scholarly journals Successful Endoscopic Closure Using Polyglycolic Acid Sheets with Fibrin Glue for Nonhealing Duodenal Ulcer with Perforation after Proton Beam Therapy of Liver Tumor

2018 ◽  
Vol 12 (3) ◽  
pp. 679-685
Author(s):  
Ko Watanabe ◽  
Takuto Hikichi ◽  
Jun Nakamura ◽  
Minami Hashimoto ◽  
Tadayuki Takagi ◽  
...  
Keyword(s):  
Duodenal Ulcer ◽  
Proton Beam ◽  
Fibrin Glue ◽  
Liver Tumor ◽  
Proton Beam Therapy ◽  
Polyglycolic Acid ◽  
Omental Patch ◽  
Perforation Site ◽  
Endoscopic Closure ◽  
First Case

We describe the first case of a nonhealing duodenal ulcer with perforation after proton beam therapy (PBT) of a liver tumor that was successfully treated endoscopically using polyglycolic acid (PGA) sheets with fibrin glue. A 69-year-old man received PBT for a liver tumor. Esophagogastroduodenoscopy (EGD) 3 months after PBT revealed a duodenal ulcer. A proton pump inhibitor was administered for 7 weeks, and the ulcer healed. Six months after the EGD, recurrence of the duodenal ulcer with perforation occurred. An emergency open surgery with placement of the omental patch was performed. However, 5 days after the surgery, because the EGD revealed a perforation site in the duodenal ulcer that was not closed, the conservative treatment was continued. Twenty-eight days after the surgery, EGD revealed that the perforation size had increased. Therefore, we conducted endoscopic closure therapy using PGA sheets with fibrin glue. Eleven days after the closure procedure, the EGD showed that the perforation site was filled with granulation tissue and was closed. Forty-nine days after the procedure, EGD revealed that the ulcer had healed. This endoscopic closure treatment was effective for a nonhealing duodenal ulcer with perforation after PBT of a liver tumor.

scholarly journals Endoscopic Closure of an Acute Duodenal Perforation Occurring during Endoscopic Ultrasound Using Endoclips and Polyglycolic Acid Sheets with Fibrin Glue

2021 ◽  
pp. 253-261
Author(s):  
Mana Matsuoka ◽  
Katsumasa Kobayashi ◽  
Yukito Okura ◽  
Tomohiro Mochida ◽  
Takahito Nozaka ◽  
...  
Keyword(s):  
Fibrin Glue ◽  
Endoscopic Ultrasound ◽  
Endoscopic Treatment ◽  
Duodenal Bulb ◽  
Pancreatic Head ◽  
Polyglycolic Acid ◽  
Duodenal Perforation ◽  
Perforation Site ◽  
Endoscopic Closure ◽  
Duodenal Perforations

Acute duodenal perforation during endoscopic ultrasound (EUS) is a serious complication. The conventional endoscopic treatment for duodenal perforations such as endoscopic clipping is unsatisfactory; recently, the effectiveness of over-the-scope clipping (OTSC) has been reported. A 91-year-old woman was referred to our hospital with the chief complaint of jaundice. Contrast-enhanced computed tomography showed a 2-cm mass in the pancreatic head; we planned EUS-guided fine-needle aspiration. During exploration for a puncture route from the duodenal bulb using a linear echoendoscope under carbon dioxide insufflation, the duodenal lumen was suddenly filled with blood. A perforation <15 mm was identified in the superior duodenal horn. We attempted an endoscopic closure with multiple endoclips but could not completely close the perforation site. Strips of bioabsorbable polyglycolic acid (PGA) sheets were placed over the gaps between the endoclips with biopsy forceps and fixed in place with fibrin glue, completely covering the perforation site. Two days after the procedure, the perforation site had closed. Nine days later, endoscopic biliary stenting was performed. The patient was diagnosed with pancreatic cancer through bile cytology, and the optimal supportive care for her age was selected. Endoscopic tissue shielding with PGA sheets and fibrin glue is increasingly being reported for use during gastrointestinal endoscopic procedures. In this case, surgery was avoided due to successful endoscopic treatment using endoclips and PGA sheets with fibrin glue without OTSC. This method may be useful for repairing acute duodenal perforations during EUS and should therefore be known to pancreatobiliary endoscopists.

scholarly journals Rosette-Forming Glioneuronal Tumor of the Fourth Ventricle: A Case of Relapse Treated with Proton Beam Therapy

Diagnostics ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. 903
Author(s):  
Antonella Cacchione ◽  
Angela Mastronuzzi ◽  
Andrea Carai ◽  
Giovanna Stefania Colafati ◽  
Francesca Diomedi-Camassei ◽  
...  
Keyword(s):  
Adjuvant Therapy ◽  
Proton Beam ◽  
Fourth Ventricle ◽  
Histopathological Examination ◽  
Local Level ◽  
Proton Beam Therapy ◽  
Disease Recurrence ◽  
Glioneuronal Tumor ◽  
First Case ◽  
Cystic Component

Rosette-forming glioneuronal tumors (RGNTs) are rare, grade I, central nervous system (CNS) tumors typically localized to the fourth ventricle. We describe a 9-year-old girl with dizziness and occipital headache. A magnetic resonance imaging (MRI) revealed a large hypodense posterior fossa mass lesion in relation to the vermis, with cystic component. Surgical resection of the tumor was performed. A RGNT diagnosis was made at the histopathological examination. During follow-up, the patient experienced a first relapse, which was again surgically removed. Eight months after, MRI documented a second recurrence at the local level. She was a candidate for the proton beam therapy (PBT) program. Three years after the end of PBT, the patient had no evidence of disease recurrence. This report underlines that, although RGNTs are commonly associated with an indolent course, they may have the potential for aggressive behavior, suggesting the need for treatment in addition to surgery. Controversy exists in the literature regarding effective management of RGNTs. Chemotherapy and radiation are used as adjuvant therapy, but their efficacy management has not been adequately described in the literature. This is the first case report published in which PBT was proposed for adjuvant therapy in place of chemotherapy in RGNT relapse.

scholarly journals Endoscopic closure of an anastomo-cutaneous fistula: Filling and shielding using polyglycolic acid sheets and fibrin glue with easily deliverable technique

2018 ◽  
Vol 06 (08) ◽  
pp. E994-E997 ◽  
Author(s):  
Hideaki Kawabata ◽  
Yuji Okazaki ◽  
Naonori Inoue ◽  
Yukino Kawakatsu ◽  
Misuzu Hitomi ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Fibrin Glue ◽  
Polyglycolic Acid ◽  
Invasive Treatment ◽  
Cutaneous Fistula ◽  
Endoscopic Closure

Abstract Background and study aims Recently, endoscopic closure of gastrointestinal fistulas using polyglycolic acid (PGA) sheets with fibrin glue (FG) has been attempted. A 70-year-old woman who had undergone pancreaticoduodenectomy for pancreatic cancer suffered from a refractory anastomo-cutaneous fistula at the site of gastro-jejunostomy. We attempted endoscopic closure with filling and shielding using PGA sheets and FG. After introducing a guidewire into the fistula, a small piece of PGA sheet was skewered onto the guidewire and then pushed using a tapered catheter over the guidewire and delivered into the fistula. A total of 10 sheets were delivered via the same procedure. Next, the mucosa around the fistula was ablated, and the orifice of the fistula along with the surrounding mucosa was shielded with a piece of PGA sheet fixed with hemoclips and FG. After this procedure, the leakage disappeared and the fistula was undetectable on contrast radiograms. Endoscopic closure of anastomo-cutaneous fistula with filling and shielding using PGA sheets and FG is an effective, safe, low-invasive treatment, and the filling technique using a guidewire ensures a safe, smooth procedure.

scholarly journals Endoscopic closure of refractory esophageal fistula after esophagectomy using polyglycolic acid sheets: a pilot study

2020 ◽  
Vol 08 (05) ◽  
pp. E591-E595 ◽  
Author(s):  
Yasuaki Nagami ◽  
Masaki Ominami ◽  
Taishi Sakai ◽  
Shusei Fukunaga ◽  
Fumio Tanaka ◽  
...  
Keyword(s):  
Pilot Study ◽  
Adverse Events ◽  
Fibrin Glue ◽  
Polyglycolic Acid ◽  
Poor Quality ◽  
Esophageal Fistula ◽  
Fistula Closure ◽  
Prospective Pilot Study ◽  
Endoscopic Closure

