scholarly journals Long-Term Management of Recurrent Cholecystitis after Initial Conservative Treatment: Endoscopic Transpapillary Gallbladder Stenting

2018 ◽  
Vol 2018 ◽  
pp. 1-7
Author(s):  
Hideki Kamada ◽  
Hideki Kobara ◽  
Naohito Uchida ◽  
Kiyohito Kato ◽  
Takayuki Fujimori ◽  
...  
Keyword(s):  
High Risk ◽  
Acute Cholecystitis ◽  
Success Rate ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Technical Success ◽  
Technical Success Rate ◽  
High Risk Patients ◽  
Risk Patients

Background. Endoscopic transpapillary gallbladder stenting (ETGBS) is an effective procedure for treating high-risk patients with acute cholecystitis and severe comorbidities. However, the efficacy of ETGBS for recurrent cholecystitis (RC) remains unclear. This study aimed to explore its efficacy in patients with RC for whom cholecystectomy is contraindicated because of its high surgical risk.Methods. Data on 19 high-risk patients who had undergone ETGBS for RC after initial conservative therapy in our institution between June 2006 and May 2012 were retrospectively examined. The primary outcome was the clinical success rate, which was defined as no recurrences of acute cholecystitis after ETGBS until death or the end of the follow-up period. Secondary outcomes were technical success rate and adverse events (AEs).Results. The clinical success rate of ETGBS was 100%, the technical success rate 94.7%, and AE rate 5%: one patient developed procedure-related mild acute pancreatitis. The clinical courses of all patients were as follows: four died of nonbiliary disease, and the remaining 15 were subsequently treated conservatively. The median duration of follow-up was 14.95 months (range 3–42 months).Conclusions. ETGBS is an effective alternative for managing RC in high-risk patients with severe comorbidities.

Tract dilation to salvage failing buttonholes in arteriovenous dialysis fistulae

2018 ◽  
Vol 20 (3) ◽  
pp. 290-300
Author(s):  
Eyal Barzel ◽  
John W Larkin ◽  
Allen Marcus ◽  
Marta M Reviriego-Mendoza ◽  
Len A Usvyat ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Success Rate ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Technical Success ◽  
Technical Success Rate ◽  
Sharp Recanalization ◽  
Tract Dilation ◽  
Lost To Follow Up

Introduction: Hemodialysis patients with an arteriovenous fistula can use buttonhole techniques for cannulation. Although buttonholes generally work well, patients may report difficult and painful cannulation, and buttonholes may fail over time. We aimed to assess the effectiveness of tract dilation in treatment of failing buttonholes. Methods: We retrospectively analyzed data from patients treated with buttonhole tract dilation at an outpatient vascular access center between January 2013 and August 2015. Results: Data from 23 patients were analyzed. There were 51 tract dilation procedures during 36 encounters for failing arteriovenous fistula buttonhole tract(s). The technical success rate for established tract dilation with “blunt-recanalization” was 90% (n = 46). The five remaining buttonholes had “sharp-recanalization” to create and dilate new tract through the buttonhole. For 46 buttonholes treated with “blunt-recanalization,” there was an 85% clinical success rate at one week (39 buttonholes), and one was lost to follow-up; there was a 70% clinical success rate after one month (32 buttonholes). In the five buttonholes with “sharp-recanalization,” there was only one clinical success with p < 0.05 for difference in success rate compared to “blunt-recanalization” at both one week and one month. There was one complication from “sharp-recanalization” requiring abandonment of the buttonhole tract. Discussion: Buttonhole tract dilation is a useful method to treat difficult cannulation and painful cannulation and has the potential to extend the life of failing buttonholes.

scholarly journals Simultaneous Stenting for Symptomatic Tandem Extracranial and Intracranial Posterior Circulation Stenoses: Long-Term Outcomes and Procedural Experience

2021 ◽  
Vol 12 ◽  
Author(s):  
Zichang Jia ◽  
Yanqing Zhao ◽  
Peng Wang ◽  
Jintao Han ◽  
Shilu Zhao ◽  
...  
Keyword(s):  
Success Rate ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Posterior Circulation ◽  
Technical Success ◽  
Long Term Outcomes ◽  
Technical Success Rate ◽  
Stent Restenosis

