Dilatation Therapy and Demographic Characteristics Significantly Influence the Amount of Propofol for Therapeutic Endoscopic Retrograde Cholangiography

Background and Study Aims. Patients undergoing therapeutic endoscopic retrograde cholangiography (ERC) may require different amounts of sedative agents depending on demographic characteristics, indication of ERC, and/or endoscopic intervention. Patients and Methods. We retrospectively analyzed all patients undergoing therapeutic ERC from 2008 – 2014 who received deep sedation with propofol ± midazolam. Results. A total of 2448 ERC procedures were performed in 781 patients. The cumulative per procedure propofol dose in the different groups was as follows: PSC 479 mg (±256), bile duct stones 356 mg (±187), benign stenosis/cholestasis 395 mg (±228), malignant stenosis 401 mg (±283), and postliver transplant complications 391 mg (±223) (p < 0.05). Multivariable analysis showed that dilatation therapy (p = 0.001), age (p = 0.001), duration of the intervention (p = 0.001), BMI (p = 0.001), gender (p = 0.001), platelet count (p = 0.003), and bilirubin (p = 0.043) influence independently the propofol consumption. Conclusions. Demographic characteristics and endoscopic interventions have a distinct influence on the amount of sedation required for therapeutic ERC. Although the sedation-associated complication rate is low optimization of sedative regimens is a prime goal to further reduce adverse events of therapeutic ERC.

Use of Self-Expandable Prosthesis for the Treatment of Colon and Rectal Benign Stenosis. Systematic Review

he main reason for the use of self-expandable prosthesis (SEP) is for the treatment of malignant colonic obstructions. The objective of this study is to determine the understanding with regard to results of applying SEP in benign stenosis of colon and rectum, measured in terms of numbers, etiology, and results. Systematic review. A search on MEDLINE, Cochrane Library CENTRAL, DARE, HTA, NHSEED, EMBASE and CINAHL and TRIP database was conducted. We considered all studies published since 1990 for this report. Search strategies were applied to each database using MesH terms, truncated, free words and Booleans. The results and level of evidence of the studies were summarized in tables summarizing efficacy, safety and complications. We obtained 19 related articles. All of these were case series and case reports (evidence level 4), totaling less than 150 cases treated with SEP. The observed results were adequate in terms of symptom reduction, however, a considerable percentage of complications were observed (intestinal perforation, migration, re-obstruction and pain). Published experience concerning the results of the installation of SEP in benign strictures of colon and rectum is scarce and evidence is limited. Therefore, further studies and articles with improved methodological qualities are required.

Treatment with a minoinvasive method of the major duodenal papilla

In this article there are data of comparative analysis of the results of minimally invasive treatment of benign stenosis of the major duodenal papilla through the use of endoscopic retrograde papillosphincterotomy and antegrade laser papillotomy carried out by means of high-energy holmium (YAG:Ho) laser.Resolution of stenosis of the major duodenal papilla was performed in the patients of the control group (n = 102) through the use of endoscopic papillosphincterotomy before and after laparoscopic cholecystectomy.Antegrade laser papillotomy (invention patent №2449757 from 09.11.2010) and cholecystectomy were performed in the patients of core group (n = 35) in the presence of evidence.Antegrade laser papillotomy was successfully performed in all cases. It allows to less traumatic resolve the stenosis of the major duodenal papilla, even in its intradiverticular location and with the combination of choledoholitiasis. It minimizes the possibility of complications such as bleeding, perforation, pancreatitis in comparison with retrograde techniques.

PS01.061: LAPAROSCOPIC ENDOSTIM PLACEMENT: CASE REPORT

Background GERD is a mechanical disorder that is caused by a dysfunction of the LES, dysfunction of the gastric emptying or an anomalous esophageal peristalsis. Methods We present the case of a 36-year-old male patient with intermittent heartburn, regurgitation, retrosternal pain and dysphagia. UE reports grade D esophagitis, manometry and pHmetry reporting DeMeester 21.1, acid percentage of 5.8%. Normal Motility and LES in 9 mmHg. Nissen-type fundoplication was performed without complications and with resolution of symptoms. 4 years later the patient begins with recurrent symptoms. Esophagitis in UE. DeMeester 20. EEI 7.7 mmHg. 80% Useful Motility. Nissen type fundoplication is redo. Nine years later the patient starts again with symptoms. Progressive deterioration of esophageal motility in manometry is documented. UE with grade D esophagitis, DeMeester 10, manometry reporting LES with normal resting pressure and coordinated relaxation with pharyngeal contraction. Peristalsis wave failure of 100% of swallows, in relation to absent peristalsis; Results Placement of Endostim was performed and patient was discharged without complications, Patient 1 month later without GERD symptoms. Conclusion Approximately 10 to 40% of patients with GERD fail to respond in their symptomatology despite medical treatment. Surgical indications for GERD consist of failure to medical treatment, poor adherence to the patient's treatment, high volume reflux, severe esophagitis, benign stenosis and Barret's esophagus. Treatment consists of fundoplication in its different variants. However 10% to 20% of patients present with persistent symptoms and 3% to 5% require surgical reoperation. Endostim is a minimally invasive therapy which normalizes the function of the LES through neurostimulation. Disclosure All authors have declared no conflicts of interest.