scholarly journals Safety and Cost-Effectiveness of N-butyl-2-Cyanoacrylate without Lipiodol in Endoscopic Management of Gastric Varices

2020 ◽  
Vol 24 (4) ◽  
pp. 292-295
Author(s):  
Mahmood Ahmad ◽  
Muhammad Ayub ◽  
Fawad Iqbal Janjua ◽  
Aisha Majeed ◽  
Nooman Gilani
Keyword(s):  
Cost Effective ◽  
Gastric Varices ◽  
Late Complications ◽  
Endoscopic Management ◽  
Medical College ◽  
Cost Effective Approach ◽  
Cost Effective Method ◽  
Upper Gi Endoscopy ◽  
The Mean

Introduction: Gastric varices are frequently seen in patients with portal hypertension. The mainstay of treatment is variceal injection with a mixture of N-butyl-2-Cyanoacrylate and lipiodol. The use of N-butyl-2-Cyanoacrylate without lipiodol is not extensively studied and it can be a cost-effective approach. The objective of our study was to evaluate whether the use of N-butyl-2-Cyanoacrylate without lipiodol is a safe and effective endoscopic treatment for gastric varices. Material and Methods: This prospective observational study was conducted between June 2016 and May 2017 at the Department of Gastroenterology, Gujranwala Medical College/ DHQ Teaching Hospital, Gujranwala. A total of 100 patients with gastric varices diagnosed on upper GI endoscopy were enrolled in the study. N-butyl-2-Cyanoacrylate without lipiodol was injected into the gastric varices of all the patients. All procedures were performed by experienced gastroenterologists. The patients underwent monthly follow-up endoscopies to determine the outcome and adverse events. Results: Out of 100 patients, 40 patients (40 %) were men and 60 (60%) were women. The mean age was 53 years. The mean volume of N-butyl-2-Cyanoacrylate used per session was 1.5ml ± 0.5 ml (range 1-2ml). Obliteration of Gastric varices was achieved in 92 patients (92%) while in 04 patients (4%) varices did not obliterate over a mean follow-up of 12 months. No treatment-related immediate or late complications were observed in all patients. Four patients (4%) died of delayed rebleeding (after two weeks of intervention). Conclusion: Injection therapy of gastric varices with N-butyl-2-Cyanoacrylate alone without lipiodol is a safe and cost-effective method for gastric varices.

scholarly journals A comparison of endoscopic and non-endoscopic biliary intervention outcomes in patients with prior bariatric surgery

2018 ◽  
Vol 06 (01) ◽  
pp. E11-E28
Author(s):  
Amrit Kamboj ◽  
Victorio Pidlaoan ◽  
Mohammad Shakhatreh ◽  
Alice Hinton ◽  
Darwin Conwell ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Nationwide Inpatient Sample ◽  
Cost Effective ◽  
Hospital Charges ◽  
Endoscopic Management ◽  
Inpatient Mortality ◽  
Total Hospital ◽  
Cost Effective Approach ◽  
History Of ◽  
The Mean

Abstract Background and study aims Endoscopic biliary intervention (BI) is often difficult to perform in patients with prior bariatric surgery (BRS). We sought to analyze outcomes of patients with prior BRS undergoing endoscopic and non-endoscopic BI. Patients and methods The Nationwide Inpatient Sample (2007 – 2011) was reviewed to identify all adult inpatients (≥ 18 years) with a history of BRS undergoing BI. The clinical outcomes of interest were in-patient mortality, length of stay (LOS), and total hospital charges. Results There were 7,343 patients with prior BRS who underwent BIs where a majority were endoscopic (4,482 vs. 2,861, P < 0.01). The mean age was 50±30.8 years and the majority were females (80.5 %). Gallstone-related disease was the most common indication for BI and managed more often with primary endoscopic management (2,146 vs. 1,132, P < 0.01). Inpatient mortality was not significantly different between patients undergoing primary endoscopic versus non-endoscopic BI (0.2 % vs. 0.7 %, P = 0.2). Patients with sepsis were significantly more likely to incur failed primary endoscopic BI (OR 2.74, 95 % CI 1.15, 6.53) and were more likely to be managed with non-endoscopic BI (OR 2.13, 95 % CI 1.3, 3.5). Primary non-endoscopic BI and failed endoscopic BI were both associated with longer LOS (by 1.77 days, P < 0.01 and by 2.17 days, P < 0.01, respectively) and higher hospitals charges (by $11,400, P < 0.01 and by $ 14,200, P < 0.01, respectively). Conclusion Primary endoscopic management may be a safe and cost-effective approach for patients with prior BRS who need BI. While primary endoscopic biliary intervention is more common, primary non-endoscopic intervention may be used more often for sepsis.