Few studies have reported on simultaneous endovascular stenting for tandem posterior circulation (PC) stenoses and its long-term outcomes. Thus, our aim was to investigate the safety and efficacy of simultaneous stenting in patients with symptomatic tandem extra- and intracranial PC stenoses. From September 2014 to June 2018, 16 such patients with symptomatic stenoses who underwent simultaneous stent placement were analyzed. The primary outcome was occurrence of any stroke, TIA, or death within 30 days after the procedure. The secondary outcomes were technical success, clinical success, and the occurrence of in-stent restenosis ≥50% during follow-up. Technical success was defined as stent coverage of all tandem lesions and residual stenosis &lt;30%. Clinical success was determined based on any occurrence of neurological events or death within 3 months after the procedure. All stents (19 intracranial and 14 extracranial) were placed with a technical success rate of 100%. One patient experienced a pontine ischemic stroke 2 days after the procedure and had recovered well at discharge. One patient experienced a minor complication of groin hematoma. The clinical success rate was 93.75% (15/16). During a median follow-up of 36.0 ± 11.0 months, two patients developed ISR ≥50% at the 1-year follow-up. None of the patients experienced stroke, TIA, or death after discharge during follow-up. Simultaneous stenting for symptomatic tandem extra- and intracranial PC stenoses is safe and feasible. Its impact on long-term stroke prevention is promising, and further study of a larger patient population is needed.

Outcome after percutaneous transluminal angioplasty of arterial stenosis in renal transplant patients

2009 ◽  
Vol 50 (3) ◽  
pp. 270-275 ◽  
Author(s):  
G. Hagen ◽  
J. Wadström ◽  
M. Magnusson ◽  
A. Magnusson
Keyword(s):  
Renal Transplant ◽  
Success Rate ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Transluminal Angioplasty ◽  
Technical Success ◽  
Technical Success Rate ◽  
Transplant Patients ◽  
Renal Transplant Patients ◽  
Percutaneous Transluminal

Background: Ensuring graft survival in renal transplant patients is of paramount importance. Early detection and treatment of complications such as transplant renal artery stenosis (TRAS) are essential. Purpose: To evaluate the technical and clinical success rate of renal transplant patients with stenosis in the transplant renal artery or in the iliac artery after percutaneous transluminal angioplasty (PTA). Material and Methods: PTA was carried out on 24 patients with TRAS or iliac artery stenosis. Altogether, 28 stenoses were treated with PTA. The immediate technical result and the clinical outcomes after 1 and 3 months were assessed as well as clinical adverse events. A reduction in serum creatinine and/or a reduction in the number of antihypertensive drugs were criteria for clinical success. Results: The immediate technical success rate after PTA was 93%. The clinical success rate after 1 month was 58%, increasing to 75% after 3 months. Conclusion: The technical success rate is not equivalent to the clinical success rate when treating TRAS with PTA. Furthermore, there is a delay in clinical response, sometimes of 3 months, after a technically successful PTA.

Fluoroscopically-Guided Manipulation of Malfunctioning Peritoneal Dialysis Catheters

1999 ◽  
Vol 19 (6) ◽  
pp. 544-549 ◽  
Author(s):  
Martin E. Simons ◽  
Gaylene Pron ◽  
Mario Voros ◽  
Leslie C. Vanderburgh ◽  
Panduranga S. Rao ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Success Rate ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Primary Patency ◽  
Safe Procedure ◽  
Technical Success ◽  
Early Complications ◽  
Surgical Interventions ◽  
Technical Success Rate

Objective To review our experience with fluoroscopic evaluation and manipulation of malpositioned, malfunctioning, peritoneal dialysis (PD) catheters. Materials and Methods Thirty-one patients, over a 5-year period (1 May 1992 to 30 April 1997) with malfunctioning PD catheters, who had fluoroscopically-guided manipulation were reviewed. Catheters were manipulated using a malleable aluminum bar and, if necessary, guide wires or other stiffeners. Technical success was assessed on the basis of adequate, fluoroscopically verified, catheter placement at the time of the procedure and improved flows. A functional PD catheter at 30 days post manipulation was considered to be a clinically successful manipulation. Results There were 41 manipulations [33 initial (IM) and 8 remanipulations (RM)] for malpositioned or kinked catheters. In 31 (19 male, 12 female) patients ranging in age from 31 to 76 years (mean age 60 years), the initial technical success rate was 85% for IM ( n = 28/33) and 63% ( n = 5/8) for RM. The overall clinical success rate, or 30-day primary patency, was 55% for IM ( n = 18/33) and 63% for RM. Catheter function (combined IM and RM) continued for a median 869 days (95% CI: 118, 1620). No early complications were noted. Conclusions Fluoroscopic manipulation, including attempts at remanipulation, of PD catheters is a safe procedure. The technique is a simple, inexpensive, and effective way of prolonging PD catheter life, thereby reducing the number of surgical interventions.

