scholarly journals Sealing the hole: endoscopic management of acute gastrointestinal perforations

2019 ◽  
Vol 11 (1) ◽  
pp. 55-61
Author(s):  
Ahmed Gabr
Keyword(s):  
Surgical Treatment ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Standard Of Care ◽  
Endoscopic Management ◽  
Anatomical Location ◽  
Gi Tract ◽  
Omental Patch ◽  
Endoscopic Closure ◽  
Number Of Factors

Acute perforations are one of the recognised complications of both diagnostic and therapeutic gastrointestinal (GI) endoscopy. The incidence rate varies according to the type of procedure and the anatomical location within the GI tract. For decades, surgical treatment has been the standard of care, but endoscopic closure has become a more popular approach, due to feasibility and the reduction of the burden of surgery. Various devices are available now such as through-the-scope clips, over-the-scope clips, endoscopic suturing devices, stents, bands and omental patch. All have been tested in studies done on humans or animal models, with a reasonable overall technical and clinical success rate, proving efficiency and feasibility of endoscopic closure. The choice of which device to use depends on the site and the size of the perforation. It also depends on availability of thee device and the endoscopist’s experience. A number of factors that could predict success of endoscopic closure or favour surgical treatment have been suggested in different studies. After successful endoscopic closure, patients are usually kept nil by mouth and receive antibiotics for a duration that varied between different studies.

scholarly journals Amplatzer occluders for refractory esophago-respiratory fistulas: a case series

2021 ◽  
Vol 09 (09) ◽  
pp. E1350-E1354
Author(s):  
Arthur Belle ◽  
Christine Lorut ◽  
Aurélie Lefebvre ◽  
Einas Abou Ali ◽  
Rachel Hallit ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Clinical Success ◽  
Case Series ◽  
Clinical Success Rate ◽  
Endoscopic Management ◽  
Vacuum Therapy ◽  
Short Term ◽  
Endoscopic Vacuum Therapy ◽  
Endoscopic Placement ◽  
Safe Treatment Option

Abstract Background and study aims Endoscopic management of esophagorespiratory fistulas (ERF) is challenging and currently available options (stents, double pigtail, endoscopic vacuum therapy) are not very effective. We report the feasibility and efficacy of endoscopic placement of Amplatzer cardiovascular occluders for this indication. Patients and methods This was a single-center, prospective study (June 2019 to September 2020) of all patients with non-malignant ERF persistent after conventional management with esophageal and/or tracheal stents. The primary outcome was the technical feasibility of Amplatzer placement. Secondary outcomes were clinical success defined by effective ERF occlusion and resolution of respiratory symptoms allowing oral food intake. Results Endoscopic placement of Amplatzer occluders was feasible in 83 % of patients (5/6), with a 50 % (3/6) clinical success rate at 9 months. The mortality rate was 33 % (2/6). Conclusions An Amplatzer cardiac or vascular occluder is a feasible and safe treatment option for refractory ERF, with a 50 % short-term clinical success.

scholarly journals Endoscopic Management of Complicated High-Grade Vesicoureteral Reflux in the First Year of Life

2021 ◽  
Author(s):  
ALI TEKIN ◽  
Sibel Tiryaki ◽  
İsmail Yağmur ◽  
Özge Kılıç ◽  
Ali Avanoğlu ◽  
...  
Keyword(s):  
Success Rate ◽  
Vesicoureteral Reflux ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Endoscopic Management ◽  
First Year ◽  
High Grade ◽  
Initial Injection ◽  
Material Volume ◽  
First Year Of Life

