Early endoscopic treatment of symptomatic pancreatic necrotic collections

EUS-guided transmural endoscopic drainage is commonly used in the treatment of WOPN in the late phase of ANP. The role of endoscopic intervention remains unclear in the early phase of ANP. This study aimed to prospectively evaluate early endoscopic treatment of ANCs compared with endoscopic drainage of WOPN. Overall, 71 patients with ANP who underwent transmural endoscopic drainage for necrotic collections were included. Endoscopic intervention was performed within the first four weeks of ANP in 25 (35.21%) patients with ANC (Group 1) and in 46 (64.79%) patients after four weeks since the onset of ANP with WOPN (Group 2). The overall mean age of patients was 49.9 (22–79) years and 59 of them were males. The mean time of active drainage and duration of total endoscopic treatment was 26.8 and 16.9 days (P = 0.0001) and 270.8 and 164.2 days (P = 0.0001) in Groups 1 and 2, respectively. The average total number of endoscopic interventions was 9.5 and 4.5 in Groups 1 and 2, respectively (P = 0.0001). The clinical success rate, frequency of complications of endoscopic interventions, long-term success rate, and recurrence rate were not significantly different between the groups (P > 0.05 for each). Transmural endoscopic drainage is effective method of treatment of early ANCs within the first four weeks of ANP. However, compared with endoscopic intervention in WOPN, more interventions and longer duration of drainage are required.

Interventional radiology techniques in the treatment of cholangiolithiasis: indications, efficacy, accessibility

Our days, the problem of treating complicated forms of cholelithiasis continues to be relevant despite the undoubted successes in the field of hepatobiliary surgery. Cholangiolithiasis is one of the most frequent and dangerous complications of cholelithiasis, it is detected in 8–26 % of patients with cholelithiasis. In some cases, it is impossible to perform an endoscopic retrograde method, these special situations require the development of new original minimally invasive methods for resolving cholangiolithiasis, which have all the advantages of «small access». The analysis of the treatment of 466 operated patients with cholelithiasis complicated by cholangiolithiasis and mechanical jaundice in the period from 2013 to 2019 was carried out. The patients were divided into 3 groups: 1 — the endoscopic retrograde method was used (n = 369), 2 — laparotomic access (n = 26), 3 — antegrade X-ray interventional method (n = 71). The results obtained allow us to conclude that the antegrade interventional radiology technique for the treatment of choledocholithiasis has a high clinical efficacy comparable to the endoscopic technique. The use of this treatment option avoids traumatic laparotomies and open interventions on the bile ducts. The use of method is justified in cases of impossibility of performing endoscopic intervention, or its ineffectiveness.

Individually designed fully covered self-expandable metal stents for pediatric refractory benign esophageal strictures

To share our institutional experience of placing individually designed fully covered self-expandable metal stents (FCSEMSs) for the treatment of refractory benign esophageal strictures (RBESs) in pediatric patients. A 10-year retrospective study between May 2009 and July 2020 that includes 14 children with RBESs who were treated with individually designed FCSEMSs. Patients were followed-up regularly after stent placement to observe the improvement of vomiting and dysphagia, changes in stenosis diameter and complications. A total of 20 stents were successfully placed in 14 patients. During a follow-up period ranging from 5 to 83 months, except for one 4-year-old child who could not endure chest pain, the remaining 13 patients all benefited from stenting. Their Ogilvie & Atkinson scores improved from grade III–IV to grade 0-I, and the diameters of the stenosis’ were enlarged from 2–5 mm to 9–14 mm. Two patients developed restenosis and granulation tissue hyperplasia was found in 2 patients and stent migration and malapposition in 2 patients with esophageal perforations that required further endoscopic intervention. The use of FCSEMS for RBES is safe and effective in selected pediatric patients. Rationally designed stents and timely management of postoperative complications are critical to ensure the success of this new method.

Interventional radiology in rendezvous technique for choledocholitiasis in elderly patients

Aim. Define the safety and effectiveness of rendezvous technique for choledocholithiasis.Material and methods. We performed a retrospective and prospective analysis of the results in percutaneous transhepatic access to the bile ducts and endoscopic intervention in the rendezvous technique for choledocholithiasis in 100 elderly patients. The patients were divided into 2 groups for 50 people. The implementation of the rendezvous began from the antegrade stage in patients from group I; in patients of group II – from the retrograde stage. Postmanipulation complications and failures were When analyzed. The control point of the study is the identification of complications associated with manipulation from the next stages of the rendezvous technique.Results. We revealed a direct dependence of the results in sequence of rendezvous technique for elderly patients with choledocholithiasis and obstructive jaundice. This fact allows recommending percutaneous transhepatic access before endoscopic intervention for these patients with statistical significance. The frequency of complications and failures in patients of group I was 18%, in group II – 52%. This allows for such patients percutaneous transhepatic access before endoscopic intervention in the rendezvous technique. The frequency of complications and failures in patients of group I was 18%, in group II – 52%.Conclusion. Dilatation of intrahepatic segmental and subsegmental 2 and 3 biliary ducts with moderate and severe obstructive jaundice is a predictor of complications with ineffective endoscopic approach. In such situations, preventive antegrade drainage of the biliary tract with rendezvous technique makes possible to prevent cholangitis, effectively eliminate biliary hypertension, clarify the severity of stenosis of the papilla with antegrade balloon revision, and also secure delayed endoscopic resolution of biliary pathology.

Clinical Efficacy of Endoscopic Technique in the Treatment of Gastrointestinal Anastomotic Complications: a Retrospective Study

Background: To evaluate the safety and effectiveness of endoscopic technique in treating postoperative anastomotic complications of digestive tract. Methods: Clinical data of patients received endoscopic treatment in our hospital due to anastomotic complications after gastrointestinal surgery from January 2015 to December 2018 were collected for retrospective analysis. Endoscopic intervention was used for postoperative anastomotic complications in all the included cases. The time of the intervention measures, laboratory examination, incidence of complications and postoperative follow-up were observed and analyzed.Results: A total of 88 patients were included in the study, including 43 patients with anastomotic stenosis,22 with anastomotic obstruction,23 with anastomotic fistula. For anastomotic obstruction patients, 36 patients with anastomosis were successfully treated with endoscopy. For anastomotic obstruction patients, 18 cases were successfully treated with endoscopy. For anastomotic fistula patients, 21 cases were successfully treated with endoscopy.During follow-up after the endoscopic procedure, 4 patients with anastomotic stenosis needed endoscopic intervention again, 3 cases undertook surgical intervention and 2 cases maintained acceptable defecation function by intermittent dilation with a plastic dilater. one patients with anastomotic obstruction had stent displacement and was removed. For the anastomotic fistula patients,one case relapsed and then underwent endoscopic intervention again, three cases converted to surgical intervention.Preoperative and postoperative blood biochemical examination had no significant statistical significanceConclusion: Endoscopic treatment of anastomosis complications was effective for some of the patients, especially for those with anastomosis stenosis or stricture, considering its saftey, it might be the first choice for anastomosis complications.