scholarly journals Flexible Endoscopic Treatment of Esophageal Diverticulum: A Case Report

2021 ◽  
Author(s):  
Quan Zhang ◽  
Sumin Zhu
Keyword(s):  
Endoscopic Treatment ◽  
Muscle Layer ◽  
Drainage Tube ◽  
Nutrition Support ◽  
Esophageal Diverticulum ◽  
Vacuum Suction ◽  
Long Term Prognosis ◽  
The Right ◽  
Titanium Clips ◽  
Enteral Nutrition Support

Abstract BackgroundIn the past, surgical resection was the only treatment available for esophageal diverticulum. Minimally invasive endoscopic treatment of esophageal diverticulum has become more and more popular in recent years. We reported a case of transoral endoscopic resection of esophageal diverticulum and crestectomy, which had a similar effect to surgery and retained the physiological function of the esophagus. It has the advantages of short procedure time, short hospital stay, and good long-term prognosis.Case presentationA 67-year-old gentleman presented with persistent dysphagia and repeated nausea and vomiting for 2 years. Combined with chest CT, barium esophagography and esophagogastroduodenoscopy, the diagnosis was a mid-esophageal diverticulum. After discussion and communication, the patient underwent oral endoscopic esophageal diverticulectomy. During the operation, the weak area of the bottom muscle layer of the diverticulum was completely removed, and the crest of the diverticulum was cut off, and the kiss suture was performed with titanium clips to reduce tension. After the operation, the right pleural effusion occurred and the lung infection was aggravated, and the right pleural drainage tube was placed to relieve the symptoms. An 18*100mm fully covered metal stent was placed under a gastroscope. Place the duodenal nutrition tube and the gastric tube drainage tube for vacuum suction. After a long period of fasting, enteral nutrition support, adequate postoperative drainage treatment and antibiotic treatment eventually l resulted in full recovery without recurrence.ConclusionThe selection of treatment for esophageal diverticulum needs to refer to many factors. For the middle esophageal diverticulum, especially those with large diverticulum sac and small mouth, and those who have indications for surgery, in addition to selective surgery and conventional endoscopic surgery, you can also try endoscopic diverticulectomy and crestectomy.

scholarly journals Extraluminal recanalization for postoperative biliary obstruction using transseptal needle

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Hiroki Horinouchi ◽  
Eisuke Ueshima ◽  
Keitaro Sofue ◽  
Shohei Komatsu ◽  
Takuya Okada ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Bile Duct ◽  
Biliary Obstruction ◽  
Hepatic Duct ◽  
Drainage Tube ◽  
Biliary Strictures ◽  
Hepatic Bile ◽  
Hepatic Bile Duct ◽  
Benign Biliary Strictures ◽  
The Right

Abstract Background Postoperative biliary strictures are commonly related to accidental bile duct injuries or occur at the site of biliary anastomosis. The first-line treatment for benign biliary strictures is endoscopic therapy, which is less invasive and repeatable. However, recanalization for biliary complete obstruction is technically challenging to treat. The present report describes a successful case of treatment by extraluminal recanalization for postoperative biliary obstruction using a transseptal needle. Case presentation A 66-year-old woman had undergone caudal lobectomy for the treatment of hepatocellular carcinoma. The posterior segmental branch of the bile duct was injured and repaired intraoperatively. Three months after the surgery, the patient had developed biliary leakage from the right hepatic bile duct, resulting in complete biliary obstruction. Since intraluminal recanalization with conventional endoscopic and percutaneous approaches with a guidewire failed, extraluminal recanalization using a transseptal needle with an internal lumen via percutaneous approach was performed under fluoroscopic guidance. The left lateral inferior segmental duct was punctured, and an 8-F transseptal sheath was introduced into the ostium of right hepatic duct. A transseptal needle was advanced, and the right hepatic duct was punctured by targeting an inflated balloon that was placed at the end of the obstructed right hepatic bile duct. After confirming successful puncture using contrast agent injected through the internal lumen of the needle, a 0.014-in. guidewire was advanced into the right hepatic duct. Finally, an 8.5-F internal–external biliary drainage tube was successfully placed without complications. One month after the procedure, the drainage tube was replaced with a 10.2-F drainage tube to dilate the created tract. Subsequent endoscopic internalization was performed 5 months after the procedure. At the 1-year follow-up examination, there was no sign of biliary obstruction and recurrence of hepatocellular carcinoma. Conclusions Recanalization using a transseptal needle can be an alternative technique for rigid biliary obstruction when conventional techniques fail.

scholarly journals Gastrostomy for infants with severe epidermolysis bullosa simplex in neonatal intensive care

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
M. Marro ◽  
S. De Smet ◽  
D. Caldari ◽  
C. Lambe ◽  
S. Leclerc-Mercier ◽  
...  
Keyword(s):  
Intensive Care ◽  
Epidermolysis Bullosa ◽  
Neonatal Intensive Care ◽  
Nutrition Support ◽  
Epidermolysis Bullosa Simplex ◽  
Withdrawal Time ◽  
Multicentric Study ◽  
Nasogastric Tubes ◽  
Mucosal Involvement ◽  
Enteral Nutrition Support

Abstract Introduction Severe epidermolysis bullosa simplex (EBS sev) is a rare genodermatosis characterized by congenital generalized blistering and mucosal involvement. Increased needs and decreased intake quickly lead to nutritional imbalance. Enteral nutrition support is proposed, but classical nasogastric tubes are not well tolerated in these patients and gastrostomy is preferred. Objective and methods To report the experience with EBS sev in neonatal units of French reference centers for gastrostomy. In this retrospective multicentric study, we included all patients with EBS sev who had gastrostomy placement before age 9 months during neonatal care hospitalization. Results Nine infants (5 males/4 females) with severe skin and mucosal involvement were included. A gastrostomy was decided, at an early age (mean 3.7 months, range 1.4 to 8 months) in infants with mean weight 4426 g (range 3500 to 6000 g). Techniques used were endoscopy with the pull technique for 5 infants and surgery under general anesthesia for 4. Main complications were local but resolved after treatment. All infants gained weight after gastrostomy. The mean withdrawal time (n = 7) for the gastrostomy was 35.8 months (range 10.5 months to 6.5 years). Seven children had persistent oral disorders. Conclusions Gastrostomy in infants with EBS sev can be necessary in neonatal intensive care units. Both surgical and endoscopic pull techniques seem efficient, with good tolerance.

Unintended Adverse Effects of Enteral Nutrition Support

2016 ◽  
Vol 62 (1) ◽  
pp. 169-173 ◽  
Author(s):  
Karoline Pahsini ◽  
Sabine Marinschek ◽  
Zahra Khan ◽  
Marguerite Dunitz-Scheer ◽  
Peter Jaron Scheer
Keyword(s):  
Adverse Effects ◽  
Enteral Nutrition ◽  
Nutrition Support ◽  
Enteral Nutrition Support

scholarly journals Nutrition support in critically ill COVID-19 patients

2020 ◽  
Vol 4 (1-3) ◽  
pp. 8
Author(s):  
Abdolreza Norouzy
Keyword(s):  
Older Adults ◽  
At Risk ◽  
Critically Ill ◽  
Diagnosis And Treatment ◽  
Nutrition Support ◽  
Patients At Risk ◽  
Short And Long Term ◽  
Long Term Prognosis ◽  
Poor Outcomes

Diagnosis and treatment of malnutrition should be considered in the management of COVID-19 patients to improve both short- and long-term prognosis. Patients at risk for poor outcomes and higher mortality following infection with COVID-19, namely older adults and polymorbid individuals, should be checked for malnutrition through screening and assessment.

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