Kaplan Meier ◽  
And Migration

Abstract Background The COVID-2019 pandemic continues to restrict access to endoscopy, resulting in delays or cancellation of non-urgent endoscopic procedures. A delay in the removal or exchange of plastic biliary stents may lead to stent occlusion with consensus recommendation of stent removal or exchange at three-month intervals [1–4]. We postulated that delayed plastic biliary stent removal (DPBSR) would increase complication rates. Aims We aim to report our single-centre experience with complications arising from DPBSR. Methods This was a retrospective, single-center, observational cohort study. All subjects who had ERCP-guided plastic biliary stent placement in Halifax, Nova Scotia between Dec 2019 and June 2020 were included in the study. DPBSR was defined as stent removal >=90 days from insertion. Four endpoints were assigned to patients: 1. Stent removed endoscopically, 2. Died with stent in-situ (measured from stent placement to documented date of death/last clinical encounter before death), 3. Pending removal (subjects clinically well, no liver enzyme elevation, not expired, endpoint 1 Nov 2020), and 4. Complication requiring urgent reintervention. Kaplan-Meier survival analysis was used to represent duration of stent patency (Fig.1). Results 102 (47.2%) had plastic biliary stents placed between 2/12/2019 and 29/6/2020. 49 (48%) were female, and the median age was 68 (R 16–91). Median follow-up was 167.5 days, 60 (58.8%) subjects had stent removal, 12 (11.8%) died before replacement, 21 (20.6%) were awaiting stent removal with no complications (median 230d, R 30–332), 9 (8.8%) had complications requiring urgent ERCP. Based on death reports, no deaths were related to stent-related complications. 72(70.6%) of patients had stents in-situ for >= 90 days. In this population, median time to removal was 211.5d (R 91-441d). 3 (4.2%) subjects had stent-related complications requiring urgent ERCP, mean time to complication was 218.3d (R 94–441). Stent removal >=90 days was not associated with complications such as occlusion, cholangitis, and migration (p=1.0). Days of stent in-situ was not associated with occlusion, cholangitis, and migration (p=0.57). Sex (p=0.275), cholecystectomy (p=1.0), cholangiocarcinoma (p=1.0), cholangitis (p=0.68) or pancreatitis (p=1.0) six weeks prior to ERCP, benign vs. malignant etiology (p=1.0) were not significantly associated with stent-related complications. Conclusions Plastic biliary stent longevity may have been previously underestimated. The findings of this study agree with CAG framework recommendations [5] that stent removal be prioritized as elective (P3). Limitations include small sample size that could affect Kaplan-Meier survival analysis. Despite prolonged indwelling stent time as a result of COVID-19, we did not observe an increased incidence of stent occlusion or other complications. Funding Agencies None

Uretero-Iliac artery fistula: a rare cause of haematuria

2020 ◽  
Vol 13 (9) ◽  
pp. e232189
Author(s):  
Natalia Hernandez ◽  
Bethany Desroches ◽  
Eric Peden ◽  
Raj Satkunasivam
Keyword(s):  
Iliac Artery ◽  
Percutaneous Nephrostomy ◽  
Arterial System ◽  
Endoscopic Evaluation ◽  
Stent Removal ◽  
Retrograde Pyelogram ◽  
History Of ◽  
Gross Haematuria ◽  
Multiple Episodes

A woman in her mid-forties with a history of cervical cancer requiring chemoradiation presented with bilateral ureteral strictures secondary to radiation therapy. The ureteral obstruction was initially relieved with bilateral percutaneous nephrostomy tubes, and subsequently, bilateral ureteral stents. Over the course of 8 months, she presented with multiple episodes of severe gross haematuria. This persisted even after stent removal and conversion back to percutaneous nephrostomy tubes. The initial evaluation, done with concern for an uretero-iliac artery fistula, which included bilateral retrograde pyelograms and CT angiography was non-diagnostic. Given continued haematuria, repeat endoscopic evaluation was undertaken; on retrograde pyelogram, brisk contrast was seen to pass into the arterial system, consistent with a left ureteroarterial fistula. The patient underwent endovascular iliac artery stent placement. Subsequently, the patient underwent resection of the iliac artery with endovascular graft in situ, left distal ureterectomy with proximal ureteral ligation following femoral-to-femoral bypass. This allowed for complete resolution of the patient’s gross haematuria episodes.

Drenaje guiado por ultrasonido endoscópico con stent metálico de aposición luminal y necrosectomía endoscópica directa para el tratamiento de la necrosis pancreática infectada

2020 ◽  
Vol 50 (2) ◽  
Keyword(s):  
Pancreatic Necrosis ◽  
Tube Feeding ◽  
Safe Procedure ◽  
Endoscopic Necrosectomy ◽  
Pancreatic Fluid ◽  
Nasojejunal Tube ◽  
Fluid Collections ◽  
Walled Off Necrosis ◽  
First Time