scholarly journals Analysing the efficacy of polidocanol in injection snoreplasty

2020 ◽  
Vol 6 (2) ◽  
pp. 258
Author(s):  
Manjunath K. ◽  
Amardeep Singh ◽  
Manjunatha Rao S. V. ◽  
Akash Aradhya S.
Keyword(s):  
Cost Effective ◽  
Neck Surgery ◽  
Spray Application ◽  
Invasive Treatment ◽  
Randomised Study ◽  
Medical College ◽  
Primary Snoring ◽  
Cost Effective Treatment ◽  
The Mean

<p class="abstract"><strong>Background:</strong> Injection snoreplasty was recently introduced as a safe, effective, and minimally invasive treatment for primary snoring. The objective of the study was to assess the effectiveness of the treatment in our patients.</p><p class="abstract"><strong>Methods:</strong> The study was a prospective, non-randomised study done on 40 patients with primary snoring. Study was done in the Department of Otorhinolaryngology and Head and Neck Surgery at Basaveshwara Medical College and Hospital, Chitradurga over 8 months between March 2019 to October 2019. The data was collected from patients about their symptoms. Detailed clinical and radiological examination was done in all patients. Almost each and every causes of snoring were ruled out. 1-3% polidocanol injection of about 1 ml with insulin syringe was administered in all the patients in 1 to 3 sittings after 10% LOX spray application on the site. Patients were assessed after 1, 3 and 6 months and their improvement was noted.  </p><p class="abstract"><strong>Results:</strong> There were 24 (60%) males and 16 (40%) females enrolled in our study with mean age as 42±5 years. The average BMI of patients was 27.14±3.1 kg/m<sup>2</sup>. All the patients except 4 were initially injected 1% polidocanol injection; the others were injected 3%. 4 (10%) patients were re-injected at 1 month and 4 (10%) had 2nd re-injection at 3 months follow up. The mean improvement in symptoms was 58%. Eleven patients (27.5%) had moderate snoring while the rest had severe snoring. The only side effect was pain which in majority of patients was mild. There was no correlation between BMI and percentage of improvement.</p><p class="abstract"><strong>Conclusions:</strong> Injection snoreplasty is a safe and cost-effective treatment for primary snoring.</p>

scholarly journals Management of occluded biliary Wallstents

Gut ◽  
1998 ◽  
Vol 42 (5) ◽  
pp. 703-707 ◽  
Author(s):  
T C K Tham ◽  
D L Carr-Locke ◽  
J Vandervoort ◽  
R C K Wong ◽  
D R Lichtenstein ◽  
...  
Keyword(s):  
Cost Effective ◽  
Endoscopic Management ◽  
Stent Insertion ◽  
Stent Patency ◽  
Plastic Stent ◽  
Cost Effective Method ◽  
Effective Option ◽  
Endoscopic Methods ◽  
Mechanical Cleaning

Background—Wallstents (Schneider Stent, Inc., USA) used for the palliation of malignant biliary strictures, although associated with prolonged patency, can occlude. There is no consensus regarding the optimal management of Wallstent occlusion.Aims—To evaluate the efficacy of different endoscopic methods for managing biliary Wallstent occlusion.Methods—A multicentre retrospective study of patients managed for a biliary Wallstent occlusion.Results—Data were available for 38 patients with 44 Wallstent occlusions, all of which had initial endoscopic management. Twenty four patients had died and 14 were alive after a median follow up of 231 (30–1095) days following Wallstent occlusion. Occlusions were managed by insertion of another Wallstent in 19, insertion of a plastic stent in 20, and mechanical cleaning in five. Endoscopic management was successful in 43 (98%). Following management of the occlusion, bilirubin decreased from 6.0 (0.5–34.3) to 2.1 (0.2–27.7) mg/100 ml (p<0.05). No complications occurred. The median duration of second stent patency was 75 days (95% confidence interval 43 to 107) after insertion of another Wallstent, 90 days (71 to 109) after insertion of a plastic stent, and 34 days (30 to 38) after mechanical cleaning (NS). The respective median survivals were 70 days (22–118), 98 days (54–142), and 34 days (30–380) (NS). Incremental cost effective analysis showed that plastic stent insertion is the most cost effective option.Conclusion—Although all three methods are equally effective in managing an occluded Wallstent, the most cost effective method appears to be plastic stent insertion.

