Parents and pediatric patients with ulcerative colitis (UC) who progressed to systemic immunotherapy are concerned about lifelong risks from such treatments. There is limited knowledge about withdrawal of such agents and step‐down (SD) to enteral 5‐aminosalicylic acid (mesalamine) before transitioning to adult care.We studied nine pediatric cases with moderate to severe UC who after a median of 2.18 years of clinical remission on systemic immunotherapy stepped down to oral mesalamine treatment.Average follow‐up time from SD was 3.49 years. Five patients (55.5%) had sustained remission (without any flare noted) after SD during follow‐up. Sustained clinical remission was 88.9% (8/9) at 1 year, 87.5% (7/8) at 2 years, and 66.7% (4/6) at 3 years after SD. Out of those tested (one patient was not tested), 62.5% (5/8) had fecal calprotectin <50 μg/g. Four out of six patients examined (66.6%) had mucosal healing on post‐SD colonoscopy.We propose that SD to mesalamine can be a reasonable therapeutic consideration for pediatric patients with UC before transitioning to adult gastroenterology care. Shared decision‐making is important before such treatment changes.
{"title":"Immunotherapy withdrawal by step‐down to mesalamine in pediatric patients with ulcerative colitis","authors":"R. Szigeti, R. Kellermayer","doi":"10.1002/jpr3.12048","DOIUrl":"https://doi.org/10.1002/jpr3.12048","url":null,"abstract":"Parents and pediatric patients with ulcerative colitis (UC) who progressed to systemic immunotherapy are concerned about lifelong risks from such treatments. There is limited knowledge about withdrawal of such agents and step‐down (SD) to enteral 5‐aminosalicylic acid (mesalamine) before transitioning to adult care.We studied nine pediatric cases with moderate to severe UC who after a median of 2.18 years of clinical remission on systemic immunotherapy stepped down to oral mesalamine treatment.Average follow‐up time from SD was 3.49 years. Five patients (55.5%) had sustained remission (without any flare noted) after SD during follow‐up. Sustained clinical remission was 88.9% (8/9) at 1 year, 87.5% (7/8) at 2 years, and 66.7% (4/6) at 3 years after SD. Out of those tested (one patient was not tested), 62.5% (5/8) had fecal calprotectin <50 μg/g. Four out of six patients examined (66.6%) had mucosal healing on post‐SD colonoscopy.We propose that SD to mesalamine can be a reasonable therapeutic consideration for pediatric patients with UC before transitioning to adult gastroenterology care. Shared decision‐making is important before such treatment changes.","PeriodicalId":501015,"journal":{"name":"JPGN reports","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139806172","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}
Pub Date : 2024-02-05eCollection Date: 2024-05-01DOI: 10.1002/jpr3.12027
Rachel B Schenker, Brian Kim, George Yanni
{"title":"Letter to the editor: A response to Hildreth and Schwimmer.","authors":"Rachel B Schenker, Brian Kim, George Yanni","doi":"10.1002/jpr3.12027","DOIUrl":"10.1002/jpr3.12027","url":null,"abstract":"","PeriodicalId":501015,"journal":{"name":"JPGN reports","volume":"5 2","pages":"236-237"},"PeriodicalIF":0.0,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11093906/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140961449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Invited commentary to immunotherapy withdrawal by step‐down to mesalamine in pediatrics patients with ulcerative colitis","authors":"Daniel M. O'Connell, Jonathan Moses","doi":"10.1002/jpr3.12047","DOIUrl":"https://doi.org/10.1002/jpr3.12047","url":null,"abstract":"","PeriodicalId":501015,"journal":{"name":"JPGN reports","volume":"69 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139863233","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}
Mindy Huynh, Rodolfo Silva, Nikhil Thiruvengadam, K. Parashette
Jaundice is an important physiologic manifestation of both benign and insidious diseases. We report on the case of an 11‐year‐old male who presented with diffuse pruritis, jaundice, and later abdominal pain. Initial work‐up revealed an obstructive cholestatic pattern, warranting investigation for structural anomalies. Extensive imaging revealed a lesion on the pancreatic head, and biopsy of the lesion confirmed the diagnosis of idiopathic fibrosing pancreatitis (IFP). Temporary stenting of the common bile duct successfully treated our patient's symptomatic IFP.
