Endoscopic Complications Research Articles

The algorithm and choice of the optimal tool for endoscopic removal of a foreign body from the gastrointestinal tract in children.

BACKGROUND: Suspicion of a foreign body (FB) is one of the most common reasons for performing an upper gastrointestinal (GI) endoscopy in children. In our opinion, the development of a new algorithm and the choice of optimal equipment will ensure timely diagnosis and success of endoscopic FB removal from the GI tract in children. AIMS: to develop an algorithm and select the optimal equipment to ensure timely diagnosis and safety of endoscopic FB removal from the GI tract in children. METHODS: a retrospective three-center study of children’s medical histories with suspected GI FB’s from 2017 to 2020. The analysis included: the patient's age, presence, localization, type of FB, visibility on X-ray, the time elapsed before its removal, the type and effectiveness of the endoscopic instrument (EI), duration, success and complications of the procedure. RESULTS: 1,173 children were examined (boys n=676, 57.6%; girls n=497, 42.4%) average age 3.5 years (±3.3, 0-17 years). The diagnosis of GI FB was confirmed in 1008 (86.1%) patients, and endoscopic examination was performed in 756 (75%) cases. The majority of FB were radiopaque (n=844, 83.7%) and had inorganic nature (n=941, 93.4%). According to the pathological effect: inert FB (n=637, 63.2%), chemical (disk batteries, n=166, 16.5%), mechanical (pointed, food bolus, bezaors, hydrogel balls, n=143, 14%), physical (magnets, n=62, 6.2%) effects on the child's body. According to localization, in 273 (27%) children, FB was located in the esophagus, 471(46.8%) in the stomach, 23 (2.2%) in the duodenum, 250 (24%) migrated from the upper GI tract. FB’s were endoscopically removed in 751 (99.3%) cases out of 756 conducted intraluminal examinations. The most in-demand EI turned out to be a gripping device of the "net" type (n=283, 37.6%), rat tooth forceps and a loop (both n=278, 37%), to a lesser extent biopsy forceps (n=86, 11.5%), a basket (n=50, 6.5%), forceps “alligator" (n=43, 5.7%) and in 10 (1.3%) free-lying FB’s were gently pushed down by an endoscope from the esophagus to the stomach. Net, “rat tooth” forceps, loop and basket turned out to be the most versatile EI’s for removing four types of FB’s, with the best average time of the procedure. There were no complications related to the FB’s endoscopic removal. Adverse events related to FB – 52 (5.1%) cases: 51 chemical burns of the esophagus(n=17) and stomach (n=34) with disc batteries, 1 perforation of the stomach due to prolonged exposure to magnets. CONCLUSIONS: the proposed modification of the algorithm for FB removal from the GI tract, the optimal choice of endoscopic equipment and manipulation accessories depending on the age of the child, localization, type and harmful effects of the swallowed object are the key to its successful and effective extraction in children.

Bilothorax as an endoscopic retrograde cholangiopancreatography complication and a review of the literature.

Bilothorax, the accumulation of bile in the pleural space, is an uncommon but serious condition often linked to biliary tract or diaphragmatic injury. This case report describes a 70-year-old female with decompensated liver cirrhosis due to primary sclerosing cholangitis, who developed a moderate sized pleural effusion following ERCP and biliary stenting. The patient's pleural effusion persisted for 2 months without respiratory symptoms, indicating a self-limited low-volume leak. She eventually underwent thoracentesis for a non-resolving unilateral effusion, which drained 435 mL of bilious fluid with an elevated pleural fluid bilirubin level, confirming the diagnosis of bilothorax. This case highlights the importance of considering bilothorax as a cause of pleural effusion in patients with biliary tract disease and who undergo high risk procedures including ERCP.

Multi-institutional Analysis of Choledocholithiasis in Pediatric vs Adult Patients

BackgroundIn adults, upfront intraoperative cholangiogram with laparoscopic common bile duct exploration (LCBDE) is well accepted for management of choledocholithiasis. Despite recent evidence supporting LCBDE utility in children, there has been hesitation to adopt this surgery first (SF) approach over ERCP first (EF) due to perceived technical challenges. We compared rates of successful stone clearance during LCBDE between adult and pediatric patients to evaluate if pediatric surgeons could anticipate similar rates of successful clearance. MethodsA multicenter, retrospective review of pediatric (<18 years) and adult patients with choledocholithiasis managed from 2018 to 2024 was performed. Demographic and clinical data were obtained. Rate of successful duct clearance with LCBDE was compared. Surgical and endoscopic complications (infections, bleeding, pancreatitis, bile leak) were also compared. Results724 patients, 333 (45.9%) pediatric and 391 (54.0%) adults, were included. The median age of pediatric vs adult patients was 15.2 years [13.1, 16.6] vs 55.5 years [34.1, 70.5], respectively. Of these, 201 (60.4%) pediatric vs 169 (43.2%) adult patients underwent SF, p < 0.001. LCBDE was attempted in 84 (41.7%) pediatric vs 140 (82.8%) adults, p = 0.002. LCBDE success was higher in pediatric vs adult patients (82.1% vs 71.4%, p = 0.004). Complications rates were similar however, pediatric patients who underwent EF had higher endoscopic complications (9.1% vs 3.6%, p = 0.03). ConclusionLCBDE is highly successful in children vs adults with no increased surgical complications. This data, coupled with the limited ERCP access for children, supports that LCBDE is an equally effective tool for managing choledocholithiasis in children as is accepted in adults. Level of EvidenceLevel III.