Abstract Purpose:The treatment of high-grade vesicoureteral reflux in infants is controversial. Subureteric injection has been tried recently with its advantage of easy application and less invasiveness. In this study, we aimed to assess the efficacy of endoscopic sub-ureteric injection to correct high-grade reflux in infants with documented indications for anti-reflux surgery.Materials and Methods:Hospital records of high-grade (grade 4-5) VUR patients who had undergone endoscopic sub-ureteric injection in the first year of life with documented breakthrough infections, between 2009-2016 were reviewed. Radiologic success was defined as complete resolution of reflux in VCUG obtained at least three months after the injection and clinical success was defined as the downgrading of reflux degree below three and absence of urinary infection.Results:A total of 23 patients with 34 high-grade refluxing units were included in the study. The mean age at first injection was 6.3±1.8 months (1-11 months). Radiologic success rate with initial injection was 61.7% and increased to 85.2% after repeated injections. The overall clinical success rate at first injection was 70.6% and 97.1% after repeated injections. Mean injected material volume was 0.34±0.27 (0.1-1) ml per ureter. Conclusion:Endoscopic treatment is a successful alternative in infants with high-grade vesicoureteral reflux suffering breakthrough infections.

Endovenous radiofrequency powered segmental thermal ablation (Closure FAST) of great saphenous veins

Phlebologie ◽  
2010 ◽  
Vol 39 (02) ◽  
pp. 69-71 ◽  
Author(s):  
T. M. Proebstle ◽  
Keyword(s):  
Side Effects ◽  
Thermal Ablation ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Duplex Ultrasound ◽  
Multicenter Trial ◽  
Saphenous Veins ◽  
Clinical Control ◽  
Prospective Multicenter Trial

Summary Background: Radiofrequency powered segmental thermal ablation Closure FAST has become a globally engaged technology for ablation of incompetent great saphenous veins (GSVs). Mid-term results of slowly resolving side effects are still not described. Methods: RSTA-treated GSVs (n = 295) were followed for 24 months in a prospective multicenter trial. Clinical control visits included flow and reflux analysis by duplex-ultrasound and assessment of treatment related side effects at all times. Results: 280 of 295 treated GSVs (94.9%) were available for 24 months follow-up. According to the method of Kaplan and Meier at 24 months after the intervention 98.6% of treated legs remained free of clinically relevant axial reflux. The average VCSS score improved from 3.9 ± 2.1 at screening to 0.7 ± 1.2 at 24 months follow-up (p < 0.0001). While only 41.1% of patients were free of pain before treatment, at 24 months 99.3% reported no pain and 96.4% did not experience pain during the 12 months before. At 24 months n=3 legs showed pigmentation along the inner thigh and one leg showed study-treatment related paresthesia. Conclusion: Radiofrequency powered segmental thermal ablation Closure FAST showed a very moderate side-effect profile in conjunction with a high and durable clinical success rate.

Clinical effectiveness of high dose versus standard dose of meropenem in ventilator-associated pneumonia caused by multidrug-resistant bacteria: a randomized single-blind clinical trial

2020 ◽  
Vol 20 ◽  
Author(s):  
Mahila Monajati ◽  
Shahram Ala ◽  
Masoud Aliyali ◽  
Roya Ghasemian ◽  
Fatemeh Heidari ◽  
...  
Keyword(s):  
Success Rate ◽  
Sofa Score ◽  
Dose Group ◽  
Clinical Success ◽  
Standard Dose ◽  
Clinical Success Rate ◽  
High Dose Group ◽  
Resistant Bacteria ◽  
High Dose ◽  
Ventilator Associated Pneumonia

Background: Meropenem standard doses are based on the minimum inhibitory concentration of sensitive pathogens and the pharmacokinetic parameter of not critically ill patients. We compared the efficacy of high versus standard dose of meropenem in ventilator-associated pneumonia (VAP). Methods: 24 out of 34 eligible patients were randomized to receive meropenem 3 g q8h (high dose group, 11 patients) or 2 g q8h (standard dose group, 13 patients) as a 3h infusion. Primary outcome was considered as clinical success that was defined as stable hemodynamic, improved sequential organ failure assessment (SOFA) score, stable or improved PaO2/FiO2 after 7 days. A sputum culture was taken before intervention. Results: Clinical success rate was not significantly different between the high and standard dose group (54.5% vs. 38.5%, P= 0.431). There was a significant difference in reduction of clinical pulmonary infection score (CPIS) compared to high dose with standard group (P=0.038). SOFA score declined significantly in high dose group through the study (P=0.006). A shorter duration of VAP treatment was recorded in high dose group (P=0.061). We did not observe any significant adverse event related to meropenem. Acinetobacter spp. (34.8%), Klebsiella spp. (32.6%) and, Pseudomonas aeruginosa (19.5%) isolated more frequently from sputum cultures. Conclusion: Treatment with high dose of meropenem seems to be safe. However, it did not provide significantly higher clinical success rate in comparison with the standard dose, but could be considered as an appropriate empirical treatment in patients with severe infection due to reducing in SOFA and CPIS.

