N. Jagtap, Sudatta B Waghmare, S. Sundaram, Rohan Khairatkar, S. Modak, S. Lakhtakia, M. Tandan, G. Rao, D. Reddy
Abstract Background In clinical practice, decision about management of choledocholithiasis is driven by availability of resources and expertise, patients and healthcare professional preferences. This survey is aimed to describe the approach of physicians and surgeons for the management of choledocholithiasis. Method A 36-question online survey was conducted using Google Forms on various aspects of management of choledocholithiasis. Results The responses from 323 participants were included, of which 202 (62.54%) were physicians and 121 (37.46%) were surgeons. The proportion of responders who do not follow American or European Society of Gastrointestinal Endoscopy guidelines is associated with increasing age and experience of responders ( p = 0.0001), while place of work (private vs. teaching) and broad specialty (physician vs surgeon) are not associated ( p >0.05). For patients with high likelihood of choledocholithiasis, 123 (38.1%) participants prefer to do endoscopic ultrasound/magnetic resonance cholangiopancreatography (EUS/MRCP) rather than directly performing endoscopic retrograde cholangiopancreatography/intraoperative cholangiography (ERCP/IOC). For intermediate likelihood, MRCP is more commonly preferred compared with EUS, due to local availability (44%), expertise (39.6%), healthcare professionals preference (30.7%), and patients preference (17.3%). For difficult common bile duct (CBD) stones, short biliary sphincterotomy with large balloon sphincteroplasty (59.4%), followed by laparoscopic CBD exploration are commonly used approaches. Prophylactic CBD stent placement after ERCP and CBD clearance is common practice. Preoperative ERCP followed by cholecystectomy is more preferred approach than cholecystectomy and CBD exploration. Conclusion There is considerable variability in the management of choledocholithiasis. The practices such as use of EUS/MRCP for high likelihood group, use of prophylactic CBD stent placement after ERCP and CBD clearance, and use of single stage approach especially in patient with intermediate likelihood group should be addressed in future studies.
{"title":"Indian Survey on Management of Choledocholithiasis—Opportunities for Improvement and Future Studies","authors":"N. Jagtap, Sudatta B Waghmare, S. Sundaram, Rohan Khairatkar, S. Modak, S. Lakhtakia, M. Tandan, G. Rao, D. Reddy","doi":"10.1055/s-0042-1758533","DOIUrl":"https://doi.org/10.1055/s-0042-1758533","url":null,"abstract":"Abstract Background In clinical practice, decision about management of choledocholithiasis is driven by availability of resources and expertise, patients and healthcare professional preferences. This survey is aimed to describe the approach of physicians and surgeons for the management of choledocholithiasis. Method A 36-question online survey was conducted using Google Forms on various aspects of management of choledocholithiasis. Results The responses from 323 participants were included, of which 202 (62.54%) were physicians and 121 (37.46%) were surgeons. The proportion of responders who do not follow American or European Society of Gastrointestinal Endoscopy guidelines is associated with increasing age and experience of responders ( p = 0.0001), while place of work (private vs. teaching) and broad specialty (physician vs surgeon) are not associated ( p >0.05). For patients with high likelihood of choledocholithiasis, 123 (38.1%) participants prefer to do endoscopic ultrasound/magnetic resonance cholangiopancreatography (EUS/MRCP) rather than directly performing endoscopic retrograde cholangiopancreatography/intraoperative cholangiography (ERCP/IOC). For intermediate likelihood, MRCP is more commonly preferred compared with EUS, due to local availability (44%), expertise (39.6%), healthcare professionals preference (30.7%), and patients preference (17.3%). For difficult common bile duct (CBD) stones, short biliary sphincterotomy with large balloon sphincteroplasty (59.4%), followed by laparoscopic CBD exploration are commonly used approaches. Prophylactic CBD stent placement after ERCP and CBD clearance is common practice. Preoperative ERCP followed by cholecystectomy is more preferred approach than cholecystectomy and CBD