Semaglutide Is an Independent Predictor of Retained Solid Gastric Contents, but Same-Day Colonoscopy Mitigates Effect

Background and AimsGlucagon-like peptide-1 receptor agonists (GLP-1RAs) are commonly prescribed for diabetes and obesity; however, their use may complicate anesthetized procedures due to delayed gastric emptying. This study sought to define rates of retained solid gastric contents, a risk factor for peri-procedural complications, in a population taking semaglutide. MethodsThis is a retrospective cohort study comparing individuals undergoing upper endoscopy over a 5-year period at a tertiary care center who were prescribed semaglutide, a long-acting GLP-1RA, for more than 4 weeks against a matched control cohort not on the medication. Multivariant logistic regression and multivariable propensity-matched association analysis were conducted to compare outcomes of interest including retained solid gastric contents, endoscopic complications, and endoscopic outcomes. ResultsIn total, 1212 patients comprised the study population (602 on semaglutide, 610 not on semaglutide). On multi-variant logistic regression analyzing causes of delayed gastric emptying, semaglutide was an independent risk factor for retained solid gastric contents (OR 4.74, 95% CI 2.40-9.35, p <0.0001). On multivariable propensity-matched association analysis utilizing demographic and clinical characteristics, semaglutide use was associated with an absolute increase of 6% of retained solid gastric contents (coefficient 0.0644, 95% CI 0.034-0.095, p<0.0001). Same-day colonoscopy was protective against this finding (OR 0.41, 95% CI 0.23-0.73, p=0.003). Intubation was rare and not associated with semaglutide use (OR 0.70, 95% CI 0.30-1.64, p=0.41). No peri-procedural aspiration events occurred. ConclusionsSemaglutide was an independent risk factor for retained solid gastric contents, even when accounting for confounding factors. This was negated in patients undergoing same-day colonoscopy, indicating an opportunity for pre-procedural fasting protocols in the absence of medication hold.

Should Prophylactic Endotracheal Intubation Be Performed in Upper Gastrointestinal Bleeding?

No consensus exists on the standard of intraoperative airway management approach to prevent endoscopy complications in acute gastrointestinal (GI) bleeding. Eight years after our initial meta-analysis, we reassessed the effect of prophylactic endotracheal intubation in acute GI bleeding in hospitalized patients. Multiple databases were reviewed in 2024, identifying 10 studies that compared prophylactic endotracheal intubation (PEI) versus no intubation in acute upper GI bleeding in hospitalized patients. Outcomes of interest included pneumonia, length of hospital stay, aspiration, and mortality. The odds ratio (OR) or mean difference (MD) using the random effects model was calculated for each outcome. In total, 11 studies (10 retrospective, one prospective) were included in the meta-analysis (n = 7,332). PEI demonstrated statistically significant higher odds of pneumonia (OR = 5.83; 95% confidence interval (CI) = 3.15-10.79; p < 0.01) and longer length of stays (MD = 0.84; 95% CI = 0.12-1.56; p = 0.02). However, mortality (OR = 1.68; 95% CI = 0.78-3.64; p = 0.19) and aspiration (OR = 2.79; 95% CI = 0.89-8.7; p = 0.08) were not statistically significant. PEI before esophagogastroduodenoscopy for hospitalized upper GI bleeding patients is associated with an increased incidence of pneumonia within 48 hours and prolonged hospitalization but no statistically significant increased risk of mortality or aspiration.

Endoscopic submucosal dissection for rectal neuroendocrine tumours: A multicentric retrospective study

IntroductionEndoscopic Submucosal Dissection (ESD) has been reported as a feasible and effective treatment for Rectal Neuroendocrine Tumours (R-NETs). However, most of the experience on the topic comes from retrospective tertiary centre from Eastern Asia. Data on ESD for R-NETs in Western centres are lacking. Materials and MethodsThis is a retrospective study, including patients who underwent endoscopic resection of R-NETS by ESD between 2015 and 2020 in Western Centres. