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Tawheed A, Ismail A, El-Tawansy A, Maurice K, Ali A, El-Fouly A, Madkour A. Third space endoscopy pulmonary complications and chylothorax post peroral endoscopic myotomy. World J Methodol 2025; 15. [DOI: 10.5662/wjm.v15.i3.102703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2024] [Revised: 01/17/2025] [Accepted: 01/23/2025] [Indexed: 03/06/2025] Open
Abstract
Third-space endoscopy (TSE) has emerged as an effective treatment modality for various gastrointestinal motility diseases and gastrointestinal tumors. TSE is based on the concept of working in the submucosa using a mucosal flap valve technique, which is the underlying premise for all TSE procedures; thus, some complications are shared across the spectrum of TSE procedures. Despite the high safety profiles of most TSE procedures, studies have reported various adverse events, including insufflation-related complications, bleeding, perforation, and infection. Although the occurrence rate of those complications is not very high, they sometimes result in critical conditions. No reports of chylous effusion following TSE procedures, particularly per-oral endoscopic myotomy, have been documented previously. We are presenting the first reported case of chylous pleural effusion after per-oral endoscopic myotomy. Additionally, we aim to present a comprehensive overview, discuss the existing data, and provide insights into pulmonary post-endoscopic complications in light of recent advancements in endoscopic procedures, especially TSE.
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Affiliation(s)
- Ahmed Tawheed
- Department of Endemic Medicine, Faculty of Medicine, Helwan University, Cairo 11795, Egypt
| | - Alaa Ismail
- Faculty of Medicine, Helwan University, Cairo 11795, Egypt
| | - Ahmed El-Tawansy
- Department of Anesthesia and Surgical Intensive Care, Helwan University, Cairo 11795, Egypt
| | - Karim Maurice
- Department of General and Laparoscopic Surgery, Cairo University, Cairo 12613, Egypt
| | - Ahmed Ali
- Department of Gastroenterology, Mansoura International Hospital, Al Mansurah 35516, Ad Daqahlīyah, Egypt
| | - Amr El-Fouly
- Department of Endemic Medicine, Faculty of Medicine, Helwan University, Cairo 11795, Egypt
| | - Ahmad Madkour
- Department of Endemic Medicine, Faculty of Medicine, Helwan University, Cairo 11795, Egypt
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2
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Mega PF, de Moura EGH, Bestetti AM, Ramai D, Kumar A, Hajjar LA, Thompson CC, de Moura DTH. Endoscopic vacuum therapy for the management of nonvariceal upper gastrointestinal bleeding: a valuable resource for the endoscopist's toolbox. Endoscopy 2025. [PMID: 39983768 DOI: 10.1055/a-2544-6448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2025]
Abstract
Endoscopic vacuum therapy (EVT) is a well-established method for managing gastrointestinal perforations. During the COVID pandemic, case reports demonstrated the effective use of EVT in controlling COVID-related diffuse duodenal bleeding. Owing to its unique mechanism of action, this approach may also be effective for other types of nonvariceal upper gastrointestinal bleeding (NVUGIB). This study aimed to assess EVT in the treatment of NVUGIB.This retrospective analysis of a prospectively collected database included patients who underwent EVT for the treatment of NVUGIB. The primary outcome was clinical success. Secondary outcomes included technical success and safety. Subgroup analysis comparing the outcomes for patients with and without COVID was conducted.19 patients underwent EVT for NVUGIB, with 57.9% having failed other therapies. Technical success occurred in all patients, and clinical success was achieved in 89.5%. There was no difference in the clinical success rates between patients with or without COVID (88% versus 91%, respectively). No procedure-related adverse events occurred. EVT appears to be safe and effective in the management of NVUGIB. This approach could be particularly useful in refractory or diffuse bleeding. Larger studies are warranted to validate these findings.
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Affiliation(s)
- Paulo Ferreira Mega
- Gastrointestinal Endoscopy Unit, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Eduardo Guimarães Hourneaux de Moura
- Gastrointestinal Endoscopy Unit, Department of Gastroenterology, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
- Gastrointestinal Endoscopy Division, Instituto D'Or de Pesquisa e Ensino, Hospital Vila Nova Star, Sao Paulo, Brazil
| | - Alexandre Moraes Bestetti
- Gastrointestinal Endoscopy Unit, Department of Gastroenterology, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
- Gastrointestinal Endoscopy Division, Instituto D'Or de Pesquisa e Ensino, Hospital Vila Nova Star, Sao Paulo, Brazil
| | - Daryl Ramai
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, United States
| | - Atul Kumar
- Piedmont Physicians Gastroenterology, Piedmont Healthcare Inc, Atlanta, United States
| | - Ludhmila Abrahão Hajjar
- Gastrointestinal Endoscopy Division, Instituto D'Or de Pesquisa e Ensino, Hospital Vila Nova Star, Sao Paulo, Brazil
- Department of Clinical Emergencies and Intensive Care, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Christopher C Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, United States
| | - Diogo Turiani Hourneaux de Moura
- Gastrointestinal Endoscopy Unit, Department of Gastroenterology, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
- Gastrointestinal Endoscopy Division, Instituto D'Or de Pesquisa e Ensino, Hospital Vila Nova Star, Sao Paulo, Brazil
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3
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Beunon C, Debourdeau A, Schaefer M, Wallenhorst T, Perez-Cuadrado-Robles E, Belle A, Gonzalez JM, Camus Duboc M, Caillol F, Toudic HP, Pioche M, Danset JB, Sportes A, Brieau B, Ben Soussan E, Petiet M, Martin A, Oumrani S, Maire F, Lemmers A, Prat F, Caillo L, Gérard R, Albouys J, Lorenzo D. Technical failure of endoscopic ultrasound-guided choledochoduodenostomy: multicenter study on rescue techniques, consequences, and risk factors. Endoscopy 2025. [PMID: 39961367 DOI: 10.1055/a-2541-2973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2025]
Abstract
BACKGROUND We aimed to determine risk factors for technical failure of endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS), evaluate short- and long-term consequences, and identify salvage techniques in patients with biliary obstruction. METHODS This retrospective multicenter study of EUS-CDS (2018-2024) included technical failure, classified as type 1 (digestive flange mispositioned), type 2 (biliary flange mispositioned), type 3 (stent deployment failure), type 4 (catheter/lumen-apposing metal stent [LAMS] through the bile duct), and type 5 (others). Controls were successful EUS-CDS in the same center and period. The primary end point was risk factors for failure. Secondary end points were endoscopic rescue techniques and immediate- and long-term consequences. RESULTS Technical failure occurred in 7 % (95 %CI 5-9). Across 23 centers, 296 patients were analyzed (mean age 71 [SD 16] years, 53 % male), including 100 technical failures: type 1 (26 %), type 2 (41 %), type 3 (11 %), type 4 (6 %), type 5 (16 %). Risk factors for technical failure in multivariate analysis included CBD diameter ≤ 15 mm, duodenal stenosis, wired technique, and low operator experience (≤ 10 LAMS). Endoscopic salvage was successful in 77 %, with 53 % using a covered metal stent and 22 % using a new LAMS. Early failures were mild in 56 % of cases, but 12 % resulted in death within 30 days. Immediate endoscopic salvage reduced severe clinical adverse events (P < 0.001) and increased success rates (P < 0.001). CONCLUSIONS EUS-CDS failures were not rare and were severe in half of cases. Recognizing risk factors, identifying failures during the procedure, and knowing endoscopic salvage methods are crucial.
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Affiliation(s)
- Clara Beunon
- Department of Digestive Endoscopy, Université Paris Cité, Beaujon University Hospital (APHP), Clichy, France
- Department of Pancreatology and Digestive Oncology, Université Paris Cité, Beaujon University Hospital (APHP), CRMR PaRaDis Pancreatic Rare Diseases, Clichy, France
| | - Antoine Debourdeau
- Gastroenterology Unit, CHU de Nîmes, CHU de Montpellier, Montpellier University MUSE, Montpellier, France
| | - Marion Schaefer
- Hepato-Gastroenterology Department, Nancy Regional University Hospital Center, Nancy, France
| | | | | | - Arthur Belle
- Department of Gastroenterology, Université Paris Cité, Cochin University Hospital (APHP), Paris, France
| | - Jean-Michel Gonzalez
- Department of Gastroenterology, Université Aix Marseille, Hôpital Nord (APHM), Marseille, France
| | - Marine Camus Duboc
- Department of Endoscopy, Université Sorbonne, Saint Antoine University Hospital (APHP), Paris, France
| | - Fabrice Caillol
- Department of Gastroenterology, Institut Paoli Calmettes, Marseille, France
| | | | - Mathieu Pioche
- Gastroenterology Unit, Hôpital Edouard Herriot, Lyon, France
| | | | - Adrien Sportes
- Gastroenterology Unit, Institut Arnault Tzanck, Saint Laurent du Var, France
| | - Bertrand Brieau
- Gastroenterology Unit, Clinique Jules Vernes, Nantes, France
| | | | - Mathilde Petiet
- Gastroenterology Unit, Grand Hôpital de l'Est Francilien, Meaux, France
| | - Antoine Martin
- Gastroenterology Unit, CHU Hôpital Bicêtre (APHP), Kremlin-Bicêtre, France
| | | | - Frédérique Maire
- Department of Pancreatology and Digestive Oncology, Université Paris Cité, Beaujon University Hospital (APHP), CRMR PaRaDis Pancreatic Rare Diseases, Clichy, France
| | - Arnaud Lemmers
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, HUB (Hôpital Universitaire de Bruxelles), ULB (Université Libre de Bruxelles), Brussels, Belgium
| | - Frédéric Prat
- Department of Digestive Endoscopy, Université Paris Cité, Beaujon University Hospital (APHP), Clichy, France
| | - Ludovic Caillo
- Gastroenterology Unit, CHU de Nîmes, Montpellier Univ, MUSE, France
| | - Romain Gérard
- Gastroenterology and Endoscopy Unit, CHU Lille, Lille, France
| | - Jérémie Albouys
- Gastroenterology and Endoscopy Unit, CHU Limoges, Limoges, France
| | - Diane Lorenzo
- Department of Digestive Endoscopy, Université Paris Cité, Beaujon University Hospital (APHP), Clichy, France
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Fritzsche JA, Fockens P, Besselink MG, Busch OR, Daams F, Wielenga MCB, Wilmink JW, Voermans RP, Van Wanrooij RLJ. Optimizing EUS-guided choledochoduodenostomy with lumen-apposing metal stents for primary drainage of malignant distal biliary obstruction (SCORPION-IIp): a prospective pilot study. Gastrointest Endosc 2025; 101:1009-1016. [PMID: 39424003 DOI: 10.1016/j.gie.2024.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 06/27/2024] [Accepted: 10/10/2024] [Indexed: 10/21/2024]
Abstract
BACKGROUND AND AIMS Biliary drainage by ERCP in patients with malignant distal bile duct obstruction (MBO) is frequently associated with adverse events, such as pancreatitis, hampering patient outcomes. EUS-guided choledochoduodenostomy (EUS-CDS) with a lumen-apposing metal stent (LAMS) is a promising alternative in patients with MBO but is associated with a worrisome risk of stent dysfunction. Placement of a fully covered self-expandable metal stent (FCSEMS) through the LAMS, thereby changing the axis of biliary drainage toward the descending duodenum, may decrease the risk of stent dysfunction while maintaining high technical success and low adverse event rates. METHODS This was a prospective single-center pilot study in patients with pathology-confirmed MBO without gastric outlet obstruction. The primary outcome was stent dysfunction, defined as recurrent jaundice after initial clinical success, ongoing jaundice in combination with persistent bile duct dilatation, or cholangitis. RESULTS Overall, 27 consecutive patients eligible for EUS-CDS were enrolled. The placement of a LAMS was successful in 24 of 27 patients (89%), and placement of a FCSEMS through the LAMS was successful in 20 of 24 (83%); in the remaining 4 patients, a coaxial double-pigtail plastic stent was placed. Two of these 20 patients experienced persistent jaundice requiring stent revision (10%), leading to a clinical success rate of 90%. No patients developed stent dysfunction after initial clinical success. CONCLUSIONS This study showed a stent dysfunction rate of 10% after technically successful EUS-CDS with placement of a FCSEMS through the LAMS. Improving the design of LAMSs may further reduce the rate of stent dysfunction. (Clinical trial registration number: NCT05595122.).
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Affiliation(s)
- Jeska A Fritzsche
- Department of Gastroenterology and Hepatology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands; Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Paul Fockens
- Department of Gastroenterology and Hepatology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands; Cancer Center Amsterdam, Amsterdam, The Netherlands; Department of Gastroenterology and Hepatology, Amsterdam UMC, location Vrije Universiteit, Amsterdam, The Netherlands
| | - Marc G Besselink
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands; Cancer Center Amsterdam, Amsterdam, The Netherlands; Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Olivier R Busch
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands; Cancer Center Amsterdam, Amsterdam, The Netherlands; Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Freek Daams
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands; Cancer Center Amsterdam, Amsterdam, The Netherlands; Department of Surgery, Amsterdam UMC, location Vrije Universiteit, Amsterdam, The Netherlands
| | - Mattheus C B Wielenga
- Department of Gastroenterology and Hepatology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands; Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Johanna W Wilmink
- Cancer Center Amsterdam, Amsterdam, The Netherlands; Department of Medical Oncology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Rogier P Voermans
- Department of Gastroenterology and Hepatology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands; Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Roy L J Van Wanrooij
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands; Cancer Center Amsterdam, Amsterdam, The Netherlands; Department of Gastroenterology and Hepatology, Amsterdam UMC, location Vrije Universiteit, Amsterdam, The Netherlands
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5
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Jaccard M, Marx M, Romailler E, Dalex M, Phillipart M, Caillol F, Mantziari S, Godat S. Gastric peroral endoscopic myotomy improves chronic diarrhea in patients with refractory gastroparesis. Ann Gastroenterol 2025; 38:255-261. [PMID: 40371201 PMCID: PMC12070340 DOI: 10.20524/aog.2025.0956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2024] [Accepted: 02/26/2025] [Indexed: 05/16/2025] Open
Abstract
Background The main symptoms of gastroparesis are early satiety, nausea, vomiting and bloating. In our daily practice, we observed some patients presenting with concomitant chronic alteration of stool frequency. The present study describes retrospectively the impact of gastric peroral endoscopic myotomy (G-POEM) on patients presenting refractory gastroparesis and concomitant chronic diarrhea or constipation. Methods This retrospective study analyzed the clinical course of patients with refractory gastroparesis and concomitant chronic alteration of stool frequency who were consecutively treated with G-POEM between January 2019 and October 2023 in a tertiary referral center. Results Of 107 patients with refractory gastroparesis treated by G-POEM, 11 (10.3%) patients (mean age 60.4±16.2 years, 64% female) had altered bowel frequency for >6 months without any other underlying disease (diarrhea n=10; constipation n=1). Scintigraphy confirmed delayed gastric emptying in 10/11 (91%) of cases. G-POEM was technically feasible in all patients without adverse events during or after endoscopic treatment. The median follow-up period was 170 days (interquartile range [IQR] 33-1002). In 9/11 (81%) patients, G-POEM achieved clinical success with a mean gastroparesis cardinal symptom index (GCSI) of 3.1 (interquartile range [IQR] 2.7-3.4) before, and 0.9 (IQR 0.7-1.7) after the endoscopic treatment. Normalization of bowel movements after G-POEM was observed in 9/11 (81%) of patients. Two patients had partial symptom improvement (loose bowels, but normal frequency), 1 of them without improvement of GCSI and persistent delayed emptying on scintigraphy. Conclusion Gastroparesis may present with concomitant chronic diarrhea that improves after endoscopic treatment by G-POEM.
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Affiliation(s)
- Maxime Jaccard
- Department of Gastroenterology and Hepatology, CHUV, Lausanne, Switzerland (Maxime Jaccard, Mariola Marx, Elodie Romailler, Meddy Dalex, Marie Phillipart, Sébastien Godat)
| | - Mariola Marx
- Department of Gastroenterology and Hepatology, CHUV, Lausanne, Switzerland (Maxime Jaccard, Mariola Marx, Elodie Romailler, Meddy Dalex, Marie Phillipart, Sébastien Godat)
| | - Elodie Romailler
- Department of Gastroenterology and Hepatology, CHUV, Lausanne, Switzerland (Maxime Jaccard, Mariola Marx, Elodie Romailler, Meddy Dalex, Marie Phillipart, Sébastien Godat)
| | - Meddy Dalex
- Department of Gastroenterology and Hepatology, CHUV, Lausanne, Switzerland (Maxime Jaccard, Mariola Marx, Elodie Romailler, Meddy Dalex, Marie Phillipart, Sébastien Godat)
| | - Marie Phillipart
- Department of Gastroenterology and Hepatology, CHUV, Lausanne, Switzerland (Maxime Jaccard, Mariola Marx, Elodie Romailler, Meddy Dalex, Marie Phillipart, Sébastien Godat)
| | - Fabrice Caillol
- Department of Gastroenterology, Paoli-Calmettes Institute, Marseille, France (Fabrice Caillol)
| | - Styliani Mantziari
- Department of Visceral Surgery, CHUV, Lausanne, Switzerland (Styliani Mantziari)
| | - Sébastien Godat
- Department of Gastroenterology and Hepatology, CHUV, Lausanne, Switzerland (Maxime Jaccard, Mariola Marx, Elodie Romailler, Meddy Dalex, Marie Phillipart, Sébastien Godat)
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6
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Santopaolo F, Giuli L, Tripodi G, Pallozzi M, Ponziani FR, Annicchiarico BE, Rizzatti G, Contegiacomo A, Posa A, Iezzi R, Talerico R, Gasbarrini A, Larghi A. Prognostic Role of Endoscopic Ultrasound Guided Direct Portal Pressure Gradient Measurement in Porto-Sinusoidal Vascular Disorder. Liver Int 2025; 45:e70096. [PMID: 40251984 PMCID: PMC12008820 DOI: 10.1111/liv.70096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2024] [Revised: 03/10/2025] [Accepted: 04/03/2025] [Indexed: 04/21/2025]
Abstract
BACKGROUND & AIMS HVPG is the gold standard for the diagnosis of clinically significant portal hypertension (CSPH), a condition associated with the risk of developing hepatic decompensation events. However, HVPG is an indirect method to measure portal pressure, and its application in the pre-sinusoidal form of portal hypertension (PH), as in porto-sinusoidal vascular disorder (PSVD), is hindered by low accuracy. Recently, endoscopic ultrasound-guided portal pressure gradient (EUS-PPG) measurement, which allows direct measurement of portal pressure, is emerging as a safe method and may overcome the limitation of HVPG. However, data in patients with CSPH and the pre-sinusoidal form of PH are still missing. This study aims to evaluate the safety and usefulness of EUS-PPG compared to HVPG in a cohort of patients with PSVD and CSPH. METHODS In this prospective single center study, patients with a diagnosis of PSVD who presented a clinical suspicion of CSPH underwent HVPG and EUS-PPG baseline measurements. A second EUS-PPG measurement was performed in patients naïve to non-selective beta-blockers (NSBBs) to evaluate haemodynamic response to therapy. RESULTS Twenty-six patients were enrolled and a total of 26 HVPG and 35 EUS-PPG measurements were performed, without any adverse events. Mean EUS-PPG was significantly higher than mean HVPG value (16.7 ± 5.5 mmHg versus 5.5 ± 2.8 mmHg). At logistic multivariate regression analysis, EUS-PPG value was the only variable associated with hepatic decompensation. CONCLUSIONS EUS-PPG measurement is safe and might have a prognostic role in patients with PSVD and CSPH, outperforming HVPG. TRIAL REGISTRATION ID5486.