{"title":"Idiopathic fibrosing pancreatitis: A rare cause of obstructive jaundice","authors":"Mindy Huynh, Rodolfo Silva, Nikhil Thiruvengadam, K. Parashette","doi":"10.1002/jpr3.12018","DOIUrl":"https://doi.org/10.1002/jpr3.12018","url":null,"abstract":"Jaundice is an important physiologic manifestation of both benign and insidious diseases. We report on the case of an 11‐year‐old male who presented with diffuse pruritis, jaundice, and later abdominal pain. Initial work‐up revealed an obstructive cholestatic pattern, warranting investigation for structural anomalies. Extensive imaging revealed a lesion on the pancreatic head, and biopsy of the lesion confirmed the diagnosis of idiopathic fibrosing pancreatitis (IFP). Temporary stenting of the common bile duct successfully treated our patient's symptomatic IFP.","PeriodicalId":501015,"journal":{"name":"JPGN reports","volume":"229 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140480830","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}
Mucosal prolapse syndrome (MPS) is a rare group of benign conditions characterized by a set of unifying histologic findings thought to be the result of repeated mucosal shearing and submucosal vascular congestion caused by straining. This set of conditions is often misdiagnosed as other polyposis syndromes, inflammatory bowel disease, or malignancy due to its clinical presentation, appearance, and rarity. We report a case of a 15‐year‐old male who presented with painless rectal bleeding. He was found to have four rectal polyps thought to be due to Peutz–Jeghers syndrome. A repeat colonoscopy with biopsies a year later revealed a diagnosis of MPS. Our case highlights the morphologic similarity between hamartomatous polyp and mucosal prolapse histology. Since MPS is a rare diagnosis even among the adult population, it has not been well described in pediatrics. This syndrome should be on the differential diagnosis for pediatric rectal polyps to prevent unnecessary invasive testing and a delay in treatment.
{"title":"Mucosal prolapse syndrome mimicking Peutz–Jeghers syndrome in a pediatric patient","authors":"Phinga Do, Claudia Phen, Michele Alkalay, Vivekanand Singh, Isabel Rojas","doi":"10.1002/jpr3.12022","DOIUrl":"https://doi.org/10.1002/jpr3.12022","url":null,"abstract":"Mucosal prolapse syndrome (MPS) is a rare group of benign conditions characterized by a set of unifying histologic findings thought to be the result of repeated mucosal shearing and submucosal vascular congestion caused by straining. This set of conditions is often misdiagnosed as other polyposis syndromes, inflammatory bowel disease, or malignancy due to its clinical presentation, appearance, and rarity. We report a case of a 15‐year‐old male who presented with painless rectal bleeding. He was found to have four rectal polyps thought to be due to Peutz–Jeghers syndrome. A repeat colonoscopy with biopsies a year later revealed a diagnosis of MPS. Our case highlights the morphologic similarity between hamartomatous polyp and mucosal prolapse histology. Since MPS is a rare diagnosis even among the adult population, it has not been well described in pediatrics. This syndrome should be on the differential diagnosis for pediatric rectal polyps to prevent unnecessary invasive testing and a delay in treatment.","PeriodicalId":501015,"journal":{"name":"JPGN reports","volume":"57 15","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140487245","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}
Ahmad Miri, Shahab Abdessalam, Andria M. Powers, Ruben E. Quiros‐Tejeira, Chinenye R Dike
Stone formation in a gallbladder remnant is a rare postcholecystectomy complication. This report describes the case of gallstones in a gallbladder remnant of an adolescent with sickle cell disease (SCD) years after laparoscopic cholecystectomy. A 15‐year‐old female with SCD presented to our gastroenterology clinic with concerns of recurrent choledocholithiasis despite cholecystectomy 2 years before presentation. About 4 months before presentation to our clinic, she was evaluated at the referring physician's emergency department for recurrent severe abdominal pain of 1 month duration. After admission to the hospital, common bile duct stones were seen on magnetic resonance cholangiopancreatography (MCRP) imaging and subsequently removed via endoscopic retrograde cholangiopancreatography (ERCP). On review of her MRCP and ERCP at our hospital, a remnant of gallbladder containing multiple stones was identified. She subsequently underwent a laparoscopic resection of the gallbladder remnant. Clinicians should consider biliary duct imaging in children with biliary colic following cholecystectomy, especially those with history of chronic hemolysis.