scholarly journals Late Complications following Endoscopic Sphincterotomy for Choledocholithiasis: A Swedish Population-Based Study

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
A. Langerth ◽  
L. Brandt ◽  
A. Ekbom ◽  
B.-M. Karlson
Keyword(s):  
Acute Pancreatitis ◽  
Endoscopic Sphincterotomy ◽  
Acute Cholangitis ◽  
Common Bile Duct Stones ◽  
Population Based ◽  
Late Complications ◽  
Swedish Population ◽  
The Mean

In order to assess the risk of long-term complications following endoscopic sphincterotomy (ES) for common bile duct stones (CBDS), we conducted a cohort study. The study included 1,113 patients who underwent ES for CBDS in six different hospitals in central Sweden between 1977 and 1990. Through the use of the Swedish population registry, each patient was assigned five population-based controls matched for sex and age. Linkage to the Inpatient Registry yielded information on morbidity and mortality for the patients as well as for the controls. After one year of washout, there were 964 patients available for follow-up. The mean age was 70.6 years, 57% were women, and the mean length of follow-up was 8.9 years. The patients’ overall morbidity was significantly higher and we observed a tendency towards increased mortality as well. Recurrent CBDS was diagnosed in 4.1% of the patients. Acute cholangitis with a hazard ratio (HR) of 36 (95%CI 11–119.4) was associated with recurrent CBDS in 39% of the patients. HR for acute pancreatitis was 6.2 (95%CI 3.4–11.3) and only one patient had CBDS at the same time. In conclusion, we consider acute pancreatitis and cholangitis both as probable long-term complications after ES.

scholarly journals LigaSure Haemorrhoidectomy versus Conventional Diathermy for IV-Degree Haemorrhoids: Is It the Treatment of Choice? A Randomized, Clinical Trial

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Maurizio Gentile ◽  
Michele De Rosa ◽  
Gabriele Carbone ◽  
Vincenzo Pilone ◽  
Francesca Mosella ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Postoperative Pain ◽  
Operative Time ◽  
Randomized Study ◽  
Late Complications ◽  
The Third ◽  
Effective Instrument ◽  
The Mean ◽  
Complications Rate

Introduction. Milligan-Morgan haemorrhoidectomy performed with LigaSure system (LS) seems to be mainly effective where a large tissue demolition is required. This randomized study is designed to compare LigaSure haemorrohidectomy with conventional diathermy (CD) for treatment of IV-degree haemorrhoids. Methods. 52 patients with IV-degree haemorrhoids were randomized to two groups (conventional diathermy versus LigaSure haemorrhoidectomy). They were evaluated on the basis of the following main outcomes: mean operative time, postoperative pain, day of discharge, early and late complications. The time of recovery of work was also assessed. All patients had a minimum follow-up of twelve months (range 12–24). All data were statistically evaluated. Results. 27 patients were treated by conventional diathermy, 25 by LigaSure. The mean operative time was significantly shorter in LS, such as postoperative pain, mainly lower on the third and fourth postoperative day: moreover pain disappeared earlier in LS than CD. The time off-work was shorter in LS, while there was no difference in hospital stay and overall complications rate. Conclusions. LigaSure is an effective instrument when a large tissue demolition is required. This study supports its use as treatment of choice for IV degree haemorrhoids, even if the procedure is more expansive than conventional operation.

scholarly journals Surgical Outcomes of Haemorrhoidectomy along With Suture Haemorrhoidopexy in Multiple Haemorrhoids

2019 ◽  
Vol 6 (2) ◽  
pp. 73-76
Author(s):  
Mohammad Ibrahim Khalil ◽  
Md Ashiqur Rahman ◽  
Adnan Ahmed ◽  
Samia Shihab Uddin ◽  
Mohammad Alauddin ◽  
...  
Keyword(s):  
Operating Time ◽  
Pain Scale ◽  
Late Complications ◽  
Anal Stenosis ◽  
Safe Procedure ◽  
College Hospital ◽  
Primary Position ◽  
Medical College ◽  
Mucosal Oedema