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Affiliation(s)
- Francesco Santopaolo
- Liver Unit, CEMAD Centro Malattie Dell'apparato Digerente, Medicina Interna e GastroenterologiaFondazione Policlinico Universitario Agostino Gemelli IRCCSRomeItaly
| | - Lucia Giuli
- Liver Unit, CEMAD Centro Malattie Dell'apparato Digerente, Medicina Interna e GastroenterologiaFondazione Policlinico Universitario Agostino Gemelli IRCCSRomeItaly
| | - Giulia Tripodi
- Digestive Endoscopy UnitFondazione Policlinico Universitario Agostino Gemelli IRCCSRomeItaly
| | - Maria Pallozzi
- Liver Unit, CEMAD Centro Malattie Dell'apparato Digerente, Medicina Interna e GastroenterologiaFondazione Policlinico Universitario Agostino Gemelli IRCCSRomeItaly
| | - Francesca Romana Ponziani
- Liver Unit, CEMAD Centro Malattie Dell'apparato Digerente, Medicina Interna e GastroenterologiaFondazione Policlinico Universitario Agostino Gemelli IRCCSRomeItaly
| | - Brigida Eleonora Annicchiarico
- Liver Unit, CEMAD Centro Malattie Dell'apparato Digerente, Medicina Interna e GastroenterologiaFondazione Policlinico Universitario Agostino Gemelli IRCCSRomeItaly
| | - Gianenrico Rizzatti
- Digestive Endoscopy UnitFondazione Policlinico Universitario Agostino Gemelli IRCCSRomeItaly
| | - Andrea Contegiacomo
- Department of BioimagingInstitute of Radiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCSRomeItaly
| | - Alessandro Posa
- Department of BioimagingInstitute of Radiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCSRomeItaly
| | - Roberto Iezzi
- Department of BioimagingInstitute of Radiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCSRomeItaly
| | - Rosa Talerico
- Department of Geriatric, Orthopedic, and Rheumatologic SciencesFondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro CuoreRomeItaly
| | - Antonio Gasbarrini
- Liver Unit, CEMAD Centro Malattie Dell'apparato Digerente, Medicina Interna e GastroenterologiaFondazione Policlinico Universitario Agostino Gemelli IRCCSRomeItaly
| | - Alberto Larghi
- Digestive Endoscopy UnitFondazione Policlinico Universitario Agostino Gemelli IRCCSRomeItaly
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7
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Rodríguez de Santiago E, Pérez de la Iglesia S, de Frutos D, Marín-Gabriel JC, Mangas-SanJuan C, Honrubia López R, Uchima H, Aicart-Ramos M, Rodríguez Gandía MÁ, Valdivielso Cortázar E, Ramos Zabala F, Álvarez MA, Solano Sánchez M, González Santiago JM, Albéniz E, Hijos-Mallada G, Castro Quismondo N, Fraile-López M, Martínez Ares D, Tejedor-Tejada J, Hernández L, Gornals JB, Quintana-Carbo S, Ocaña J, Cunha Neves JA, Martínez Martínez J, López-Cerón Pinilla M, Dolz Abadía C, Pellisé M. Delphi consensus statement for the management of delayed post-polypectomy bleeding. Therap Adv Gastroenterol 2025; 18:17562848251329145. [PMID: 40297208 PMCID: PMC12035264 DOI: 10.1177/17562848251329145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2025] [Accepted: 03/06/2025] [Indexed: 04/30/2025] Open
Abstract
Background Delayed post-polypectomy bleeding (DPPB) is the most common adverse event following colonic polypectomy, yet its management remains highly heterogeneous and lacks standardization. A considerable number of colonoscopies performed for DPPB may be unnecessary and do not result in hemostatic intervention. Objectives To develop evidence-based statements to guide clinical decision-making in DPPB. Design Multidisciplinary Delphi consensus statement. Methods A panel of 29 experts in gastroenterology, hematology, radiology, and surgery was assembled. Through a systematic review of the literature and a modified Delphi process, consensus statements were developed through iterative rounds of anonymous voting. Statements were revised following anonymous voting and feedback at each round. Those achieving 80% agreement were accepted. Results The expert panel reached a consensus on 36 statements, covering areas such as antithrombotic management, bowel preparation, colonoscopy indications, and therapeutic hemostatic modalities. Key recommendations include guidance for managing self-limited bleeding and risk stratification to reduce the rate of unnecessary colonoscopies, as well as recommendations for hemodynamically unstable patients who may require primary angioembolization. A practical clinical algorithm is proposed. Conclusion This document provides a consensus-based framework for managing DPPB. These recommendations aim to improve patient outcomes and optimize healthcare resources while fostering a standardized approach to this common adverse event.
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Affiliation(s)
- Enrique Rodríguez de Santiago
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
- Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBEREHD), M-607, Carretera de Colmenar Viejo Km 9,100. 28034 Madrid, Spain
| | - Sandra Pérez de la Iglesia
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Diego de Frutos
- Department of Gastroenterology, Hospital Universitario Puerta de Hierro, Instituto de Investigación Sanitaria Puerta de Hierro—Segovia de Arana, Majadahonda, Spain
| | - José Carlos Marín-Gabriel
- Endoscopy Unit, Department of Gastroenterology, i+12 Research Institute, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Carolina Mangas-SanJuan
- Endoscopy Unit, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Raúl Honrubia López
- Department of Gastroenterology, Hospital Universitario Infanta Sofía, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, San Sebastián de los Reyes, Madrid, Spain
| | - Hugo Uchima
- Department of Gastroenterology, Hospital Universitario Germans Trias i Pujol, Badalona, Spain Centro Médico Teknon, Barcelona, Spain
| | - Marta Aicart-Ramos
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Miguel Ángel Rodríguez Gandía
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | | | - Felipe Ramos Zabala
- Department of Gastroenterology, Hospital Universitario HM Montepríncipe, HM Hospitales, Madrid, Spain Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
| | - Marco Antonio Álvarez
- Gastrointestinal Oncology Endoscopy and Surgery (GOES) Research Group, Althaia Xarxa Assistencial Universitària de Manresa, Institut de Recerca i Innovació en Ciències de la Vida i de la Salut de la Catalunya Central (IRIS-CC), Manresa, Barcelona, Spain
| | - Marina Solano Sánchez
- Department of Gastroenterology, Hospital Comarcal de Alcañiz, Grupo de investigación INDOGASTRO, Zaragoza, Spain
| | - Jesús Manuel González Santiago
- Department of Gastroenterology and Hepatology, University Hospital of Salamanca, Institute for Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
| | - Eduardo Albéniz
- Endoscopy Unit, Department of Gastroenterology, Hospital Universitario de Navarra Navarrabiomed Biomedical Research Center, Universidad Pública de Navarra (UPNA), Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Gonzalo Hijos-Mallada
- Department of Gastroenterology, Hospital Clínico Universitario Lozano Blesa, Instituto de Investigación Sanitaria (IIS), Aragón, Zaragoza, Spain
| | - Nerea Castro Quismondo
- Department of Hematology and Hemotherapy, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Miguel Fraile-López
- Department of Gastroenterology and Hepatology, Clinical and Translational Research in Digestive Diseases, Valdecilla Research Institute (IDIVAL), Marqués de Valdecilla University Hospital, Santander, Spain
| | - David Martínez Ares
- Department of Gastroenterology—Ingaled, Hospital Quirónsalud Miguel Domínguez, Pontevedra, Spain
- Department of Gastroenterology, Hospital Quirónsalud A Coruña, A Coruña, Spain
| | | | - Luis Hernández
- Department of Gastroenterology, Hospital Santos Reyes, Aranda de Duero, Spain
| | - Joan B. Gornals
- Department of Digestive Diseases, Hospital Universitari de Bellvitge, Universitat de Barcelona, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Sergi Quintana-Carbo
- Department of Digestive Diseases, Hospital Universitari de Bellvitge, Universitat de Barcelona, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Juan Ocaña
- Department of Surgery, Colorectal Surgery Unit, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - João A. Cunha Neves
- Department of Gastroenterology, Unidade Local de Saúde do Algarve, Hospital de Portimão, Portimão, Portugal
| | - Juan Martínez Martínez
- Department of Radiology, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - María López-Cerón Pinilla
- Endoscopy Unit, Department of Gastroenterology, i+12 Research Institute, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Carlos Dolz Abadía
- Department of Gastroenterology, Hospital Juaneda Miramar, Palma de Mallorca, Spain
| | - María Pellisé
- Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- Department of Gastroenterology, Hospital Clinic Barcelona, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Facultat de Medicina i Ciencies de la Salud, Universitat de Barcelona, Barcelona, Spain
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8
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Rizzo GEM, Facciorusso A, Binda C, Mazza S, Maida M, Rancatore G, Carrozza L, Ligresti D, Mauro A, Anderloni A, Fabbri C, Tarantino I. What is the benefit of endoscopic ultrasound-guided gastrojejunal anastomosis for patients with benign gastric outlet obstruction? A systematic review with meta-analysis. Dig Liver Dis 2025:S1590-8658(25)00293-2. [PMID: 40246669 DOI: 10.1016/j.dld.2025.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2025] [Revised: 03/06/2025] [Accepted: 03/19/2025] [Indexed: 04/19/2025]
Abstract
BACKGROUND Gastric outlet obstruction for benign indications (bGOO) is an uncommon condition, typically treated with surgery when medical therapy or endoscopic treatments fail. At present, endoscopic ultrasound (EUS)-guided gastrojejunostomy (GJ) may prove to be an effective alternative. AIMS We performed a systematic review with meta-analysis evaluating outcomes of EUS-GJ for bGOO. METHODS A comprehensive search was conducted up to February 2025. Pooled estimates were obtained using a random-effects model. Study quality was evaluated using the Newcastle-Ottawa quality scale. Heterogeneity was evaluated with I2 statistic. Technical success, clinical success, recurrence rate, and adverse events (AE) rate were the main outcomes. RESULTS Fifteen (15) studies, including a total of 376 patients, were identified. Pooled technical success was 95.8 % (CI 95 %, 93.8 %-97.8 %, I2 =0 %), while clinical success was 93.4 % (CI 95 %, 90.4 %-96.5 %, I2= 31.83 %). Pooled recurrence rate was 11.6 % (CI 95 %, 5.5 %-17.7 %, I2=32.36 %). The pooled rate of AE was 11.6 % (CI 95 %, 6.8-16.5 %, I2 = 57.18 %). Subgroup analyses found differences in safety when AE classification was used (17 % use vs. 6 % no use, p = 0.02) and based on quality of studies (low 22 % vs. moderate 10 % vs. high 3 %, p = 0.04). CONCLUSION In conclusion, our findings show that EUS-GJ is effective and safe in those patients with bGOO in whom other endoscopic treatments fail, and surgery is not an option or could be performed as bridge-to-surgery. Our results suggest that safety is influenced by the use of AE classification and the quality of studies.
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Affiliation(s)
- Giacomo Emanuele Maria Rizzo
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS - ISMETT, Palermo, Italy, University of Pittsburgh Medical Center Italy (UPMCI), Palermo, Italy.
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy
| | - Cecilia Binda
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena, Italy
| | - Stefano Mazza
- Digestive Gastroenterology and Endoscopy unit, IRCCS Foundation, Policlinico San Matteo, Pavia, Italy
| | - Marcello Maida
- Department of Medicine and Surgery, University of Enna 'Kore', Enna, Italy; Gastroenterology Unit, Umberto I Hospital, Enna, Italy
| | - Gabriele Rancatore
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS - ISMETT, Palermo, Italy, University of Pittsburgh Medical Center Italy (UPMCI), Palermo, Italy
| | - Lucio Carrozza
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS - ISMETT, Palermo, Italy, University of Pittsburgh Medical Center Italy (UPMCI), Palermo, Italy; Gastroenterology Unit, Papardo Hospital, Messina, Italy
| | - Dario Ligresti
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS - ISMETT, Palermo, Italy, University of Pittsburgh Medical Center Italy (UPMCI), Palermo, Italy
| | - Aurelio Mauro
- Digestive Gastroenterology and Endoscopy unit, IRCCS Foundation, Policlinico San Matteo, Pavia, Italy
| | - Andrea Anderloni
- Digestive Gastroenterology and Endoscopy unit, IRCCS Foundation, Policlinico San Matteo, Pavia, Italy
| | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena, Italy
| | - Ilaria Tarantino
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS - ISMETT, Palermo, Italy, University of Pittsburgh Medical Center Italy (UPMCI), Palermo, Italy
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9
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Dell’Anna G, Fasulo E, Cecinato P, Barbara G, Barchi A, Viale E, Esposito D, Grillo S, Sassatelli R, Malesci A, Massironi S, Annese V, Fuccio L, Facciorusso A, Donatelli G, Danese S, Azzolini F. Endoscopic Submucosal Dissection (ESD) for the Management of Fibrotic Non-Lifting Colorectal Lesions (NLCLs): Results from a Large Multicenter Retrospective Study. Cancers (Basel) 2025; 17:1242. [PMID: 40227777 PMCID: PMC11987842 DOI: 10.3390/cancers17071242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2025] [Revised: 02/21/2025] [Accepted: 02/23/2025] [Indexed: 04/15/2025] Open
Abstract
Background/Objectives: The management of non-lifting colorectal lesions (NLCLs), often resulting from previous unsuccessful treatments or biopsies, remains challenging due to submucosal fibrosis that prevents adequate lifting. Endoscopic submucosal dissection (ESD) is a viable option for achieving complete resection in such cases. However, when standard ESD is not feasible, conversion to hybrid ESD (H-ESD) has been proposed as a rescue strategy. This study aimed to assess ESD's feasibility, effectiveness, and safety for NLCLs, including cases requiring conversion to H-ESD, when performed by experienced endoscopists in tertiary referral centers. Methods: In this multicenter retrospective study, data from patients with NLCLs treated by ESD/H-ESD between January 2009 and September 2022 were analyzed. The primary endpoint was the recurrence rate (RR). Secondary endpoints included the adverse event (AE) rate, technical success (TS) rate (en bloc resection regardless of technique), complete resection (CR), curative resection (cR) rates, and surgical intervention rate. Predictors of ESD technical success were identified. Results: In total, 178 patients with NLCLs were included (52 previously biopsied, 126 recurrent after previous resection). ESD was used in 111 (62.4%) and H-ESD in 67 (37.6%) cases. During a median follow-up of 373 days (IQR 540), the overall RR was 3.6%. The overall AE rate was 13.4%, and perforation was the most frequent (8.4%). All AEs were successfully managed endoscopically. The TS rate was 71.9%, significantly higher in previously biopsied lesions compared to recurrent ones (78.8% vs. 55.6%, p = 0.04). On multivariate analysis, rectal location (p < 0.001), F1 fibrosis (p = 0.026), and previously biopsied lesions (p = 0.006) predicted ESD TS without the need for conversion to H-ESD. Conclusions: ESD/H-ESD is feasible and safe for NLCLs when performed by experienced operators, with low RR amenable to endoscopic treatment. Previously biopsied lesions, rectal location, and low fibrosis predict ESD TS.
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Affiliation(s)
- Giuseppe Dell’Anna
- Gastroenterology and Gastrointestinal Endoscopy, IRCCS San Raffaele Hospital, 20132 Milan, Italy; (E.F.); (A.B.); (E.V.); (D.E.); (A.M.); (S.D.); (F.A.)
- Gastroenterology and Gastrointestinal Endoscopy, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy;
| | - Ernesto Fasulo
- Gastroenterology and Gastrointestinal Endoscopy, IRCCS San Raffaele Hospital, 20132 Milan, Italy; (E.F.); (A.B.); (E.V.); (D.E.); (A.M.); (S.D.); (F.A.)
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, 20132 Milan, Italy;
| | - Paolo Cecinato
- Gastroenterology and Digestive Endoscopy Unit, Arcispedale Santa Maria Nuova di Reggio Emilia, AUSL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (P.C.); (S.G.); (R.S.)
- Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Giovanni Barbara
- Gastroenterology Unit, Istituti Ospedalieri Bergamaschi, 24046 Bergamo, Italy;
| | - Alberto Barchi
- Gastroenterology and Gastrointestinal Endoscopy, IRCCS San Raffaele Hospital, 20132 Milan, Italy; (E.F.); (A.B.); (E.V.); (D.E.); (A.M.); (S.D.); (F.A.)
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, 20132 Milan, Italy;
| | - Edi Viale
- Gastroenterology and Gastrointestinal Endoscopy, IRCCS San Raffaele Hospital, 20132 Milan, Italy; (E.F.); (A.B.); (E.V.); (D.E.); (A.M.); (S.D.); (F.A.)
| | - Dario Esposito
- Gastroenterology and Gastrointestinal Endoscopy, IRCCS San Raffaele Hospital, 20132 Milan, Italy; (E.F.); (A.B.); (E.V.); (D.E.); (A.M.); (S.D.); (F.A.)
| | - Simone Grillo
- Gastroenterology and Digestive Endoscopy Unit, Arcispedale Santa Maria Nuova di Reggio Emilia, AUSL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (P.C.); (S.G.); (R.S.)
| | - Romano Sassatelli
- Gastroenterology and Digestive Endoscopy Unit, Arcispedale Santa Maria Nuova di Reggio Emilia, AUSL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (P.C.); (S.G.); (R.S.)
| | - Alberto Malesci
- Gastroenterology and Gastrointestinal Endoscopy, IRCCS San Raffaele Hospital, 20132 Milan, Italy; (E.F.); (A.B.); (E.V.); (D.E.); (A.M.); (S.D.); (F.A.)
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, 20132 Milan, Italy;
| | - Sara Massironi
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, 20132 Milan, Italy;
- Gastroenterology Unit, Istituti Ospedalieri Bergamaschi, 24046 Bergamo, Italy;
| | - Vito Annese
- Gastroenterology and Gastrointestinal Endoscopy, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy;
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, 20132 Milan, Italy;
| | - Lorenzo Fuccio
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40100 Bologna, Italy;
| | - Antonio Facciorusso
- Faculty of Medicine and Surgery, University of Salento, 73100 Lecce, Italy;
- Clinical Effectiveness Research Group, University of Oslo, 0316 Oslo, Norway
| | - Gianfranco Donatelli
- Unité d’Endoscopie Interventionnelle, Hôpital Privé des Peupliers, 75013 Paris, France;
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80138 Naples, Italy
| | - Silvio Danese
- Gastroenterology and Gastrointestinal Endoscopy, IRCCS San Raffaele Hospital, 20132 Milan, Italy; (E.F.); (A.B.); (E.V.); (D.E.); (A.M.); (S.D.); (F.A.)
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, 20132 Milan, Italy;
| | - Francesco Azzolini
- Gastroenterology and Gastrointestinal Endoscopy, IRCCS San Raffaele Hospital, 20132 Milan, Italy; (E.F.); (A.B.); (E.V.); (D.E.); (A.M.); (S.D.); (F.A.)
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10
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Gökce E, Devisscher L, Rashidian N, Palmeri E, Hindryckx P. Lumen-apposing metal stents for anastomosis creation throughout the gastrointestinal tract: A large single-center experience. DEN OPEN 2025; 5:e419. [PMID: 39398259 PMCID: PMC11470743 DOI: 10.1002/deo2.419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 07/26/2024] [Accepted: 08/01/2024] [Indexed: 10/15/2024]
Abstract
Objectives The introduction of lumen-apposing metal stents (LAMSs) has revolutionized the field of therapeutic endoscopic ultrasound. This study aims to evaluate the efficacy and safety of LAMS in creating an endoscopic ultrasound-guided anastomosis between two segments of the gastrointestinal (GI) tract. Methods Data from all consecutive LAMS procedures for anastomosis creation between two segments of the GI, conducted between October 2019 and February 2024, were retrospectively analyzed for technical success (defined as correct deployment of the LAMS in the target), clinical success (defined as achievement of the intended clinical goal), and adverse events. Results A total of 145 LAMS procedures were performed in 136 patients. Indications for LAMS procedures included the need for endoscopic access to or reversal of surgically excluded segments of the GI tract (n = 73, 50.3%), and the alleviation of any GI outflow obstruction (n = 72, 49.7%). The overall technical and clinical success rates were very high (97.2% and 95.2%, respectively). Adverse events were observed in 20/145 (13.8%) cases, including 11 (7.6%) minor events (AGREE <3) and nine (6.2%) major events (AGREE ≥3). Major events included stent migration (n = 1), persisting fistula (n = 3), and bleeding (n = 4). All adverse events were successfully managed, and there were no procedure-related deaths. Loss of LAMS patency occurred in 4/145 (2.8%) cases and could be endoscopically managed in all cases. Conclusions The creation of anastomoses with LAMS between two segments of the GI tract appears to be effective and safe, with a low reintervention rate due to loss of LAMS patency.
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Affiliation(s)
- Emine Gökce
- Department of Gastroenterology and HepatologyGhent University HospitalGhentBelgium
- Department of Basic and Applied Medical SciencesGut‐Liver Immunopharmacology Unit, Ghent UniversityGhentBelgium
- Department of Liver Research Center GhentGhent UniversityGhentBelgium
| | - Lindsey Devisscher
- Department of Basic and Applied Medical SciencesGut‐Liver Immunopharmacology Unit, Ghent UniversityGhentBelgium
- Department of Liver Research Center GhentGhent UniversityGhentBelgium
| | - Niki Rashidian
- Department of HPB Surgery and Liver TransplantationGhent University HospitalGhentBelgium
| | - Enrico Palmeri
- Department of Gastroenterology and HepatologyGhent University HospitalGhentBelgium
| | - Pieter Hindryckx
- Department of Gastroenterology and HepatologyGhent University HospitalGhentBelgium
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11
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Sarkis Y, Al-Haddad M, Stainko S, Wreglesworth L, Ashcraft K, DeWitt J. Safety of same day discharge after Zenker's diverticulum peroral endoscopic myotomy. Dig Liver Dis 2025; 57:902-905. [PMID: 39919979 DOI: 10.1016/j.dld.2025.01.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Revised: 10/31/2024] [Accepted: 01/13/2025] [Indexed: 02/09/2025]
Abstract
INTRODUCTION There are limited data on the safety of same-day discharge (SDD) following peroral endoscopic myotomy for Zenker's diverticulum (Z-POEM). Our aim is to assess the frequency and etiology of emergency department (ED) visits or hospital admissions after SDD after Z-POEM. METHODS Patients at our institution between 02/2020 and 08/2023 who had SDD after Z-POEM were identified. Criteria for SDD were: 1)no procedure-related serious adverse event; 2)post-POEM esophagram without leak; 3)stable vital signs; 4)ability to take liquids; 5)pain controlled without IV analgesia; 6)social support for transit to ED; 7)ASA class I-III. Relevant post-procedure events, ED visits and hospitalizations within 30 days were reported. A causative relationship between Z-POEM and ED visits and hospitalizations was assigned by consensus. RESULTS 39 Z-POEMs were performed, and 26 (67 %) patients (58 % male, median age 72 years) had SDD. Mean ZD diameter was 29±14 mm and mean baseline Dakkak and Bennett's score was 2.9 ± 0.9. Within 30 days of Z-POEM, two(7.7 %) ED visits occurred 13 days and 9 days post-procedure for a COPD exacerbation(n = 1) and pneumonia(n = 1), respectively. Both patients were discharged without admission and only the visit for pneumonia was considered related to Z-POEM. CONCLUSION Eligible patients who follow and fulfill a strict protocol after Z-POEM may be safely discharged the same day of the procedure.