{"title":"Gallbladder remnant: A potential source for biliary stones postcholecystectomy; a case report in a child with sickle cell disease","authors":"Ahmad Miri, Shahab Abdessalam, Andria M. Powers, Ruben E. Quiros‐Tejeira, Chinenye R Dike","doi":"10.1002/jpr3.12039","DOIUrl":"https://doi.org/10.1002/jpr3.12039","url":null,"abstract":"Stone formation in a gallbladder remnant is a rare postcholecystectomy complication. This report describes the case of gallstones in a gallbladder remnant of an adolescent with sickle cell disease (SCD) years after laparoscopic cholecystectomy. A 15‐year‐old female with SCD presented to our gastroenterology clinic with concerns of recurrent choledocholithiasis despite cholecystectomy 2 years before presentation. About 4 months before presentation to our clinic, she was evaluated at the referring physician's emergency department for recurrent severe abdominal pain of 1 month duration. After admission to the hospital, common bile duct stones were seen on magnetic resonance cholangiopancreatography (MCRP) imaging and subsequently removed via endoscopic retrograde cholangiopancreatography (ERCP). On review of her MRCP and ERCP at our hospital, a remnant of gallbladder containing multiple stones was identified. She subsequently underwent a laparoscopic resection of the gallbladder remnant. Clinicians should consider biliary duct imaging in children with biliary colic following cholecystectomy, especially those with history of chronic hemolysis.","PeriodicalId":501015,"journal":{"name":"JPGN reports","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139596886","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}
Katia N. Estrada‐Medrano, Sergio J. Fernández‐Ortiz, Oscar Tamez-Rivera, E. Villarreal
Congenital mixed hiatal hernia is a disorder that combines features of both sliding and paraoesophageal hernias. The precise incidence of congenital mixed hiatal hernia during the pediatric and neonatal period remains uncertain, making diagnosis challenging within this age cohort. This case presents a 15‐day‐old female with an 8% postnatal weight loss and apost‐feeding vomiting. An upper gastrointestinal series, computer tomography, and upper endoscopy revealed a mixed hiatal hernia. The patient underwent a laparoscopic herniorrhaphy and Nissen fundoplication achieving successful resumption of complete oral feeding before discharge. Diagnosis and management of this condition in neonates remain challenging due to its rarity and variable clinical presentations. This report emphasizes the importance of early recognition, accurate diagnosis, and tailored management strategies in the neonatal period. Further research, with a collaborative effort between pediatricians and surgeons, is needed to refine diagnostic criteria, establish evidence‐based management approaches, and improve outcomes for affected children.
{"title":"Congenital mixed hiatal hernia: A case report of an atypical cause of neonatal vomiting","authors":"Katia N. Estrada‐Medrano, Sergio J. Fernández‐Ortiz, Oscar Tamez-Rivera, E. Villarreal","doi":"10.1002/jpr3.12042","DOIUrl":"https://doi.org/10.1002/jpr3.12042","url":null,"abstract":"Congenital mixed hiatal hernia is a disorder that combines features of both sliding and paraoesophageal hernias. The precise incidence of congenital mixed hiatal hernia during the pediatric and neonatal period remains uncertain, making diagnosis challenging within this age cohort. This case presents a 15‐day‐old female with an 8% postnatal weight loss and apost‐feeding vomiting. An upper gastrointestinal series, computer tomography, and upper endoscopy revealed a mixed hiatal hernia. The patient underwent a laparoscopic herniorrhaphy and Nissen fundoplication achieving successful resumption of complete oral feeding before discharge. Diagnosis and management of this condition in neonates remain challenging due to its rarity and variable clinical presentations. This report emphasizes the importance of early recognition, accurate diagnosis, and tailored management strategies in the neonatal period. Further research, with a collaborative effort between pediatricians and surgeons, is needed to refine diagnostic criteria, establish evidence‐based management approaches, and improve outcomes for affected children.","PeriodicalId":501015,"journal":{"name":"JPGN reports","volume":"54 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139598682","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}
Olivier Goulet, E. Payen, C. Talbotec, C. Poisson, Amélia Rocha, Karina Brion, Marie‐Bernadette Madras, Isabelle Eicher, Isabelle Martinez, Clémence Bégo, Céline Chasport, Julie Ollivier, Cécile Godot, Claude Villain, Francisca Joly, C. Lambe
