Closure of a Traumatic Esophagomediastinal Fistula in a Child by Endoscopic Fulguration and Fibrin Injection

Posttraumatic esophagomediastinal fistula is an uncommon clinical entity that warrants surgical awareness due to its life-threatening potential. Its management, especially in previously operated field, is controversial and several endoscopic methods are being proposed as alternatives. Ours is the first report of endoscopic fulguration and fibrin injection in successful closure of such fistula. A 9-year-old female sustained complete tracheoesophageal transection from a gunshot wound to the neck and underwent immediate primary repair. She presented nine months later with fevers and swelling over anterior neck. CT revealed air tracking posteriorly to the dorsal neck and interiorly to the mediastinum. Considering difficulty of open surgical approach, endoscopic intervention was attempted. Posterior wall fistula was identified via microlaryngoscopy above the esophageal anastomosis. The fistula tract was de-epithelialized via a Bugbee fulgurating electrode and then sealed with fibrin glue. Consequent imaging studies demonstrated complete occlusion of the fistula. Posterior posttraumatic esophagomediastinal fistula presents a challenging scenario from a surgical standpoint, as it combines difficulty of safe approach, high rate of injury to surrounding structures, and significant postoperative recurrence rate. Endoscopic Bugbee fulguration and fibrin glue injection are a safe and effective alternative to the traditional approach.

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Efficacy and safety of combined endoscopic cyanoacrylate injection and balloon-occluded retrograde transvenous occlusion (BRTOcc) of gastrorenal shunts in patients with bleeding gastric fundal varices

Gastroenterology Report ◽

10.1093/gastro/goaa082 ◽

2020 ◽

Author(s):

Fateh Bazerbachi ◽

Akira Dobashi ◽

Swarup Kumar ◽

Sanjay Misra ◽

Navtej S Buttar ◽

...

Keyword(s):

Adverse Events ◽

Gastric Varices ◽

High Rate ◽

Efficacy And Safety ◽

Cyanoacrylate Glue ◽

Serious Adverse Events ◽

Gastroesophageal Varices ◽

Life Threatening ◽

Glue Embolization

Abstract Background Endoscopic cyanoacrylate (glue) injection of fundal varices may result in life-threatening embolic adverse events through spontaneous gastrorenal shunts (GRSs). Balloon-occluded retrograde transvenous occlusion (BRTOcc) of GRSs during cyanoacrylate injection may prevent serious systemic glue embolization through the shunt. This study aimed to evaluate the efficacy and safety of a combined endoscopic–interventional radiologic (BRTOcc) approach for the treatment of bleeding fundal varices. Methods We retrospectively analysed the data of patients who underwent the combined procedure for acutely bleeding fundal varices between January 2010 and April 2018. Data were extracted for patient demographics, clinical and endoscopic findings, technical details, and adverse events of the endoscopic–BRTOcc approach and patient outcomes. Results We identified 30 patients (13 [43.3%] women; median age 58 [range, 25–92] years) with gastroesophageal varices type 2 (53.3%, 16/30) and isolated gastric varices type 1 (46.7%, 14/30) per Sarin classification, and median clinical and endoscopic follow-up of 151 (range, 4–2,513) days and 98 (range, 3–2,373) days, respectively. The median volume of octyl-cyanoacrylate: Lipiodol injected was 7 (range, 4–22) mL. Procedure-related adverse events occurred in three (10.0%) patients, including transient fever, non-life-threatening pulmonary glue embolism, and an injection-site ulcer bleed. Complete gastric variceal obturation was achieved in 18 of 21 patients (85.7%) at endoscopic follow-up. Delayed variceal rebleeding was confirmed in one patient (3.3%) and suspected in two patients (6.7%). Although no procedure-related deaths occurred, the overall mortality rate was 46.7%, primarily from liver-disease progression and co-morbidities. Conclusion The combined endoscopic–BRTOcc procedure is a relatively safe and effective technique for bleeding fundal varices, with a high rate of variceal obturation and a low rate of serious adverse events.

