Early Endoscopic Management Research Articles

Percutaneous Endoscopic Gastrostomy Tube Gone Wrong: Endoscopic Closure to the Rescue

AbstractPercutaneous endoscopic gastrostomy (PEG) is one of the most commonly performed endoscopic procedures and a first-line treatment for the establishment of enteral access in those with intolerance or contraindication to oral feedings. A small amount of pneumoperitoneum in the immediate postprocedure period is well reported after PEG tube placement. However, pneumoperitoneum resulting from displaced gastric bumper within 24 hours postprocedure is uncommon and rarely reported in the literature. Timely diagnosis and early endoscopic management can help tackle such an unusual complication.

Early Endoscopic Intervention in Pancreaticopleural Fistula: A Single-Center Experience

Abstract Background Pancreaticopleural fistulas are among the rarest complications of chronic pancreatitis. The main objective of the research, conducted on a total of seven patients, was to evaluate the effectiveness of early endoscopic management of pancreaticopleural fistula. Methods The diagnosis of fistula was reached when fistulous tract was demonstrated on imaging studies and/or pleural fluid amylase level was greater than 2,000 U/L. The data were retrospectively analyzed from the records. Results The prototype patient in our series was a chronic alcoholic male with median age of 45 years. Computed tomography scan was performed in all the seven patients but could diagnose leak only in four patients. Magnetic resonance cholangiopancreatography was better in the remaining three patients for diagnosing fistula. Endoscopic retrograde cholangiopancreatography was the most sensitive test that diagnosed fistula in all the seven patients. Pancreatic duct (PD) cannulation was successful and pancreatic sphincterotomy with PD stenting was performed in all the seven patients. We could avoid surgical intervention in our patients. Conclusions We advise early endoscopic treatment within 7 days of symptom onset as opposed to 3 weeks, which was proposed previously. Medical therapies should be complimentary to PD stenting.

Emergency Endoscopic Management of Pediatric Upper Gastrointestinal Tract Foreign Bodies: A North Indian Study

Introduction: Ingestion of a foreign body (FB) is a common pediatric emergency seen in daily clinical practice all over. Scarce data on this problem is available from this part of the world. Methods: We present our experience over four years about the spectrum of foreign bodies presenting to a gastrointestinal endoscopy (GI) centre and their subsequent management. Data was collected from all consecutive patients with FB ingestion presenting to our endoscopy center from January 2015 to December 2018. The demographic data, clinical presentation and endoscopic management was reviewed and analyzed. Results: A total of 130 patients with suspected FB ingestion underwent endoscopic management. 130 FBs were found in 130 patients with suspected FB. Scarf pin was most common type seen in 69 % cases followed by coins in 10.7 % cases. Button battery was noted in 7.7 % patients. Most of the FBs were located in the stomach (69 %) followed by esophagus (13.8 %). The majority of patients (94.4 %) were successfully removed with flexible endoscopy with the addition of suitable devices without any serious procedure-related or anesthesia -related complications. Conclusion: In this part of the world the pattern and types of Upper gastrointestinal (UGI) tract foreign bodies in pediatric population is unique not seen elsewhere across the globe. Early endoscopic management was found to be highly safe and efficacious.

Early endoscopic management for early bowel obstruction after gastrectomy: a case report.

BackgroundEarly bowel obstruction is not a rare complication of gastrectomy, and it may require re-operation in some cases.Case presentationWe report the case of a 71-year-old woman who underwent a total gastrectomy with Roux-en-Y reconstruction for a massive gastrointestinal stromal tumor. Postoperatively, she was making good progress and started consuming meals on postoperative day 3. However, on postoperative day 10, she complained of upper abdominal discomfort and nausea. Blood tests showed a mild inflammatory reaction. An upper gastrointestinal series showed obstruction of the elevated jejunum. An abdominal computed tomography scan suggested upper bowel obstruction. Endoscopic observation and repositioning was selected as an effective approach for treatment considering the patient’s clinical condition and background. Upper gastrointestinal endoscopy showed kinking of the elevated jejunum, easy passage through to the anal intestine, and no evidence of mucosal edema, stenosis of the Roux-en-Y anastomosis, bowel ischemia, or necrosis. After endoscopic repositioning, upper gastrointestinal series showed good passage of the jejunum and no evidence of bowel obstruction. At the 6-month follow-up examination, the patient was in good condition and had no complaints.ConclusionWe concluded that early endoscopic management should be the effective procedure considered for diagnosis and treatment of early bowel obstruction after gastrectomy in some cases.

The management of endoscopic retrograde cholangiopancreatography-related duodenal perforation.

Uneventful duodenal perforation during endoscopic retrograde cholangiopancreatography (ERCP) is an uncommon but occasionally fatal complication. ERCP-related perforations may occur during sphincterotomy and improper manipulation of the equipment and scope. Traditionally, duodenal perforation has been treated with early surgical repair. Recently, nonoperative early endoscopic management techniques including clips or fibrin glue have been reported. In the present paper we review the literature pertaining to the treatment of perforations.

Management of Non Variceal Upper Gastrointestinal Bleed

Upper gastrointestinal bleeding has 10% in-hospital mortality. Despite significant advances in the management, there has not been any improvement in mortality. The only improvement over the last 25 years has been in variceal bleeds. Increasing age and comorbidities are the major factors related to mortality. Early endoscopic management of severe upper GI bleeds improves survival. Adopting a system which identifies severe bleeding and vulnerable patients is essential.