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Affiliation(s)
- Yara Sarkis
- Department of Gastroenterology and Hepatology, Indiana University Health Medical Center, Indianapolis, IN, USA
| | - Mohammad Al-Haddad
- Department of Gastroenterology and Hepatology, Indiana University Health Medical Center, Indianapolis, IN, USA
| | - Sarah Stainko
- Department of Gastroenterology and Hepatology, Indiana University Health Medical Center, Indianapolis, IN, USA
| | - Laura Wreglesworth
- Department of Gastroenterology and Hepatology, Indiana University Health Medical Center, Indianapolis, IN, USA
| | - Krista Ashcraft
- Department of Gastroenterology and Hepatology, Indiana University Health Medical Center, Indianapolis, IN, USA
| | - John DeWitt
- Department of Gastroenterology and Hepatology, Indiana University Health Medical Center, Indianapolis, IN, USA.
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Terrin M, D'Errico F, Rotkopf H, Tuszynski T, Dumont JL, Dehry S, Maselli R, Fugazza A, Tranchart H, Gaujoux S, Dagher I, Scatton O, Repici A, Donatelli G. First-intention EUS-guided transluminal drainage with LAMS: an effective and safe method for management of fluid collections after any kind of surgery. Surg Endosc 2025; 39:2415-2424. [PMID: 39966131 DOI: 10.1007/s00464-025-11615-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2024] [Accepted: 02/08/2025] [Indexed: 02/20/2025]
Abstract
BACKGROUND Symptomatic postoperative collections (PCs) frequently complicate surgery with significant morbidity and mortality. In contrast with pancreatic inflammatory collections, little is known about endoscopic ultrasound-guided drainage of PCs (EUS-PCD). The aim of this study is to evaluate the safety and efficacy of EUS-PCD using lumen-apposing metal stent (LAMS) as the first-line drainage approach for PCs of any kind. METHODS This is a monocentric retrospective study. We retrieved all consecutive symptomatic PCs treated at our center between February 2019 and September 2024. All cases were considered suitable for EUS-PCD after multidisciplinary discussion. Rates of technical success, clinical success, and AEs were calculated. RESULTS We retrieved 66 PCs, mainly resulting from pancreatic and lower gastrointestinal tract surgery. The median size of collections was 7.6 cm and infection occurred in 54 of the cases. The median time from surgery to drainage was 19 days (IQR 13-29); in 10 cases, this occurred ≤ 7 days after surgery. 51 drainages were performed from the gastric/duodenal window, 15 transrectally. LAMS were removed after a median time of 18.5 days (IQR 12-27). After removal, double-pigtail stents were placed in 25 PCs and at least one necrosectomy session was performed in 13. Technical success was achieved in 97.0% of cases. Clinical success was achieved in 95.2%; in 3 cases, collection recurrence occurred and retreatment with LAMS was successful. Overall AEs rate was 9.1%, but only one was severe, requiring surgery. Rates of technical and clinical failure and AEs were not affected by surgery type (pancreatic, non-pancreatic), timing of drainage (≤ 7, 7-10, > 10 days), size of collections (≤ 4, 4-10, > 10 cm), and access window (transgastric/duodenal/rectal). Necrosectomy performance was the only predictor of AEs occurrence (OR 6.9, C.I.: 1.1-46.9, p = 0.048) at univariable analysis. CONCLUSION First-intention EUS-PCD seems to be a safe and effective treatment, regardless of the origin and size of the collection and drainage timing.
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Affiliation(s)
- Maria Terrin
- Interventional Endoscopy Unit, Private Hospital Peupliers, Ramsay Santé, Paris, France
- Department of Biomedical Sciences, Pieve Emanuele, Italy and Humanitas Clinical and Research Center IRCCS, Endoscopy Unit, Humanitas University, Rozzano, Italy
| | - Francesca D'Errico
- Interventional Endoscopy Unit, Private Hospital Peupliers, Ramsay Santé, Paris, France
- Gastroenterology and Endoscopy Unit, Ente Ecclesiastico F. Miulli, Acquaviva Delle Fonti, Bari, Italy
| | - Hugo Rotkopf
- Interventional Endoscopy Unit, Private Hospital Peupliers, Ramsay Santé, Paris, France
| | - Thierry Tuszynski
- Interventional Endoscopy Unit, Private Hospital Peupliers, Ramsay Santé, Paris, France
| | - Jean-Loup Dumont
- Interventional Endoscopy Unit, Private Hospital Peupliers, Ramsay Santé, Paris, France
| | - Serge Dehry
- Interventional Endoscopy Unit, Private Hospital Peupliers, Ramsay Santé, Paris, France
| | - Roberta Maselli
- Department of Biomedical Sciences, Pieve Emanuele, Italy and Humanitas Clinical and Research Center IRCCS, Endoscopy Unit, Humanitas University, Rozzano, Italy
| | - Alessandro Fugazza
- Department of Biomedical Sciences, Pieve Emanuele, Italy and Humanitas Clinical and Research Center IRCCS, Endoscopy Unit, Humanitas University, Rozzano, Italy
| | - Hadrien Tranchart
- Department of Minimally Invasive Digestive Surgery, Antoine Beclere Hospital, AP-HP, Clamart, France
| | - Sébastien Gaujoux
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Pitié-Salpêtrière Hospital, AP-HP, Paris, France and Sorbonne University, Paris, France
| | - Ibrahim Dagher
- Department of Minimally Invasive Digestive Surgery, Antoine Beclere Hospital, AP-HP, Clamart, France
| | - Olivier Scatton
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Pitié-Salpêtrière Hospital, AP-HP, Paris, France and Sorbonne University, Paris, France
| | - Alessandro Repici
- Department of Biomedical Sciences, Pieve Emanuele, Italy and Humanitas Clinical and Research Center IRCCS, Endoscopy Unit, Humanitas University, Rozzano, Italy
| | - Gianfranco Donatelli
- Interventional Endoscopy Unit, Private Hospital Peupliers, Ramsay Santé, Paris, France.
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy.
- Unité d'Endoscopie Interventionnelle, Ramsay Santé, Hôpital Privé Des Peupliers, 8 Place de L'Abbé G. Hénocque, 75013, Paris, France.
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Pollack E, Norwood D, Caceres H, Rapaka B, Perry IE, Barlass U, Mitchell R, McCreight J, Peter S, Mulki R, Ahmed A, Kyanam K, Sánchez‐Luna SA. Lumen-apposing metal stents provide early and late clinical benefits for the management of benign gastrointestinal strictures: Is there a role for definitive therapy? DEN OPEN 2025; 5:e70005. [PMID: 39220854 PMCID: PMC11366066 DOI: 10.1002/deo2.70005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 08/08/2024] [Accepted: 08/17/2024] [Indexed: 09/04/2024]
Abstract
Objectives This study aimed to characterize the clinical outcomes, safety, and efficacy of lumen-apposing metal stents (LAMS) in treating benign gastrointestinal strictures. Methods A single-center retrospective review of all patients who underwent LAMS placement for benign strictures from June 2017 to July 2023. Primary outcomes were technical success, early clinical success, late clinical success (LCS), and sustained post-LAMS clinical success (SPLCS). Secondary outcomes included stent dwell time, stenosis changes, adverse events, reintervention rates, and symptomatology evaluation. Results Thirty-five patients underwent placement of 42 LAMS (74% female, mean age: 54.2 ± 11.7 years). Anastomotic strictures accounted for 64% of cases (N = 27, 45% at the gastrojejunal anastomosis). The median STD was 91.0 days (interquartile range [IQR]: 55.0-132.0). Technical success was obtained in all cases. Early clinical successand LCS were achieved in 80% of cases overall. SPLCS was achieved in 45% (n = 15) of cases. The overall reintervention rate was 63%, with a median time to reintervention being 50.5 days (IQR: 24-105). adverse events occurred in 28% (n = 12) overall, with a 24% migration rate (n = 10). Follow-up was completed in 83% of cases with a median duration of 629 days (range: 192.0-1297.0). Overall symptom improvement occurred in 79% (n = 27) during indwelling LAMS versus 58% and 56% at 30- and 60-days post-removal, respectively. Conclusions LAMS for benign gastrointestinal strictures are associated with high technical and early clinical success/LCS rates, positive quality-of-life metrics, and a tolerable adverse event rate. Overall, recurrence of symptoms and high reintervention rates post-LAMS removal reinforce the difficulty in managing benign gastrointestinal strictures but also argue for LAMS as a definitive therapy in select cases.
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Affiliation(s)
- Ethan Pollack
- Department of Internal MedicineThe University of Alabama at Birmingham Heersink School of MedicineBirminghamAlabamaUSA
| | - Dalton Norwood
- Department of Internal MedicineUAB Minority Health and Health Equity Research CenterThe University of Alabama at Birmingham Heersink School of MedicineBirminghamAlabamaUSA
| | - Hector Caceres
- Department of Internal MedicineUAB Minority Health and Health Equity Research CenterThe University of Alabama at Birmingham Heersink School of MedicineBirminghamAlabamaUSA
| | - Babusai Rapaka
- Department of Internal MedicineDivision of Gastroenterology & HepatologyBasil I. Hirschowitz Endoscopic Center of ExcellenceThe University of Alabama at Birmingham Heersink School of MedicineBirminghamAlabamaUSA
| | - Isaac E. Perry
- Department of Internal MedicineDivision of Gastroenterology & HepatologyBasil I. Hirschowitz Endoscopic Center of ExcellenceThe University of Alabama at Birmingham Heersink School of MedicineBirminghamAlabamaUSA
| | - Usman Barlass
- Department of Internal MedicineDivision of Gastroenterology & HepatologyBasil I. Hirschowitz Endoscopic Center of ExcellenceThe University of Alabama at Birmingham Heersink School of MedicineBirminghamAlabamaUSA
| | - Rachel Mitchell
- Department of Internal MedicineDivision of Gastroenterology & HepatologyBasil I. Hirschowitz Endoscopic Center of ExcellenceThe University of Alabama at Birmingham Heersink School of MedicineBirminghamAlabamaUSA
| | - Jessica McCreight
- Department of Internal MedicineDivision of Gastroenterology & HepatologyBasil I. Hirschowitz Endoscopic Center of ExcellenceThe University of Alabama at Birmingham Heersink School of MedicineBirminghamAlabamaUSA
| | - Shajan Peter
- Department of Internal MedicineDivision of Gastroenterology & HepatologyBasil I. Hirschowitz Endoscopic Center of ExcellenceThe University of Alabama at Birmingham Heersink School of MedicineBirminghamAlabamaUSA
| | - Ramzi Mulki
- Department of Internal MedicineDivision of Gastroenterology & HepatologyBasil I. Hirschowitz Endoscopic Center of ExcellenceThe University of Alabama at Birmingham Heersink School of MedicineBirminghamAlabamaUSA
| | - Ali Ahmed
- Department of Internal MedicineDivision of Gastroenterology & HepatologyBasil I. Hirschowitz Endoscopic Center of ExcellenceThe University of Alabama at Birmingham Heersink School of MedicineBirminghamAlabamaUSA
| | - Kondal Kyanam
- Department of Internal MedicineDivision of Gastroenterology & HepatologyBasil I. Hirschowitz Endoscopic Center of ExcellenceThe University of Alabama at Birmingham Heersink School of MedicineBirminghamAlabamaUSA
| | - Sergio A. Sánchez‐Luna
- Department of Internal MedicineDivision of Gastroenterology & HepatologyBasil I. Hirschowitz Endoscopic Center of ExcellenceThe University of Alabama at Birmingham Heersink School of MedicineBirminghamAlabamaUSA
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14
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Zhang ZC, Xu JQ, Pan HT, Liu XY, Chen SY, Zhong YS, Zhang YQ, Ma LL, Hu JW, Cai MY, Qin WZ, Li QL, Chen WF, Zhou PH. Peroral endoscopic myotomy for symptomatic blown-out myotomy following previous myotomy for achalasia. Endoscopy 2025. [PMID: 40154504 DOI: 10.1055/a-2552-8282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/01/2025]
Abstract
Blown-out myotomy (BOM) may impair the discharge of esophageal contents, leading to recurrent symptoms following myotomy. This study aimed to evaluate the safety and effectiveness of salvage peroral endoscopic myotomy (POEM) for symptomatic BOM.Between August 2011 and August 2022, 77 patients with recurrent achalasia with BOM and 168 with recurrent achalasia without BOM underwent POEM and were retrospectively enrolled. Operation-related parameters were compared between the two groups.Salvage POEM was performed in patients with symptomatic BOM, with a mean procedure duration of 60.8 minutes. The mean hospital stay was 3.2 days. Procedure-related adverse events included 16 cases (20.8%) of Type I mucosal injury, 3 cases (3.9%) of Type II mucosal injury, 5 cases (6.5%) of pneumothorax, 2 cases (2.6%) of emphysema, and 2 cases (2.6%) of pneumoperitoneum. Three patients (3.9%) experienced major adverse events. No statistically significant differences were found between the two groups in the incidence of mucosal injury, gas-related adverse events, and major adverse events. Clinical success was equivalent between the two groups at the 2-year follow-up (85.7% vs. 92.3%; P = 0.16).Based on this study, POEM could be considered as an effective treatment option for patients with symptomatic BOM.
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Affiliation(s)
- Zhao-Chao Zhang
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
| | - Jia-Qi Xu
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
| | - Hai-Ting Pan
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
| | - Xin-Yang Liu
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
| | - Shi-Yao Chen
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
| | - Yun-Shi Zhong
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
| | - Yi-Qun Zhang
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
| | - Li-Li Ma
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
| | - Jian-Wei Hu
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
| | - Ming-Yan Cai
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
| | - Wen-Zheng Qin
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
| | - Quan-Lin Li
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
| | - Wei-Feng Chen
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
| | - Ping-Hong Zhou
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
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15
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Nagesh VK, Pulipaka SP, Bhuju R, Martinez E, Badam S, Nageswaran GA, Tran HHV, Elias D, Mansour C, Musalli J, Bhattarai S, Shobana LS, Sethi T, Sethi R, Nikum N, Trivedi C, Jarri A, Westman C, Ahmed N, Philip S, Weissman S, Weinberger J, Bangolo AI. Management of gastrointestinal bleed in the intensive care setting, an updated literature review. World J Crit Care Med 2025; 14:101639. [DOI: 10.5492/wjccm.v14.i1.101639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2024] [Revised: 11/08/2024] [Accepted: 12/02/2024] [Indexed: 12/11/2024] Open
Abstract
Gastrointestinal (GI) bleeding is a critical and potentially life-threatening condition frequently observed in the intensive care unit (ICU). This literature review consolidates current insights on the epidemiology, etiology, management, and outcomes of GI bleeding in critically ill patients. GI bleeding remains a significant concern, especially among patients with underlying risk factors such as coagulopathy, mechanical ventilation, and renal failure. Managing GI bleeding in the ICU requires a multidisciplinary approach, including resuscitation, endoscopic intervention, pharmacologic therapy, and sometimes surgical procedures. Even with enhanced management strategies, GI bleeding in the ICU is associated with considerable morbidity and mortality, particularly when complicated by multi-organ failure. This review reiterates the need for adequate resuscitation and interventions in managing GI bleeding in critically ill patients, aiming to enhance survival rates and improve the quality of care within the ICU setting.
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Affiliation(s)
- Vignesh K Nagesh
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Sai Priyanka Pulipaka
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Ruchi Bhuju
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Emelyn Martinez
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Shruthi Badam
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Gomathy Aarthy Nageswaran
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States
| | - Hadrian Hoang-Vu Tran
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Daniel Elias
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Charlene Mansour
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Jaber Musalli
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Sanket Bhattarai
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Lokeash Subramani Shobana
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Tannishtha Sethi
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Ritvik Sethi
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Namrata Nikum
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Chinmay Trivedi
- Department of Gastroenterology, Hackensack University Medical Center, Hackensack, NJ 07061, United States
| | - Amer Jarri
- Department of Pulmonology and Critical Care, HCA Florida Bayonet Point Hospital, Hudson, FL 34667, United States
| | - Colin Westman
- Department of Gastroenterology, Hackensack University Medical Center, Hackensack, NJ 07061, United States
| | - Nazir Ahmed
- Department of Gastroenterology, Hackensack University Medical Center, Hackensack, NJ 07061, United States
| | - Shawn Philip
- Department of Gastroenterology, Hackensack University Medical Center, Hackensack, NJ 07061, United States
| | - Simcha Weissman
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Jonathan Weinberger
- Department of Gastroenterology, Hackensack University Medical Center, Hackensack, NJ 07061, United States
| | - Ayrton I Bangolo
- Department of Hematology & Oncology, John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ 07601, United States
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16
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Wannhoff A, Canakis A, Sharaiha RZ, Fayyaz F, Schlag C, Sharma N, Elsayed I, Khashab MA, Baron TH, Caca K, Irani SS. Endoscopic ultrasound-guided gastroenterostomy for the treatment of gastric outlet obstruction secondary to acute pancreatitis. Endoscopy 2025; 57:249-254. [PMID: 39529322 DOI: 10.1055/a-2452-5307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2024]
Abstract
BACKGROUND Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is a minimally invasive technique for treating gastric outlet obstruction (GOO). The aim of this study was to assess the outcomes of EUS-GE in managing benign GOO caused by duodenal stenosis in patients with acute pancreatitis. METHODS This international retrospective study analyzed patients treated with EUS-GE for GOO caused by acute pancreatitis until December 2023, evaluating technical and clinical success, adverse events, and reintervention. RESULTS 39 patients (median age 55 years, 15 women) were included. There was a 92.3% technical success rate, with only three patients unable to undergo EUS-GE owing to a long distance between the stomach and small bowel or an inadequate window for puncture. Clinical success was observed in 34 patients (87.2%). The median Gastric Outlet Obstruction Scoring System (GOOSS) improved from 0 before EUS-GE to 2 afterward (P <0.001). Follow-up (≥3 months) was available in 25 patients. During a median follow-up of 23 months, four patients required reintervention. It was possible to remove the lumen-apposing metal stent in 18 patients. The only adverse event was a gastrocolic fistula detected incidentally after 3 months. CONCLUSION EUS-GE is an effective and safe method for managing benign GOO in the setting of acute pancreatitis.
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Affiliation(s)
- Andreas Wannhoff
- Department of Internal Medicine and Gastroenterology, Ludwigsburg Hospital, Ludwigsburg, Germany
| | - Andrew Canakis
- Division of Gastroenterology and Hepatology, The University of North Carolina at Chapel Hill, Chapel Hill, United States
| | - Reem Z Sharaiha
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, United States
| | - Farimah Fayyaz
- Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, Baltimore, United States
| | - Christoph Schlag
- Department of Gastroenterology and Hepatology, UniversitätsSpital Zürich, Zürich, Switzerland
| | - Neil Sharma
- Division of Interventional Oncology and Surgical Endoscopy (IOSE), Parkview Health, Fort Wayne, United States
| | - Ismaeil Elsayed
- Department of Internal Medicine and Gastroenterology, Ludwigsburg Hospital, Ludwigsburg, Germany
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, Baltimore, United States
| | - Todd H Baron
- Division of Gastroenterology and Hepatology, The University of North Carolina at Chapel Hill, Chapel Hill, United States
| | - Karel Caca
- Department of Internal Medicine and Gastroenterology, Ludwigsburg Hospital, Ludwigsburg, Germany
| | - Shayan S Irani
- Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, United States
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17
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Garg R, Baron TH, Trieu JA, Martínez-Moreno B, Aparicio Tormo JR, Akiki K, Storm AC, Kumar P, Singh A, Simons-Linares CR, Chahal P. Safety and effectiveness of endoscopic ultrasound-guided gallbladder drainage in patients with cirrhosis: an international multicenter experience. Endoscopy 2025. [PMID: 39814044 DOI: 10.1055/a-2517-0927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2025]
Abstract
Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) for symptomatic gallbladder disease has been shown to be safe and effective in patients with high surgical risk, but data are lacking for patients with cirrhosis. We investigated the safety and effectiveness of EUS-GBD in patients with and without cirrhosis.This retrospective review included patients who underwent EUS-GBD at four (three US and one Spanish) international tertiary care centers. Outcomes, including technical success, clinical success, and procedure-related adverse events, were compared between patients with and without cirrhosis.170 patients (47 with cirrhosis, 123 without cirrhosis) were included. There was no difference in age, sex, race, comorbidities, antiplatelet use, hemoglobin, or international normalized ratio between the two groups (P > 0.05 for all). The most common etiology of cirrhosis was alcohol (42.6%) with mean Model of End-stage Liver Disease-Sodium (MELD-Na) score of 16.2 (SD 8.8). Acute cholecystitis was more common in patients with cirrhosis (74.5% vs. 56.9%; P = 0.02). Technical (cirrhosis 97.9% vs. no cirrhosis 95.1%; P = 0.67) and clinical (93.6% vs. 94.9%; P = 0.71) success rates were similar in the two groups. Adverse events were infrequent and similar between groups, the most common being stent maldeployment (cirrhosis 4.3% vs. no cirrhosis 5.7%; P = 0.99). Survival rates were similar at the end of follow-up.EUS-GBD was safe and effective in patients with cirrhosis, with outcomes similar to patients without cirrhosis when performed by experienced echoendoscopists. Patients with cirrhosis and symptomatic gallbladder disease can be considered for EUS-GBD.
