Multiple episodes of postpancreatectomy hemorrhage resolved by endoscopy and ultrasound-guided percutaneous thrombin injection into a common hepatic artery aneurysm: a case report

Postpancreatectomy hemorrhage (PPH) is one of the most common complications after pancreatoduodenectomy (PD). It mainly includes gastrointestinal hemorrhage and abdominal hemorrhage. With the development of digestive endoscopy and ultrasonic/radiological interventional technology, hemostasis can be effectively performed by minimally invasive methods in many patients with PPH. This report describes the successful treatment of multiple episodes of postoperative hemorrhage after PD. The patient developed anastomotic hemorrhage after PD and was successfully treated by endoscopic hemostasis. However, he also developed intra-abdominal hemorrhage after PD caused by a pseudoaneurysm that had formed next to the common hepatic artery. We effectively performed hemostasis by injecting lyophilized thrombin powder into the pseudoaneurysm with ultrasound guidance, which is a rarely used method. This case indicates that digestive endoscopy provides great advantages in the treatment of gastrointestinal hemorrhage after PD. For patients who develop PPH with a pseudoaneurysm, interventional ultrasonography is an option if transcatheter arterial embolization or covered stenting fails.

Robotics in Gastrointestinal Endoscopy

Recent advances in endoscopic technology allow clinicians to not only detect digestive diseases early, but also provide appropriate treatment. The development of various therapeutic endoscopic technologies has changed the paradigm in the treatment of gastrointestinal diseases, contributing greatly to improving the quality of life of patients. The application of robotics for gastrointestinal endoscopy improves the maneuverability and therapeutic ability of gastrointestinal endoscopists, but there are still technical limitations. With the development of minimally invasive endoscopic treatment, clinicians need more sophisticated and precise endoscopic instruments. Novel robotic systems are being developed for application in various clinical fields, to ultimately develop into minimally invasive robotic surgery to lower the risk to patients. Robots for endoscopic submucosal dissection, autonomous locomotive robotic colonoscopes, and robotic capsule endoscopes are currently being developed. In this review, the most recently developed innovative endoscopic robots were evaluated according to their operating mechanisms and purpose of use. Robotic endoscopy is an innovative treatment platform for future digestive endoscopy.

Characteristics and main risk factors correlated to nausea and vomiting after painless digestive endoscopy

Background Nausea and vomiting is relatively frequent after painless digestive endoscopy. It not only occurs after surgery, but may also occur after painless digestive endoscopy. Here we study the characteristics and main risk factors associated with nausea and vomiting after painless digestive endoscopy. Methods A retrospective analysis of 1336 patients who had undergone painless digestive endoscopy in our hospital from January 2020 to May 2020 was performed. The incidence and timing of nausea and vomiting was examined, and the risk factors of nausea and vomiting of painless digestive endoscopy were analyzed. Results 57 cases had nausea or vomiting (4.3% of 1336 cases, female to male ratio 3.38:1, average age 49.49 ± 13.30 years). 55 cases had nausea (4.1%) and 39 cases had vomiting (2.9%). Nausea and vomiting mostly occur within 6 hours after painless digestive endoscopy. In one-way analysis of variance, female, weight less than 60kg, diazoxide dose exceeding 2.5 mg, history of motion sickness, and history of smoke had significant correlation with nausea and vomiting, while female (OR=3.640, P=0.001), weight less than 60kg (OR 0.942, P=0.001), diazoxide dose exceeding 2.5 mg (OR=2.074, P=0.000) were independent risk factors of nausea and vomiting after painless digestive endoscopy by logistic regression analysis. Conclusions In our patients, female, weight less than 60kg and the dosage of diazoxide more than 2.5mg are the main risk factors of nausea and vomiting after painless digestive endoscopy. This study suggests that the dose of diazoxide no more than 2.5mg may reduce the occurrence of nausea and vomiting after painless digestive endoscopy.

Retro-pneumoperitoneum and pneumomediastinum as a consequence of perforation of a duodenal diverticulum after upper digestive endoscopy

Resumen La enfermedad diverticular del duodeno es una entidad poco frecuente. Suele ser asintomática y descubrirse de manera incidental pero, cuando existe sintomatología, se relaciona con alguna complicación, encontrándose entre éstas la perforación iatrogénica por endoscopia digestiva alta. El diagnóstico precoz es fundamental para reducir la morbimortalidad, siendo la prueba de imagen de elección la TC abdominal, con visualización de gas extraluminal. Igualmente, el tratamiento debe ser precoz, y puede ser tanto conservador como endoscópico o quirúrgico, en función de la etiología y de la gravedad del paciente. Es importante que no se demore más allá de las 24 horas, debido a que el pronóstico dependerá directamente del intervalo de tiempo entre la perforación y el tratamiento.