DOES PRENATAL DIAGNOSIS INFLUENCE THE MORBIDITY ASSOCIATED WITH LEFT IN SITU NONFUNCTIONING OR POORLY FUNCTIONING RENAL MOIETY AFTER ENDOSCOPIC PUNCTURE OF URETEROCELE?

We compared long-term morbidity associated with left in situ nonfunctioning or poorly functioning renal moiety of a duplex system in children with prenatal vs postnatal diagnosis of ureterocele who underwent endoscopic puncture. A total of 48 children underwent primary endoscopic puncture of duplex system ureterocele. Of the cases 35 (73%) were diagnosed prenatally (group 1) and 13 (27%) postnatally (group 2). Median age at time of puncture was 4 months in group 1 and 3.5 years in group 2. A total of 20 patients in group 1 (57%) and 8 in group 2 (62%) presented with intravesical ureterocele, while 15 in group 1 (43%) and 5 in group 2 (38%) had ectopic ureterocele. A total of 20 children in group 1 (57%) and 7 in group 2 (54%) had a nonfunctioning renal moiety, and 15 in group 1 (43%) and 6 in group 2 (46%) had a poorly functioning ureterocele moiety. Vesicoureteral reflux (VUR) was present in 23 children in group 1 (66%) comprising 30 renal refluxing units (RRUs), and in 12 in group 2 (92%) comprising 14 RRUs. Median followup was 9 years (range 1 to 15) for both groups. Preoperative urinary tract infection (UTI) was common in group 2 (92%) vs group 1 (20%). No patient in group 1 had development of UTI after puncture, while 23% of the children in group 2 presented with UTI. Four children (2 from each group) with ectopic ureterocele required secondary puncture resulting in satisfactory drainage. A total of 14 RRUs (47%) showed spontaneous resolution of VUR in group 1 compared to 3 (21%) in group 2. Four RRUs (13%) required endoscopic correction due to high grade VUR in group 1. Two RRUs (17%) were treated with endoscopic correction and 2 (17%) with ureteral reimplantation due to UTI in group 2. Only 1 patient in group 1 underwent nephrectomy due to nonfunctioning kidney, while 2 patients in group 2 required partial nephrectomy due to UTI. Our data reveal that prenatal diagnosis of duplex system ureterocele is associated with fewer UTIs, and early endoscopic management may decrease UTI and the need for additional surgery. Nonfunctioning or poorly functioning renal moieties left in situ following successful endoscopic decompression of ureterocele are not associated with additional morbidity and do not require partial nephrectomy in the majority of the cases.

Early endoscopic management of anastomotic leakage of esophageal atresia

SummaryAnastomotic leaks (AL) of esophageal atresia (EA) close spontaneously with tube drainage and nutritional support, but this conservative management carries some risk factors. The present study describes an alternative endoscopic approach in evaluation and management. The endoscopic procedure, including esophagoscopy, catheterization of leakage point, and application of fibrin glue (FG) has been evaluated. It was applied seven times to four patients. The diagnostic criteria, the technique and the results are discussed. It has been determined that early endoscopic demonstration of AL in EA and application of FG prevent the possible complications of the conservative management, such as mediastinitis and lung collapse with pneumothorax due to ineffective chest drain, and side effects of parenteral nutrition and antibiotics. If a quickly solidified FG in a proper amount «0,5 ml) is used in an early phase with a correct positioning of the AL by radiological or endoscopic examination, a satisfactory result can be obtained.

Early endoscopic management of acute gallstone pancreatitis—an evidence-based review

Early endoscopic management of acute gallstone pancreatitis—an evidence-based review

Hemoclipping for postpolypectomy and postbiopsy colonic bleeding

Background: Obtaining colonoscopic biopsies and polypectomy can result in hemorrhage. The most effective management of this complication has not been determined. The objective of this study was to evaluate the endoscopic hemoclip in postprocedural colonic bleeding. Methods: Among 9555 consecutive colonoscopies, cases of postprocedural colonic bleeding (postpolypectomy and postbiopsy) requiring treatment were retrospectively reviewed. Endoscopic hemoclipping was initially attempted in each case; the rate of hemostasis after hemoclipping, use of additional hemostatic methods, and clinical outcome (need for transfusion/hospitalization) were analyzed. Results: There were 72 cases of bleeding in which treatment was required (45 immediate postpolypectomy, 18 delayed postpolypectomy and 9 postbiopsy). Endoscopic hemostasis was achieved in all cases of immediate postpolypectomy and postbiopsy bleeding and in all but one of the cases with delayed postpolypectomy bleeding. A detachable snare was used in addition to hemoclips in 3 cases of delayed postpolypectomy bleeding. There were no episodes of recurrent bleeding, deaths or need for surgery related to bleeding. Conclusion: Early endoscopic management of postprocedural bleeding by hemoclipping provides hemostasis in the great majority of cases. (Gastrointest Endosc 2000;51:37-41.)

Nine cases of acute gastric anisakiasis

From 1983 to 1988, we treated 19 patients with acute gastritis which was highly suggestive of gastritis anisakiasis. Almost all of these patients complained of sharp, periodic, upper abdominal pains which occurred several hours after ingestion of raw fish. Among the 19 patients, 10 anisakis larvae from nine patients were successfully removed by endoscopic forceps. However, in the remaining 10 patients, who also showed the typical clinical course of anisakiasis, we could not find the anisakis larvae endoscopically. All 10 larvae were identified as stage III, anisakis type 1. The intolerable pain was relieved as soon as endoscopic removal of the larvae was accomplished in all nine patients. The purpose of this article was to report the clinical findings and emphasize the importance of early endoscopic management of acute gastric anisakiasis.