exploration. Conclusion There is considerable variability in the management of choledocholithiasis. The practices such as use of EUS/MRCP for high likelihood group, use of prophylactic CBD stent placement after ERCP and CBD clearance, and use of single stage approach especially in patient with intermediate likelihood group should be addressed in future studies.","PeriodicalId":43098,"journal":{"name":"Journal of Digestive Endoscopy","volume":"13 1","pages":"224 - 228"},"PeriodicalIF":0.7,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48282645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Endoscopic ultrasound-guided tissue acquisition (EUS TA) has increasingly become imperative for pancreatic pathology in arriving at the correct diagnosis because of its simplicity, cost-effectiveness, and availability at high-volume centers. The advent of EUS fine-needle biopsy (FNB) has revolutionized EUS TA by providing samples that are larger and more diagnostic compared with fine-needle aspiration (FNA). Rapid onsite evaluation (ROSE) has been conventionally used for improving the cytological yield as well as diagnostic accuracy of EUS FNA. The development of FNB has obviated the need for ROSE, and evidence from retrospective and comparative studies has suggested that FNB is as good as FNA with ROSE in terms of diagnostic accuracy and reduced costs. However, strong evidence in the form of a randomized controlled trial (RCT) was missing. In this news and views, we discuss a multicenter RCT that has compared the diagnostic accuracy of EUS FNB alone to EUS FNA with ROSE in patients with solid pancreatic lesions. This study has reemphasized that EUS FNB has a diagnostic accuracy comparable to EUS + ROSE at a comparable cost and requires fewer passes and has a shorter procedure time.
{"title":"Endoscopic Ultrasound-Guided Fine-Needle Biopsy for Pancreatic Lesions is the Way Forward: Here is the Evidence!","authors":"D. Jha, S. Rana","doi":"10.1055/s-0042-1748493","DOIUrl":"https://doi.org/10.1055/s-0042-1748493","url":null,"abstract":"Endoscopic ultrasound-guided tissue acquisition (EUS TA) has increasingly become imperative for pancreatic pathology in arriving at the correct diagnosis because of its simplicity, cost-effectiveness, and availability at high-volume centers. The advent of EUS fine-needle biopsy (FNB) has revolutionized EUS TA by providing samples that are larger and more diagnostic compared with fine-needle aspiration (FNA). Rapid onsite evaluation (ROSE) has been conventionally used for improving the cytological yield as well as diagnostic accuracy of EUS FNA. The development of FNB has obviated the need for ROSE, and evidence from retrospective and comparative studies has suggested that FNB is as good as FNA with ROSE in terms of diagnostic accuracy and reduced costs. However, strong evidence in the form of a randomized controlled trial (RCT) was missing. In this news and views, we discuss a multicenter RCT that has compared the diagnostic accuracy of EUS FNB alone to EUS FNA with ROSE in patients with solid pancreatic lesions. This study has reemphasized that EUS FNB has a diagnostic accuracy comparable to EUS + ROSE at a comparable cost and requires fewer passes and has a shorter procedure time.","PeriodicalId":43098,"journal":{"name":"Journal of Digestive Endoscopy","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49469167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rabih Ghazi, E. Vargas, D. Abboud, Farah Abdul Razak, Tala Mahmoud, A. Storm, V. Chandrasekhara, B. A. Abu Dayyeh
Obesity has been escalating as one of the worst public health epidemics. Conservative therapies including lifestyle modifications and weight loss medications have limited efficacy and long-term sustainability. Bariatric surgeries, although effective, remain underutilized due to their cost, safety concerns, and patient acceptance. In the past two decades, endoscopic bariatric and metabolic therapies (EBMTs) have emerged as safe, effective, and less invasive options for the treatment of obesity and its comorbidities, with recent studies reporting favorable outcomes in terms of weight loss and metabolic parameters. This article reviews the major and newly developed EBMTs, with emphasis on their metabolic effects and potential use in the management of metabolic conditions.
