scholarly journals Endoscopic stenting for malignant tumors in the area of the bauginium fl ap

2020 ◽  
Vol 174 (5) ◽  
pp. 78-81
Author(s):  
A. S. Vodoleev ◽  
M. S. Burdyukov ◽  
S. S. Pirogov ◽  
E. S. Karpova ◽  
D. G. Sukhin ◽  
...  
Keyword(s):  
Emergency Surgery ◽  
Malignant Tumors ◽  
Clinical Success ◽  
Colonic Obstruction ◽  
Stent Migration ◽  
Endoscopic Stenting ◽  
High Morbidity ◽  
Right Colon ◽  
Long Distance ◽  
Ileocecal Region

Introduction. Stenting in the ileocecal region is not a routine procedure. Proximal colonic obstruction is generally managed with primary surgery, although there are no RCTs to support this assumption. Recent reports have shown that emergency right colon resection can be associated with high morbidity and mortality rates. We report about 8 cases of obstructive ileocecal cancer for palliative treatment. Case report. Four men and 4 women (mean age, 69 years; range, 62–82 years) were stenting for obstructive ileocecal cancer between September 2014 and December 2019. Emergency SEMS placement was attempted in the remaining 5 cases. An uncovered colonic stent (S&G Biotech; Boston Scientifi c) 22, 24, 25 mm in diameter, 6, 8or 9cm in length, was used. Clinical success is achieved in all cases. One patient was diagnosed with stent migration 4 weeks after stenting, and repeated stenting was performed. Five patients received chemotherapy after stenting, two patients refused further treatment. Discussion. Placing SEMS for ileocecal obstruction is technically challenging for the following reasons. The long distance from the anus, tortuosity of the bowel and angled anatomy of stricture make an ileocecal lesion difficult to reach endoscopically. SEMS can be an alternative to emergency surgery for obstruction due to right colon cancer. In our study, we had migration in 1 case, no perforations or stent ingrown were detected. Conclusion. Stenting for malignant tumors of the ileocecal region, complicated by intestinal obstruction is an eff ective and safe minimally invasive intervention, and can be used as an alternative to emergency surgery.

scholarly journals Fluoroscopic Stenting as a Bridge to Surgery versus Emergency Management for Malignant Obstruction of the Colon

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Fan Xue ◽  
Feng Lin ◽  
Jun Zhou ◽  
Ning Feng ◽  
You-Gang Cui ◽  
...  
Keyword(s):  
Emergency Surgery ◽  
Clinical Success ◽  
Colonic Obstruction ◽  
Laparoscopic Approach ◽  
Metallic Stent ◽  
Bridge To Surgery ◽  
Success Rates ◽  
Clinicopathologic Characteristics ◽  
Sems Group ◽  
Malignant Colonic Obstruction

Aim. To investigate the feasibility of a SEMS (self-expandable metallic stent) as a bridge to surgery for malignant colonic obstruction. Methods. We retrospectively reviewed 83 patients that were in accordance with inclusion criteria; of these, 33 patients that underwent fluoroscopy-guided SEMS placement followed by elective curative resection were classified as a SEMS group and 50 patients, who received emergency surgery (ES), were classified as an ES group. The clinicopathological characteristics, surgery-related parameters, complications, and three-year survival rate were compared between the two groups. Results. No significant differences between the two groups were observed in any of the clinicopathologic characteristics except for higher preoperative absolute neutrophil count in the ES group (P<0.001). Compared to the ES group, the SEMS group has significantly more cases, which featured a laparoscopic approach (72.7% vs. 14.0%, P<0.001), lower overall stoma rate (0% vs. 34.0%, P<0.001), and lower overall postoperative morbidity (27.3% vs. 56.0%, P=0.010). The oncological outcomes did not differ significantly between the two groups in terms of three-year overall survival (P=0.125). The technical and clinical success rates of stent placement were 91.7% and 100%, respectively. Conclusion. Patients treated with the stent-surgery approach had significant short-term superiorities and similar long-term outcomes, compared to patients who had emergency surgery alone. The SEMS is, therefore, safe and feasible as a bridge to surgery for malignant colonic obstruction.