Ferric sulfate as pulpotomy agent in primary teeth: twenty month clinical follow-up

2000 ◽  
Vol 24 (4) ◽  
pp. 269-272 ◽  
Author(s):  
Hamijeta Ibricevic ◽  
Qumasha Al-Jame
Keyword(s):  
Success Rate ◽  
Primary Teeth ◽  
Root Resorption ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Ferric Sulfate ◽  
Primary Molar ◽  
Molar Teeth ◽  
The Moment

Seventy primary molar teeth, carious exposed, symptom free, without any sign of root resorption in children aged from 3 to 6 years (main age 4.3yr) were treated with conventional pulpotomy procedures. Ferric sulfate 15.5% solution (applied for 15 second for 35 teeth) and formocresol solution (five minute procedure of Buckley's formula for next 35 teeth) have been used as pulpotomy agents. In both groups, pulp stumps were covered with zinc-oxide eugenol paste. Permanent restorations were stainless steel crowns. Clinical check up was every three-months and radiographic follow-up time was six and twenty months after treatment. Our results within this period revealed 100% clinical success rate in both groups. Radiographic success rate was in both groups 97.2%, while in 2.8% cases has shown internal root resorption. On the basis of these results, we can recommend ferric sulfate as a pulpotomy agent in primary teeth in substitution for formocresol at the moment.

scholarly journals 1306. Comparison of the Use of Extended and Intermittent Infusion Cefepime and Piperacillin/tazobactam in Non-critically Ill, Obese Patients

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S667-S667
Author(s):  
Carolyn Marg ◽  
Zach DeLanoit ◽  
Kimberly D Boeser
Keyword(s):  
Clinical Success ◽  
Small Sample Size ◽  
Clinical Success Rate ◽  
Intermittent Infusion ◽  
Volume Of Distribution ◽  
Small Sample ◽  
Hospital Length Of Stay ◽  
Obese Patients ◽  
Target Time ◽  
All Cause Mortality

Abstract Background Obesity rates have dramatically increased over the last several decades, however, there is limited data to guide how antibiotics should be adjusted in obese patients. Physiologic differences including an increased volume of distribution and increased renal clearance may alter their pharmacokinetics and pharmacodynamics and subsequently, their efficacy. For beta-lactams like piperacillin/tazobactam (pip/tazo) and cefepime, extended infusion (EI) maximizes the time above the minimum inhibitory concentration (MIC) for optimal bactericidal activity. This dosing strategy may help decrease variability in achieving the target time above MIC in this patient population and lead to more favorable outcomes. Methods This single-center, retrospective, pre-/post- analysis included patients with a body mass index (BMI) &gt; 30 that received EI (infused over 4 hours) or intermittent infusion (II) (infused over 30 minutes) pip/tazo or cefepime between 2/1/2020-4/30/2020 and 2/1/2019-4/30/2019, respectively. The primary outcome was in-hospital, all-cause mortality. Secondary outcomes included clinical success rate and hospital length of stay (LOS). Results During the evaluation periods, 98 patients met inclusion criteria (EI, N=53; II, N=45). Mean BMI was not statistically different between groups (EI, 36.0 kg/m2 [30.1-46.3]; II, 36.5 kg/m2 [30-48]). There were no cases of mortality in either group. The mean LOS in the II group was 13 days compared to 11.5 days in the EI group [95% CI -4.14-7.04; p=0.606]. After excluding one outlier of 104 days in the EI group, the average LOS was 9.5 days [95% CI: -0.87-7.33; p=0.121]. Markers of clinical success including time to resolution of fever (II: 47 hours; EI: 34 hours; p=0.216) and time to resolution of leukocytosis (II: 2 days; EI: 3.8 days; p=0.089) were not significantly different between groups. Conclusion The use of EI pip/tazo and cefepime was not associated with any differences in in-hospital, all-cause mortality, hospital LOS, or clinical success when compared to the use of II pip/tazo and cefepime. The lack of significant differences between groups may be attributable to the small sample size limiting the ability to detect a difference, especially regarding hospital LOS. Disclosures All Authors: No reported disclosures