{"title":"Future of Metabolic Endoscopy","authors":"Rabih Ghazi, E. Vargas, D. Abboud, Farah Abdul Razak, Tala Mahmoud, A. Storm, V. Chandrasekhara, B. A. Abu Dayyeh","doi":"10.1055/s-0042-1754335","DOIUrl":"https://doi.org/10.1055/s-0042-1754335","url":null,"abstract":"Obesity has been escalating as one of the worst public health epidemics. Conservative therapies including lifestyle modifications and weight loss medications have limited efficacy and long-term sustainability. Bariatric surgeries, although effective, remain underutilized due to their cost, safety concerns, and patient acceptance. In the past two decades, endoscopic bariatric and metabolic therapies (EBMTs) have emerged as safe, effective, and less invasive options for the treatment of obesity and its comorbidities, with recent studies reporting favorable outcomes in terms of weight loss and metabolic parameters. This article reviews the major and newly developed EBMTs, with emphasis on their metabolic effects and potential use in the management of metabolic conditions.","PeriodicalId":43098,"journal":{"name":"Journal of Digestive Endoscopy","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46324189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Colorectal cancer (CRC)-related mortality can be reduced through screening and early detection. The aim of any CRC screening program is to detect as many adenomas/polyps in the early stage as possible and hence, adenoma detection rate (ADR) is a key quality indicator of colonoscopy. Various methods and techniques have been studied and developed over the years to improve the quality of colonoscopy and thereby increase ADR. This ranges from use of various regimens to improve bowel preparation, defining an optimum colonoscope withdrawal time for the operator, distal attachment caps, use of different wavelength of light, colonoscope with increased degree of view to the use of modern-day artificial intelligence to improve ADR. Of all the various measures, use of distal attachment device seems an easy, cheap and readily usable technique to increase real-time ADR. A variety of such devices have been evaluated over time starting from simple transparent caps, EndoRings, Endocuff to Endocuff Vision for their effectiveness. In this review, we have provided a brief description of the various available distal attachment devices and a detailed technical overview of Endocuff and its modification the Endocuff Vision.
{"title":"Endocuff Vision to Improve Adenoma Vision: A Brief Overview","authors":"J. Shukla, J. Samanta","doi":"10.1055/s-0042-1755338","DOIUrl":"https://doi.org/10.1055/s-0042-1755338","url":null,"abstract":"Colorectal cancer (CRC)-related mortality can be reduced through screening and early detection. The aim of any CRC screening program is to detect as many adenomas/polyps in the early stage as possible and hence, adenoma detection rate (ADR) is a key quality indicator of colonoscopy. Various methods and techniques have been studied and developed over the years to improve the quality of colonoscopy and thereby increase ADR. This ranges from use of various regimens to improve bowel preparation, defining an optimum colonoscope withdrawal time for the operator, distal attachment caps, use of different wavelength of light, colonoscope with increased degree of view to the use of modern-day artificial intelligence to improve ADR. Of all the various measures, use of distal attachment device seems an easy, cheap and readily usable technique to increase real-time ADR. A variety of such devices have been evaluated over time starting from simple transparent caps, EndoRings, Endocuff to Endocuff Vision for their effectiveness. In this review, we have provided a brief description of the various available distal attachment devices and a detailed technical overview of Endocuff and its modification the Endocuff Vision.","PeriodicalId":43098,"journal":{"name":"Journal of Digestive Endoscopy","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43594125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background and Aims The training in esophageal stricture dilation is difficult to obtain and have few simulation models. The aim of the study was to evaluate a novel stricture simulation for training a wire-guided, controlled radial expansile (CRE) balloon dilation. Methods The study was a pretest–posttest design without a control group involving a novel simulation device for esophageal stricture. The training session involved 12 final year gastroenterology fellows from five different centers. The trainees received 2 hours of education sessions featuring didactic content, a live demonstration of step-by-step demonstration of wire-guided CRE balloon dilation and a study material on the procedure. The simulation device used was a single-use hose pipe along with a red color nonhardening modeling clay with a 5.0-to-8.0-mm hole in the center. Results All the trainees and instructor uniformly rated the model as excellent or good with simulation device being mild stiffer in haptics than of the real tissue. The mean (%) pretest scores of 39 (21.6%) improved significantly to 160 (88.8%) in mean (%) posttest questionnaire (p < 0.05). There was a significant improvement in the questionnaire of the dilation procedure after the simulation training episode. Conclusion The novel stricture simulation model had good performance evaluation and can be used to train CRE balloon dilation procedure.