Su1728 LONG-TERM SURVIVAL ANALYSIS AFTER ENDOSCOPIC STENTING AS A BRIDGE TO SURGERY FOR MALIGNANT COLONIC OBSTRUCTION: COMPARISON WITH EMERGENCY SURGERY

2019 ◽  
Vol 89 (6) ◽  
pp. AB397-AB398
Author(s):  
Rodrigo Corsato Scomparin ◽  
Bruno da Costa Martins ◽  
Carlos F. Marques ◽  
Caio Sergio R. Nahas ◽  
Fabio S. Kawaguti ◽  
...  
Keyword(s):  
Survival Analysis ◽  
Emergency Surgery ◽  
Colonic Obstruction ◽  
Endoscopic Stenting ◽  
Bridge To Surgery ◽  
Term Survival ◽  
Long Term Survival ◽  
Malignant Colonic Obstruction

Duodenal Duplication Cyst in adult male; An Extremely Rare Entity and a Diagnostic Pitfall leading to Whipple procedure

2021 ◽  
Vol 156 (Supplement_1) ◽  
pp. S56-S57
Author(s):  
F Hussain ◽  
H Sonani ◽  
C Anderson ◽  
N Varshney
Keyword(s):  
Malignant Tumors ◽  
Treatment Options ◽  
Outlet Obstruction ◽  
Duodenal Mucosa ◽  
Duplication Cyst ◽  
Whipple Procedure ◽  
High Morbidity ◽  
Ileocecal Region ◽  
Duodenal Duplication ◽  
Cystic Tumors

Abstract Introduction/Objective Whipple procedure is a complex, invasive operation and has high morbidity and mortality. It is the most commonly indicated treatment for treating malignant tumors, however, it can be also used for benign entities as well including biliary stricture, chronic pancreatitis, choledochal cyst, inflammatory pseudotumour, and duodenal angiodysplasia. Methods/Case Report We report a case of a 50-year-old man who presented with symptoms of gastric outlet obstruction. Esophagogastroduodenoscopy and CT scan showed an obstruction at the level of the second part of the duodenum with proximal dilation. Subsequently, a Whipple procedure was performed based on high clinical suspicion of duodenal cancer. Gross examination revealed a unilocular thick walled cyst (4.2 cm) in the duodenum. Histopathologic examination showed a cyst lined by duodenal mucosa with thick smooth muscle wall and focal ectopic gastric tissue. This was finally diagnosed as a duodenal cyst consistent with duplication cyst. Results (if a Case Study enter NA) NA Conclusion Duplication cysts are rare congenital abnormality predominantly diagnosed in infancy and childhood. They are most commonly located in the distal ileum, followed by the esophagus and ileocecal region, and are extremely rare in duodenum. Differential diagnosis includes choledochocele, pancreatic pseudocyst, and cystic tumors of the pancreas, mesenteric cysts, and duodenal diverticulums. Treatment options include total excision, cystojejunostomy, and endoscopic marsupialization but occasionally may lead to more invasive measures such as the Whipple procedure. Although duodenal duplication cysts can have variable clinical presentation and radiological findings, making preoperative diagnosis very challenging, it is still pertinent to be aware of this entity for the optimal patient care.

scholarly journals Colonic Stenting in the Emergency Setting

Medicina ◽  
2021 ◽  
Vol 57 (4) ◽  
pp. 328
Author(s):  
Mario Morino ◽  
Alberto Arezzo ◽  
Francesca Farnesi ◽  
Edoardo Forcignanò
Keyword(s):  
Emergency Surgery ◽  
Scientific Evidence ◽  
Colonic Obstruction ◽  
Large Bowel Obstruction ◽  
Endoscopic Stenting ◽  
Emergency Setting ◽  
Bridge To Surgery ◽  
Term Survival ◽  
Colonic Stenting

Nowadays, colorectal cancer (CRC) is the third most frequent cancer, and about a third of patients with CRC presents themselves with symptoms of large bowel obstruction. Historically, surgical resection was the treatment of choice for colonic obstruction, but this kind of approach is burdened by a high risk of postoperative morbidity and mortality. In recent times, the use of a colonic stent has been proposed to overcome the obstruction and transform an emergency surgical case into an elective one to avoid emergency surgery complications. Endoscopic stenting is the first-line treatment option in the palliative management of colonic obstruction, and there is sufficient scientific evidence to support this approach. However, endoscopic stent used as a bridge to surgery is not yet widely adopted because the concern was raised about the long-term survival and cancer safety of this approach. The recent scientific evidence has shown that this approach improves the short-term outcomes, such as postoperative complications and the stoma rate, without differences in long-term outcomes compared to emergency surgery. Therefore, the European Society for Gastrointestinal Endoscopy in 2020 has reconsidered stenting as a bridge to surgery as a valid alternative to emergency surgery.