Abstract Background and study aims Esophageal fistulas after esophagectomy are associated with high mortality and poor quality of life. They are sometimes intractable to conservative management and surgery that increases mortality. Few studies have assessed use of polyglycolic acid (PGA) sheets with fibrin glue for esophageal fistulas. We investigated the safety of using PGA sheets with fibrin glue for esophageal fistulas after esophagectomy. Patients and methods This was a single-center prospective pilot study. Patients who had refractory esophageal fistulas after esophagectomy were included. PGA sheets were filled in the fistula using biopsy forceps. Fibrin glue was applied to the PGA sheets. We repeated the procedure 1 week later. The outcome measures were the incidence of adverse events (AEs) and closure of the fistula. Results Five patients were assessed. No adverse events were observed. The esophageal fistula was closed with the application of PGA sheets four times in 40 % (2/5) of the cases. Conclusions PGA sheets with fibrin glue were safe for esophageal fistula closure after esophagectomy and do not involve the risk of AEs.

scholarly journals Proton Beam Therapy for Thymic Carcinoma with Pericardial Involvement

2020 ◽  
Author(s):  
Pierre Loap ◽  
Nathaniel Scher ◽  
Farid Goudjil ◽  
Youlia Kirova ◽  
Nicolas Girard ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Dose Reduction ◽  
Proton Beam ◽  
Thymic Carcinoma ◽  
Left Lung ◽  
Proton Beam Therapy ◽  
Breath Hold ◽  
Mediastinal Tumors ◽  
First Case ◽  
Pericardial Involvement

Abstract Purpose Thymic malignancies are the most common anterior mediastinal tumors. Advanced thymic carcinoma treatment relies on chemotherapy and definitive radiation therapy when possible. However, pericardial involvement is problematic for radiation therapy treatment planning owing to significant cardiac radiation exposure. We report the first case of definitive proton beam therapy (PBT) for an advanced thymic carcinoma with pericardial invasion. Materials and Methods We report the case of a 69-year-old patient treated with definitive radiation therapy for a stage IVB thymic carcinoma with pericardial invasion. Mean doses delivered to critical organs at risk were compared between deep inspiration breath-hold (DIBH) volumetric modulated arc therapy (VMAT) and DIBH-PBT. Results When compared to DIBH-VMAT, DIBH-PBT reduced the mean doses delivered to the heart by 3.72 Gy (19.0% dose reduction), to the right lung by 5.9 Gy (41.7% dose reduction), to the left lung by 3.63 Gy (19.0% dose reduction), and to the esophagus by 3.57 Gy (21.3% dose reduction). Despite an early mediastinal relapse after 3.0 months, our patient is still alive after a 14-month follow-up, without any radiation-induced cardiac adverse events and is undergoing pembrolizumab-based immunotherapy. Conclusion Proton beam therapy is an option for definitive irradiation of thymic malignancies invading the pericardium; in this situation, PBT reduces doses to the heart and may help to reduce cardiotoxicity when compared with photon techniques.

scholarly journals Successful Endoscopic Management of Non-Healing Perforated Duodenal Ulcer with Polyglycolic Acid Sheet and Fibrin Glue

2016 ◽  
Vol 3 (1) ◽  
pp. e197 ◽  
Author(s):  
Tsuyoshi Mishiro ◽  
Kotaro Shibagaki ◽  
Kayo Matsuda ◽  
Chika Fukuyama ◽  
Mayumi Okada ◽  
...  
Keyword(s):  
Duodenal Ulcer ◽  
Fibrin Glue ◽  
Polyglycolic Acid ◽  
Endoscopic Management ◽  
Perforated Duodenal Ulcer ◽  
Polyglycolic Acid Sheet

Complications after Proton Beam Therapy to Skull Base Tumors: Case Series

2019 ◽  
Author(s):  
Gustavo Rangel ◽  
Mostafa Shahein ◽  
Thiago Felicio ◽  
Guilhermo Malave ◽  
Nyall London ◽  
...  
Keyword(s):  
Skull Base ◽  
Proton Beam ◽  
Case Series ◽  
Proton Beam Therapy ◽  
Skull Base Tumors

Proton Beam Therapy for Unresectable Adenoid Cystic Carcinoma of the Skull Base

Skull Base ◽  
2008 ◽  
Vol 18 (S 01) ◽  
Author(s):  
Annie Chan ◽  
Paul Busse ◽  
Urmila Kamat ◽  
Derrick Lin ◽  
Norbert Liebsch
Keyword(s):  
Adenoid Cystic Carcinoma ◽  
Skull Base ◽  
Proton Beam ◽  
Proton Beam Therapy ◽  
Adenoid Cystic

Proton Beam Therapy: The future of radiotherapy?

2018 ◽  
Author(s):  
Yen Ching Chang
Keyword(s):  
Proton Beam ◽  
Proton Beam Therapy ◽  
The Future
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