scholarly journals Percutaneous afferent lymphatic vessel sclerotherapy for postoperative lymphatic leakage after previous ineffective therapeutic transpedal lymphangiography

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
F. Pan ◽  
M. Loos ◽  
T. D. Do ◽  
G. M. Richter ◽  
H. U. Kauczor ◽  
...  
Keyword(s):  
Success Rate ◽  
Lymphatic Vessel ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Technical Success ◽  
Ct Guided ◽  
Technical Success Rate ◽  
Lymphatic Fistula ◽  
Leakage Site

Abstract Background To demonstrate the efficacy of percutaneous computed tomography (CT)-guided afferent lymphatic vessel sclerotherapy (ALVS) in the treatment of postoperative lymphatic leakage (LL) after ineffective therapeutic transpedal lymphangiography (TL). Methods A retrospective review in this institute involving 201 patients was conducted from May 2011 to September 2018. Patients diagnosed with postoperative LL undergoing ineffective therapeutical TL before the performance of percutaneous CT-guided ALVS were involved. Technical success and clinical success of TL and ALVS were established. The technical success and efficacy of ALVS in the treatment of postoperative LL after ineffective therapeutic TL were assessed. The clinical success rate of ALVS is also assessed, and the complications are reviewed. Results In total, nine patients were involved including three patients (33.3%) presented with chylothorax, three patients (33.3%) presented with inguinal lymphatic fistula/lymphocele, and three patients (33.3%) presented with lymphatic fistula in the thigh; 27 ± 18 days (mean ± standard deviation) after surgery, therapeutic TL was successfully performed and showed definite afferent lymphatic vessel and leakage site in all the patients. Due to clinical failure after TLs, the following ALVS was performed with a mean interval of 12 ± 8 days after TL. The technical success rate was 9/9 (100.0%, 95% confidence interval [CI] 63.1–100.0%). An average of 2.7 ± 1.3 mL 95% ethanol as sclerosant agent was injected during the procedure. The clinical success was observed in 8 of the 9 patients (88.9%, 95% CI 51.8–99.7%) with a time between ALVS and the LL cure of 8 ± 6 days. No complications were reported. Conclusions Our results showed the role of percutaneous CT-guided ALVS as a safe, feasible, and effective salvage treatment for postoperative LL after ineffective TL.

The Treatment of Post-Partum Bleeding With Embolization

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Anna Maria Ierardi ◽  
Enrico Maria Fumarola ◽  
Antonio Pinto ◽  
Mariano Scaglione ◽  
Gianpaolo Carrafiello
Keyword(s):  
Success Rate ◽  
Clinical Success ◽  
Post Partum ◽  
Clinical Success Rate ◽  
Arterial Embolization ◽  
Transcatheter Embolization ◽  
Gelatin Sponge ◽  
Intensive Care Treatment ◽  
Technical Success Rate

Aim: To assess safety and efficacy of transcatheter embolization in the treatment of post-partum bleedings. Materials and Methods: In a single institution, the outcome of 15 patients who underwent trans arterial embolization (TAE) for post-partum hemorrhages (PPH) were retrospectively reviewed. Eleven patients presented with hemodynamic instability requiring blood transfusion (73 %), four patients were hemodynamically stable (27 %). Arterial embolization was performed with gelatin sponge, particles and coils. Results: Mean follow-up time was 21.2 months (range 12-48 months). Technical success rate was 100%. The overall clinical success rate was 100%. No major complications that required intensive care treatment were registered during or after the procedures. No patient required emergency surgery and subsequent hysterectomy. During follow-up, four patients become pregnant after transcatheter arterial embolization, and delivered full-term and healthy infants. Conclusions: TAE is a safe method that allows to avoid surgery and hysterectomy for uncontrollable post-partum hemorrhage; a future normal pregnancy after embolization may be hypothesized.