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Affiliation(s)
- Rajat Garg
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, United States
| | - Todd H Baron
- Department of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, United States
| | - Judy A Trieu
- Department of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, United States
| | | | | | - Karl Akiki
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, United States
| | - Andrew C Storm
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, United States
| | - Prabhat Kumar
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, United States
| | - Amandeep Singh
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, United States
| | - C Roberto Simons-Linares
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, United States
| | - Prabhleen Chahal
- Division of Gastroenterology, Hepatology and Nutrition, University of Texas Health, San Antonio, United States
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18
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Lisotti A, D'Errico F, Fusaroli P, Decembrino F, Masciangelo G, Khoury T, Barbara G, Leblanc S, Lepilliez V, Napoléon B, Donatelli G. Safety and efficacy of EUS-guided pelvic abscess drainage with lumen-apposing metal stents for complicated acute diverticulitis. Gastrointest Endosc 2025:S0016-5107(25)00072-0. [PMID: 39924065 DOI: 10.1016/j.gie.2025.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2024] [Revised: 12/29/2024] [Accepted: 02/03/2025] [Indexed: 02/11/2025]
Abstract
BACKGROUND AND AIMS EUS-guided pelvic abscess drainage (EUS-PAD) with a lumen-apposing metal stent (LAMS) is an alternative approach for postsurgical and inflammatory pelvic collections. This study assessed the safety and efficacy of EUS-PAD with an LAMS in a large population of complicated acute diverticulitis (AD). METHODS Data were retrieved on consecutive patients who underwent EUS drainage attempts for complicated AD from 2019 to 2023 in 3 referral centers. All cases have been considered suitable for EUS-PAD after multidisciplinary discussion. Continuous variables are expressed as median (IQR). RESULTS Data on 66 patients were retrieved; in 13 cases, EUS-PAD was not indicated because no or small abscess was found. Fifty-three patients (29 female subjects; age, 74 [62-83] years) were finally included. Forty (75.5%) patients had a pelvic abscess, and 13 (24.5%) had a para-colonic abscess, with a median size of 50 (40-60) mm. Transrectal and transcolonic EUS-PAD procedures were performed in 34 (64.2%) and 19 (35.8%) cases, respectively. Technical and clinical success rates were 92.5% and 88.7%; incidence of adverse events was 3.8% (1 bleeding, 1 late migration). LAMSs were removed after 19 (14-28) days. Median follow-up was 12 (8-12) months. Four (7.5%) patients underwent an urgent Hartmann sigmoidectomy, and 12 (22.6%) patients required elective surgery; 2 (3.8%) patients presented with recurrent diverticular abscesses. No procedure-related or disease-specific mortality was observed. CONCLUSIONS EUS-PAD could be considered a safe and effective rescue strategy in case of a failed or contraindicated percutaneous approach for the management of complicated AD to reduce the need for urgent surgery. Comparative data are necessary to confirm these observations.
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Affiliation(s)
- Andrea Lisotti
- Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola (Bologna), Italy; Gastroenterology Unit, Hôpital Privé Jean Mermoz, Ramsay Generale de Santé, Lyon, France.
| | - Francesca D'Errico
- Gastroenterology and Endoscopy Unit, Ente Ecclesiastico F. Miulli, Acquaviva delle Fonti, Bari, Italy; Interventional Endoscopy Unit, Hôpital Privé des Peupliers, Ramsay Générale de Santé, Paris, France
| | - Pietro Fusaroli
- Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola (Bologna), Italy
| | - Francesco Decembrino
- Gastroenterology and Endoscopy Unit, Ente Ecclesiastico F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Graziella Masciangelo
- Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola (Bologna), Italy
| | - Tawfik Khoury
- Gastroenterology Unit, Hôpital Privé Jean Mermoz, Ramsay Generale de Santé, Lyon, France; Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel; Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Giovanni Barbara
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Sarah Leblanc
- Gastroenterology Unit, Hôpital Privé Jean Mermoz, Ramsay Generale de Santé, Lyon, France
| | - Vincent Lepilliez
- Gastroenterology Unit, Hôpital Privé Jean Mermoz, Ramsay Generale de Santé, Lyon, France
| | - Bertrand Napoléon
- Gastroenterology Unit, Hôpital Privé Jean Mermoz, Ramsay Generale de Santé, Lyon, France
| | - Gianfranco Donatelli
- Interventional Endoscopy Unit, Hôpital Privé des Peupliers, Ramsay Générale de Santé, Paris, France
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19
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Kadkhodayan K, Pathak S, Chandan S, Abassi A, Viana A, Hayat M, Arain MA, Cosgrove N, Jain D, Yang D, Hasan MK, Irani S. EUS-guided rendezvous is a viable salvage technique for failed billiary cannulation in patients with Roux-en-Y gastric bypass undergoing BAE-ERCP. Endosc Int Open 2025; 13:a25097500. [PMID: 40007646 PMCID: PMC11855226 DOI: 10.1055/a-2509-7500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2024] [Accepted: 12/16/2024] [Indexed: 02/27/2025] Open
Abstract
Background and study aims Biliary cannulation via balloon-assisted-ERCP (BAE-ERCP) can be challenging. Patients with Roux-en-Y gastric bypass (RYGB) have among the lowest reported BAE-ERCP success rates when compared with other types of surgically altered anatomy. We explored the role of EUS-guided rendezvous (EUS-RV) as a rescue technique when BAE-ERCP fails. Patients and methods Consecutive patients with RYGB underwent BAE-ERCP for both benign and malignant indications. Among them, patients in whom BAE-ERCP failed despite use of conventional advanced biliary cannulation techniques underwent EUS-RV if the ampulla could be reached. Results Forty-three consecutive patients with RYGB underwent BAE-ERCP. The procedure was successful in 30 patients (69.7%). Among the 13 patients with failed ERCP, EUS-RV was performed in five. Technical success was achieved in all five patients (100%), thereby increasing the overall BAE-ERCP success to 35 patients (81.3%). There were no major procedure-related adverse events on immediate and 3-month follow-up. Average total procedure time for failed BAE-ERCP followed by EUS-RV was 129 minutes (range 47-205 minutes). Conclusions EUS-RV in patients with RYGB has high technical and clinical success and can be a viable alternative to more invasive options when BAE-ERCP fails using traditional cannulation techniques.
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Affiliation(s)
- Kambiz Kadkhodayan
- Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States
| | - Sagar Pathak
- Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States
| | - Saurabh Chandan
- Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States
| | - Abdullah Abassi
- Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States
| | - Artur Viana
- Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States
| | - Maham Hayat
- Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States
| | - Mustafa A Arain
- Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States
| | - Natalie Cosgrove
- Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States
| | - Deepanshu Jain
- Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States
| | - Dennis Yang
- Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States
| | | | - Shayan Irani
- Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, United States
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20
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Bronswijk M, Gökce E, Hindryckx P, Van der Merwe S. Single-session endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography with a dedicated over-the-scope fixation device: Feasibility study (with video). Dig Endosc 2025; 37:176-182. [PMID: 39073172 DOI: 10.1111/den.14879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 06/13/2024] [Indexed: 07/30/2024]
Abstract
OBJECTIVES Endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography (ERCP; EDGE) is proposed as a less invasive alternative to laparoscopy-assisted ERCP. However, postponing ERCP for 1-2 weeks to reduce the risk of lumen-apposing metal stent (LAMS) migration may not be practical in urgent cases such as cholangitis, leading to increased procedural burden. This study aimed to assess the feasibility and safety of a single-session EDGE utilizing a dedicated over-the-scope fixation device. METHODS A retrospective analysis of prospectively collected data from three referral centers was performed, including consecutive single-session EDGE procedures with the Stentfix device, utilizing only 20 × 10 mm LAMS. The primary outcome was LAMS migration, and key secondary outcomes included adverse events and technical success. RESULTS Twenty patients (mean age 59 [standard deviation (SD) ± 11.3] years, 65.0% female) with a predominantly classic Roux-en-Y gastric bypass history (90.0%, mini-bypass 10.0%) underwent ERCP for indications such as common bile duct stones (60.0%), cholangitis (25.0%), or biliary pancreatitis (15.0%). No LAMS migration occurred, and technical success was achieved in 95.0%. Over a median follow-up of 102 days (interquartile range [IQR] 24.8-182), two adverse events were reported (10.0%), comprising postprocedural pain (grade I) and post-ERCP pancreatitis (grade II). CONCLUSION While acknowledging potential contributions from LAMS orientation and stent caliber, our data suggest that utilizing a dedicated over-the-scope stent fixation device may effectively prevent LAMS migration during single-session EDGE without the need for endoscopic suturing.
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Affiliation(s)
- Michiel Bronswijk
- Department of Gastroenterology and Hepatology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium
- Department of Gastroenterology and Hepatology, Imelda Hospital, Bonheiden, Belgium
| | - Emine Gökce
- Department of Gastroenterology and Hepatology, Ghent University Hospital, Ghent, Belgium
| | - Pieter Hindryckx
- Department of Gastroenterology and Hepatology, Ghent University Hospital, Ghent, Belgium
| | - Schalk Van der Merwe
- Department of Gastroenterology and Hepatology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium
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21
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Gonzalez J, Ouazzani S, Vanbiervliet G, Gasmi M, Barthet M. Endoscopic ultrasound-guided gastrojejunostomy with wire endoscopic simplified technique: Move towards benign indications (with video). Dig Endosc 2025; 37:167-175. [PMID: 39253824 PMCID: PMC11808632 DOI: 10.1111/den.14895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 07/04/2024] [Indexed: 09/11/2024]
Abstract
OBJECTIVES Endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ) is an alternative to duodenal stenting and surgical GJ (SGGJ) in malignant gastric outlet obstruction (MGOO). European Society of Gastrointestinal Endoscopy guidelines restricted EUS-GJ for MGOO only, because of misdeployment. The aim was to evaluate its outcomes focusing on benign indications. METHODS This was a retrospective study conducted from 2016 to 2023 in a tertiary center. Patients included had malignant or benign GOO indicated for EUS-GJ. Techniques were the direct approach until August 2021, and the wire endoscopic simplified technique (WEST) afterwards. The main objective was to compare outcomes in benign vs. MGOO. Secondary end-points were technical success, adverse events rates, and describing the evolution of techniques and indications. RESULTS In all, 87 patients were included, 46 men, mean age 66 ± 16.2 years. Indications were malignant in 60.1% and benign in 39.1%. The EUS-GJ technique was direct in 33 patients (37.9%) and WEST in 54 (62.1%). No difference was found in terms of technical, clinical, or adverse events rates. The initial technical success rate was 88.5%. The final technical and clinical success rates were 96.6% and 94.25%, respectively. In the last year, benign exceeded malignant indications (70.4% vs. 29.6%, P < 0.05). Seven misdeployments occurred, six being addressed with the rescue technique. The misdeployment rate was significantly decreased using the WEST approach compared to the direct one: 3.7% vs. 18% (P < 0.05). The severe postoperative adverse events rate was 2.3%. CONCLUSION This study demonstrated similar outcomes of EUS-GJ between benign and MGOO, with a decreasing misdeployment rate (<4%) applying WEST. This represents an additional step towards recommending EUS-GJ in benign indications.
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Affiliation(s)
- Jean‐Michel Gonzalez
- Department of GastroenterologyAix‐Marseille Université, AP‐HM, Hôpital NordMarseilleFrance
| | - Sohaib Ouazzani
- Department of Gastroenterology, Hepatopancreatology and Digestive OncologyUniversité Libre de Bruxelles (ULB), Erasme HospitalBrusselsBelgium
| | | | - Mohamed Gasmi
- Department of GastroenterologyAix‐Marseille Université, AP‐HM, Hôpital NordMarseilleFrance
| | - Marc Barthet
- Department of GastroenterologyAix‐Marseille Université, AP‐HM, Hôpital NordMarseilleFrance
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22
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Norton BC, Papaefthymiou A, Telese A, Murray C, Murino A, Johnson G, Bisschops R, Haidry R. The A to Z of Peroral Endoscopic Myotomy. J Clin Gastroenterol 2025; 59:110-120. [PMID: 39774595 DOI: 10.1097/mcg.0000000000002082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2025]
Abstract
Peroral endoscopic myotomy (POEM) is a novel technique within the field of third space endoscopy. The overarching principal is creation of a mucosal incision, careful dissection of the submucosal space using an electrosurgical knife to reach the muscularis (ie, tunneling), performing a controlled myotomy, and finally, closure of the mucosal incision. POEM was first developed for the management of achalasia, and now a decade of evidence shows the procedure is safe, effective, and highly reproducible. Since then, the indications for POEM have expanded to a range of benign upper gastrointestinal (GI) pathologies including cricopharyngeal bar (C-POEM), Zenker's diverticulum (Z-POEM), esophageal diverticula (D-POEM), and gastroparesis (G-POEM). POEM offers the benefit of a minimally invasive alternative to surgical intervention with high clinical success and low rate of adverse events. As the field expands, there is need for more high-quality prospective evidence for the use of POEM within the upper GI tract akin to the ground-breaking work that has been achieved in achalasia. Within this review, we discuss the 5 main indications for POEM, the technical aspects of each corresponding procedure, and analyze the current evidence supporting their use in clinical practice.
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Affiliation(s)
- Benjamin Charles Norton
- Digestive Disease and Surgery Institute, Cleveland Clinic London, UK
- Centre for Obesity Research, University College London, UK
| | | | - Andrea Telese
- Digestive Disease and Surgery Institute, Cleveland Clinic London, UK
- Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Charles Murray
- Digestive Disease and Surgery Institute, Cleveland Clinic London, UK
| | - Alberto Murino
- Digestive Disease and Surgery Institute, Cleveland Clinic London, UK
| | - Gavin Johnson
- Digestive Disease and Surgery Institute, Cleveland Clinic London, UK
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, UZ Leuven, TARGID, KU Leuven, Belgium
| | - Rehan Haidry
- Digestive Disease and Surgery Institute, Cleveland Clinic London, UK
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Coluccio C, Cappetta S, Romagnoli G, Di Giorgio V, Giuffrida P, Fabbri S, Fabbri C, Binda C. Endoscopic-Ultrasound-Guided Radiofrequency Ablation for Pancreatic Tumors. J Clin Med 2025; 14:495. [PMID: 39860500 PMCID: PMC11765552 DOI: 10.3390/jcm14020495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2024] [Revised: 01/09/2025] [Accepted: 01/11/2025] [Indexed: 01/27/2025] Open
Abstract
Endoscopic ultrasound (EUS)-guided radiofrequency ablation (RFA) is a promising minimally invasive technique for the treatment of pancreatic lesions. This review first focuses on the technical aspects in EUS-RFA: the procedure typically employs EUS probes with integrated radiofrequency electrodes, enabling accurate targeting and ablation of pancreatic lesions. Different types of RFA devices, monopolar and bipolar energy delivery systems, are discussed, along with considerations for optimal ablation, including energy settings, procedure time, and pre- and post-procedural management. This paper presents a comprehensive literature review of EUS-RFA applied to both solid and cystic pancreatic lesions, including functioning and non-functioning pancreatic neuroendocrine tumors (pNETs), pancreatic cystic lesions (PCLs), pancreatic ductal adenocarcinoma (PDAC), and pancreatic metastases (PMs), discussing current evidence on safety, efficacy, clinical outcomes, and adverse events (AEs). EUS-RFA is an emerging technique with expanding potential for the treatment of both benign and malignant conditions; however, further studies are needed to better define patient selection criteria, assess long-term benefits, and establish definitive indications for its use.
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Affiliation(s)
- Chiara Coluccio
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, 47121 Romagna, Italy
| | - Stefania Cappetta
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Giovanna Romagnoli
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, 47121 Romagna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Valentina Di Giorgio
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Paolo Giuffrida
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, 47121 Romagna, Italy
| | - Stefano Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, 47121 Romagna, Italy
| | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, 47121 Romagna, Italy
| | - Cecilia Binda
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, 47121 Romagna, Italy
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24
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Lee H, Park KH, Rosas U, El Helou MO, Lee JM, Bancila L, Jamil LH, Liu Q, Watson RR, Gaddam S, Lo SK. Predictive factors for early mortality after EUS-guided gastroenterostomy in malignant gastric outlet obstruction. Endosc Int Open 2025; 13:a24749802. [PMID: 39958672 PMCID: PMC11827758 DOI: 10.1055/a-2474-9802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Accepted: 11/15/2024] [Indexed: 02/18/2025] Open
Abstract
Background and study aims Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) has recently emerged as a potential treatment option for malignant gastric outlet obstruction (mGOO), with a relatively long duration of patency and low rate of reintervention. Its intrinsic risk for serious adverse events and high procedure cost mandates careful patient selection beyond the common safety profiles. This study aimed to assess for predictors of early post-EUS-GE mortality. Patients and methods We conducted a retrospective analysis of all patients with unresectable mGOO who underwent EUS-GE. Predictive factors for postoperative 30-day mortality with crude and adjusted hazard ratios were examined using univariate and multivariate penalized likelihood Firth logistic regression analyses. Results Technical and clinical success was achieved in 96.7% and 93.1% of the patients, respectively. The 30-day mortality rate after the procedure was 11.7%, and no procedure complications were observed. The 30-day mortality group had a significantly low rate of initial clinical success (66.7% vs. 96.2%, P = 0.007). Univariate analysis identified significantly higher postoperative 30-day mortality in patients with poor baseline ECOG performance status scale (≥ 2) and ascites. Presence of grade 2 ascites was confirmed as an independent predictive factor in the multivariate analysis (adjusted hazard ratio 52.41, 95% confidence interval 1.55 to 1775.64, P = 0.024). Conclusions EUS-GE should be carefully considered for patients with ascites which was an independent predictor for early mortality after procedure in mGOO, especially those with grade 2 or higher level of ascites.
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Affiliation(s)
- Hyuk Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kenneth Hyunsoo Park
- Karsh Division of Digestive Diseases and Hepatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, United States
| | - Ulysses Rosas
- Karsh Division of Digestive Diseases and Hepatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, United States
| | - Mohamad Othman El Helou
- Karsh Division of Digestive Diseases and Hepatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, United States
| | - Jae Min Lee
- Department of Internal Medicine, Institute of Digestive Disease and Nutrition, Korea University College of Medicine, Seoul, Korea (the Republic of)
| | - Liliana Bancila
- Karsh Division of Digestive Diseases and Hepatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, United States
| | - Laith H Jamil
- Gastroenterology and Hepatology, William Beaumont Hospital - Royal Oak, Royal Oak, United States
| | - Quin Liu
- Karsh Division of Digestive Diseases and Hepatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, United States
| | - Rabindra R. Watson
- Karsh Division of Digestive Diseases and Hepatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, United States
| | - Srinivas Gaddam
- Karsh Division of Digestive Diseases and Hepatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, United States
| | - Simon K Lo
- Karsh Division of Digestive Diseases and Hepatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, United States
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Dahel Y, Caillol F, Ratone JP, Zemmour C, Palen A, Garnier J, Ewald J, Turrini O, Hoibian S, Giovannini M. Safety of intrabiliary radiofrequency ablation in cases of residual and recurrent neoplasia after endoscopic papillectomy. Endosc Int Open 2025; 13:a24872598. [PMID: 39958668 PMCID: PMC11827740 DOI: 10.1055/a-2487-2598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 09/18/2024] [Indexed: 02/18/2025] Open
Abstract
Background and study aims Intrabiliary radiofrequency ablation (IB-RFA) is a therapeutic option for cases of positive margin or recurrence after endoscopic papillectomy (EP) for superficial neoplasia. We report our experience concerning safety and efficiency of IB-RFA. Patients and methods This was a single tertiary center retrospective study. All patients who underwent IB-RFA indicated for residual or recurrent neoplasia after EP were included. We assessed morbidity (<30 days) and late complications (>30 days). Secondary outcomes were clinical success and late recurrence (absence of recurrence at the papillectomy site 12 months after IB-RFA and recurrence beyond 12 months, respectively). Results Twenty-five patients were included and underwent IB-RFA for deep positive margins (20/25, 80%) or relapse (5/25, 20%) and 40 sessions were delivered. The morbidity rate was 8% (2/24) (1 pancreatitis, 1 bleeding). Acute pancreatitis was significantly more common in the absence of pancreatic stenting (0% vs. 22%, P =0.046). One patient for whom pancreatic stenting failed died from acute severe pancreatitis in the first month (mortality rate=4%). Late complications occurred in 12 of 24 patients (50%) concerning only biliary stricture, all of which were managed endoscopically without sequelae. The clinical success rate was 92% (22/24), and late recurrence occurred in two of 24 patients (8%). Conclusions IB-RFA is relatively safe and efficient in cases of residual or recurrent neoplasia after EP and is an alternative to surgery in well-selected cases. Biliary stricture occurred frequently (50%) but could be managed endoscopically without sequelae in all cases. In cases of pancreatic stenting failure and because of the risk of severe and potentially lethal acute pancreatitis, IB-RFA should be postponed.
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Affiliation(s)
- Yanis Dahel
- Digestive Endoscopy Unit, Paoli-Calmettes Institute, Marseille, France
| | - Fabrice Caillol
- Digestive Endoscopy Unit, Paoli-Calmettes Institute, Marseille, France
| | | | | | - Anais Palen
- Digestive Surgery Unit, Paoli-Calmettes Institute, Marseille, France
| | - Jonathan Garnier
- Digestive Surgery Unit, Paoli-Calmettes Institute, Marseille, France
| | - Jacques Ewald
- Digestive Surgery Unit, Paoli-Calmettes Institute, Marseille, France
| | - Olivier Turrini
- Digestive Surgery Unit, Paoli-Calmettes Institute, Marseille, France
| | - Solene Hoibian
- Digestive Endoscopy Unit, Paoli-Calmettes Institute, Marseille, France
| | - Marc Giovannini
- Digestive Endoscopy Unit, Paoli-Calmettes Institute, Marseille, France
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26
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Ichkhanian Y, Chaudhary AJ, Veracruz N, Faisal MS, Peller MT, Kushnir V, Daugherty T, Genere JR, Pawa R, Pawa S, Ahmed W, Huggett MT, Paranandi B, Aparicio JR, Martínez-Moreno B, Nimri F, Ashraf T, Alluri S, Obri M, Dang D, Singla S, Piraka C, Zuchelli T. Endoscopic ultrasound-guided drainage of intra-abdominal abscess using 15-mm versus 10-mm lumen-apposing metal stents: an international case-matched study. Gastrointest Endosc 2025:S0016-5107(25)00005-7. [PMID: 39788214 DOI: 10.1016/j.gie.2025.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/12/2024] [Accepted: 01/03/2025] [Indexed: 01/12/2025]
Abstract
BACKGROUND AND AIMS Efficacy and safety of endoscopic ultrasound (EUS)-guided placement of lumen-apposing metal stents (LAMSs) has been reported, but the advantage of using 15-mm LAMSs over 10-mm LAMSs has yet to be explored. METHODS This was an international, retrospective, case-matched study of patients with intra-abdominal abscess who underwent EUS-guided drainage with 15-mm (case) and 10-mm (control) LAMSs from March 2019 through September 2022. RESULTS Fifty-one patients underwent EUS-guided drainage using LAMSs (15-mm, 29 [57%]; 10-mm, 22 [43%]). The most common location of the abscess was peripancreatic 43%. Technical success rate was achieved in 97% of the case subjects and 100% of the control subjects (P = .412), and clinical success was achieved in 98% and 96%, respectively (odds ratio, 1.3; P = .089). Adverse events occurred in 7.8% of the case subjects. Patients with 15-mm LAMSs underwent fewer total endoscopic procedures (mean, 2.5 vs 3.6; P < .023). CONCLUSIONS Both sizes showed similar clinical success and safety profiles, with a significant trend of the need for fewer endoscopic procedures with the 15-mm LAMS.