Walled-off necrosis (WON) is a serious complication of acute pancreatitis (AP) and, when is infected, has a poor prognosis and mortality rate (15%). The endoscopic approach is preferable to surgical treatment due to its lower morbidity. Objectives. 1) Present a patient with infected pancreatic necrosis resolved by Endoscopic Ultrasound (EUS) guided drainage with a luminal apposition metal stent (LAMS) and Direct Endoscopic Necrosectomy (DEN). 2) Report placement of the LAMS Hot Axios ® (Boston Scientific) for the first time ever in Argentina. Methods. Male, 38 years old, without relevant history. He is hospitalized for a severe acute biliary pancreatitis (AP), early satiety and digestive intolerance. At 4 weeks, CT scan shows a PFC of 16 cm. EUS-guided drainage was performed with LAMS Hot Axios ®, draining 1600 ml of brown liquid content. Ten days later, another episode of severe AP. Continuous fever. New CT and EUS, showed increased collection, in situ stent and necrosis inside (WON). Four sessions of DEN through-the-LAMS and laparoscopic cholecystectomy were performed. Percutaneous drainage of left pararenal necrosis. Nasojejunal tube feeding between each necrosectomy. At 8th week, absence of necrosis and granulation tissue was observed, then the LAMS was removed. Hospital discharge. After 6 months of follow up, CT control showed normal pancreatic parenchyma. Conclusions. EUS-guided drainage of Pancreatic fluid collections (PFC) with LAMS is a safe procedure. In cases of WON, LAMS also allows transluminal interventional procedures, expediting the treatment of pancreatic necrosis, in a minimally invasive way.

scholarly journals Endoscopic ultrasound-guided placement of plastic pigtail stents for the drainage of refractory malignant ascites

2017 ◽  
Vol 05 (11) ◽  
pp. E1096-E1099 ◽  
Author(s):  
Rafael Romero-Castro ◽  
Victoria Jimenez-Garcia ◽  
Jaime Boceta-Osuna ◽  
Luis Castilla-Guerra ◽  
Francisco Pellicer-Bautista ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Poor Prognosis ◽  
Malignant Ascites ◽  
Refractory Ascites ◽  
Plastic Stents ◽  
Pancreatic Pseudocysts ◽  
Metal Stents ◽  
Ultrasound Guided ◽  
Walled Off Necrosis

AbstractEndoscopic ultrasound (EUS)-guided drainage is now the treatment of choice in cases of pancreatic pseudocysts and walled-off necrosis, especially in the absence of luminal bulging and in patients with portal hypertension. Malignant refractory ascites usually heralds a poor prognosis and substantially impairs the quality of life of patients because of the symptoms experienced and the need for repeated paracentesis. EUS-guided placement of lumen-apposing, fully covered, self-expandable metal stents (FCSEMS) has been reported for the drainage of malignant ascites. Herein, we present the results of EUS-guided placement of plastic pigtails stents for the drainage of refractory malignant ascites in three patients. The aim was to improve symptoms and minimize the possible drawbacks of large-caliber FCSEMS. In this preliminary experience, EUS-guided placement of plastic stents was feasible and avoided further paracentesis.

Removal of Peritnoeo-venous-atrial shunt thrombus without cardiopulmonary bypass

2018 ◽  
Vol 26 (5) ◽  
pp. 387-389
Author(s):  
Pragnesh Joshi ◽  
Sameer Thakur ◽  
Jonathan Tibballs
Keyword(s):  
Cardiopulmonary Bypass ◽  
Tricuspid Valve ◽  
Thrombus Formation ◽  
Rare Complication ◽  
Surgical Removal ◽  
Intracardiac Thrombus ◽  
Significant Morbidity ◽  
Peritoneovenous Shunt ◽  
Atrial Shunt ◽  
Intracardiac Catheters

Thrombus formation is not uncommon in longstanding intracardiac catheters, but formation of a thrombus at the tip of a Peritnoeo-venous-atrial shunt, causing obstruction of the tricuspid valve, is a rare complication and frequently unrecognized. A large intracardiac thrombus causing valve obstruction requires surgical removal with the support of cardiopulmonary bypass which is associated with significant morbidity. We successfully removed a thrombus attached to the tip of peritoneovenous shunt without cardiopulmonary bypass in a 25-year-old man.

scholarly journals Mind the Gap: Successful Endoscopic Closure of a Large Gastric Sleeve Leak Using an Endoscopic Stent and Over-the-Scope Clips

2017 ◽  
Vol 11 (3) ◽  
pp. 763-768 ◽  
Author(s):  
Jiannis Anastasiou ◽  
Anas Hussameddin ◽  
Abdulaziz Al Quorain 
Keyword(s):  
Staple Line ◽  
Low Cost ◽  
Safe Procedure ◽  
Significant Morbidity ◽  
Significant Weight Loss ◽  
Endoscopic Stent ◽  
Staple Line Leak ◽  
Endoscopic Closure ◽  
Short Period ◽  
Gastric Sleeve Leak

Laparoscopic sleeve gastrectomy (LSG) is gaining popularity for the treatment of morbid obesity. It is regarded as a simple, low-cost procedure achieving significant weight loss within a short period of time. LSG is considered a safe procedure with a relatively low complication rate. The complications encountered nevertheless can result in significant morbidity and may even be lethal. The most significant complications are staple-line bleeding, stricture, and staple-line leak. The purpose of this paper is to present a case of a 31-year-old patient complicated by a 3.06 cm staple-line leak 10 days after LSG. Review of the current literature regarding this complication as well as outline of a strategy for the management of large post-LSG gastric leaks is suggested.

Sign in / Sign up

Export Citation Format

Share Document