scholarly journals Use of microspheres in embolization for unruptured renal angiomyolipomas

Open Medicine ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. 655-659
Author(s):  
Masashi Shimohira ◽  
Keiichi Nagai ◽  
Kengo Ohta ◽  
Yusuke Sawada ◽  
Taku Naiki ◽  
...  
Keyword(s):  
Success Rate ◽  
Complication Rate ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Arterial Embolization ◽  
Major Complication ◽  
Shrinkage Rate ◽  
Technical Success ◽  
Technical Success Rate ◽  
Major Complication Rate

Abstract Purpose To describe our initial experience with use of microspheres in transcatheter arterial embolization (TAE) for unruptured sporadic renal angiomyolipomas (AMLs). Materials and methods Seven consecutive patients with seven unruptured sporadic renal AMLs, 6 females and 1 male, with a median age of 45 years (range, 30–69 years), underwent TAE using microspheres between November 2016 and February 2020. We evaluated the technical success rate, complications related to the procedure, clinical success rate, and the shrinkage rate of renal AML. Technical success was defined as the completion of TAE. Clinical success was defined as presence of shrinkage of the renal AML after TAE. Results In all patients, TAE using microspheres was accomplished and technical success rate was 100% (7/7). Three patients exhibited slight pain, but it improved with only observation, and the minor complication rate was 43% (3/7) and major complication rate was 0% (0/7). After the TAE, shrinkage of renal AML was confirmed in 6 of 7 patients, and clinical success rate was 86% (6/7). The median of shrinkage rate was 47% (range, 26–83%) with a median follow-up period of 19 months (range, 4–30 months). Conclusion TAE using microspheres appears to be effective and safe for unruptured sporadic renal AMLs.

scholarly journals Endoscopic pancreatic necrosectomy: why scuff when you can flush the muck – make it an easy row to hoe

2017 ◽  
Vol 05 (09) ◽  
pp. E847-E853 ◽  
Author(s):  
Rinkesh Bansal ◽  
Rajesh Puri ◽  
Narendra Choudhary ◽  
Sumit Bhatia ◽  
Nisharg Patel ◽  
...  
Keyword(s):  
Hydrogen Peroxide ◽  
Adverse Events ◽  
Success Rate ◽  
Clinical Success ◽  
Tertiary Care ◽  
Clinical Success Rate ◽  
Technical Success ◽  
End Points ◽  
Technical Success Rate ◽  
Life Threatening

Abstract Background and aims Endoscopic ultrasound (EUS) guided drainage of symptomatic pancreatic walled-off necrosis (WON) followed by fully covered self-expanding metal stent (FCSEMS) placement offers several advantages such as higher technical success rate and the option of necrosectomy. The aim of this study was to evaluate the safety and efficacy of EUS guided drainage of patients with WON by using FCSEMS and intracavitary lavage with a solution containing hydrogen peroxide and adopting a step-up approach. Methods A prospective open label study was carried out at a single tertiary care center between January 2014 and January 2016. Patients with symptomatic WON who underwent EUS guided drainage followed by FCSEMS placement were included. Primary end points were complete drainage with improvement in symptoms or major adverse events. Secondary end points were minor adverse events related to the procedures. Results A total of 64 patients (mean age 36 years; 52 males) were included. Technical success was achieved in 100 % of patients and clinical success was achieved in 90.6 %. Complete drainage was achieved with FCSEMS alone in 18 (28.1 %), FCSEMS with necrosectomy using lavage in 40 (62.5 %), FCSEMS with percutaneous drainage (PCD) in 5 (7.8 %), and 1 (1.6 %) patient required salvage surgery. The major adverse event was life threatening bleeding in 3 (4.7 %) patients. Minor adverse events were non-life threatening bleeding in 2 (3.1 %) patients and stent migration in 3 (4.7 %) patients. Conclusion EUS guided WON drainage with FCSEMS followed by necrosectomy with lavage using a solution containing hydrogen peroxide as a step-up approach is a minimally invasive and effective method with a high technical and clinical success rate. Patients with solid debris > 40 % need aggressive management.

scholarly journals Feasibility of esophageal stent fixation with an over-the-scope-clip for malignant esophageal strictures to prevent migration