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Affiliation(s)
- Yervant Ichkhanian
- Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan, USA; Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Ammad J Chaudhary
- Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan, USA
| | - Nicolette Veracruz
- Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan, USA
| | | | - Matthew T Peller
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Vladimir Kushnir
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Tyler Daugherty
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Juan Reyes Genere
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Rishi Pawa
- Wake Forest University, Winston-Salem, North Carolina, USA
| | - Swati Pawa
- Wake Forest University, Winston-Salem, North Carolina, USA
| | - Wafaa Ahmed
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | | | | | - José Ramón Aparicio
- Hospital General Universitario Dr Balmis Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain
| | - Belén Martínez-Moreno
- Hospital General Universitario Dr Balmis Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain
| | - Faisal Nimri
- Department of Gastroenterology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Taha Ashraf
- Department of Gastroenterology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Spandana Alluri
- Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan, USA
| | - Mark Obri
- Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan, USA
| | - Duyen Dang
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Sumit Singla
- Division of Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Cyrus Piraka
- Division of Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Tobias Zuchelli
- Division of Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, Michigan, USA
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27
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Ogura T, Ueno S, Okuda A, Nishioka N, Sakamoto J, Matsuno J, Uba Y, Tomita M, Hattori N, Nakamura J, Bessho K, Nishikawa H. Technical outcomes between a drill dilator and ultra-tapered mechanical dilator during EUS-guided pancreaticogastrostomy: Comparative study. Endosc Int Open 2025; 13:a24873545. [PMID: 40012579 PMCID: PMC11863539 DOI: 10.1055/a-2487-3545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2024] [Accepted: 11/22/2024] [Indexed: 02/28/2025] Open
Abstract
Background and study aims Endoscopic ultrasound-guided pancreaticogastrostomy (EUS-PGS) is performed for patients who have failed ERCP. Tract dilation is one of the challenging procedural steps during EUS-PGS. Recently, a bougie dilator, the drill dilator, has become available. With this device, tract dilation can be easily performed without pushback of the echoendoscope, allowing stable scope positioning to be achieved during tract dilation. However, comparative studies between ultra-tapered mechanical and drill dilators have not been reported. The aim of this study was to compare the technical outcomes of these dilation devices. Patients and methods Symptomatic patients with main pancreatic duct (MPD) strictures from January 2021 to November 2023 were included in this retrospective study. The technical success rate of tract dilation was first evaluated. Overall technical success rate, procedure time, and adverse events were evaluated as secondary outcomes. Results The technical success rate of initial device insertion into the MPD was higher with the Tornus ES (100%, 12/12) compared with the ES dilator (60%, 9/15) ( P =0.013). Additional tract dilation rate to deploy the stent was needed in 86.7% (13/15) in the ES dilator group, and 8.3% (1/12) in the Tornus group ( P =0.001) and the overall technical success rate in the Tornus ES group was 100% (12/12). Mean procedure time was shorter in the Tornus ES group (13.38±3.80 min) compared with the ES dilator group (21.40±1.54 min) ( P =0.0013). Conclusions In conclusion, Tornus ES might be considered as the initial dilation device during EUS-PGS.
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Affiliation(s)
- Takeshi Ogura
- Endoscopy Center, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Saori Ueno
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Atsushi Okuda
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Nobu Nishioka
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Jun Sakamoto
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Jun Matsuno
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Yuki Uba
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Mitsuki Tomita
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Nobuhiro Hattori
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Junichi Nakamura
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Kimi Bessho
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Hiroki Nishikawa
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
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Martinez-Moreno B, Martínez Martínez J, Herrera I, Guilabert L, Rodríguez-Soler M, Bellot P, Miralles C, Pascual S, Irúrzun J, Zapater P, Palazón-Azorín JM, Gil Guillén V, Jover R, Aparicio JR. Correlation of endoscopic ultrasound-guided portal pressure gradient measurements with hepatic venous pressure gradient: a prospective study. Endoscopy 2025; 57:62-67. [PMID: 39025130 DOI: 10.1055/a-2369-0759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
BACKGROUND Hepatic venous portal gradient (HVPG) measurement remains the gold standard for estimating portal pressure gradient (PPG). This study aimed to evaluate the correlation between endoscopic ultrasound (EUS)-guided PPG and HVPG in patients with chronic portal hypertension. METHODS Patients with chronic portal hypertension in whom HVPG assessment was clinically indicated were invited to undergo transjugular HVPG and EUS-PPG with a 22-G needle in separate sessions for comparison. Intraclass correlation coefficient (ICC) and the Bland-Altman method were used to evaluate the agreement between techniques. RESULTS 33 patients were included. No significant differences in technical success were observed: EUS-PPG (31/33, 93.9%) vs. HVPG (31/33, 93.9%). Overall, 30 patients who underwent successful EUS-PPG and HVPG were analyzed. Correlation between the two techniques showed an ICC of 0.82 (0.65-0.91). Four patients had major discrepancies (≥5 mmHg) between HVPG and EUS-PPG. No significant differences in adverse events were observed. CONCLUSIONS The correlation between EUS-PPG and HVPG was almost perfect. EUS-PPG could be a safe and reliable method for direct PPG measurement in patients with cirrhosis and a valid alternative to HVPG.
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Affiliation(s)
- Belén Martinez-Moreno
- Endoscopy Unit, Hospital General Universitario Dr. Balmis, ISABIAL, Alicante, Spain
- Gastroenterology Department, Hospital General Universitario Dr. Balmis, ISABIAL, Alicante, Spain
| | - Juan Martínez Martínez
- Radiology Department, Hospital General Universitario Dr. Balmis, ISABIAL, Alicante, Spain
| | - Iván Herrera
- Gastroenterology Department, Hospital General Universitario Dr. Balmis, ISABIAL, Alicante, Spain
| | - Lucía Guilabert
- Gastroenterology Department, Hospital General Universitario Dr. Balmis, ISABIAL, Alicante, Spain
| | - María Rodríguez-Soler
- Gastroenterology Department, Hospital General Universitario Dr. Balmis, ISABIAL, Alicante, Spain
| | - Pablo Bellot
- Gastroenterology Department, Hospital General Universitario Dr. Balmis, ISABIAL, Alicante, Spain
| | - Cayetano Miralles
- Gastroenterology Department, Hospital General Universitario Dr. Balmis, ISABIAL, Alicante, Spain
| | - Sonia Pascual
- Gastroenterology Department, Hospital General Universitario Dr. Balmis, ISABIAL, Alicante, Spain
| | - Javier Irúrzun
- Radiology Department, Hospital General Universitario Dr. Balmis, ISABIAL, Alicante, Spain
| | - Pedro Zapater
- Universidad Miguel Hernández de Elche, Alicante, Spain
| | | | | | - Rodrigo Jover
- Endoscopy Unit, Hospital General Universitario Dr. Balmis, ISABIAL, Alicante, Spain
- Gastroenterology Department, Hospital General Universitario Dr. Balmis, ISABIAL, Alicante, Spain
| | - José R Aparicio
- Endoscopy Unit, Hospital General Universitario Dr. Balmis, ISABIAL, Alicante, Spain
- Gastroenterology Department, Hospital General Universitario Dr. Balmis, ISABIAL, Alicante, Spain
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29
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Debourdeau A, Daniel J, Caillo L, Assenat E, Bertrand M, Bardol T, Souche F, Pouderoux P, Gerard R, Lorenzo D, Bourgaux J. Effectiveness of endoscopic ultrasound (EUS)-guided choledochoduodenostomy vs. EUS-guided gallbladder drainage for jaundice in patients with malignant distal biliary obstruction after failed endoscopic retrograde cholangiopancreatography: Retrospective, multicenter study (GALLBLADEUS Study). Dig Endosc 2025; 37:103-114. [PMID: 38380564 PMCID: PMC11718144 DOI: 10.1111/den.14750] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 12/24/2023] [Indexed: 02/22/2024]
Abstract
OBJECTIVES The aim of this study was to compare endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) vs. EUS-gallbladder drainage (EUS-GBD) in cases of failed endoscopic retrograde cholangiopancreatography (ERCP) for jaundice resulting from malignant distal biliary obstruction (MDBO). METHODS This multicenter retrospective study included patients with obstructive jaundice secondary to MDBO who underwent EUS-GBD or EUS-CDS with lumen-apposing metal stents after failed ERCP. The primary end-point was clinical success rate. Secondary end-points were technical success, periprocedural adverse events rate (<24 h), late adverse events rate (>24 h), overall survival, and time to recurrent biliary obstruction. RESULTS A total of 78 patients were included: 41 underwent EUS-GBD and 37 underwent EUS-CDS. MDBO was mainly the result of pancreatic cancer (n = 63/78, 80.7%). Clinical success rate was similar for both procedures: 87.8% for EUS-GBD and 89.2% for EUS-CDS (P = 0.8). Technical success rate was 100% for EUS-GBD and 94.6% for EUS-CDS (P = 0.132). Periprocedural morbidity (<24 h) rates were similar between both groups: 4/41 (9.8%) for EUS-GBD and 5/37 (13.5%) for EUS-CDS (P = 0.368). There was a significantly higher rate of late morbidity (>24 h) among patients in the EUS-CDS group (8/37 [21.6%]) than in the EUS-GBD group (3/41 [7.3%]) (P = 0.042). The median follow-up duration was 4.7 months. Overall survival and time to recurrent biliary obstruction did not significantly differ between the groups. DISCUSSION After failed ERCP for MDBO, EUS-GBD and EUS-CDS show comparable clinical success rates and technical success. EUS-GBD appears to be a promising alternative for MDBO, even as a second-line treatment after failed ERCP. Further studies are needed to validate these findings and compare the long-term outcomes of EUS-GBD and EUS-CDS.
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Affiliation(s)
- Antoine Debourdeau
- Hepatogastroenterology DepartmentNimes University Hospital, University of MontpellierNimesFrance
- Hepatogastroenterology DepartmentMontpellier University Hospital, University of MontpellierMontpellierFrance
| | - Jules Daniel
- Hepatogastroenterology DepartmentNimes University Hospital, University of MontpellierNimesFrance
| | - Ludovic Caillo
- Hepatogastroenterology DepartmentNimes University Hospital, University of MontpellierNimesFrance
| | - Eric Assenat
- Hepatogastroenterology DepartmentMontpellier University Hospital, University of MontpellierMontpellierFrance
| | - Martin Bertrand
- Surgery DepartmentNimes University Hospital, University of MontpellierNimesFrance
| | - Thomas Bardol
- Surgery DepartmentMontpellier University Hospital, University of MontpellierMontpellierFrance
| | - François‐Régis Souche
- Surgery DepartmentMontpellier University Hospital, University of MontpellierMontpellierFrance
| | - Philippe Pouderoux
- Hepatogastroenterology DepartmentNimes University Hospital, University of MontpellierNimesFrance
| | - Romain Gerard
- Hepatogastroenterology DepartmentLille University Hospital, Lille UniversityLilleFrance
| | - Diane Lorenzo
- Hepatogastroenterology DepartmentBeaujon University Hospital, Paris Cité UniversityParisFrance
| | - Jean‐François Bourgaux
- Hepatogastroenterology DepartmentNimes University Hospital, University of MontpellierNimesFrance
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Neri B, Stigliano S, Biasutto D, Citterio N, Lisotti A, Fusaroli P, Mangiavillano B, Donatelli G, Tonini G, Di Matteo FM. Endoscopic ultrasound-guided entero-colostomy with lumen-apposing metal stent as a rescue treatment for malignant intestinal occlusion: a multicenter study. Endoscopy 2025; 57:77-82. [PMID: 38925153 DOI: 10.1055/a-2354-3352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
BACKGROUND Surgery is the first-choice treatment for malignant intestinal obstruction (MIO); however, many patients are deemed unfit for surgery. Endoscopic ultrasound-guided entero-colostomy (EUS-EC) with a lumen-apposing metal stent (LAMS) could represent a new treatment option. METHODS Consecutive patients undergoing EUS-EC for MIO from November 2021 to September 2023 at four European tertiary referral centers were retrospectively enrolled. Multidisciplinary meetings determined whether patients were unsuitable for surgery or colonic stent placement, or refused surgery. The primary outcome was technical success of EUS-EC and secondary outcomes were clinical outcome, safety, and hospital stay. RESULTS 12 patients were enrolled (median age 72.5 [range 42-85] years; 58.3% female). Colonic adenocarcinoma was the primary tumor in 75.0% of patients and 91.7% had stage IV disease. Technical success was 100%. No LAMS misdeployment or other procedural adverse events occurred; three patients (25.0%) had severe post-procedural complications. Clinical success was achieved in 10 patients (83.3%), with 5 (50.0%) resuming chemotherapy after the procedure. Median post-procedural hospital stay was 9 (1-20) days and median overall survival was 47.5 (2-270) days. CONCLUSIONS EUS-EC was a feasible technique and could be considered a possible alternative to standard approaches for MIO in highly selected patients.
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Affiliation(s)
- Benedetto Neri
- Therapeutic GI Endoscopy Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Department of Systems Medicine, Gastroenterology Unit, University 'Tor Vergata' of Rome, Rome, Italy
| | - Serena Stigliano
- Therapeutic GI Endoscopy Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Dario Biasutto
- Therapeutic GI Endoscopy Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Nicolò Citterio
- Therapeutic GI Endoscopy Unit, TherFondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Gastroenterology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Andrea Lisotti
- Gastroenterology Unit, Hospital of Imola, University of Bologna, Bologna, Italy
| | - Pietro Fusaroli
- Gastroenterology Unit, Hospital of Imola, University of Bologna, Bologna, Italy
| | - Benedetto Mangiavillano
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza, Italy - Humanitas University, Milan, Italy
| | - Gianfranco Donatelli
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
- Department of Interventional Endoscopy and Endoscopic Surgery, Hopital Privé des Peupliers, Paris, France
| | - Giuseppe Tonini
- Department of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
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Sarkis Y, Stainko S, Perkins A, Al-Haddad MA, DeWitt JM. Comparison of flexible endoscopic needle-knife septotomy and peroral endoscopic myotomy for treatment of Zenker's diverticulum. Gastrointest Endosc 2025; 101:82-89. [PMID: 39218270 DOI: 10.1016/j.gie.2024.08.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 06/24/2024] [Accepted: 08/23/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND AND AIMS Treatment of Zenker's diverticulum (ZD) has evolved from flexible endoscopic septotomy (FES) to peroral endoscopic myotomy for ZD (Z-POEM). In this study, we compare the efficacy and safety of flexible endoscopic needle-knife septotomy (FENKS) and Z-POEM for symptomatic ZD. METHODS Consecutive patients at a single institution who underwent endoscopic ZD treatment by FENKS or Z-POEM were identified. Demographics, clinical characteristics, procedure technique, technical and clinical success, and adverse events (AEs) within 30 days were reviewed and compared between the 2 groups. AEs were classified by the AGREE classification. Baseline and postprocedure Dakkak and Bennett (DB) scores were reported at 6, 12, and 24 months. Clinical success (DB score ≤1) was assessed by per-protocol (PP) and intention-to-treat analyses (ITT). RESULTS Sixty patients (55% men; mean age, 72 ± 12 years) underwent FENKS (n = 21) or Z-POEM (n = 39) between 2016 and 2023. Baseline clinical characteristics were similar, and overall technical success was 98.3%. Clinical success by PP and ITT analyses at 6, 12, and 24 months after each intervention were similar between both groups. The FENKS group had a higher prevalence (29% vs 5%, P = .018) and severity (P = .032) of AEs and were more likely to be hospitalized after treatment (71% vs 33%, P = .007). During a median follow-up of 18 months, reintervention was required for 5 cases (10%), 2 (9%) in the FENKS and 3 (7.6%) in the Z-POEM group (P = 1.0) a mean 7.6 ± 4.4 months after initial therapy. CONCLUSIONS Treatment of ZD with Z-POEM appears to be safer than FENKS with similar short and midterm clinical success.
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Affiliation(s)
- Yara Sarkis
- Department of Gastroenterology and Hepatology, Indiana University Health Medical Center, Indianapolis, Indiana, USA
| | - Sarah Stainko
- Department of Gastroenterology and Hepatology, Indiana University Health Medical Center, Indianapolis, Indiana, USA
| | - Anthony Perkins
- Department of Biostatistics and Health Data Science, Indiana University Health Medical Center, Indianapolis, Indiana, USA
| | - Mohammad A Al-Haddad
- Department of Gastroenterology and Hepatology, Indiana University Health Medical Center, Indianapolis, Indiana, USA
| | - John M DeWitt
- Department of Gastroenterology and Hepatology, Indiana University Health Medical Center, Indianapolis, Indiana, USA
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Balducci D, Ratone JP, Schaefer M, Godat S, Perez-Cuadrado-Robles E, Hoibian S, Dahel Y, Dalex M, Chevaux JB, Caillol F, Giovannini M. EUS-guided hepaticojejunostomy in patients with history of total gastrectomy: a multicenter retrospective feasibility study (with video). Gastrointest Endosc 2025; 101:117-122. [PMID: 39038522 DOI: 10.1016/j.gie.2024.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 06/24/2024] [Accepted: 07/14/2024] [Indexed: 07/24/2024]
Abstract
BACKGROUND AND AIMS EUS-guided hepaticogastrostomy (EUS-HGS) is an effective biliary drainage technique for patients with altered anatomy or duodenal strictures. EUS-guided hepaticojejunostomy (EUS-HJS) can be used to create a fistula between the left hepatic duct and the jejunum in patients with a history of total gastrectomy. No specific data on this technique have been published. The aim of this study was to assess the feasibility and safety of EUS-HJS in patients with a history of total gastrectomy. METHODS This retrospective multicenter study included all adult patients who underwent EUS-HJS at 3 tertiary French centers and 1 tertiary Swiss center between May 2011 and February 2023. The primary outcome was clinical success, which was defined as the disappearance of pruritus, jaundice, and/or cholangitis. An improvement in bilirubin >30% within the first week and/or bilirubin normalization within 1 month after the procedure were also considered indicators of clinical success. Secondary outcomes were technical success, rate of adverse events, need for endoscopic revision, possibility of resuming anticancer treatment, median survival, and technical differences compared with EUS-HGS. RESULTS Twenty-one patients with history of complete gastrectomy who underwent EUS-HJS were included. Technical success was achieved in 100% of patients (95% confidence interval [CI], 85-100). Clinical success was achieved in 80% of patients (95% CI, 58-92). The incidence of recorded adverse events was 33% (95% CI, 17-55), with cholangitis being the most frequent adverse event. Seven patients (39%) were able to benefit from anticancer treatment after the procedure. Median survival time was 6 months (interquartile range, 1.5-12). CONCLUSIONS EUS-HJS is an effective and feasible procedure for patients whose anatomy has been altered by total gastrectomy.
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Affiliation(s)
| | | | - Marion Schaefer
- Centre Hospitalier Régional Universitaire de Nancy, Nancy, France
| | - Sébastien Godat
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | | | - Solene Hoibian
- Endoscopy Unit, Paoli-Calmettes Institute, Marseille, France
| | - Yanis Dahel
- Endoscopy Unit, Paoli-Calmettes Institute, Marseille, France
| | - Meddy Dalex
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | | | - Fabrice Caillol
- Endoscopy Unit, Paoli-Calmettes Institute, Marseille, France
| | - Marc Giovannini
- Endoscopy Unit, Paoli-Calmettes Institute, Marseille, France
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Sadeghi A, Arabpour E, Rastegar R, Omidvari S, Looha MA, Keshavarzian M, Zali MR. Impact of major duodenal papilla morphology on the outcomes of primary needle-knife fistulotomy for deep biliary cannulation. Sci Rep 2024; 14:31949. [PMID: 39738703 PMCID: PMC11686267 DOI: 10.1038/s41598-024-83446-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2024] [Accepted: 12/16/2024] [Indexed: 01/02/2025] Open
Abstract
The morphology of the major duodenal papilla (MDP) plays a crucial role in the selection of the cannulation technique. Primary needle-knife fistulotomy (pNKF) is an advanced cannulation technique is getting more popular because of the lower risk of post-ERCP pancreatitis (PEP). However, few studies have explored the impact of MDP morphology on pNKF outcomes. This study aimed to assess the safety and efficacy of pNKF for different MDP morphologies. A review of medical records between 2022 and 2024 revealed 200 patients with naïve MDP who underwent pNKF at Taleghani Hospital. Patients were classified into the three groups on the basis MDP morphology: regular: n = 34 (17%), long: n = 104 (52%), and bulging: n = 64 (31%). There were no patients with small papilla who underwent pNKF in the records. We compared successful biliary cannulation, the difficulty of procedure, and post-ERCP adverse events among these three groups. The success rates of pNKF in primary biliary cannulation were 94.1%, 98.1%, and 98.4% in the patients with regular, long, and bulging papilla; respectively (p = 0.38). Moreover, there was no significant difference in the rates of PEP (p = 0.71), bleeding (p = 0.11), perforation (p = 0.48), or cholangitis (p = 1.00). However, the procedure in the regular papilla group was associated with more cannulation attempts (p = 0.025) and longer time for manipulation of the papilla (p < 0.001). In conclusion, pNKF is an effective and safe cannulation technique for regular, long, or bulging papillae, although it may be associated with more cannulation attempts and longer cannulation times for regular papilla. Further multicenter trials with large populations are needed to confirm these findings, and investigate the applicability and the outcomes of pNKF in small papillae.
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Affiliation(s)
- Amir Sadeghi
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Erfan Arabpour
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- RIGLD, Arabi Ave, Daneshjoo Blvd, Velenjak, Tehran, Iran.
| | - Reyhaneh Rastegar
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Samareh Omidvari
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Azizmohammad Looha
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Reza Zali
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Abad J, Llop E, Arias-Loste MT, Burgos-Santamaría D, Martínez Porras JL, Iruzubieta P, Graus J, Ruiz-Antorán B, Sánchez Yuste MR, Romero-Gómez M, Albillos A, Crespo J, Calleja JL. Endoscopic Sleeve Gastroplasty Plus Lifestyle Intervention in Patients With Metabolic Dysfunction-associated Steatohepatitis: A Multicentre, Sham-controlled, Randomized Trial. Clin Gastroenterol Hepatol 2024:S1542-3565(24)01080-2. [PMID: 39694202 DOI: 10.1016/j.cgh.2024.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 09/06/2024] [Accepted: 10/22/2024] [Indexed: 12/20/2024]
Abstract
BACKGROUND & AIMS Metabolic dysfunction-associated steatohepatitis (MASH) is commonly seen in biopsy-proven steatotic liver disease. Lifestyle intervention reaching a weight loss higher than 10% promotes MASH resolution, but this goal is only achieved by a small number of patients. Endoscopic sleeve gastroplasty (ESG) has recently emerged as a safe and effective option to promote weight loss in the obese population. We report the results of a multicenter, randomized, controlled, and double-blind study to evaluate the effectiveness and safety of ESG in patients with MASH. METHODS Forty patients were randomized 1:1 to ESG plus lifestyle modification vs sham endoscopy (SE) plus lifestyle intervention. Inclusion criteria included biopsy-proven MASH with nonalcoholic fatty liver disease activity score (NAS) ≥3 and fibrosis stage F0 to F3. Eighteen patients from the ESG group and 19 from the endoscopic simulated intervention (ESI) group completed follow-up over 72 weeks. Baseline to end of follow-up changes in body weight, liver tests, liver stiffness (vibration-controlled transient elastography), and liver histology were recorded RESULTS: Total body weight loss (TBWL) was 9.47% (±9.38%) in the ESG group vs 3.91% (±5.43%) in the ESI group (P < .05). Liver stiffness decreased 5.63 (±7.17) KPa in the ESG group vs 0.2 (±5.38) KPa in the ESI group (P < .05). Steatosis was significantly reduced in the ESG group (-0.94 ± 0.87) vs the ESI group (-0.26 ± 0.99) (P = .033). No differences on NAS (-1.89 ± 2.11 vs -1.47 ± 2.01) score or fibrosis (-0.1 ± 0.91 vs -0.84 ± 1.21) was seen. In patients achieving weight loss >10%, we found a significant improvement on NAS score (-4 ± 0.94 vs -0.81 ± 1.62; P < .01), but not in fibrosis stage (-0.3 ± 1.06 vs -0.59 ± 1.25). Only 2 patients from the ESG group had adverse events that required admission; these resolved conservatively in 72 hours. CONCLUSION ESG is an effective and safe method to promote weight reduction associated with significant improvement in patients with MASH and obesity. CLINICALTRIALS gov, Number: NCT03426111.
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Affiliation(s)
- Javier Abad
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - Elba Llop
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - María Teresa Arias-Loste
- Department of Gastroenterology and Hepatology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Diego Burgos-Santamaría
- Servicio de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - José Luis Martínez Porras
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - Paula Iruzubieta
- Department of Gastroenterology and Hepatology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Javier Graus
- Servicio de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Belén Ruiz-Antorán
- Department of Clinical Pharmacology, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | | | - Manuel Romero-Gómez
- UCM Digestive Diseases and Ciberehd, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Agustin Albillos
- Servicio de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Javier Crespo
- Department of Gastroenterology and Hepatology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - José Luis Calleja
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro, Majadahonda, Spain.
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Goubert K, Degroote H, De Vos M, Khalenkow M, Hindryckx P. Factors Associated with the Severity of ERCP-Related Complications: A Retrospective Single-Centre Study. J Clin Med 2024; 13:7481. [PMID: 39685938 DOI: 10.3390/jcm13237481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2024] [Revised: 11/25/2024] [Accepted: 12/06/2024] [Indexed: 12/18/2024] Open
Abstract
Objectives: Risk factors for post-endoscopic retrograde cholangiopancreatography (ERCP) complications have been extensively studied and are well established; most complications are mild and self-limiting. This study aims to identify patients at risk of severe early post-ERCP complications. Methods: We conducted a retrospective cohort study with data from 2810 ERCP procedures performed at Ghent University Hospital between 2016 and 2022. Patient records and a maintained ERCP registry were used to identify all ERCP-related complications and possible risk factors. The AGREE classification was used to determine the severity of the complication. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of severe complications. Results: Out of 2810 procedures, 223 cases (7.9%) had post-ERCP complications, with severe complications occurring in 20.3% of cases. The most common severe complication was haemorrhage (22/49 severe complications, 44.9%), with perforation having the highest probability of being severe (10/15 cases, 67%). Independent predictors of severe complications included anticoagulative therapy (OR 6.3, 95% CI 1.4-28.3, p = 0.016) and high procedural difficulty (Schutz category 3: OR 11.5, 95% CI 2.4-54.6, p = 0.002; category 4: OR 5.9, 95% CI 1.4-23.5, p = 0.012). Conclusions: Patients on anticoagulation and those undergoing complex ERCP procedures (Schutz 3 or 4) are at particular risk of severe procedure-related complications.
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Affiliation(s)
- Kristel Goubert
- Ghent University Hospital, Coupure Rechts 136, 9000 Ghent, Belgium
| | - Helena Degroote
- Ghent University Hospital, Coupure Rechts 136, 9000 Ghent, Belgium
| | - Martine De Vos
- Ghent University Hospital, Coupure Rechts 136, 9000 Ghent, Belgium
| | - Maxim Khalenkow
- Ghent University Hospital, Coupure Rechts 136, 9000 Ghent, Belgium
| | - Pieter Hindryckx
- Ghent University Hospital, Coupure Rechts 136, 9000 Ghent, Belgium
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Sadeghi A, Arabpour E, Movassagh-koolankuh S, Rastegar R, Moghadam PK, Omidvari S, Alizadeh M, Zali MR. Primary Needle-Knife Fistulotomy Versus Standard Transpapillary Technique for Cannulation of Long-Size Papilla: A Randomized Clinical Trial. Clin Transl Gastroenterol 2024; 15:e00788. [PMID: 39626015 PMCID: PMC11671062 DOI: 10.14309/ctg.0000000000000788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2024] [Accepted: 10/30/2024] [Indexed: 12/28/2024] Open
Abstract
INTRODUCTION The morphology of the major papilla plays a crucial role in the selection of the cannulation method for the common bile duct during endoscopic retrograde cholangiopancreatography. Nevertheless, there is limited evidence available that compares the efficacy and safety of cannulation approaches in certain papilla morphologies. The aim of this study was to assess the safety and effectiveness of 2 cannulation methods, including primary needle-knife fistulotomy (pNKF) and standard transpapillary (STP), in patients with long-size papilla. METHODS A total of 260 patients with intact long-size papilla were enrolled and were randomly assigned to the pNKF or STP groups (n = 130 in each group). The primary endpoint was the rate of postendoscopic retrograde cholangiopancreatography pancreatitis. Biliary cannulation success rates, the duration of cannulation and the overall procedure, and the incidence of adverse events were also compared between the groups. All of the patients were hospitalized for at least 24 hours after the procedure. RESULTS A total of 125 (96.2%) patients in the pNKF and 114 (87.7%) patients in the STP groups had successful primary biliary cannulation ( P = 0.01) and were included in the final analysis. Postendoscopic retrograde cholangiopancreatography pancreatitis occurred in 11 patients in the STP group and 3 patients in the pNKF group (9.6% vs 2.4%, P = 0.02; number needed to treat [95% confidence interval] = 13.9 [7.5-83.2]). Moreover, compared with the pNKF, STP was associated with more cannulation attempts (3.4 vs 2.5, P < 0.001) and longer cannulation time (258 vs 187 seconds, P < 0.001). DISCUSSION In patients with long-size papilla, pNKF is a safer, easier, and more efficient approach to gain primary biliary access than the STP technique.
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Affiliation(s)
- Amir Sadeghi
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Erfan Arabpour
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahryar Movassagh-koolankuh
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reyhaneh Rastegar
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pardis Ketabi Moghadam
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Samareh Omidvari
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrnoosh Alizadeh
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Zali
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Stigliano S, Marocchi G, Baldaro F, Neri B, Del Vecchio Blanco G, Troncone E, Di Matteo FM. Timing of lumen-apposing metal stents removal in pancreatic fluid collections: Could we go beyond? Pancreatology 2024; 24:1252-1256. [PMID: 39488448 DOI: 10.1016/j.pan.2024.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 10/02/2024] [Accepted: 10/26/2024] [Indexed: 11/04/2024]
Abstract
BACKGROUND AND AIMS Lumen-apposing metal stents (LAMS) are the mainstay treatment for pancreatic fluid collections (PFC). A 4-weeks interval for LAMS removal has been suggested to avoid adverse events (AEs). Primary aim is to evaluate the AEs rate in patients with LAMS removal <4 and >4 weeks from placement and possible associated factors. METHODS Retrospective study on patients underwent EUS-guided drainage of PFC with LAMS at two Italian centers between January 2017 and November 2023. PFC and LAMS features were collected. AEs were defined as bleeding, obstruction and buried LAMS. RESULTS 108 patients were enrolled (62.9 % males; mean age 61 ± 14 years old). In 38 % PFC was in pancreatic head. In 64.8 % of patients LAMS ≥15 mm was used. Mean time of LAMS indwelling was 71 ± 87 days and in 73.1 % of patients the LAMS was removed after 4 weeks. AE occurred in 8.3 % of patients and the most common (77.8 %) was bleeding. There was no association between LAMS indwelling >4 weeks (8/9 vs 65/93 p = 0.44) and the rate of AE. A comparable mean time of LAMS persistence (108 ± 96 vs 67 ± 86 p = 0.18) between patients with and without AE was observed. PFC in the head (7/9 vs 33/93 p = 0.02) and LAMS ≥15 mm (9/9 vs 58/93 p = 0.03) were associated with a higher rate of AE. CONCLUSION When needed, LAMS removal >4 weeks appears to be as safe as LAMS removal within 4 weeks. LAMS ≥15 mm and Head location were associated with higher rate of AE and thus should arouse more caution.
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Affiliation(s)
- S Stigliano
- Operative Digestive Endoscopy Department, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - G Marocchi
- Gastroenterology and Digestive Endoscopy Unit, Ospedale F. Spaziani, Frosinone, Italy
| | - F Baldaro
- Department of Digestive Diseases, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - B Neri
- Operative Digestive Endoscopy Department, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy; Gastroenterology Unit, Policlinico Universitario "Tor Vergata" of Rome, Italy
| | | | - E Troncone
- Gastroenterology Unit, Policlinico Universitario "Tor Vergata" of Rome, Italy
| | - F M Di Matteo
- Operative Digestive Endoscopy Department, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.
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Koduri KK, Jagtap N, Lakhtakia S, Jahangeer B, Asif S, Talukdar R, Trikudanathan G, Tandan M, Kalapala R, Nabi Z, Gupta R, Ramchandani M, Singh J, Memon SF, Rao GV, Reddy DN. Biflanged metal stents versus plastic stents for endoscopic ultrasound-guided drainage of walled-off necrosis: a randomized controlled trial. Endoscopy 2024; 56:915-923. [PMID: 38782021 DOI: 10.1055/a-2332-3448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
BACKGROUND Endoscopic ultrasound (EUS)-guided drainage of walled-off necrosis (WON) using either plastic or metal stents is the mainstay of WON management. Our single-center randomized controlled trial aimed to evaluate the efficacy of biflanged metal stents (BFMSs) and plastic stents for WON drainage. METHODS Patients with symptomatic WON amenable to EUS-guided drainage were randomized to receive either BFMSs or plastic stents. The primary outcome was reintervention-free clinical success at 4 weeks. Secondary outcomes were: overall clinical success (complete resolution of symptoms and significant reduction in size of WON [<50% of original size and <5 cm in largest diameter at 4-week follow-up]); number of reinterventions; adverse events (AEs); hospital stay for first admission; and medium-term outcomes at 6 months (recurrence, disconnected pancreatic duct, chronic pancreatitis, and new-onset diabetes mellitus). RESULTS 92 patients were randomized: 46 in each arm. The reintervention-free clinical success rate was significantly higher in the BFMS group on intention-to-treat analysis (67.4% vs. 43.5%; P = 0.02). Overall clinical success at 1 month was similar in both groups. There were significantly fewer reinterventions (median 0 [IQR 0-1] vs. 1 [0-2]; P = 0.03) and shorter hospital stays in the BFMS group (7.0 [SD 3.4] vs. 9.1 [5.5] days; P = 0.04). There were no differences in procedure-related AEs, mortality, or medium-term outcomes. CONCLUSIONS BFMSs provide better reintervention-free clinical success at 4 weeks, with shorter hospital stay and without increased risks of AEs, compared with plastic stents for EUS-guided drainage of WON. Medium-term outcomes are however similar for both stent types.
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Affiliation(s)
| | - Nitin Jagtap
- Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Sundeep Lakhtakia
- Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Basha Jahangeer
- Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Shujaath Asif
- Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Rupjyoti Talukdar
- Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Guru Trikudanathan
- Gastroenterology, Hepatology and Nutrition, University of Minnesota Twin Cities, Minneapolis, United States
| | - Manu Tandan
- Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Rakesh Kalapala
- Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Zaheer Nabi
- Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Rajesh Gupta
- Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Mohan Ramchandani
- Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Jagadish Singh
- Radiodiagnosis and Interventional Radiology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Sana Fatima Memon
- Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - G Venkat Rao
- Surgical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - D Nageshwar Reddy
- Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
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Moon JH, Park SW, Lee YN, Lee SH, Kim SH, Lee DW, Cho CM, Kim SB, Park CH. A comparison of novel electrocautery-enhanced lumen-apposing metal stents and plastic stents in endoscopic ultrasound-guided drainage of infected walled-off necrosis: a multicenter randomized study. Endoscopy 2024; 56:926-937. [PMID: 38857618 PMCID: PMC11716544 DOI: 10.1055/a-2342-1140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 06/07/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND Although lumen-apposing metal stents (LAMSs) have been increasingly used for walled-off necrosis (WON), their advantages over plastic stents in infected WON are unclear. We investigated the safety and efficacy of a novel electrocautery-enhanced LAMS for managing infected WON. METHODS Patients who required endoscopic ultrasound-guided WON drainage were randomly assigned to LAMS or plastic stent groups. The primary outcome was total number of direct endoscopic necrosectomy (DEN) procedures required to achieve clinical success. Secondary outcomes included rates of technical success, clinical success, and adverse events. RESULTS 46 patients were included in the LAMS (n = 23) and plastic stent (n = 23) groups. The median total number of DEN procedures did not differ significantly between the plastic stent group (4 procedures, interquartile range [IQR] 2.5-5.0) and LAMS group (9 procedures, IQR 8.0-9.0) (P = 0.07). The LAMS group demonstrated a significantly higher clinical success rate than the plastic stent group based on intention-to-treat analysis (100% vs. 73.9%, P =0.03) at 8 weeks but not at 4 weeks. Significant bleeding occurred in one patient in the plastic stent group and no patients in the LAMS group. CONCLUSIONS We found no significant difference in the total number of DEN procedures between LAMSs and plastic stents for managing infected WON. The only statistically significant finding was a higher clinical success rate at 8 weeks for patients treated with LAMS. The use of LAMS did not result in any adverse events, such as bleeding or buried LAMS syndrome, within the study duration.
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Affiliation(s)
- Jong Ho Moon
- Division of Gastroenterology, Department of Internal Medicine, SoonChunHyang University College of Medicine, Bucheon, Korea (the Republic of)
| | - Se Woo Park
- Division of Gastroenterology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea (the Republic of)
| | - Yun Nah Lee
- Division of Gastroenterology, Department of Internal Medicine, SoonChunHyang University College of Medicine, Bucheon, Korea (the Republic of)
| | - Sang Hyub Lee
- Division of Gastroenterology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Seong-Hun Kim
- Department of Internal Medicine, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea (the Republic of)
| | - Dong Wook Lee
- Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea (the Republic of)
| | - Chang Min Cho
- Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea (the Republic of)
| | - Sung Bum Kim
- Division of Gastroenterology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea (the Republic of)
| | - Chan Hyuk Park
- Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea (the Republic of)
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Tejedor-Tejada J, Alvarez-Alvarez A, Olmos JM, González-Bernal AC, Jimenez-Jurado A, Robles-Gaitero S, Perez-Pariente JM. Secondary uncovered versus fully-covered metal stents for the management of occluded stent in unresectable distal malignant biliary obstruction. GASTROENTEROLOGIA Y HEPATOLOGIA 2024; 47:502218. [PMID: 38857753 DOI: 10.1016/j.gastrohep.2024.502218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 05/22/2024] [Accepted: 05/24/2024] [Indexed: 06/12/2024]
Abstract
INTRODUCTION Self-expandable metallic stents (SEMS) have been widely placed for unresectable distal malignant biliary obstruction (UDMBO). However, the dysfunction rate is 19-40% and its treatment is controversial. We aimed asses the efficacy and safety of a secondary biliary stents (uncovered (UC) versus fully-covered (FC) stent) for the management of occluded SEMS. PATIENTS AND METHODS Between 2015 and June 2023, 41 patients with UDMBO underwent secondary biliary stent placement as "stent-in-stent" (20 FCSEMS and 21 UCSEMS). The primary outcomes were technical and clinical success of SEMS placement. Secondary outcomes included adverse events (AEs), patency and survival. Patients were prospectively followed until death or loss of follow-up. RESULTS Technical (100% vs 85.5%) and clinical (100% vs 95.2%) success rates were similar in FCSEMS and UCSEMS groups. The median follow-up period was 510 days (range 290-630). The median duration of stent patency of FCSEMS (220 days, IQR 137.5-442.5) was longer than UCSEMS (150 days, IQR 110-362.5) (P=0.395), although stent dysfunction within 6 months was not different between groups. Multivariate analysis indicated that sex (HR=0.909, 0.852-0.970), antitumor treatment (HR=0.248, 0.032-0.441), stent patency (HR=0.992, 0.986-0.998) and clinical success (HR=0.133, 0.026-0.690) were significant factors for overall survival. There were no remarkable differences in AEs. CONCLUSIONS The placement of additional biliary stent using the stent-in-stent method is an effective and safe rescue treatment for patients with UDMBO and occluded stent. In addition, the use of FCSEMS compared UCSEMS has unclear benefits regarding stent patency and overall survival.
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Affiliation(s)
- Javier Tejedor-Tejada
- Department of Gastroenterology, Hospital Universitario de Cabueñes, Gijón, Asturias, Spain.
| | | | - Jose Manuel Olmos
- Department of Gastroenterology, Hospital Universitario de Cabueñes, Gijón, Asturias, Spain
| | | | - Andrea Jimenez-Jurado
- Department of Gastroenterology, Hospital Universitario de Cabueñes, Gijón, Asturias, Spain
| | - Samuel Robles-Gaitero
- Department of Gastroenterology, Hospital Universitario de Cabueñes, Gijón, Asturias, Spain
| | - Jose M Perez-Pariente
- Department of Gastroenterology, Hospital Universitario de Cabueñes, Gijón, Asturias, Spain
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Gibiino G, Binda C, Papparella LG, Spada C, Andrisani G, Di Matteo FM, Gagliardi M, Maurano A, Sferrazza S, Azzolini F, Grande G, de Nucci G, Cesaro P, Aragona G, Cennamo V, Fusaroli P, Staiano T, Soriani P, Campanale M, Di Mitri R, Pugliese F, Anderloni A, Cucchetti A, Repici A, Fabbri C. Technical failure during colorectal endoscopic full-thickness resection: the "through thick and thin" study. Endoscopy 2024; 56:831-839. [PMID: 38754466 DOI: 10.1055/a-2328-4753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
BACKGROUND Endoscopic full-thickness resection (EFTR) is an effective and safe technique for nonlifting colorectal lesions. Technical issues or failures with the full-thickness resection device (FTRD) system are reported, but there are no detailed data. The aim of our study was to quantify and classify FTRD technical failures. METHODS We performed a retrospective study involving 17 Italian centers with experience in advanced resection techniques and the required devices. Each center shared and classified all prospectively collected consecutive failures during colorectal EFTR using the FTRD from 2018 to 2022. The primary outcome was the technical failure rate and their classification; secondary outcomes included subsequent management, clinical success, and complications. RESULTS Included lesions were mainly recurrent (52 %), with a mean (SD) dimension of 18.4 (7.5) mm. Among 750 EFTRs, failures occurred in 77 patients (35 women; mean [SD] age 69.4 [8.9] years). A classification was proposed: type I, snare noncutting (53 %); type II, clip misdeployment (31 %); and type III, cap misplacement (16 %). Among endoscopic treatments completed, rescue endoscopic mucosal resection was performed in 57 patients (74 %), allowing en bloc and R0 resection in 71 % and 64 %, respectively. The overall adverse event rate was 27.3 %. Pooled estimates for the rates of failure, complications, and rescue endoscopic therapy were similar for low and high volume centers (P = 0.08, P = 0.70, and P = 0.71, respectively). CONCLUSIONS Colorectal EFTR with the FTRD is a challenging technique with a non-negligible rate of technical failure and complications. Experience in rescue resection techniques and multidisciplinary management are mandatory in this setting.
