A125 SNARE TIP SPRAY COAGULATION FOR NON-CONTACT HEMOSTASIS: A SINGLE OPERATOR RETROSPECTIVE STUDY OF CLINICAL OUTCOMES.

Abstract Background An emerging non-contact endoscopic method for hemostasis is the use of spray coagulation (SC) using a polypectomy snare tip. Other non-contact options, such as argon plasma coagulation (APC), can be inconvenient and costly. Our current practice includes using SC where APC would be traditionally indicated. Aims The aim of this study was to characterize the clinical outcomes, including rates of successful hemostasis, rebleeding, and complications, for snare tip SC in hemostasis. Methods We conducted a retrospective chart review of all patients who underwent therapeutic endoscopy for hemostasis using snare tip SC by a single operator at a large Canadian tertiary care centre between January 2018 and September 2020. Results 14 patients, including 10 males and 4 females, were included. 5 (35%) patients received SC during an EGD, 5 (35%) patients during a colonoscopy, and 4 (29%) patients during a small bowel enteroscopy. Mean age was 74.4 (±11). All patients were referred for work-up of gastrointestinal bleeding or anemia. 5 (35%) patients were treated for vascular lesions including AVMs or angioectasias, 4 (29%) patients for GAVE, 3 (21%) patients for radiation proctitis, and 2 (14%) patients for bleeding ulcers. Adequate hemostasis, defined by cessation of bleeding symptoms, lack of a 10g/L or more decrease in hemoglobin post-procedure, and no further endoscopic therapies in the subsequent 28 days, was achieved in 11 patients (79%). 2 of the 3 patients in which adequate hemostasis was not achieved had additional investigations in which a second source of bleeding was found and treated. 1 patient with colonic AVMs and 1 patient with radiation proctitis required a repeat treatment in 2 weeks and 6 months, respectively. There were no incidence of prolonged abdominal pain, perforations or deaths. Conclusions Snare tip spray coagulation appears to be a safe and effective modality for non-contact hemostasis. Larger studies will help solidify its use in daily practice. Funding Agencies None

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Comparison of Clinical Outcomes With Drug Coated Balloons Versus Plain Balloon Angioplasty In Chronic Limb-Threatening Ischemia

Vascular and Endovascular Surgery ◽

10.1177/15385744211022598 ◽

2021 ◽

pp. 153857442110225

Author(s):

Joel Mathew John ◽

Vimalin Samuel ◽

Dheepak Selvaraj ◽

Prabhu Premkumar ◽

Albert A Kota ◽

...

Keyword(s):

Clinical Outcomes ◽

Interventional Procedure ◽

Tertiary Care ◽

Arterial Disease ◽

Multivariable Logistic Regression Analysis ◽

Tertiary Care Centre ◽

Chi Square ◽

Exact Test ◽

Institutional Review ◽

Chi Square Test

Objective: The use of drug coated balloon (DCB) for angioplasty has shown superior efficacy against plain balloons for treating complex infrainguinal arterial disease. We report and compare the clinical outcomes following application of DCB(Paclitaxel) and plain angioplasty (POBA) in our tertiary care centre. Methods: A retrospective, single centre analysis of 301 patients with chronic limb-threatening ischemia involving the infrainguinal segment was conducted between September 2014 and September 2018, after approval from the Institutional review board. We analyzed clinical outcomes by measuring postoperative ABI improvement, restenosis requiring reintervention procedure, minor and major amputations at the end of 18 months. . To find the association between the group variables (POBA and DCB) and other risk variables, Chi-square test/Fisher’s exact test was used. Multivariable logistic regression analysis was used. Results: Patients who underwent treatment with plain balloon (POBA) and DCB(Paclitaxel) angioplasty were 246(81.7%) and 55(18.3%) respectively. Our study group was predominantly male (Male: Female = 6.7:1), most patients were more than 50 years of age (n = 251, 83.4%). Smoking (n = 199, 66.1%) and diabetes (n = 210, 69.8%) were the most common atherosclerotic risk factors. Postoperative Ankle Brachial Pressure Index (ABI) improvement were similar in both groups (POBA = 57.7%; DCB = 69.8%; p = 0.103). Minor and major amputations following POBA were 26% and 22%; and DCB were 12.7% and 16.4% respectively. Re-stenosis requiring a re-interventional procedure within 18 months was 15%, (n = 37) following POBA; and 12.7% (n = 7) following DCB (p = 0.661). Conclusions: This retrospective study shows similar clinical limb related outcomes following POBA and DCB at 18 months. However, our comparative analysis between the POBA and DCB groups was totally unadjusted and not adjusted for common confounders such as age and sex. Hence, for one to draw definitive conclusions leading to changes in clinical practice; a randomized, prospective study with a larger patient cohort is needed.