{"title":"A Simulation Study to Investigate the Usefulness of a Novel Stricture Tool for Training Wire Guided Balloon Dilation","authors":"Avinash Bhat Balekuduru, M. Sahu","doi":"10.1055/s-0042-1751109","DOIUrl":"https://doi.org/10.1055/s-0042-1751109","url":null,"abstract":"\u0000 Background and Aims The training in esophageal stricture dilation is difficult to obtain and have few simulation models. The aim of the study was to evaluate a novel stricture simulation for training a wire-guided, controlled radial expansile (CRE) balloon dilation.\u0000 Methods The study was a pretest–posttest design without a control group involving a novel simulation device for esophageal stricture. The training session involved 12 final year gastroenterology fellows from five different centers. The trainees received 2 hours of education sessions featuring didactic content, a live demonstration of step-by-step demonstration of wire-guided CRE balloon dilation and a study material on the procedure. The simulation device used was a single-use hose pipe along with a red color nonhardening modeling clay with a 5.0-to-8.0-mm hole in the center.\u0000 Results All the trainees and instructor uniformly rated the model as excellent or good with simulation device being mild stiffer in haptics than of the real tissue. The mean (%) pretest scores of 39 (21.6%) improved significantly to 160 (88.8%) in mean (%) posttest questionnaire (p < 0.05). There was a significant improvement in the questionnaire of the dilation procedure after the simulation training episode.\u0000 Conclusion The novel stricture simulation model had good performance evaluation and can be used to train CRE balloon dilation procedure.","PeriodicalId":43098,"journal":{"name":"Journal of Digestive Endoscopy","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42945095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tuberculosis is one of the common causes of benign small bowel obstruction and endoscopic management mainly relies on serial balloon dilatation. In this report, we describe a 35 year male with refractory post-tubercular ileal stricture that was successfully treated with a lumen apposing metal stent
{"title":"Successful Resolution of Refractory Post-tubercular Ileocecal Stricture by Lumen Apposing Metal Stent","authors":"S. Rana, Rajesh Gupta","doi":"10.1055/s-0042-1747961","DOIUrl":"https://doi.org/10.1055/s-0042-1747961","url":null,"abstract":"Tuberculosis is one of the common causes of benign small bowel obstruction and endoscopic management mainly relies on serial balloon dilatation. In this report, we describe a 35 year male with refractory post-tubercular ileal stricture that was successfully treated with a lumen apposing metal stent","PeriodicalId":43098,"journal":{"name":"Journal of Digestive Endoscopy","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45738206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Pal, M. Ramchandani, P. Inavolu, D. Reddy, M. Tandan
Background Endoscopic full thickness resection (EFTR) is an emerging therapeutic option for resecting subepithelial lesions (SELs) and epithelial neoplasms. We aimed to systematically review the techniques, applications, outcomes, and complications of EFTR. Methods A systematic literature search was performed using PubMed. All relevant original research articles involving EFTR were included for the review along with case report/series describing novel/rare techniques from 2001 to February 2022. Results After screening 7,739 citations, finally 141 references were included. Non-exposed EFTR has lower probability of peritoneal contamination or tumor seeding compared with exposed EFTR. Among exposed EFTR, tunneled variety is associated with lower risk of peritoneal seeding or contamination compared with non-tunneled approach. Closure techniques involve though the scope (TTS) clips, loop and clips, over the scope clips (OTSC), full thickness resection device (FTRD), and endoscopic suturing/plicating/stapling devices. The indications of EFTR range from esophagus to rectum and include SELs arising from muscularis propria (MP), non-lifting adenoma, recurrent adenoma, and even early gastric cancer (EGC) or superficial colorectal carcinoma. Other indications include difficult locations (involving appendicular orifice or diverticulum) and full thickness biopsy for motility disorders. The main limitation of FTRD is feasibility in smaller lesions (<20–25 mm), which can be circumvented by hybrid EFTR techniques. Oncologic resection with lymphadencetomy for superficial GI malignancy can be accomplished by hybrid natural orifice transluminal endoscopic surgery (NOTES) combining EFTR and NOTES. Bleeding, perforation, appendicitis, enterocolonic fistula, FTRD malfunction, peritoneal tumor seeding, and contamination are among various adverse events. Post OTSC artifacts need to be differentiated from recurrent/residual lesions to avoid re-FTRD/surgery. Conclusion EFTR is safe and effective therapeutic option for SELs, recurrent and non-lifting adenomas, tumors in difficult locations and selected cases of superficial GI carcinoma.