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Abstract 16884: Evaluating the Effectiveness of Atrial Fibrillation Ablation Guided by Spatiotemporal Electrogram Dispersion

Circulation ◽

10.1161/circ.142.suppl_3.16884 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Brian Liu ◽

Arismendy Nunez-Garcia ◽

Cao Tran ◽

Michael Wu

Keyword(s):

Atrial Fibrillation ◽

Atrial Tachycardia ◽

Statistical Significance ◽

Univariate Analysis ◽

External Validation ◽

Posterior Wall ◽

High Rate ◽

Single Center Experience ◽

The Mean

Introduction: Catheter ablation of atrial fibrillation (AF) guided by spatiotemporal dispersion (SD) of electrograms has been proposed as an ablation strategy to treat patients with persistent AF. However, external validation of this technique is lacking. Here we report a single center experience using ablation by SD. Hypothesis: Targeting regions with SD is associated with a high rate of termination and favorable freedom from AF among patients with persistent AF. Methods: Patients with persistent AF who underwent SD from November 2018 to January 2020 were included in this study. All patients underwent pulmonary vein isolation (PVI) in addition to targeting areas of SD. Lesions on areas of electrogram dispersion were anchored to the PVI or to mitral or posterior wall lines where appropriate. EKG, Holter, event monitors or device interrogations were obtained at 3 and 6 months to assess for arrhythmia recurrence. Results: 44 patients met the inclusion criteria and were included in the study. The patients had a mean age of 69±8 years and were 68 % male. The prevalence of comorbidities was as follows: hypertension (89%), diabetes (21%), OSA (37%) and CAD (26%). Average CHADSVASC score was 2.9±1.4, LVEF was 53±11% and left atrium (LA) diameter was 5.2±1 cm. The recurrence rate of AF at 6 months was 14% whereas the recurrence of atrial tachycardia was 20%. Acute AF termination was observed in 73% of the patients. Termination to sinus occurred in 38% of the patients and the remaining terminated to atrial tachycardia which was subsequently ablated to sinus. The mean procedure duration was 240±90 minutes. Univariate analysis showed recurrence was associated with LA diameter (r=.52; p<.001). No recurrences were observed among patients with a LA diameter < 5 cm. Termination rates were higher among patients with LA diameter < 5 cm when compared to LA diameter ≥ 5 cm. However, it did not reach statistical significance (80% vs. 60%; p=.21). Conclusions: The target of electrograms with SD during AF ablation added to PVI was associated with a high termination rate and a good freedom from AF recurrence at 6 months. The ideal candidate for this procedure may be those with LA diameter < 5 cm among persistent AF. The long-term efficacy of this technique merits further studies in larger populations.

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Treatment of Anorexia Nervosa: The Importance of Disease Progression in the Prognosis

Acta Médica Portuguesa ◽

10.20344/amp.8963 ◽

2017 ◽

Vol 30 (7-8) ◽

pp. 517

Author(s):

Rodrigo Andrade ◽

Manuel Gonçalves-Pinho ◽

António Roma-Torres ◽

Isabel Brandão

Keyword(s):

Anorexia Nervosa ◽

Dropout Rate ◽

University Hospital ◽

High Rate ◽

Prognostic Features ◽

Illness Duration ◽

Intense Fear ◽

Life Threatening ◽

Fear Of Weight Gain ◽

The Impact

Introduction: Anorexia nervosa is a severe, usually chronic, life-threatening disease of complex etiology characterized by food restriction, overestimation of the importance of body weight and image, intense fear of weight gain and distortion of body image. Anorexia nervosa is associated with high rates of mortality, suicide and decreased quality of life. Our aim is to present an anorexia nervosa treatment program offered in a major university hospital in Portugal, and to determine the impact of illness duration before admission on the outcome. Our hypothesis is that patients with greater disease longevity may have worse prognosis and poorer outcome.Material and Methods: The sample included data from case records of 169 patients seen consecutively and for the first time at Centro Hospitalar São João, between 2010 and 2015. We performed a retrospective observational study which included data collected at admission and from later follow-up years.Results: From the initially selected patients, 14.8% reached total remission, 16% accomplished partial remission and 14.2% ended up with exacerbation/stagnation of the disease. The dropout rate was of 55% throughout our study period. We found significant differences on outcome rates between distinct illness duration groups (p = 0.007).Discussion: There are several factors frequently associated with poor outcome for anorexia nervosa. The interpretation of outcome findings was limited by the high rate of dropout and lack of consistent definition criteria.Conclusion: Our results support the idea that illness duration has an important role on the outcome and prognostic features of these patients.