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Characteristics of infective endocarditis in a cancer population

Open Heart ◽

10.1136/openhrt-2021-001664 ◽

2021 ◽

Vol 8 (2) ◽

pp. e001664

Author(s):

Cullen Grable ◽

Syed Yusuf ◽

Juhee Song ◽

George M Viola ◽

Owais Ulhaq ◽

...

Keyword(s):

Infective Endocarditis ◽

Tertiary Care ◽

Retrospective Chart Review ◽

Mortality Data ◽

Limited Information ◽

Tertiary Care Centre ◽

Indwelling Catheters ◽

Patients With Cancer ◽

Duke Criteria ◽

Immunocompromised State

BackgroundInfective endocarditis (IE) is more common in patients with cancer as compared with the general population. Due to an immunocompromised state, the need for invasive procedures, hypercoagulability and the presence of indwelling catheters, patients with cancer are particularly predisposed to the development of IE.ObjectivesLimited information exists about IE in patients with cancer. We aimed to evaluate the characteristics of patients with cancer and IE at our tertiary care centre, including a comparison of the microorganisms implicated and their association with mortality.MethodsA retrospective chart review of patients with cancer who had echocardiography for suspicion of endocarditis was conducted. A total of 56 patients with a confirmed diagnosis of cancer and endocarditis, based on the modified Duke criteria, were included in the study. Baseline demographics, risk factors for developing IE, echocardiography findings, microbiology and mortality data were analysed.ResultsFollowing the findings of vegetations by echocardiography, the median survival time was 8.5 months. Staphylococcus aureus was the most common organism identified as causing endocarditis. The mitral and aortic valves were the most commonly involved sites of endocarditis. Patients with S. aureus endocarditis (SAE) had a significantly poorer survival when compared with patients without SAE (p=0.0217) over the 12-month period from diagnosis of endocarditis.ConclusionsOverall survival of patients with cancer and endocarditis is poor, with a worse outcome in patients with SAE.

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Effective use of argon plasma coagulation in the treatment of severe radiation proctitis

Diseases of the Colon & Rectum ◽

10.1007/bf02234452 ◽

2001 ◽

Vol 44 (12) ◽

pp. 1766-1771 ◽

Cited By ~ 64

Author(s):

Sarah Taïeb ◽

Alain Rolachon ◽

Jean-Claude Cenni ◽

Stephane Nancey ◽

Sylvette Bonvoisin ◽

...

Keyword(s):

Argon Plasma Coagulation ◽

Argon Plasma ◽

Radiation Proctitis ◽

Plasma Coagulation ◽

Effective Use

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4483 Argon plasma coagulation is an effective and well tolerated treatment for rectal bleeding due to chronic radiation proctitis.

Gastrointestinal Endoscopy ◽

10.1016/s0016-5107(00)14330-5 ◽

2000 ◽

Vol 51 (4) ◽

pp. AB147 ◽

Cited By ~ 1

Author(s):

Mehdi Kaassis ◽

Frederic Oberti ◽

Pascal Burtin ◽

Jean Boyer

Keyword(s):

Rectal Bleeding ◽

Argon Plasma Coagulation ◽

Argon Plasma ◽

Radiation Proctitis ◽

Plasma Coagulation ◽

Chronic Radiation Proctitis ◽

Chronic Radiation

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Nauja formalino aplikacijos gydant radiacinį hemoraginį proktitą metodika

Lietuvos chirurgija ◽

10.15388/lietchirur.2008.1.2169 ◽

2008 ◽

Vol 6 (1) ◽

pp. 0-0

Author(s):

Narimantas Evaldas Samalavičius

Keyword(s):

