iGIE最新文献

The higher number of imaging examinations (CT and magnetic resonance imaging) being performed and their improved definition are increasing the number of incidental diagnoses of pancreatic cystic lesions. It is therefore necessary to differentiate benign cysts from those with a potential for malignancy that may require surveillance or further treatment. To do so, lesions that present risk stigmata (worrisome features) must be stratified, integrating the findings with the patient age, comorbidities, and performance status. We describe a case of difficult interpretation of the risk stigmata because there were 2 adjacent independent cysts of distinct nature. We emphasize the role of EUS with FNA as crucial for decision-making at the multidisciplinary meeting.

Background and Aims

Endoscopic biliary stent placement is commonly used for multiple indications. This study investigated reported adverse events associated with Boston Scientific WallFlex, Cook Evolution, and Gore Viabil biliary stents.

Methods

The MAUDE (Manufacturer and User Facility Device Experience) database of the U.S. Food and Drug Administration was queried for stent-related reports between March 2013 and April 2023.

Results

Boston Scientific WallFlex stents had 964 device-related events, including 123 patient adverse events, and Cook Evolution stents had 99 device-related events with 21 patient adverse events. Gore Viabil stents exhibited 33 device-related events, including 13 patient adverse events. Of all reported Boston Scientific WallFlex stent cases, 20.3% were infection-related problems, and 25.5% were material/component issues. For Cook Evolution stents, 24% were bleeding/hemorrhage and 33% were breakage as major adverse events. For Gore Viabil stents, 23% were bleeding-related problems, and 36% were structural integrity issues. Comparing fully covered versus uncovered/partially covered Boston Scientific WallFlex stents, the former had more device detachment/migration. Uncovered/partially covered stents had higher rates of activation/positioning/separation issues and device obstruction/blockage.

Conclusions

This study provides insights into the potential adverse events and device failures associated with commonly used biliary stents. Further research is needed to confirm these findings and investigate the underlying causes of these adverse events and device failures.

Background and aims

Living donor liver transplantation (LDLT) allows for decreased listing-to-transplant time in patients with end-stage liver disease but has been noted to be associated with higher rates of biliary adverse events. The aim of this study was to assess the adverse events of LDLT and compare them versus those of deceased donor liver transplantation (DDLT) patients.

Methods

We retrospectively reviewed patients having undergone duct-to-duct anastomosis LDLT at a single center from 2011 to 2020. Exclusion criteria included pediatric patients and LDLT with Roux-en-Y hepaticojejunostomy. Patients were then matched 1:1 with DDLT. Matching was performed by age, gender, etiology of liver disease, and Model for End-Stage Liver Disease score. Outcomes of interest included incidence of biliary strictures, bile leak, stricture recurrence rate, and the number of interventions required for stricture resolution.

Results

Fifty patients with LDLT were matched to 50 patients with DDLT. Bile leak occurred in 14 (38%) patients in the LDLT group versus 5 (10%) patients in the DDLT group (P = .001). Biliary strictures occurred in 14 (28%) versus 15 (30%) patients in the LDLT and DDLT groups, respectively (P = .68). There was no difference in the median (interquartile range) number of interventions required to resolve the strictures (3 [2-6] vs 4 [3-5]; P = .79]. Three patients in each group had recurrence of strictures after documented resolution. Mortality in both groups were similar (5 [10%] patients in the LDLT group vs 6 [12%] in the DDLT group; P = .75).

Conclusions

Patients who underwent LDLT were equally as likely to develop anastomotic strictures compared with DDLT. Duct-to-duct anastomosis LDLT should be frequently considered in patients with end-stage liver disease with favorable anatomy.