scholarly journals Clinical outcome of endoscopic therapy in patients with symptomatic pancreas divisum: a Dutch cohort study

2021 ◽  
Vol 09 (07) ◽  
pp. E1164-E1170
Author(s):  
David M. de Jong ◽  
Pauline M. Stassen ◽  
Jan Werner Poley ◽  
Paul Fockens ◽  
Robin Timmer ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Cohort Study ◽  
Endoscopic Therapy ◽  
Clinical Success ◽  
Pancreas Divisum ◽  
Univariate Analysis ◽  
Clinical Success Rate ◽  
Recurrent Acute Pancreatitis ◽  
Pancréas Divisum

Abstract Background and study aims Although the majority of patients with pancreas divisum (PDiv) are asymptomatic, a subgroup present with recurrent pancreatitis or pain for which endoscopic therapy may be indicated. The aim of this study was to evaluate success rates and long-term outcomes of endoscopic treatment in patients with symptomatic PDiv. Patients and methods A multicenter, retrospective cohort study was performed. Patients with symptomatic PDiv presenting with recurrent acute pancreatitis (RAP), chronic pancreatitis (CP), or chronic abdominal pancreatic-type pain (CAP) who underwent endoscopic retrograde cholangiopancreatography (ERCP) between January 2000 and December 2019 were included. The primary outcome was clinical success, defined as either no recurrent episode of acute pancreatitis (AP) for RAP patients, no flares for CP patients, or absence of abdominal pain for patients with CAP after technically successful ERCP. Results In 60 of 81 patients (74.1 %) a technically successful papilla minor intervention was performed. Adverse events were reported in 30 patients (37 %), with post-ERCP pancreatitis in 18 patients. The clinical success rate for patients with at least 3 months of follow-up was 42.6 %, with higher rates of success among patients presenting with RAP (44.4 %) as compared to those with CP (33.3 %) or CAP (33.3 %). Long-term sustained response was present in 40.9 % of patients with a technically successful intervention. In patients with RAP who did not completely respond to treatment, the mean number of AP episodes after treatment decreased significantly from 3.5 to 1.1 per year, and subsequently the interval between AP episodes increased from 278 to 690 days (P = 0.0006). A potential predictive factor of failure of clinical success after technically successful ERCP, at univariate analysis, was male sex (OR = 0.25, P = 0.02). Conclusions Endoscopic therapy in patients with symptomatic PDiv is moderately effective, with its highest yield in patients presenting with RAP. Future studies are needed to assess factors predictive for success of endoscopic therapy and potential risk factors for relapse after ERCP.

scholarly journals Endoscopic management of ampullary tumors: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Endoscopy ◽  
2021 ◽  
Author(s):  
Geoffroy Vanbiervliet ◽  
Marin Strijker ◽  
Marianna Arvanitakis ◽  
Arthur Aelvoet ◽  
Urban Arnelo ◽  
...  
Keyword(s):  
Clinical Success ◽  
Endoscopic Management ◽  
R0 Resection ◽  
En Bloc ◽  
Strong Recommendation ◽  
Moderate Quality ◽  
Endoscopic Papillectomy ◽  
Pancreatic Duct Stenting ◽  
Ampullary Tumors ◽  
Quality Evidence