Argon Plasma Coagulation ◽

Treatment Strategies ◽

Argon Plasma ◽

Radiation Proctitis ◽

Pelvic Malignancies ◽

Radiation Induced ◽

Hemorrhagic Proctitis ◽

Number Of Treatment ◽

Submucosal Fibrosis ◽

Endarteritis Obliterans

Narimantas Evaldas SamalavičiusVilniaus universiteto Onkologijos instituto Chirurgijos klinika, Santariškių g. 1, LT-08406 VilniusEl paštas: [email protected] Radiacinis hemoraginis proktitas yra dėl spindulinio gydymo atsiradę tiesiosios žarnos pokyčiai, pasireiškiantys pogleivio fibroze ir obliteruojančiu endarteritu; išsivysčiusi talangiektazinė gleivinės neovaskuliarizacija lemia gleivinės trapumą ir polinkį kraujuoti. Esama įvairių radiacinio hemoraginio proktito gydymo metodikų. Pastaruoju metu efektyviausi literatūroje aprašomi metodai yra formalino aplikacija ir argono plazmos koaguliacija. Formalino aplikacija yra paprastas, pigus ir saugus gydymo būdas. Šiame straipsnyje pateikiamas naujas radiacinio hemoraginio proktito gydymo būdas – formalino aplikacijos. Pagrindiniai žodžiai: radiacinis proktitas, kraujavimas, formalino aplikacijaNew method of formalin application for the treatment of hemorrhagic radiation proctitis Narimantas Evaldas SamalavičiusVilnius University, Institute of Oncology, Clinic of Surgery,Santariškių str. 1, LT-08406 Vilnius, LithuaniaE-mail: [email protected] Radiation-induced hemorrhagic proctitis is a complication of radiotherapy for pelvic malignancies, which is caused by submucosal fibrosis, and endarteritis obliterans gives rise to telangiectatic neovasculature which is fragile and prone to bleeding. A number of treatment strategies of hemorrhagic radiation proctitis have been described. According to latest studies, formalin application and argon plasma coagulation seem to be most effective. Formalin application is a simple, inexpensive and safe method of treatment. A novel way of formalin application is described for those suffering from radiation hemorrhagic proctitis. Keywords: radiation proctitis, hemorrhage, formalin application

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Patterns of care and clinical outcomes in stage IVA cervical cancer: 14-year experience from a tertiary care centre in South India

Journal of Radiotherapy in Practice ◽

10.1017/s1460396921000443 ◽

2021 ◽

pp. 1-7

Author(s):

Neenu Oliver John ◽

Arvind Sathyamurthy ◽

Shanthi Prasoona ◽

Jeba Karunya Ramireddy ◽

Grace Rebekah ◽

...

Keyword(s):

Cervical Cancer ◽

Clinical Outcomes ◽

South India ◽

Tertiary Care ◽

Progression Free Survival ◽

Concurrent Chemotherapy ◽

Patterns Of Care ◽

Care Centre ◽

Tertiary Care Centre ◽

Gynecology And Obstetrics

Abstract Aim: To analyse the patterns of care and clinical outcomes of patients diagnosed with cervical cancer International Federation of Gynecology and Obstetrics (FIGO) stage IVA treated at a tertiary care centre in South India. Materials and methods: The electronic medical records of 2,476 patients diagnosed with cervical cancer at a tertiary care institution between January 2005 and December 2018 were reviewed. Among them, 96 patients diagnosed with histologically proven carcinoma cervix stage IVA established by either cystoscopy or proctoscopy were included. Four patients who did not receive treatment at the study centre were excluded and 92 patients were available for final analysis. Results: The median follow-up period was 12 months (2–131 months). Of the 92 patients, 59 patients (64·13%) received radiation therapy (RT) alone, 22 patients (23·9%) received chemoradiation (CRT), three patients (3·26%) received neoadjuvant chemotherapy (NACT) followed by RT, one (1·08%) received NACT followed by CRT, four patients (4·35%) received chemotherapy alone, while three (3·26%) were offered best supportive care. The median progression-free survival (PFS) was 12 months (95% CI: 9·6–14·4 months) and median overall survival (OS) was 25 months (95% CI: 16·6–33·4 months). The 2-year and 3-year PFS was 30 and 20%, respectively, and the OS was 50 and 32%, respectively. Conclusion: The management of stage IVA cervical cancer needs to be individualised to achieve a fine balance between local control, toxicity, and quality of life. RT is the mainstay of treatment with concurrent chemotherapy in carefully selected patients. Involvement of palliative care team early in the course of treatment adds a holistic approach to the continuum of oncological care.

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