Background: Haemorroid stapler becomes easier and safe to deal multiple and prolapsed haemorrhoid at a time. Objectives: The purpose of the present study was to evaluate the outcome of suture haemorrhoidopexy for secondary position haemorrhoids in addition to haemorrhoidectomy for primary haemorrhoids (multiple). Methodology: This prospective interventional study was performed in Dhaka Medical College Hospital, Dhaka, Bangladesh and in a private hospital in Gazipur, Bangladesh for over five (05) years from January 2012 to December 2016. Patients who were presented with secondary position haemorrhoids in addition to primary position haemorrhoids (multiple haemorrhoids) were included in this study. Open haemorrhoidectomy (Milligan-Morgan) followed by suture haemorrhoidopexy was done. All patients were followed up after 1, 2, 4, 8 weeks, 6 months and 1 yearly. Result: Total 18 patients were operated. Among those immediate complications were encountered in patients in the form of per rectal bleeding 1(5.55%), pain 3(visual pain scale 4)16.66%, mucosal oedema 6(33.33%), no patient developed early postoperative prolapse. No patient developed bowel incontinence. Late complications experienced as prolapse at 1 year follow up which was treated by conservative measures. No patient developed anal stenosis. Mean operating time was 25 minutes and duration of hospital stay was 1 day. Conclusion: Stapled haemorrhoidopexy is a safe procedure for circumferential excision of mucosa and submucosa dealing all haemorrhoids and prolapse simultaneously. Journal of Current and Advance Medical Research 2019;6(2): 73-76

4150 Is telephone follow-up by specialist nurses a cost effective approach?

2009 ◽  
Vol 7 (2) ◽  
pp. 230-231 ◽  
Author(s):  
K. Beaver ◽  
W. Hollingworth ◽  
R. McDonald ◽  
G. Dunn ◽  
D. Tysver-Robinson ◽  
...  
Keyword(s):  
Cost Effective ◽  
Cost Effective Approach ◽  
Specialist Nurses

Risk of Transmission and Features of Hepatitis C After Needlestick Injuries

1999 ◽  
Vol 20 (01) ◽  
pp. 63-64 ◽  
Author(s):  
Saeed S. Hamid ◽  
Badar Farooqui ◽  
Qudsia Rizvi ◽  
Tarranum Sultana ◽  
Anwar A. Siddiqui
Keyword(s):  
Hepatitis C ◽  
Healthcare Workers ◽  
Cost Effective ◽  
Asymptomatic Infection ◽  
Needlestick Injury ◽  
Hcv Rna ◽  
Needlestick Injuries ◽  
Cost Effective Method ◽  
Polymerase Chain

Abstract The rate of transmission and management of needlestick injuries from hepatitis C virus (HCV) patients to healthcare workers is still a matter of debate. We used a stringent protocol using monthly transaminase levels and polymerase chain reaction for HCV RNA to monitor 53 healthcare workers prospectively for up to 6 months following needle injuries from HCV-positive patients. Evidence of transmission of HCV was found in only 2 workers (4%) with mild asymptomatic infection, one of which resolved spontaneously. Based on our experience, we now use a less-intensive follow-up protocol. Further investigation is required to determine the most cost-effective method to monitor individuals who suffer a needlestick injury from an HCV-positive patient.

Transoral Incisionless Fundoplication: Initial Experience in Patients Referred to an Integrated Academic Institution

2011 ◽  
Vol 77 (10) ◽  
pp. 1386-1389 ◽  
Author(s):  
Allan Nguyen ◽  
Thomas Vo ◽  
Xuan-Mai T. Nguyen ◽  
Brian R. Smith ◽  
Kevin M. Reavis
Keyword(s):  
Gastric Surgery ◽  
Late Complications ◽  
Initial Experience ◽  
Additional Time ◽  
Transoral Incisionless Fundoplication ◽  
Working Space ◽  
Symptom Scores ◽  
The Mean ◽  
New Treatment

Transoral incisionless fundoplication is a new treatment for patients with gastroesophageal reflux disease. We present our initial experience with 10 patients undergoing this procedure with varying past surgical histories. All procedures were performed under general nasotracheal anesthesia. RAND-36 and Visual Analog Scale symptom scores were collected at pre and postoperative appointments for a mean of 9.2 months. The mean procedure time was 68 minutes. There were no intraoperative or postoperative complications. Patients with prior pancreaticoduodenectomy had observed reduced working space due to prior distal gastrectomy and required additional insufflation due to no pyloric resistance to insufflation of the small bowel. The patient with prior fundoplication required additional time and force for fastener penetration of the resultant scar from the partially disrupted fundoplication. All patients were discharged within 23 hours of the procedure. Throughout the follow-up period, patients reported gradual changes in medication requirements and symptom scores. There were no late complications. Transoral incisionless fundoplication is technically safe in well-selected patients including those with prior esophageal and gastric surgery.

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