Facing with an increasing demand for transition to adult care management, our home parenteral nutrition (HPN) team designed an adolescent therapeutic educational program (ATEP) specifically intended for adolescents on long‐term HPN. The aim of this study was to report on the first sessions of this program.The ATEP is designed in three sessions of five consecutive days, during school holidays over the year. It includes group sessions on catheter handling, disconnecting and connecting the PN and catheter dressing, dealing with unforeseen events (e.g., fever or catheter injury), but also sessions with psychologist, social worker, sports teacher, fashion specialist, meeting with adults who received HPN since childhood. Specific course for the accompanying parents were also provided. Six months after the last session, a 3‐day trip to the attraction park “le Futuroscope,” Poitiers, France, was organized without any parental presence.After 3 ATEP courses, a total of 16 adolescents have been enrolled. They were aged between 13 and 17 years (median 14 IQR: 14–16.25). All were on long term HPN started during the neonatal period except for four who started PN at a median age of 10 years old (IQR: 1–10). At the time of the ATEP, their median PNDI was 105% (IQR: 95.5–120.8) while receiving a median of six infusions per week (IQR: 5–7). Thirteen received Taurolidine lock procedure. After the ATEP, 11 adolescents could be considered as fully autonomous, 4 as partially autonomous and one failed to gain any autonomy. Course evaluation by adolescents or parents was good to excellent.Through the holistic and multiprofessional approach of this training and the group cohesion, the adolescents were not only able to handle catheter care and PN connections but were able to understand and accept better their illness and project themselves into their own future.
{"title":"An innovative educational program for adolescents on home parenteral nutrition for the “transition” to adulthood","authors":"Olivier Goulet, E. Payen, C. Talbotec, C. Poisson, Amélia Rocha, Karina Brion, Marie‐Bernadette Madras, Isabelle Eicher, Isabelle Martinez, Clémence Bégo, Céline Chasport, Julie Ollivier, Cécile Godot, Claude Villain, Francisca Joly, C. Lambe","doi":"10.1002/jpr3.12033","DOIUrl":"https://doi.org/10.1002/jpr3.12033","url":null,"abstract":"Facing with an increasing demand for transition to adult care management, our home parenteral nutrition (HPN) team designed an adolescent therapeutic educational program (ATEP) specifically intended for adolescents on long‐term HPN. The aim of this study was to report on the first sessions of this program.The ATEP is designed in three sessions of five consecutive days, during school holidays over the year. It includes group sessions on catheter handling, disconnecting and connecting the PN and catheter dressing, dealing with unforeseen events (e.g., fever or catheter injury), but also sessions with psychologist, social worker, sports teacher, fashion specialist, meeting with adults who received HPN since childhood. Specific course for the accompanying parents were also provided. Six months after the last session, a 3‐day trip to the attraction park “le Futuroscope,” Poitiers, France, was organized without any parental presence.After 3 ATEP courses, a total of 16 adolescents have been enrolled. They were aged between 13 and 17 years (median 14 IQR: 14–16.25). All were on long term HPN started during the neonatal period except for four who started PN at a median age of 10 years old (IQR: 1–10). At the time of the ATEP, their median PNDI was 105% (IQR: 95.5–120.8) while receiving a median of six infusions per week (IQR: 5–7). Thirteen received Taurolidine lock procedure. After the ATEP, 11 adolescents could be considered as fully autonomous, 4 as partially autonomous and one failed to gain any autonomy. Course evaluation by adolescents or parents was good to excellent.Through the holistic and multiprofessional approach of this training and the group cohesion, the adolescents were not only able to handle catheter care and PN connections but were able to understand and accept better their illness and project themselves into their own future.","PeriodicalId":501015,"journal":{"name":"JPGN reports","volume":"92 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139596631","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}
Anna Kozłowska‐Jalowska, A. Stróżyk, Andrea Horvath, H. Szajewska
Infant colic is a common functional gastrointestinal disorder that affects infants during their first months of life. The etiology of this condition remains unclear. However, some studies suggest lactase deficiency may be a contributing factor. Currently, the evidence on dietary treatment and lactase supplementation for management of infant colic is limited. We aim to systematically review evidence on the efficacy and safety of using a lactase supplementation for managing infant colic. The Cochrane Central Register of Controlled Trials (CENTRAL, the Cochrane Library), MEDLINE, and EMBASE will be searched to identify randomized controlled trials comparing oral lactase supplementation with placebo or no intervention in infants aged less than 6‐month‐old with infant colic using any recognized definition. The risk of bias will be assessed using the second version of the Cochrane Collaboration's risk‐of‐bias tool. The main outcome will be the number of responders in each group after treatment, defined as infants who experienced a decrease in daily crying as reported by the study authors. Additional outcomes will include the duration and frequency of crying episodes, infant sleep duration, parental satisfaction, discomfort of infants, number of hospital admissions, family quality of life, and adverse events during the intervention. The study findings will be published in a peer‐reviewed journal and will be submitted to relevant conferences.