Main Recommendations 1 ESGE recommends against diagnostic/therapeutic papillectomy when adenoma is not proven.Strong recommendation, low quality evidence. 2 ESGE recommends endoscopic ultrasound and abdominal magnetic resonance cholangiopancreatography (MRCP) for staging of ampullary tumors.Strong recommendation, low quality evidence. 3 ESGE recommends endoscopic papillectomy in patients with ampullary adenoma without intraductal extension, because of good results regarding outcome (technical and clinical success, morbidity, and recurrence).Strong recommendation, moderate quality evidence. 4 ESGE recommends en bloc resection of ampullary adenomas up to 20–30 mm in diameter to achieve R0 resection, for optimizing the complete resection rate, providing optimal histopathology, and reduction of the recurrence rate after endoscopic papillectomy.Strong recommendation, low quality evidence. 5 ESGE suggests considering surgical treatment of ampullary adenomas when endoscopic resection is not feasible for technical reasons (e. g. diverticulum, size > 4 cm), and in the case of intraductal involvement (of > 20 mm). Surveillance thereafter is still mandatory.Weak recommendation, low quality evidence. 6 ESGE recommends direct snare resection without submucosal injection for endoscopic papillectomy.Strong recommendation, moderate quality evidence. 7 ESGE recommends prophylactic pancreatic duct stenting to reduce the risk of pancreatitis after endoscopic papillectomy.Strong recommendation, moderate quality evidence. 8 ESGE recommends long-term monitoring of patients after endoscopic papillectomy or surgical ampullectomy, based on duodenoscopy with biopsies of the scar and of any abnormal area, within the first 3 months, at 6 and 12 months, and thereafter yearly for at least 5 years.Strong recommendation, low quality evidence.

A new treatment paradigm for phlegmasia cerulea dolen: Single stage endovascular pharmacomechanical thrombectomy with venoplasty and stenting

2020 ◽  
pp. 026835552097727
Author(s):  
GuangMing Tan ◽  
Bryan PY Yan
Keyword(s):  
Clinical Success ◽  
Treatment Algorithm ◽  
Clinical Success Rate ◽  
Iliac Vein ◽  
Single Stage ◽  
Bleeding Complications ◽  
Common Iliac Vein ◽  
Period 2 ◽  
Treatment Paradigm ◽  
Iliac Vein Compression

Background Phlegmasia Cerulae Dolen (PCD) is potentially a lethal disease but there is currently no established treatment algorithm for it. The aim of this study was to assess the safety and effectiveness of single stage endovascular pharmacomechanical thrombectomy with venoplasty and stenting in the treatment of PCD. Method This was a retrospective single centre observational study of consecutive patients who underwent endovascular intervention for the treatment of PCD between June 2016 and March 2020. Clinical and procedural details were recorded. Procedural and clinical success rate, procedural complications, and 30 days mortality were reported. Result 11 patients were treated during the study period. 2 (18.2%) had active malignancy. 63.6% were uncomplicated PCD on presentation. Common iliac vein compression or stenosis were demonstrated in all patients. Venous stents were implanted in all cases and procedures were successful in all cases. All patients had symptoms improvement at 72 hours post procedure. Other than 2 major bleeding complications, there was no other adverse event. The 30 days mortality was 18.2%. Active malignancy and the presence of anaemia were significantly associated with major complications. Conclusion Single stage endovascular thrombectomy and stenting was effective and safe in the treatment of patients with PCD. Common Iliac vein compression was a common underlying cause of PCD.

The concept of oligometastatic disease in gastric cancer: reality or fiction?

2021 ◽  
Author(s):  
Serge Kassar ◽  
Ramy Samaha ◽  
Rany Aoun ◽  
Makram Khoury ◽  
Joseph Kattan
Keyword(s):  
Gastric Cancer ◽  
Surgical Treatment ◽  
Standard Of Care ◽  
Oligometastatic Disease ◽  
Independent Entity ◽  
Positive Results

Positive results in the RENAISSANCE Trial will establish oligometastatic gastric cancer as a real independent entity where total surgical treatment will become the standard of care.

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