2017 ◽  
Vol 05 (11) ◽  
pp. E1044-E1049 ◽  
Author(s):  
Ko Watanabe ◽  
Takuto Hikichi ◽  
Jun Nakamura ◽  
Tadayuki Takagi ◽  
Rei Suzuki ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Success Rate ◽  
Esophageal Stricture ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Technical Success ◽  
Sems Placement ◽  
Technical Success Rate ◽  
Dysphagia Score ◽  
Over The Scope Clip

Abstract Background and study aims Fixation of an esophageal self-expandable metal stent (SEMS) with an over-the-scope-clip (OTSC) system for a benign stricture to prevent migration has been reported. However, the efficacy of SEMS fixation with an OTSC for malignant esophageal stricture remains unclear. The aim of this retrospective study was to evaluate the feasibility of SEMS fixation with an OTSC for a malignant esophageal stricture. Patients and methods Twelve patients who underwent esophageal SEMS placement and fixation with an OTSC for a malignant esophageal stricture were included in this retrospective study. The primary endpoint was technical success. The secondary endpoint was clinical success, which was defined as an improvement of at least 1 grade in the dysphagia score 1 week after SEMS placement or changes in the dysphagia score from before SEMS placement to 1 week after SEMS placement. Results The technical success rate was 100 %. The clinical success rate was 92.3 %. In 6 mild stricture cases in which a standard peroral endoscope could be used, no migration of the SEMS was observed. The median dysphagia score before and at 1 week after SEMS placement was 3 (range 2 – 4) and 0 (0 – 4), respectively, which indicated improvement at 1 week after SEMS placement compared with before SEMS placement (P = 0.002). There were no adverse events associated with placement of SEMS and deployment of an OTSC. Conclusions SEMS fixation with an OTSC is feasible for prevention of migration due to a malignant esophageal stricture.

scholarly journals Safety and efficacy of endoscopic ultrasound-guided gastroenterostomy using double balloon occlusion methods: a clinical retrospective study in 36 patients with malignant gastric outlet obstruction

2020 ◽  
Vol 08 (11) ◽  
pp. E1690-E1697
Author(s):  
Guifang Xu ◽  
Yonghua Shen ◽  
Ying Lv ◽  
Xiaoliang Zhou ◽  
Wen Li ◽  
...  
Keyword(s):  
Success Rate ◽  
Median Time ◽  
Median Survival ◽  
Gastric Outlet Obstruction ◽  
Clinical Success ◽  
Outlet Obstruction ◽  
Clinical Success Rate ◽  
Technical Success ◽  
Safety And Efficacy ◽  
Technical Success Rate

Abstract Background and study aims Gastric outlet obstruction (GOO) is common in the late stage of many malignant tumors of the digestive system. Endoscopic ultrasound (EUS)-guided gastroenterostomy (EUS-GE) is commonly used for palliative treatment of malignant GOO. The objective of this study was to investigate the safety, efficacy, and prognosis of EUS-GE in treatment of malignant GOO in Chinese patients. Patients and methods This was a retrospective, single-center study with 36 consecutive patients with malignant GOO who were treated with EUS-GE. The main outcome measures were technical success rate, clinical success rate, incidence of adverse events (AEs), and median survival time. Results A total of 36 patients with malignant GOO underwent double-balloon-assisted EUS-GE between March 2017 and June 2019 in our hospital. GOO occurred mainly in elderly men (mean age 69.0 years, M:F 0.89). The most common etiology of GOO was pancreatic cancer (41.7 %). The most common obstruction site was the second part of the duodenum (63.9 %). The technical success rate was 100 % (36/36). The clinical success rate was 94.4 % (34/36). Median time for the total procedure was 52 minutes (range 34 – 156 min). Median time for determination of puncture site was 20 minutes (range 15 – 28 min). Median time between puncture and successful delivery of the stent was 38 minutes (range 19 – 128 min). The GOOSS score was 0.2 before EUS-GE. The GOO Scoring System (GOOSS) score was 2.2 at 15 days after the EUS-GE (P = 0.001). The GOOSS score was still higher than 2 during a median follow-up period of 89 days. AEs were observed in nine patients (25.0 %) and 13 total AEs occurred. One patient died as a result of delayed stent migration and bleeding. Mean length of hospital stay was 5.8 ± 4.7 days. The median survival period was 103 days. The rate of GOO recurrence was 2.7 % (1/36). Conclusion EUS-GE was associated with increased safety and efficacy for treatment of malignant GOO in Chinese Mainland.

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