婴儿肠绞痛是一种常见的功能性胃肠道疾病，多发于婴儿出生后的头几个月。其病因尚不清楚。不过，一些研究表明，乳糖酶缺乏可能是诱因之一。目前，有关通过饮食治疗和补充乳糖酶来治疗婴儿肠绞痛的证据还很有限。我们旨在系统地回顾有关使用乳糖酶补充剂治疗婴儿肠绞痛的有效性和安全性的证据。我们将检索 Cochrane 对照试验中央注册中心（Cochrane Central Register of Controlled Trials，Cochrane 图书馆）、MEDLINE 和 EMBASE，以确定随机对照试验，比较口服乳糖酶补充剂与安慰剂或无干预措施对任何公认定义的 6 个月以下婴儿肠绞痛的治疗效果。偏倚风险将使用 Cochrane 协作组织的偏倚风险工具第二版进行评估。主要结果是治疗后各组应答者的人数，即研究作者报告的每天哭闹次数减少的婴儿。其他结果将包括哭闹持续时间和频率、婴儿睡眠时间、父母满意度、婴儿不适感、入院次数、家庭生活质量以及干预期间的不良事件。研究结果将发表在同行评审期刊上，并提交给相关会议。
{"title":"Evaluating the impact of lactase supplementation on infant colic: Study protocol for a systematic review of randomized controlled trials","authors":"Anna Kozłowska‐Jalowska, A. Stróżyk, Andrea Horvath, H. Szajewska","doi":"10.1002/jpr3.12024","DOIUrl":"https://doi.org/10.1002/jpr3.12024","url":null,"abstract":"Infant colic is a common functional gastrointestinal disorder that affects infants during their first months of life. The etiology of this condition remains unclear. However, some studies suggest lactase deficiency may be a contributing factor. Currently, the evidence on dietary treatment and lactase supplementation for management of infant colic is limited. We aim to systematically review evidence on the efficacy and safety of using a lactase supplementation for managing infant colic. The Cochrane Central Register of Controlled Trials (CENTRAL, the Cochrane Library), MEDLINE, and EMBASE will be searched to identify randomized controlled trials comparing oral lactase supplementation with placebo or no intervention in infants aged less than 6‐month‐old with infant colic using any recognized definition. The risk of bias will be assessed using the second version of the Cochrane Collaboration's risk‐of‐bias tool. The main outcome will be the number of responders in each group after treatment, defined as infants who experienced a decrease in daily crying as reported by the study authors. Additional outcomes will include the duration and frequency of crying episodes, infant sleep duration, parental satisfaction, discomfort of infants, number of hospital admissions, family quality of life, and adverse events during the intervention. The study findings will be published in a peer‐reviewed journal and will be submitted to relevant conferences.","PeriodicalId":501015,"journal":{"name":"JPGN reports","volume":"105 19","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139605668","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}
Carolena Trocchia, H. Shieh, Isabella Dolan, Michael J Wilsey, C. J. Smithers
Endoscopic vacuum‐assisted therapy offers an easier and safer alternative to thoracic surgery, self‐expanding stents, or esophageal clips and has been shown to be a promising technique for management of pediatric esophageal perforations. In this report, we present a novel application of a percutaneous endoscopic gastrostomy‐assisted pull technique, wherein a preexisting gastrostomy is reaccessed to allow safe placement of the vacuum sponge with a more comfortable and effective endoscopic vacuum‐assisted closure therapy compared to transnasal or transoral options. A 7‐year‐old male with a history of type C esophageal atresia with distal tracheoesophageal fistula complicated by leak and refractory esophageal stricture, severe tracheomalacia, and prior esophageal stricture resection presented for posterior tracheoplasty and tracheopexy complicated by esophageal perforation. A preexisting gastrostomy site was re‐accessed to allow for a novel approach for endoluminal sponge placement in endoscopic vacuum‐assisted closure (EVAC) therapy by gastrostomy‐assisted pull technique. The patient had appropriate healing without further leak 1 month after repair. This case highlights the use of EVAC as a minimally invasive option for repair of esophageal perforation using a pull‐through method at the percutaneous endoscopic gastrostomy tube site as gastric access. This method may improve control of placement and reduce sponge migration, reduce intraluminal distance of sponge placement, and reduce morbidity by avoiding thoracotomy.