{"title":"Endoscopic Full Thickness Resection: A Systematic Review","authors":"P. Pal, M. Ramchandani, P. Inavolu, D. Reddy, M. Tandan","doi":"10.1055/s-0042-1755304","DOIUrl":"https://doi.org/10.1055/s-0042-1755304","url":null,"abstract":"\u0000 Background Endoscopic full thickness resection (EFTR) is an emerging therapeutic option for resecting subepithelial lesions (SELs) and epithelial neoplasms. We aimed to systematically review the techniques, applications, outcomes, and complications of EFTR.\u0000 Methods A systematic literature search was performed using PubMed. All relevant original research articles involving EFTR were included for the review along with case report/series describing novel/rare techniques from 2001 to February 2022.\u0000 Results After screening 7,739 citations, finally 141 references were included. Non-exposed EFTR has lower probability of peritoneal contamination or tumor seeding compared with exposed EFTR. Among exposed EFTR, tunneled variety is associated with lower risk of peritoneal seeding or contamination compared with non-tunneled approach. Closure techniques involve though the scope (TTS) clips, loop and clips, over the scope clips (OTSC), full thickness resection device (FTRD), and endoscopic suturing/plicating/stapling devices. The indications of EFTR range from esophagus to rectum and include SELs arising from muscularis propria (MP), non-lifting adenoma, recurrent adenoma, and even early gastric cancer (EGC) or superficial colorectal carcinoma. Other indications include difficult locations (involving appendicular orifice or diverticulum) and full thickness biopsy for motility disorders. The main limitation of FTRD is feasibility in smaller lesions (<20–25 mm), which can be circumvented by hybrid EFTR techniques. Oncologic resection with lymphadencetomy for superficial GI malignancy can be accomplished by hybrid natural orifice transluminal endoscopic surgery (NOTES) combining EFTR and NOTES. Bleeding, perforation, appendicitis, enterocolonic fistula, FTRD malfunction, peritoneal tumor seeding, and contamination are among various adverse events. Post OTSC artifacts need to be differentiated from recurrent/residual lesions to avoid re-FTRD/surgery.\u0000 Conclusion EFTR is safe and effective therapeutic option for SELs, recurrent and non-lifting adenomas, tumors in difficult locations and selected cases of superficial GI carcinoma.","PeriodicalId":43098,"journal":{"name":"Journal of Digestive Endoscopy","volume":"1 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41594088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
V. Dixit, M. Sahu, V. Venkatesh, V. Bhargav, Vinod Kumar, Mayank Bhushan Pateriya, J. Venkataraman
Many gastrointestinal (GI) disorders present to the emergency room with acute clinical presentations, some even life threatening. Common emergencies encountered that require urgent endoscopic interventions include GI hemorrhage (variceal and nonvariceal), foreign body ingestion, obstructive jaundice, postprocedure-related complications such as postpolypectomy bleed or perforation, etc. A major advantage of emergency endoscopy is that it is cost effective and, on many occasions, can be life-saving. The present review will highlight a practical approach on various endoscopic modalities and their use in the GI emergencies.