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Affiliation(s)
- Giulia Gibiino
- Gastroenterology and Digestive Endoscopy Units, Morgagni - Pierantoni Hospital, Forlì, and Maurizio Bufalini Hosptial, Cesena, Italy
| | - Cecilia Binda
- Gastroenterology and Digestive Endoscopy Units, Morgagni - Pierantoni Hospital, Forlì, and Maurizio Bufalini Hosptial, Cesena, Italy
| | - Luigi Giovanni Papparella
- Center for Endoscopic Research Therapeutics and Training (CERTT), Policlinico Agostino Gemelli University, Rome, Italy
| | - Cristiano Spada
- Center for Endoscopic Research Therapeutics and Training (CERTT), Policlinico Agostino Gemelli University, Rome, Italy
| | | | | | - Mario Gagliardi
- Digestive Endoscopy Unit, Ospedale Gaetano Fucito, Mercato San Severino, Italy
| | - Attilio Maurano
- Digestive Endoscopy Unit, Ospedale Gaetano Fucito, Mercato San Severino, Italy
| | - Sandro Sferrazza
- Gastroenterology and Digestive Endoscopy Unit, ARNAS Civico Hospital, Palermo, Italy
| | - Francesco Azzolini
- Gastroenterology and Gastrointestinal Endocopy, Vita-Salute San Raffaele University, Milan, Italy
| | - Giuseppe Grande
- Gastroenterology and Digestive Endoscopy Unit, Azienda Ospedaliero - Universitaria di Modena, Modena, Italy
| | - Germana de Nucci
- Gastroenterology and Endoscopy Unit, Garbagnate Milanese Hospital, Milan, Italy
| | - Paola Cesaro
- Digestive Endoscopy Unit, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Giovanni Aragona
- Gastroenterology and Hepatology Unit, Ospedale "Guglielmo da Saliceto", Piacenza, Italy
| | - Vincenzo Cennamo
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL di Bologna, Bologna, Italy
| | - Pietro Fusaroli
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | | | - Paola Soriani
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL di Modena, Carpi, Italy
| | | | - Roberto Di Mitri
- Gastroenterology and Digestive Endoscopy Unit, ARNAS Civico Hospital, Palermo, Italy
| | - Francesco Pugliese
- Digestive Endoscopy Unit, Niguarda Hospital, ASST Niguarda, Milan, Italy
| | - Andrea Anderloni
- Department of Endoscopy, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessandro Cucchetti
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Alessandro Repici
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Endoscopy Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
| | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Units, Morgagni - Pierantoni Hospital, Forlì, and Maurizio Bufalini Hosptial, Cesena, Italy
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Steinbrück I, Rempel V, Kuellmer A, Miedtke V, Faiss S, von Hahn T, Pohl J, Grothaus J, Friesicke M, Schmidt A, Allgaier HP. Flexible endoscopic treatment of Zenker's diverticulum-a retrospective, observational multicenter study. Surg Endosc 2024; 38:6493-6505. [PMID: 39271511 DOI: 10.1007/s00464-024-11234-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Accepted: 08/28/2024] [Indexed: 09/15/2024]
Abstract
BACKGROUND The European Society of Gastroenterology and Endoscopy recommends a primarily flexible endoscopic approach for the treatment of Zenker's diverticulum. Due to the rarity of the disorder, evidence for its effectiveness and safety comes mainly from small, retrospective, single-center studies. METHODS In this retrospective, observational, multicenter cohort study, data from six German tertiary referral centers were analyzed. The primary outcome parameters were technical and clinical success; among the secondary outcomes, the rates of adverse events (AE) and re-admission with symptomatic recurrence and mortality were the most relevant. RESULTS Between 2003 and 2024, 384 treatments were performed in 327 patients (61.8% male, mean age 74.70 (± 10.60)). Incision methods/techniques were 250 needle knives, 44 ESD knives, 64 stag beetle knives, 24 staplers, one APC-probe, and one Z-POEM. The Zenker's diverticulum overtube was used in 65.1%, prophylactic clipping in 30.2%, and antibiotic therapy in 25.3% of treatments. The rates of technical and clinical success were 99.2% and 97.4%, and the rates of AE and re-admission with symptomatic recurrence were 11.2% and 16.7%, respectively. Mortality was 0.3%. Comparative subgroup analyses of 312 diverticula without prior treatment versus 72 symptomatic recurrences and incision methods/techniques showed no significant differences in outcome parameters. The use of additional devices and prophylactic measures (clipping, antibiotic therapy) were not independent predictors of technical/clinical success or AE in uni-/multivariable regression analysis. CONCLUSIONS Flexible endoscopic Zenker's diverticulotomy is a safe and effective minimally invasive treatment. Recurrences can be treated by flexible endoscopy with comparable results. None of the cutting methods, ancillary devices, or prophylactic measures showed superiority in effectiveness or safety.
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Affiliation(s)
- Ingo Steinbrück
- Department of Medicine and Gastroenterology, Evangelisches Diakoniekrankenhaus Freiburg, Academic Teaching Hospital, University of Freiburg, Freiburg, Germany.
| | - Viktor Rempel
- Department of Gastroenterology, St. Anna Hospital Herne, Academic Teaching Hospital, Ruhr University Bochum, Bochum, Germany
| | - Armin Kuellmer
- Department of Medicine II, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Valentin Miedtke
- Department of Medicine II, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Siegbert Faiss
- Department of Gastroenterology, Sana Klinikum Lichtenberg, Academic Teaching Hospital, Universtiy of Berlin, Berlin, Germany
| | - Thomas von Hahn
- Department of Gastroenterology, Hepatology and Endoscopy, Asklepios Klinik Barmbek, Academic Teaching Hospital, University of Hamburg, Hamburg, Germany
| | - Jürgen Pohl
- Department of Gastroenterology, Asklepios Klinik Altona, Academic Teaching Hospital, University of Hamburg, Hamburg, Germany
| | - Johannes Grothaus
- Department of Gastroenterology, Asklepios Klinik Altona, Academic Teaching Hospital, University of Hamburg, Hamburg, Germany
| | - Matthias Friesicke
- Department of Gastroenterology, Asklepios Klinik Altona, Academic Teaching Hospital, University of Hamburg, Hamburg, Germany
| | - Arthur Schmidt
- Department of Medicine II, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Gastroenterology, Hepatology and Endocrinology, Robert-Bosch-Krankenhaus, Academic Teaching Hospital, University of Tübingen, Stuttgart, Germany
| | - Hans-Peter Allgaier
- Department of Medicine and Gastroenterology, Evangelisches Diakoniekrankenhaus Freiburg, Academic Teaching Hospital, University of Freiburg, Freiburg, Germany
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Vargas-Madrigal J, Chan SM, Dhar J, Teoh AYB, Samanta J, Lakhtakia S, Giovannini M. Dedicated cautery-enhanced tubular self-expandable metal stent for endoscopic ultrasound-guided hepaticogastrostomy: feasibility study. Endoscopy 2024; 56:864-869. [PMID: 38848744 DOI: 10.1055/a-2340-7432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
BACKGROUND Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is an alternative for biliary drainage in patients with obstructive pancreaticobiliary pathology when endoscopic retrograde cholangiopancreatography (ERCP) is not feasible. Despite its effectiveness, EUS-HGS is associated with a significant risk of adverse events. This study aimed to evaluate the feasibility and safety of a newly designed dedicated cautery-enhanced tubular self-expandable metal stent (SEMS) for EUS-HGS. METHODS This multicenter prospective study included patients with malignant biliary obstruction in whom ERCP had failed because of tumor infiltration, inability to drain the intrahepatic ducts, or surgically altered anatomy. A dedicated cautery-enhanced tubular SEMS was used for EUS-HGS. Technical and clinical success rates, procedure times, and adverse events were evaluated. RESULTS 20 patients underwent EUS-HGS with the dedicated stent. Technical and clinical success rates of 100% were achieved, with no reported severe adverse events or mortality. The median procedure time was 16 minutes. Recurrent biliary obstruction was observed in 1 patient. CONCLUSIONS The dedicated cautery-enhanced tubular SEMS for EUS-HGS can simplify the procedure and enhance its safety and efficacy. This innovation shows promise for improving patient outcomes, although further studies are needed to validate these findings in a broader patient population.
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Affiliation(s)
- Jorge Vargas-Madrigal
- Gastroenterology, Hospital San Juan de Dios, Caja Costarricense de Seguro Social, San Jose, Costa Rica
| | - Shannon M Chan
- Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Jahnvi Dhar
- Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anthony Y B Teoh
- Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Jayanta Samanta
- Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sundeep Lakhtakia
- Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Marc Giovannini
- Gastroenterology, Institut Paoli-Calmettes, Marseille, France
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Frank A, Bernstedt SW, Jamizadeh N, Forsberg A, Hedin C, Blom J, Backman AS. Complications of colonoscopy surveillance of patients with Lynch syndrome - 33 years of follow up. Fam Cancer 2024; 23:599-605. [PMID: 39102097 PMCID: PMC11512902 DOI: 10.1007/s10689-024-00416-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2024]
Abstract
BACKGROUND AND STUDY AIMS Lynch syndrome (LS) is a hereditary autosomal dominant condition, with an increased lifetime risk of developing malignancies including colorectal cancer (CRC). Current guidelines differ in recommended colonoscopy-surveillance intervals from 1 to 2 years. Although colonoscopy is considered a safe procedure, there are risks of severe adverse events (SAEs), such as perforation and bleeding, as well as adverse events (AEs), such as abdominal discomfort and post-colonoscopy gastrointestinal infections. Colonoscopy-related bleeding and perforation rates have been reported 0.17% and 0.11%, respectively. However, there are insufficient data regarding complications of colonoscopy-surveillance for LS patients. This study aims to investigate the risk of AEs among LS patients during colonoscopy in the Stockholm region. PATIENTS AND METHODS This retrospective cohort study includes 351 LS patients undergoing endoscopic surveillance at the Karolinska University Hospital, August 1989 - April 2021. Data from endoscopic surveillance colonoscopies were extracted from patients' medical records. RESULTS Of 1873 endoscopies in 351 LS patients, 12 complications (AEs) were documented within 30 days (0.64%) and with a total of 3 bleedings (SAEs, 0.16%). No perforations were identified. CONCLUSION Colonoscopy surveillance for LS patients shows a comparatively low risk of AEs per-examination. Colonoscopy complications per-patient, including both SAEs and AEs, show a significantly higher risk. Colonoscopy complications only including SAEs, show a comparatively low risk. Understanding the lifetime risk of surveillance-related colonoscopy complications is important when designing targeted surveillance programmes.
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Affiliation(s)
- Alexander Frank
- Dept. of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden.
- Gastroenterology unit, Dept. of Medicine, Capio S:t Görans Hospital, Stockholm, Sweden.
| | - Sophie Walton Bernstedt
- Dept. of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
- Gastroenterology unit, Dept. of Gastroenterology, Dermatovenereology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
- Div. of Upper Gastrointestinal diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Nigin Jamizadeh
- Dept. of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Anna Forsberg
- Gastroenterology unit, Dept. of Medicine, Capio S:t Görans Hospital, Stockholm, Sweden
- Dept. of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - Charlotte Hedin
- Gastroenterology unit, Dept. of Gastroenterology, Dermatovenereology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
- Dept. of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - Johannes Blom
- Dept. of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
- Dept. of Surgery, Södersjukhuset, Stockholm, Sweden
| | - Ann-Sofie Backman
- Dept. of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
- Gastroenterology unit, Dept. of Medicine, Ersta Hospital, Stockholm, Sweden
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Dell’Anna G, Mandarino FV, Fanizza J, Fasulo E, Barchi A, Barà R, Vespa E, Viale E, Azzolini F, Fanti L, Battaglia S, Puccetti F, Cossu A, Elmore U, Fuccio L, Annese V, Malesci A, Rosati R, Danese S. Endoscopic Management of Post-Esophagectomy Delayed Gastric Conduit Emptying (DGCE): Results from a Cohort Study in a Tertiary Referral Center with Comparison between Procedures. Cancers (Basel) 2024; 16:3457. [PMID: 39456551 PMCID: PMC11505969 DOI: 10.3390/cancers16203457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2024] [Revised: 10/07/2024] [Accepted: 10/11/2024] [Indexed: 10/28/2024] Open
Abstract
Background/Objectives: Delayed gastric conduit emptying (DGCE) occurs in 15-39% of patients who undergo esophagectomy. Intra-Pyloric Injection of Botulinum Toxin (IPBT), Pneumatic Balloon Dilation (PBD), and the same session combination (BTPD) represent the main endoscopic procedures, but comparative data are currently unavailable. Methods: We retrospectively analyzed prospectively collected data on all consecutive patients with DGCE treated endoscopically with IPBT, PBD, or BTPD. ISDE Diagnostic Criteria were used for DGCE diagnosis and classification. A Gastric Outlet Obstruction Score was used for clinical staging. All patients undergoing IPBT received 100 UI of toxin, while those undergoing PBD were dilated up to 20 mm. Clinical success (CS) was defined as the resolution of symptoms/resumption of feeding at discharge or expanding dietary intake at any rate. Recurrence was defined as symptom relapse after more than 15 days of well-being requiring endoscopic/surgical intervention. Results: A total of 64 patients (81.2% male, 90.6% Ivor-Lewis esophagectomy, 77.4% adenocarcinoma) with a median age of 62 years (IQR 55-70) were enrolled: 18 (28.1%) in the IPBT group, 24 (37.5%) in the PBD group, and 22 (34.4%) in the BTPD group. No statistically significant differences were found in the baseline characteristics, surgical techniques, and median follow-up among the three groups. BTPD showed a higher CS rate (100%) compared to the PD and BTPD groups (p = 0.02), and a Kaplan-Meier analysis with a log-rank test revealed that the BTPD group was associated both with a significatively shorter mean time to refeed of 1.16 days (95% CI 0.8-1.5; p = 0.001) and a shorter median time to discharge of one day (95% CI 1-3; p = 0.0001). Conclusions: Endoscopic management of DGCE remains challenging. Waiting for further strong evidence, BTPD can offer patients a higher clinical efficacy rate and a shorter time to refeed and be discharged.
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Affiliation(s)
- Giuseppe Dell’Anna
- Gastroenterology and Gastrointestinal Endoscopy Unit, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; (F.V.M.); (J.F.); (E.F.); (A.B.); (R.B.); (E.V.); (E.V.); (F.A.); (L.F.); (A.M.); (S.D.)
- Gastroenterology and Gastrointestinal Endoscopy Unit, IRCCS Policlinico San Donato, Piazza Edmondo Malan 2, 20097 San Donato Milanese, Italy;
| | - Francesco Vito Mandarino
- Gastroenterology and Gastrointestinal Endoscopy Unit, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; (F.V.M.); (J.F.); (E.F.); (A.B.); (R.B.); (E.V.); (E.V.); (F.A.); (L.F.); (A.M.); (S.D.)
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 56, 20132 Milan, Italy; (U.E.); (R.R.)
| | - Jacopo Fanizza
- Gastroenterology and Gastrointestinal Endoscopy Unit, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; (F.V.M.); (J.F.); (E.F.); (A.B.); (R.B.); (E.V.); (E.V.); (F.A.); (L.F.); (A.M.); (S.D.)
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 56, 20132 Milan, Italy; (U.E.); (R.R.)
| | - Ernesto Fasulo
- Gastroenterology and Gastrointestinal Endoscopy Unit, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; (F.V.M.); (J.F.); (E.F.); (A.B.); (R.B.); (E.V.); (E.V.); (F.A.); (L.F.); (A.M.); (S.D.)
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 56, 20132 Milan, Italy; (U.E.); (R.R.)
| | - Alberto Barchi
- Gastroenterology and Gastrointestinal Endoscopy Unit, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; (F.V.M.); (J.F.); (E.F.); (A.B.); (R.B.); (E.V.); (E.V.); (F.A.); (L.F.); (A.M.); (S.D.)
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 56, 20132 Milan, Italy; (U.E.); (R.R.)
| | - Rukaia Barà
- Gastroenterology and Gastrointestinal Endoscopy Unit, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; (F.V.M.); (J.F.); (E.F.); (A.B.); (R.B.); (E.V.); (E.V.); (F.A.); (L.F.); (A.M.); (S.D.)
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 56, 20132 Milan, Italy; (U.E.); (R.R.)
| | - Edoardo Vespa
- Gastroenterology and Gastrointestinal Endoscopy Unit, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; (F.V.M.); (J.F.); (E.F.); (A.B.); (R.B.); (E.V.); (E.V.); (F.A.); (L.F.); (A.M.); (S.D.)
| | - Edi Viale
- Gastroenterology and Gastrointestinal Endoscopy Unit, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; (F.V.M.); (J.F.); (E.F.); (A.B.); (R.B.); (E.V.); (E.V.); (F.A.); (L.F.); (A.M.); (S.D.)
| | - Francesco Azzolini
- Gastroenterology and Gastrointestinal Endoscopy Unit, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; (F.V.M.); (J.F.); (E.F.); (A.B.); (R.B.); (E.V.); (E.V.); (F.A.); (L.F.); (A.M.); (S.D.)
| | - Lorella Fanti
- Gastroenterology and Gastrointestinal Endoscopy Unit, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; (F.V.M.); (J.F.); (E.F.); (A.B.); (R.B.); (E.V.); (E.V.); (F.A.); (L.F.); (A.M.); (S.D.)
| | - Silvia Battaglia
- Gastrointestinal Surgery Unit, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; (S.B.); (F.P.); (A.C.)
| | - Francesco Puccetti
- Gastrointestinal Surgery Unit, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; (S.B.); (F.P.); (A.C.)
| | - Andrea Cossu
- Gastrointestinal Surgery Unit, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; (S.B.); (F.P.); (A.C.)
| | - Ugo Elmore
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 56, 20132 Milan, Italy; (U.E.); (R.R.)
- Gastrointestinal Surgery Unit, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; (S.B.); (F.P.); (A.C.)
| | - Lorenzo Fuccio
- Unit of Gastroenterology, Department of Medical and Surgical Sciences, S. Orsola-Malpighi University Hospital, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy;
| | - Vito Annese
- Gastroenterology and Gastrointestinal Endoscopy Unit, IRCCS Policlinico San Donato, Piazza Edmondo Malan 2, 20097 San Donato Milanese, Italy;
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 56, 20132 Milan, Italy; (U.E.); (R.R.)
| | - Alberto Malesci
- Gastroenterology and Gastrointestinal Endoscopy Unit, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; (F.V.M.); (J.F.); (E.F.); (A.B.); (R.B.); (E.V.); (E.V.); (F.A.); (L.F.); (A.M.); (S.D.)
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 56, 20132 Milan, Italy; (U.E.); (R.R.)
| | - Riccardo Rosati
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 56, 20132 Milan, Italy; (U.E.); (R.R.)
- Gastrointestinal Surgery Unit, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; (S.B.); (F.P.); (A.C.)
| | - Silvio Danese
- Gastroenterology and Gastrointestinal Endoscopy Unit, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; (F.V.M.); (J.F.); (E.F.); (A.B.); (R.B.); (E.V.); (E.V.); (F.A.); (L.F.); (A.M.); (S.D.)
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 56, 20132 Milan, Italy; (U.E.); (R.R.)
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Drews J, Baar LC, Schmeisl T, Bunde T, Stang A, Reese T, Wagner KC, Oldhafer KJ, von Hahn T. Biliary drainage in palliative and curative intent European patients with hilar cholangiocarcinoma and malignant hilar obstruction: a retrospective single center analysis. BMC Gastroenterol 2024; 24:359. [PMID: 39390363 PMCID: PMC11468282 DOI: 10.1186/s12876-024-03429-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 09/23/2024] [Indexed: 10/12/2024] Open
Abstract
BACKGROUND AND AIMS Relief of cholestasis in hilar cholangiocarcinoma is commonly undertaken in both curative and palliative treatment plans. There are numerous open questions with regard to the ideal biliary drainage strategy - including what constitutes clinical success (CS). In the existing data, curative patients and patients from the Western world are underrepresented. PATIENTS AND METHODS We performed a retrospective analysis of patients with complex malignant hilar obstruction (Bismuth-Corlette II and higher) due to cholangiocarcinoma who underwent biliary drainage at a German referral center between 2010 and 2020. We aimed to define CS and complication rates and directly compare outcomes in curative and palliative patients. RESULTS 56 curative and 72 palliative patients underwent biliary drainage. In patients with curative intent, CS was achieved significantly more often regardless of what definition of CS was applied (e.g., total serum bilirubin (TSB) < 2 mg/dl: 66.1% vs. 27.8%, p = < 0.001, > 75% reduction of TSB: 57.1% vs. 29.2%, p = 0.003). This observation held true only when subgroups with the same Bismuth-Corlette stage were compared. Moreover, palliative patients experienced a significantly greater percentage of adverse events (33.3% vs. 12.5%, p = 0.01). Curative intent treatment and TSB at presentation were predictive factors of CS regardless of what definition of CS was applied. The observed CS rates are comparable to published studies involving curative patients, but inferior to reported CS rates in palliative series mostly from Asia. CONCLUSIONS Biliary drainage in complex malignant hilar obstruction due to cholangiocarcinoma is more likely to be successful and less likely to cause adverse events in curative patients compared to palliative patients.