High Morbidity Seen in Emergency Surgery

2010 ◽  
Vol 3 (9) ◽  
pp. 10
Author(s):  
DIANA MAHONEY
Keyword(s):  
Emergency Surgery ◽  
High Morbidity

scholarly journals Propensity score‐matched comparison of stenting as a bridge to surgery and emergency surgery for acute malignant left‐sided colonic obstruction

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yuepeng Cao ◽  
Qing Chen ◽  
Zhizhan Ni ◽  
Feng Wu ◽  
Chenshen Huang ◽  
...  
Keyword(s):  
Overall Survival ◽  
Propensity Score ◽  
Emergency Surgery ◽  
Perineural Invasion ◽  
Cox Regression ◽  
Colonic Obstruction ◽  
Metal Stents ◽  
Bridge To Surgery ◽  
Cox Regression Analysis ◽  
Self Expanding Metal Stents

Abstract Background Bridge to elective surgery (BTS) using self-expanding metal stents (SEMSs) is a common alternative to emergency surgery (ES) for acute malignant left-sided colonic obstruction (AMLCO). However, studies regarding the long-term impact of BTS are limited and have reported unclear results. Methods A multicenter observational study was performed at three hospitals from April 2012 to December 2019. Propensity score matching (PSM) was introduced to minimize selection bias. The primary endpoint was overall survival. The secondary endpoints included surgical approaches, primary resection types, total stent-related adverse effects (AEs), surgical AEs, length of hospital stay, 30-day mortality and tumor recurrence. Results Forty-nine patients in both the BTS and ES groups were matched. Patients in the BTS group more often underwent laparoscopic resection [31 (63.3%) vs. 8 (16.3%), p < 0.001], were less likely to have a primary stoma [13 (26.5%) vs. 26 (53.1%), p = 0.007] and more often had perineural invasion [25 (51.0 %) vs. 13 (26.5 %), p = 0.013]. The median overall survival was significantly lower in patients with stent insertion (41 vs. 65 months, p = 0.041). The 3-year overall survival (53.0 vs. 77.2%, p = 0.039) and 5-year overall survival (30.6 vs. 55.0%, p = 0.025) were significantly less favorable in the BTS group. In multivariate Cox regression analysis, stenting (hazard ratio(HR) = 2.309(1.052–5.066), p = 0.037), surgical AEs (HR = 1.394 (1.053–1.845), p = 0.020) and pTNM stage (HR = 1.706 (1.116–2.607), p = 0.014) were positively correlated with overall survival in matched patients. Conclusions Self-expanding metal stents as “a bridge to surgery” are associated with more perineural invasion, a higher recurrence rate and worse overall survival in patients with acute malignant left-sided colonic obstruction compared with emergency surgery.

Modified endoscopic ultrasound-guided double-balloon-occluded gastroenterostomy bypass (M-EPASS): a pilot study

Endoscopy ◽  
2021 ◽  
Author(s):  
Amanda Marino ◽  
Ali Bessissow ◽  
Corey Miller ◽  
David Valenti ◽  
Louis Boucher ◽  
...  
Keyword(s):  
Gastric Outlet Obstruction ◽  
Endoscopic Ultrasound ◽  
Clinical Success ◽  
Outlet Obstruction ◽  
Stent Migration ◽  
Stent Insertion ◽  
Ultrasound Guided ◽  
Double Balloon ◽  
Low Residue Diet ◽  
The Mean

Abstract Introduction We recently developed a double-balloon device, using widely available existing technology, to facilitate endoscopic ultrasound-guided gastroenterostomy (EUS-GE). Our aim is to assess the feasibility of this modified approach to EUS-guided double-balloon-occluded gastroenterostomy bypass (M-EPASS). Methods This was a single-center retrospective study of consecutive patients undergoing M-EPASS from January 2019 to August 2020. The double-balloon device consists of two vascular balloons that optimize the distension of a targeted small-bowel segment for EUS-guided stent insertion. The primary end point was the rate of technical success. Results 11 patients (45 % women; mean [standard deviation (SD)] age 64.9 [8.6]) with malignant gastric outlet obstruction were included. Technical and clinical success (ability to tolerate an oral diet) were achieved in 91 % (10/11) and 80 % (8/10) of patients, respectively. There was one adverse event (9 %) due to stent migration. Two patients (18 %) required re-intervention for stent obstruction secondary to food impaction. The mean (SD) time to a low residue diet was 3.5 (2.4) days. Conclusion M-EPASS appears to facilitate the technique of EUS-GE, potentially enhancing its safety and clinical adoption. Larger studies are needed to validate this innovative approach to gastric outlet obstruction.

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