{"title":"Gastrointestinal Emergencies and the Role of Endoscopy","authors":"V. Dixit, M. Sahu, V. Venkatesh, V. Bhargav, Vinod Kumar, Mayank Bhushan Pateriya, J. Venkataraman","doi":"10.1055/s-0042-1755303","DOIUrl":"https://doi.org/10.1055/s-0042-1755303","url":null,"abstract":"Many gastrointestinal (GI) disorders present to the emergency room with acute clinical presentations, some even life threatening. Common emergencies encountered that require urgent endoscopic interventions include GI hemorrhage (variceal and nonvariceal), foreign body ingestion, obstructive jaundice, postprocedure-related complications such as postpolypectomy bleed or perforation, etc. A major advantage of emergency endoscopy is that it is cost effective and, on many occasions, can be life-saving. The present review will highlight a practical approach on various endoscopic modalities and their use in the GI emergencies.","PeriodicalId":43098,"journal":{"name":"Journal of Digestive Endoscopy","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46288005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hamidreza Goudarzi, Jacob R. Obney, Mahsa Hemmatizadeh, Taha Anbara
Introduction Endoscopic treatments have become popular by providing the best solution for healing complications while allowing oral nutrition. In this study, we aim to evaluate outcomes of the endoscopic-covered stents for staple line complications following bariatric surgery. Methods A prospective evaluation was performed for all patients treated for staple line complications after bariatric surgery. Bariatric patients with acute leaks, chronic gastrocutaneous fistulas, and anastomotic strictures refractory to endoscopic dilation after sleeve gastrectomy were included in this survey. Results From January 2019 to June 2020, 41 patients (12 with acute leaks, 16 with chronic fistulas, and 13 with strictures) were treated with endoscopic silicone-covered stents (polyester or nitinol). The mean follow-up was 3.5 months. Immediate symptomatic improvement occurred in 95.2% (91.7% of acute leaks, 81.2% of fistulas, and 92.3% of strictures). In addition, 87.8% of patients initiated oral feeding immediately after stenting. There was no mortality case in this population. Conclusion Although stent migration rarely occurs in subjects, the endoscopic silicone-covered stents strategy is one of the best treatments for anastomotic complications after bariatric surgery, providing rapid healing while simultaneously allowing for oral nutrition.
{"title":"Endoscopic Self-Expanding Metallic Stent Placement in the Management of Post Laparoscopic Sleeve Gastrectomy Complications","authors":"Hamidreza Goudarzi, Jacob R. Obney, Mahsa Hemmatizadeh, Taha Anbara","doi":"10.1055/s-0042-1754333","DOIUrl":"https://doi.org/10.1055/s-0042-1754333","url":null,"abstract":"\u0000 Introduction Endoscopic treatments have become popular by providing the best solution for healing complications while allowing oral nutrition. In this study, we aim to evaluate outcomes of the endoscopic-covered stents for staple line complications following bariatric surgery.\u0000 Methods A prospective evaluation was performed for all patients treated for staple line complications after bariatric surgery. Bariatric patients with acute leaks, chronic gastrocutaneous fistulas, and anastomotic strictures refractory to endoscopic dilation after sleeve gastrectomy were included in this survey.\u0000 Results From January 2019 to June 2020, 41 patients (12 with acute leaks, 16 with chronic fistulas, and 13 with strictures) were treated with endoscopic silicone-covered stents (polyester or nitinol). The mean follow-up was 3.5 months. Immediate symptomatic improvement occurred in 95.2% (91.7% of acute leaks, 81.2% of fistulas, and 92.3% of strictures). In addition, 87.8% of patients initiated oral feeding immediately after stenting. There was no mortality case in this population.\u0000 Conclusion Although stent migration rarely occurs in subjects, the endoscopic silicone-covered stents strategy is one of the best treatments for anastomotic complications after bariatric surgery, providing rapid healing while simultaneously allowing for oral nutrition.","PeriodicalId":43098,"journal":{"name":"Journal of Digestive Endoscopy","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44867802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：