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Affiliation(s)
- Jan Drews
- Department of Gastroenterology, Hepatology and Interventional Endoscopy, Asklepios Hospital Barmbek, Ruebenkamp 220, 22307, Hamburg, Germany
- Semmelweis University of Medicine, Asklepios Campus Hamburg, Hamburg, Germany
- Asklepios Tumorzentrum Hamburg, Hamburg, Germany
| | - Lea-Catharina Baar
- Department of Gastroenterology, Hepatology and Interventional Endoscopy, Asklepios Hospital Barmbek, Ruebenkamp 220, 22307, Hamburg, Germany
- Semmelweis University of Medicine, Asklepios Campus Hamburg, Hamburg, Germany
- Asklepios Tumorzentrum Hamburg, Hamburg, Germany
| | - Theresa Schmeisl
- Department of Gastroenterology, Hepatology and Interventional Endoscopy, Asklepios Hospital Barmbek, Ruebenkamp 220, 22307, Hamburg, Germany
- Semmelweis University of Medicine, Asklepios Campus Hamburg, Hamburg, Germany
- Asklepios Tumorzentrum Hamburg, Hamburg, Germany
| | - Torsten Bunde
- Department of Gastroenterology, Hepatology and Interventional Endoscopy, Asklepios Hospital Barmbek, Ruebenkamp 220, 22307, Hamburg, Germany
- Semmelweis University of Medicine, Asklepios Campus Hamburg, Hamburg, Germany
- Asklepios Tumorzentrum Hamburg, Hamburg, Germany
| | - Axel Stang
- Semmelweis University of Medicine, Asklepios Campus Hamburg, Hamburg, Germany
- Asklepios Tumorzentrum Hamburg, Hamburg, Germany
- Department of Oncology and Palliative Care, Asklepios Hospital Barmbek, Hamburg, Germany
| | - Tim Reese
- Semmelweis University of Medicine, Asklepios Campus Hamburg, Hamburg, Germany
- Asklepios Tumorzentrum Hamburg, Hamburg, Germany
- Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Asklepios Hospital Barmbek, Hamburg, Germany
| | - Kim Caroline Wagner
- Semmelweis University of Medicine, Asklepios Campus Hamburg, Hamburg, Germany
- Asklepios Tumorzentrum Hamburg, Hamburg, Germany
- Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Asklepios Hospital Barmbek, Hamburg, Germany
| | - Karl Jürgen Oldhafer
- Semmelweis University of Medicine, Asklepios Campus Hamburg, Hamburg, Germany
- Asklepios Tumorzentrum Hamburg, Hamburg, Germany
- Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Asklepios Hospital Barmbek, Hamburg, Germany
| | - Thomas von Hahn
- Department of Gastroenterology, Hepatology and Interventional Endoscopy, Asklepios Hospital Barmbek, Ruebenkamp 220, 22307, Hamburg, Germany.
- Semmelweis University of Medicine, Asklepios Campus Hamburg, Hamburg, Germany.
- Asklepios Tumorzentrum Hamburg, Hamburg, Germany.
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Jürgensen C, Eckart M, Haberbosch L, Tacke F, Sandforth A, Birkenfeld AL, Overkamp D, Daniels M, Mogl M, Goretzki P, Strasburger C, Mai K, Spranger J, Jumpertz von Schwartzenberg R. Endoscopic ultrasound-guided ethanol ablation versus surgical resection of insulinomas. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2024; 45:519-527. [PMID: 37931914 DOI: 10.1055/a-2204-5814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
PURPOSE Insulinoma is a rare tumor of the pancreas that can lead to hypoglycemia. To date, the standard therapy is surgical resection. After the first case report of successful endoscopic ultrasound-guided (EUS) ethanol injection 16 years ago, the need for establishing an alternative treatment method remains unchanged given the high morbidity rates of surgery and its unsuitability in some patients. MATERIALS AND METHODS Here, we provide retrospective data from 33 insulinoma patients that were treated at our center between 2010 and 2021. Of these, 9 patients were treated with EUS-guided ethanol injection and 24 underwent pancreatic surgery. RESULTS The ethanol group was older (ethanol: mean ± SE 67.8±11.2 years vs. surgery: 52.3±15.7, p=0.014) with a higher Charlson Comorbidity Index (3.0 (1.0;4.0) vs. 1.0 (0.0;2.0), p=0.008). The lowest glucose values were similar between groups before (ethanol: 2.09±0.17 mmol/l vs. surgery: 1.81±0.08, p=0.158) and after (4.95±0.74 vs. 5.41±0.28, p=0.581) the respective treatments. Complications occurred more frequently in the surgery group (11 % vs. 54 %, p=0.026). One patient after prior partial pancreatectomy died postoperatively. The hospitalization time was significantly shorter in the ethanol group (4.78±0.78 days vs. 19.88±4.07, p<0.001). CONCLUSION EUS-guided ethanol injection can be similarly effective for the treatment of hyperinsulinemic hypoglycemia compared with pancreatic surgery but seems to be associated with less severe complications. This implies the need for prospective randomized trials in insulinoma patients with a low risk for malignancy.
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Affiliation(s)
- Christian Jürgensen
- Department of Hepatology and Gastroenterology, Charité University Medicine, Berlin, Germany
| | - Marius Eckart
- Department of Hepatology and Gastroenterology, Charité University Medicine, Berlin, Germany
| | - Linus Haberbosch
- Department of Endocrinology and Metabolic Diseases (including Lipid Metabolism), Charité University Medicine, Berlin, Germany
| | - Frank Tacke
- Department of Hepatology and Gastroenterology, Charité University Medicine, Berlin, Germany
| | - Arvid Sandforth
- Department of Internal Medicine IV, Division of Diabetology, Endocrinology and Nephrology, Eberhard-Karls University of Tübingen, Tübingen, Germany
- Institute of Diabetes Research and Metabolic Diseases (IDM), Helmholtz Center Munich, Neuherberg, Germany
| | - Andreas L Birkenfeld
- Department of Internal Medicine IV, Division of Diabetology, Endocrinology and Nephrology, Eberhard-Karls University of Tübingen, Tübingen, Germany
- Institute of Diabetes Research and Metabolic Diseases (IDM), Helmholtz Center Munich, Neuherberg, Germany
| | - Dietrich Overkamp
- Department of Internal Medicine IV, Division of Diabetology, Endocrinology and Nephrology, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Martin Daniels
- Department of Endocrinology and Metabolic Diseases (including Lipid Metabolism), Charité University Medicine, Berlin, Germany
| | - Martina Mogl
- Department of Surgery, Charité University Medicine, Berlin, Germany
| | - Peter Goretzki
- Department of Surgery, Charité University Medicine, Berlin, Germany
| | - Christian Strasburger
- Department of Endocrinology and Metabolic Diseases (including Lipid Metabolism), Charité University Medicine, Berlin, Germany
| | - Knut Mai
- Department of Endocrinology and Metabolic Diseases (including Lipid Metabolism), Charité University Medicine, Berlin, Germany
| | - Joachim Spranger
- Department of Endocrinology and Metabolic Diseases (including Lipid Metabolism), Charité University Medicine, Berlin, Germany
- Berlin Institute of Health at Charite, Berlin, Germany
| | - Reiner Jumpertz von Schwartzenberg
- Department of Internal Medicine IV, Division of Diabetology, Endocrinology and Nephrology, Eberhard-Karls University of Tübingen, Tübingen, Germany
- Institute of Diabetes Research and Metabolic Diseases (IDM), Helmholtz Center Munich, Neuherberg, Germany
- German Center for Diabetes Research, München-Neuherberg, Germany
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Verhoeve S, Verloop C, Bruno M, Terpstra V, Van Driel L, Perk L, Hol L. Efficacy of EUS-guided keyhole biopsies in diagnosing subepithelial lesions of the upper gastrointestinal tract. Endosc Int Open 2024; 12:E1183-E1189. [PMID: 39411358 PMCID: PMC11479790 DOI: 10.1055/a-2417-0580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Accepted: 09/13/2024] [Indexed: 10/19/2024] Open
Abstract
Background and study aims Tissue acquisition is required for diagnosis of subepithelial lesions (SELs). However, obtaining adequate tissue remains challenging. This study investigated an EUS-guided technique using a forceps to create a channel and take multiple biopsies from the center of the lesion, therefore called endoscopic ultrasound-guided keyhole biopsy (EUS-KB). Patients and methods A retrospective cohort study was conducted in 56 patients with SELs in the upper gastrointestinal tract who were scheduled to undergo EUS-KB. The primary aim was to assess diagnostic yield, defined as the percentage of procedures where EUS-KB resulted in a definitive histopathological diagnosis. Furthermore, factors influencing diagnostic yield were investigated. Additional outcomes included technical success and adverse events. Results Technical success was achieved in 55 of 60 biopsies (91.7%). EUS-KB provided a diagnosis in 44 of 55 biopsies (80.0%), histology mostly showing gastrointestinal stromal tumor or leiomyoma. The diagnostic yield was not significantly influenced by the size or location of the SEL. Adverse events occurred in one patient (1.7%). Conclusions EUS-KB is a feasible and safe technique for obtaining a classifying diagnosis for SELs in the upper gastrointestinal tract. It could offer an alternative diagnostic modality, especially in lesions smaller than 20 mm.
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Affiliation(s)
- Sen Verhoeve
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, Netherlands
- Department of Gastroenterology and Hepatology, Maasstad Hospital, Rotterdam, Netherlands
| | - Cynthia Verloop
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, Netherlands
- Department of Gastroenterology and Hepatology, Maasstad Hospital, Rotterdam, Netherlands
| | - Marco Bruno
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Valeska Terpstra
- Department of Pathology, Medical Centre Haaglanden, Den Haag, Netherlands
| | - Lydi Van Driel
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Lars Perk
- Department of Gastroenterology and Hepatology, Medisch Centrum Haaglanden, Den Haag, Netherlands
| | - Lieke Hol
- Department of Gastroenterology and Hepatology, Maasstad Hospital, Rotterdam, Netherlands
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Mangiavillano B, Ramai D, Kahaleh M, Tyberg A, Shahid H, Sarkar A, Samanta J, Dhar J, Bronswijk M, Van der Merwe S, Kouanda A, Ji H, Dai SC, Deprez P, Vargas-Madrigal J, Vanella G, Leone R, Arcidiacono PG, Robles-Medranda C, Alcivar Vasquez J, Arevalo-Mora M, Fugazza A, Ko C, Morris J, Lisotti A, Fusaroli P, Dhaliwal A, Mutignani M, Forti E, Cottone I, Larghi A, Rizzatti G, Galasso D, Barbera C, Di Matteo FM, Stigliano S, Binda C, Fabbri C, Pham KDC, Di Mitri R, Amata M, Crinó SF, Ofosu A, De Luca L, Al-Lehibi A, Auriemma F, Paduano D, Calabrese F, Gentile C, Hassan C, Repici A, Facciorusso A. Outcomes of lumen apposing metal stent placement in patients with surgically altered anatomy: Multicenter international experience. Endosc Int Open 2024; 12:E1143-E1149. [PMID: 39398449 PMCID: PMC11466529 DOI: 10.1055/a-2411-1814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Accepted: 09/06/2024] [Indexed: 10/15/2024] Open
Abstract
Background and study aims Although outcomes of lumen-apposing metal stents (LAMS) placement in native anatomy have been reported, data on LAMS placement in surgically altered anatomy (SAA) are sparse. We aimed to assess outcomes of LAMS placement in patients with SAA for different indications. Patients and methods This was an international, multicenter, retrospective, observational study at 25 tertiary care centers through November 2023. Consecutive patients with SAA who underwent LAMS placement were included. The primary outcome was technical success defined as correct placement of LAMS. Secondary outcomes were clinical success and safety. Results Two hundred and seventy patients (125 males; average age 61 ± 15 years) underwent LAMS placement with SAA. Procedures included EUS-directed transgastric ERCP (EDGE) and EUS-directed transenteric ERCP (EDEE) (n = 82), EUS-guided entero-enterostomy (n = 81), EUS-guided biliary drainage (n = 57), EUS-guided drainage of peri-pancreatic fluid collections (n = 48), and EUS-guided pancreaticogastrostomy (n = 2). Most cases utilized AXIOS stents (n = 255) compared with SPAXUS stents (n = 15). Overall, technical success was 98%, clinical success was 97%, and the adverse event (AE) rate was 12%. Using AGREE classification, five events were rated as Grade II, 21 events as Grade IIIa, and six events as IIIb. No difference in AEs were noted among stent types ( P = 0.52). Conclusions This study shows that placement of LAMS is associated with high technical and clinical success rates in patients with SAA. However, the rate of AEs is noteworthy, and thus, these procedures should be performed by expert endoscopists at tertiary centers.
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Affiliation(s)
- Benedetto Mangiavillano
- Gastrointestinal Endoscopy, Istituto Clinico Mater Domini Casa di Cura Privata SpA, Castellanza, Italy
| | - Daryl Ramai
- Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, United States
| | - Michel Kahaleh
- Foundation of Interventional and Therapeutic Endoscopy, New Brunswick, United States
| | - Amy Tyberg
- Division of Gastroenterology, Hackensack Meridian Hospital, Hackensack, United States
| | - Haroon Shahid
- Division of Gastroenterology, Hackensack Meridian Hospital, Hackensack, United States
| | - Avik Sarkar
- Division of Gastroenterology, Hackensack Meridian Hospital, Hackensack, United States
| | - Jayanta Samanta
- Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jahnvi Dhar
- Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Michiel Bronswijk
- Gastroenterology and Hepatology, KU Leuven University Hospitals Leuven, Leuven, Belgium
| | - Schalk Van der Merwe
- Hepatology and GI Research Laboratory, Department of Immunology, University of Pretoria, Pretoria, South Africa
- Department of Hepatology and Biliopancreatic Disease, KU Leuven, Leuven, Belgium
| | - Abdul Kouanda
- Gastroenterology, University of California San Francisco Medical Center at Parnassus, San Francisco, United States
| | - Hyun Ji
- Gastroenterology, University of California San Francisco, San Francisco, United States
| | - Sun-Chuan Dai
- Gastroenterology Division, University of California San Francisco Medical Center, San Francisco, United States
| | - Pierre Deprez
- Gastroenterology, Clin Univ St-Luc, Bruxelles, Belgium
| | - Jorge Vargas-Madrigal
- Gastroenterology Department, Enrique Baltodano Briceno Hospital, Liberia, Costa Rica, Costa Rica, Costa Rica
| | - Giuseppe Vanella
- Pancreato-BiliaryEndoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy, Milan, Italy
| | - Roberto Leone
- Medicine, Vita-Salute San Raffaele University, Milano, Italy
| | - Paolo Giorgio Arcidiacono
- Gastroenterology and Gastrointestinal Endoscopy, Vita-Salute-San Raffaele University - IRCCS San Raffaele Hospital, Milan, Italy
| | - Carlos Robles-Medranda
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas - IECED, Guayaquil, Ecuador
- Endoscopy, Omni Hospital, Guayaquil, Ecuador
| | - Juan Alcivar Vasquez
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas - IECED, Guayaquil, Ecuador
| | | | - Alessandro Fugazza
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Rozzano, Italy
| | - Christopher Ko
- Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, United States
| | - John Morris
- Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, United States
| | - Andrea Lisotti
- Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola, Italy
| | - Pietro Fusaroli
- Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola, Italy
| | - Amaninder Dhaliwal
- Division of Gastroenterology, University of Nebraska Medical Center, Omaha, United States
| | | | - Edoardo Forti
- Digestive Endoscopy, Ospedale Niguarda-Ca' Granda, Milan, Italy
| | - Irene Cottone
- Digestive Endoscopy, Ospedale Niguarda-Ca' Granda, Milan, Italy
| | - Alberto Larghi
- Digestive Endoscopy Unit, Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - Gianenrico Rizzatti
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Domenico Galasso
- Department of Medicine, Gastroenterology Unit, Hôpital Riviera-Chablais, Rennaz, Switzerland
| | - Carmelo Barbera
- Gastroenterology and Digestive Endoscopy Unit, Nuovo Ospedale Civile S.Agostino-Estense, Baggiovara di Modena (Mo), Italy
- Gastroenterology and Digestive Endoscopy Unit, Azienda Unita Sanitaria Locale di Modena, Italy
| | | | - Serena Stigliano
- Therapeutic GI Endoscopy Unit, Campus Bio-Medico University Hospital, Roma, Italy
| | - Cecilia Binda
- Unit of Gastroenterology and Digestive Endoscopy, Morgagni-Pierantoni Hospital, Forli, Italy
- Unit of Gastroenterology and Digestive Endoscopy, Maurizio Bufalini Hospital, Cesena, Italy
| | - Carlo Fabbri
- Digestive Endoscopy and Gastroenterology Unit, Forlì-Cesena Hospitals, Azienda Unita Sanitaria Locale della Romagna, Forlì-Cesena, Italy
| | - Khanh Do-Cong Pham
- Medicine, Haukeland University Hospital, Bergen, Norway
- Clinical medicine, K1, University of Bergen, Bergen, Norway
| | - Roberto Di Mitri
- Gastroenterology and Endoscopy Unit, A.R.N.A.S. Civico-Di Cristina-Benfratelli Hospital, Palermo, Italy
| | | | - Stefano Francesco Crinó
- Gastroenterology and Digestive Endoscopy Unit, Pancreas Institute, University of Verona, Verona, Italy
| | - Andrew Ofosu
- Gastroenterology and Hepatology, Brooklyn Hospital Center, Brooklyn, United States
| | - Luca De Luca
- Gastroenterology and Digestive Endoscopy, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Abed Al-Lehibi
- Gastroenterology & Hepatology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Francesco Auriemma
- Gastroenterologia, Università Federico II, Napoli, Italy
- Digestive Endoscopy Unit, Division of Gastroenterology, Istituto Clinico Humanitas, Rozzano, Italy
| | - Danilo Paduano
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza, Italy
| | - Federica Calabrese
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza, Varese, Italy
| | - Carmine Gentile
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza, Varese, Italy
| | - Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Endoscopy Unit, IRCCS Humanitas Clinical and Research Center, Milan, Italy
| | - Alessandro Repici
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Digestive Endoscopy Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
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50
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Monino L, Marique L, Deswysen Y, Thoma M, Deprez PH, Goffette P, Navez B, Moreels TG. Endoscopic Management of Biliary and Pancreatic Pathologies in Roux-en-Y Gastric Bypass Patients: Development of a Treatment Algorithm Based on 9-Year Experience. Obes Surg 2024; 34:3717-3725. [PMID: 39225915 DOI: 10.1007/s11695-024-07471-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Revised: 08/10/2024] [Accepted: 08/14/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Management of biliopancreatic pathology in Roux-en-Y gastric bypass (RYGB) patients is challenging despite the availability of multiple approaches like single-balloon enteroscopy-assisted ERCP (SBE-ERCP), laparoscopy-assisted ERCP (LA-ERCP), and EUS-directed transgastric intervention (EDGI). We evaluated the outcomes of the interchangeable combination of endoscopic procedures to treat biliopancreatic pathology in RYGB patients. MATERIALS AND METHODS This is a monocentric retrospective study of consecutive RYGB patients with biliopancreatic pathology between June 2014 and September 2023. Primary endpoints were technical success, adverse events (AE), and parameters of endoscopic procedures according to etiology. A clinically useful management algorithm was developed. RESULTS A total of 102 patients with RYGB (73 women; mean age 55 ± 10 years) were included. A total of 113 SBE-ERCP (in 90 patients), 26 EDGI (in 23 patients), and 2 LA-ERCP (in 2 patients) were performed. Technical success of SBE-ERCP was lower compared to EDGI (74.4% vs 95.1%, p = 0.002). The AE rate was lower using SBE-ERCP compared to EDGI (12.4% vs 38.5%, p = 0.003). Two sub-groups based on etiology were identified as "common bile duct stone" (CBDS) and "Other." In the CBDS group, the mean number and time of procedures were lower in SBE-ERCP as the first-line technique compared to first-line EDGI (1.1 vs 2.7, p < 0.00 and 91 ± 20.7 min vs 161 ± 61.3 min, p < 0.00). CONCLUSION A combination of endoscopic procedures can achieve high technical success in managing biliopancreatic pathology in RYGB patients with an acceptable AE rate. In the case of CBDS, SBE-ERCP appeared to be a good first-line single-step option. For other indications, EDGI should be proposed as the first line.
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Affiliation(s)
- Laurent Monino
- Department of Hepatogastroenterology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Avenue Hippocrate 10, 1200, Brussels, Belgium.
- Department of Hepatogastroenterology, CHU Saint Eloi, 80 Ave Augustin Fliche, 34090, Montpellier, France.
| | - Lancelot Marique
- Department of Digestive Surgery, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Yannick Deswysen
- Department of Digestive Surgery, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Maximilien Thoma
- Department of Digestive Surgery, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Pierre H Deprez
- Department of Hepatogastroenterology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Pierre Goffette
- Departement of Radiology, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Benoit Navez
- Department of Digestive Surgery, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Tom G Moreels
- Department of Hepatogastroenterology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Avenue Hippocrate 10, 1200, Brussels, Belgium
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