Utility of the Novel SpyGlassTM DS II System and Laser Lithotripsy for Choledocholithiasis in Pregnancy

<b><i>Background and Aim:</i></b> Endoscopic retrograde cholangiopancreatography (ERCP) is considered a safe therapeutic modality even in pregnant women; however, adequate care needs to be taken. The utility of the SpyGlass^TM DS II system in choledocholithiasis among pregnant women is unexplored. <b><i>Methods:</i></b> We retrospectively analyzed patients who underwent<b><i></i></b>ERCP for choledocholithiasis in the absence of fluoroscopy using the SpyGlass DS II system from October 2019 to November 2020. Depending on the size and location of the stones, we used laser lithotripsy (LL) for large impacted stones, the balloon extraction technique for multiple stones, and the SpyGlass retrieval basket for single solitary stones. <b><i>Results:</i></b> A total of 10 (100% female) patients with a mean (±SD) age of 29.5 (±2.5) years underwent ERCP. Abdominal pain was the commonest presenting symptom in all patients. Four (40%) patients had cholangitis and 3 (30%) had pancreatitis. The majority of the patients (9; 90%) were in the second trimester. MRCP was the commonest radiological entity, used in 9 (90%) patients. ERCP was technically successful and the stones were removed from all of the patients in a mean (±SD) time of 30 (±3.5) min. LL was used successfully in 4 (40%) patients, balloon extraction in 3 (30%) patients, and the SpyGlass retrieval basket in 3 (30%) patients. There were no pre- or post-procedural complications. All of the patients had an uneventful childbirth, after which they underwent cholecystectomy and subsequent stent removal 2 weeks later. <b><i>Conclusions:</i></b> Use of the SpyGlass DS II system and LL during ERCP appears safe and effective for the treatment of choledocholithiasis among pregnant women.

Specialist shortage in developing countries: comprehending delays in care

We describe a case of a middle-aged woman who presented with progressive jaundice and was suspected to have rebound choledocholithiasis, which was initially managed with balloon extraction through endoscopic retrograde cholangiopancreatography at her first presentation. Healthcare in Pakistan, like many other developing countries, is divided into public and private sectors. The public sector is not always completely free of cost. Patients seeking specialised care in the public sector may find lengthy waiting times for an urgent procedure due to a struggling system and a lack of specialists and technical expertise. Families of many patients find themselves facing ‘catastrophic healthcare expenditure’, an economic global health quandary much ignored.

Evaluation of Direct versus Delayed Bariatric Surgery after Extraction of Intragastric Balloon

Background Obesity is nowadays considered as one of the public health problem which is associated with a great variety of diseases, most notably affecting the cardiovascular system. Aim of the Work is to evaluate and compare between the outcome of bariatric surgery directly after Intragastric balloon extraction versus delayed bariatric surgery (six weeks to three months) following balloon extraction. Patients and Methods The study was a Prospective Randomized study which included 30 patients who underwent a planned mini gastric bypass surgery following an intragastric balloon extraction. The patients were divided according to time of surgery to 2 groups: Group A (15patients): Delayed Second scheduled surgery after balloon extraction (6 weeks to 3 months). Group B (15 patients) Immediate surgery in the same session of balloon extraction. Results The mean age of the study was 35.36 years ranging from 21 to 50 years with ±8.227 standard deviation. The mean age of Group A was 35.6 versus 35.13 in Group B. The mean weight of the patients was 112.5±9.8kg ranging from 95 kg to 145kg. The mean weight of Group A was 110.13±8.27 versus 114.86±10.88 in Group B. The mean BMI of the study was 46.46±4.7 ranging from 38 to 60. The mean BMI for Group A was 45.66 versus 47.26 for Group B. Conclusion We concluded that a delayed bariatric surgery following an extraction of the balloon is more favorable than a same session surgery and extraction of the balloon in terms of duration of the operation, hospital stay and early post-operative complications.