内窥镜真空辅助疗法为胸腔手术、自膨胀支架或食管夹提供了更简便、更安全的替代方法，已被证明是治疗小儿食管穿孔的一种很有前途的技术。在本报告中，我们介绍了经皮内镜胃造口术辅助牵拉技术的一种新应用，与经鼻或经口的方法相比，这种方法是将原有的胃造口术重新接入，以便安全地放置真空海绵，并采用更舒适、更有效的内镜真空辅助闭合疗法。一名 7 岁男性患者曾患有 C 型食管闭锁，伴有远端气管食管瘘，并发有渗漏和难治性食管狭窄、严重气管瘘，之前曾进行过食管狭窄切除术，因食管穿孔并发后气管成形术和气管成形术。为了在内窥镜真空辅助闭合（EVAC）疗法中采用新型方法放置腔内海绵体，患者重新进入了之前存在的胃造口部位，采用了胃造口辅助牵拉技术。患者在修复 1 个月后伤口愈合良好，没有再出现渗漏。本病例强调了使用 EVAC 作为修复食管穿孔的微创选择，在经皮内镜胃造瘘管部位使用牵拉法作为胃通路。这种方法可以改善对海绵置入的控制，减少海绵移位，缩短海绵置入的腔内距离，并通过避免开胸手术降低发病率。
{"title":"Pulling instead of pushing: A case report of gastrostomy‐assisted pull technique as an alternative method for endoluminal sponge placement in EVAC therapy","authors":"Carolena Trocchia, H. Shieh, Isabella Dolan, Michael J Wilsey, C. J. Smithers","doi":"10.1002/jpr3.12040","DOIUrl":"https://doi.org/10.1002/jpr3.12040","url":null,"abstract":"Endoscopic vacuum‐assisted therapy offers an easier and safer alternative to thoracic surgery, self‐expanding stents, or esophageal clips and has been shown to be a promising technique for management of pediatric esophageal perforations. In this report, we present a novel application of a percutaneous endoscopic gastrostomy‐assisted pull technique, wherein a preexisting gastrostomy is reaccessed to allow safe placement of the vacuum sponge with a more comfortable and effective endoscopic vacuum‐assisted closure therapy compared to transnasal or transoral options. A 7‐year‐old male with a history of type C esophageal atresia with distal tracheoesophageal fistula complicated by leak and refractory esophageal stricture, severe tracheomalacia, and prior esophageal stricture resection presented for posterior tracheoplasty and tracheopexy complicated by esophageal perforation. A preexisting gastrostomy site was re‐accessed to allow for a novel approach for endoluminal sponge placement in endoscopic vacuum‐assisted closure (EVAC) therapy by gastrostomy‐assisted pull technique. The patient had appropriate healing without further leak 1 month after repair. This case highlights the use of EVAC as a minimally invasive option for repair of esophageal perforation using a pull‐through method at the percutaneous endoscopic gastrostomy tube site as gastric access. This method may improve control of placement and reduce sponge migration, reduce intraluminal distance of sponge placement, and reduce morbidity by avoiding thoracotomy.","PeriodicalId":501015,"journal":{"name":"JPGN reports","volume":"7 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139525871","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}
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