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Endoscopic fibrin glue injection for closure of pancreatocutaneous fistula following transgastric endoscopic necrosectomy

World Journal of Gastroenterology ◽

10.3748/wjg.14.6093 ◽

2008 ◽

Vol 14 (39) ◽

pp. 6093 ◽

Cited By ~ 6

Author(s):

Ji Woong Jang ◽

Do Hyun Park ◽

Sung-Hoon Moon ◽

Sang Soo Lee ◽

Dong Wan Seo ◽

...

Keyword(s):

Fibrin Glue ◽

Endoscopic Necrosectomy ◽

Glue Injection

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Esophageal Perforation Caused by a Fish Bone Treated with Surgically Indwelling Drainage and Fibrin Glue Injection for Fistula Formation

Annals of Thoracic and Cardiovascular Surgery ◽

10.5761/atcs.cr.12.01906 ◽

2013 ◽

Vol 19 (4) ◽

pp. 289-292 ◽

Cited By ~ 7

Author(s):

Toru Kimura ◽

Toshiki Takemoto ◽

Yoshinori Fujiwara ◽

Katsunari Yane ◽

Hiroyuki Shiono

Keyword(s):

Fibrin Glue ◽

Esophageal Perforation ◽

Fish Bone ◽

Fistula Formation ◽

Glue Injection

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P.05.22 TREATMENT OF REFRACTORY POST-SPHINCTEROTOMY AND POST-PAPILLECTOMY BLEEDING BY ENDOSCOPIC FIBRIN GLUE INJECTION. RESULTS OF A LARGE SERIES

Digestive and Liver Disease ◽

10.1016/s1590-8658(19)30383-4 ◽

2019 ◽

Vol 51 ◽

pp. e193

Author(s):

G. Valerii ◽

A. Tringali ◽

F. Borrelli De Andreis ◽

S. Greco ◽

V. Perri ◽

...

Keyword(s):

Fibrin Glue ◽

Large Series ◽

Glue Injection

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Sa1483 Fibrin Glue Injection for the Patients With Upper Gastrointestinal Bleeding

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2014.05.102 ◽

2014 ◽

Vol 79 (5) ◽

pp. AB229-AB230

Author(s):

Soon Man Yoon ◽

Ki Bae Kim ◽

Joo Young Lee ◽

Joung-Ho Han ◽

Hee Bok Chae ◽

...

Keyword(s):

Gastrointestinal Bleeding ◽

Fibrin Glue ◽

Upper Gastrointestinal Bleeding ◽

Glue Injection ◽

Upper Gastrointestinal

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Aortoduodenal Fistula After Endovascular Abdominal Aortic Aneurysm Repair

Vascular and Endovascular Surgery ◽

10.1177/1538574420918969 ◽

2020 ◽

Vol 54 (5) ◽

pp. 445-448

Author(s):

Akihiro Hosaka ◽

Masaru Nemoto ◽

Manabu Motoki ◽

Atsushi Akai ◽

Masaaki Kato

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Primary Repair ◽

Recurrent Infection ◽

Abdominal Aortic Aneurysm Repair ◽

Duodenal Wall ◽

Aortoduodenal Fistula ◽

Abdominal Aortic ◽

Life Threatening ◽

Aneurysm Repair

Aortoduodenal fistula after endovascular treatment of abdominal aortic aneurysm is a very rare but life-threatening complication. Herein, we describe 4 cases of aortoduodenal fistula diagnosed at 15 to 78 months after the index aortic intervention, all successfully treated by surgery. All patients underwent primary repair of the duodenal wall, creation of tube duodenostomy, stent graft removal, and in situ reconstruction using a rifampicin-soaked prosthesis. Patients received prolonged antibiotic treatment for at least 2 months postoperatively, and all were free of recurrent infection at follow-up. Prompt and appropriate surgical intervention is required to effectively manage this condition.

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