Kentaro Matsuo, Shinya Urakawa, Matthew Symer, Art Sedrakyan, Bradley Pua, Jeffrey Milsom
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The median age of participants was 67.5 years (range 42-81); two-thirds were women; and median American Society of Anesthesiology class was 3.</p><p><strong>Interventions: </strong>All participants underwent one of three novel access methods, followed by wire-guided balloon dilation of a narrowed area of small bowel. These methods combined endoscopic, fluoroscopic, and surgical techniques. The techniques were (1) a purely endoscopic approach aided by an over-the-scope double-balloon device, (2) a combined endoscopic and percutaneous approach, and (3) a cut-down approach.</p><p><strong>Main outcome measures: </strong>Procedural success (defined as successful access to the small bowel and successful balloon dilation of the stenotic area). Secondary outcomes included major complications, recurrence, length of stay, and procedure time.</p><p><strong>Results: </strong>Procedural success was achieved in 10 of 12 patients (83%). At the time of median follow-up of 10 months, recurrence of SBO was observed in two patients. In only one patient, the novel method did not change the treatment plan. No major complications occurred. Conventional operative intervention was avoided in all patients who achieved technical success with one of the novel approaches. The median postprocedure length of hospital stay was 4 days. Median procedure time was 135 min.</p><p><strong>Conclusions: </strong>Novel minimally invasive approaches to SBO represent feasible alternatives to surgical procedures in select patients. Further study should compare these approaches to standard ones as new methods are refined.</p>","PeriodicalId":33349,"journal":{"name":"BMJ Surgery Interventions Health Technologies","volume":"5 1","pages":"e000150"},"PeriodicalIF":2.1000,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/cd/91/bmjsit-2022-000150.PMC10201263.pdf","citationCount":"1","resultStr":"{\"title\":\"Iterative evaluation of novel access techniques for small bowel obstruction: combining image guided, percutaneous, and endoscopic methods.\",\"authors\":\"Kentaro Matsuo, Shinya Urakawa, Matthew Symer, Art Sedrakyan, Bradley Pua, Jeffrey Milsom\",\"doi\":\"10.1136/bmjsit-2022-000150\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To avoid the need for extensive adhesiolysis in patients with small bowel obstruction (SBO). We evaluated the feasibility of using advanced imaging, percutaneous access, and endoscopy as alternative therapies for SBO.</p><p><strong>Design: </strong>Retrospective case series (IDEAL [Idea, Development, Exploration, Assessment, and Long-term Study Collaborative] stages 1 and 2a).</p><p><strong>Setting: </strong>Single tertiary referral center.</p><p><strong>Participants: </strong>Twelve adults with chronic SBO resulting from inflammatory bowel disease, disseminated cancer, radiation, and/or adhesive disease. Participants were included if they underwent one of three novel access procedures. There were no exclusion criteria. The median age of participants was 67.5 years (range 42-81); two-thirds were women; and median American Society of Anesthesiology class was 3.</p><p><strong>Interventions: </strong>All participants underwent one of three novel access methods, followed by wire-guided balloon dilation of a narrowed area of small bowel. These methods combined endoscopic, fluoroscopic, and surgical techniques. The techniques were (1) a purely endoscopic approach aided by an over-the-scope double-balloon device, (2) a combined endoscopic and percutaneous approach, and (3) a cut-down approach.</p><p><strong>Main outcome measures: </strong>Procedural success (defined as successful access to the small bowel and successful balloon dilation of the stenotic area). Secondary outcomes included major complications, recurrence, length of stay, and procedure time.</p><p><strong>Results: </strong>Procedural success was achieved in 10 of 12 patients (83%). At the time of median follow-up of 10 months, recurrence of SBO was observed in two patients. In only one patient, the novel method did not change the treatment plan. No major complications occurred. Conventional operative intervention was avoided in all patients who achieved technical success with one of the novel approaches. 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引用次数: 1
摘要
目的:避免小肠梗阻(SBO)患者进行广泛粘连松解术。我们评估了先进成像、经皮穿刺和内窥镜作为SBO替代疗法的可行性。设计:回顾性案例系列(IDEAL [Idea, Development, Exploration, Assessment, and Long-term Study Collaborative]阶段1和2a)。环境:单一三级转诊中心。参与者:12名由炎症性肠病、播散性癌症、放射和/或粘连性疾病引起的慢性SBO成人。如果参与者接受了三种新的访问程序中的一种,他们就被包括在内。没有排除标准。参与者的中位年龄为67.5岁(42-81岁);三分之二是女性;美国麻醉学学会的中位数为3。干预措施:所有的参与者都接受了三种新颖的进入方法中的一种,然后是钢丝引导的气球扩张狭窄的小肠区域。这些方法结合了内窥镜、透视和外科技术。这些技术包括:(1)在镜外双气囊装置辅助下的纯内窥镜入路,(2)内窥镜和经皮联合入路,以及(3)切口入路。主要观察指标:手术成功(定义为成功进入小肠和成功扩张狭窄区域)。次要结果包括主要并发症、复发、住院时间和手术时间。结果:12例患者中10例(83%)手术成功。中位随访10个月时,2例患者出现SBO复发。只有一个病人,新方法没有改变治疗计划。无重大并发症发生。所有采用新方法取得技术成功的患者均避免了常规手术干预。术后住院时间中位数为4天。中位手术时间为135分钟。结论:新型微创入路治疗SBO在特定患者中是外科手术的可行选择。随着新方法的完善,进一步的研究应该将这些方法与标准方法进行比较。
Iterative evaluation of novel access techniques for small bowel obstruction: combining image guided, percutaneous, and endoscopic methods.
Objective: To avoid the need for extensive adhesiolysis in patients with small bowel obstruction (SBO). We evaluated the feasibility of using advanced imaging, percutaneous access, and endoscopy as alternative therapies for SBO.
Design: Retrospective case series (IDEAL [Idea, Development, Exploration, Assessment, and Long-term Study Collaborative] stages 1 and 2a).
Setting: Single tertiary referral center.
Participants: Twelve adults with chronic SBO resulting from inflammatory bowel disease, disseminated cancer, radiation, and/or adhesive disease. Participants were included if they underwent one of three novel access procedures. There were no exclusion criteria. The median age of participants was 67.5 years (range 42-81); two-thirds were women; and median American Society of Anesthesiology class was 3.
Interventions: All participants underwent one of three novel access methods, followed by wire-guided balloon dilation of a narrowed area of small bowel. These methods combined endoscopic, fluoroscopic, and surgical techniques. The techniques were (1) a purely endoscopic approach aided by an over-the-scope double-balloon device, (2) a combined endoscopic and percutaneous approach, and (3) a cut-down approach.
Main outcome measures: Procedural success (defined as successful access to the small bowel and successful balloon dilation of the stenotic area). Secondary outcomes included major complications, recurrence, length of stay, and procedure time.
Results: Procedural success was achieved in 10 of 12 patients (83%). At the time of median follow-up of 10 months, recurrence of SBO was observed in two patients. In only one patient, the novel method did not change the treatment plan. No major complications occurred. Conventional operative intervention was avoided in all patients who achieved technical success with one of the novel approaches. The median postprocedure length of hospital stay was 4 days. Median procedure time was 135 min.
Conclusions: Novel minimally invasive approaches to SBO represent feasible alternatives to surgical procedures in select patients. Further study should compare these approaches to standard ones as new methods are refined.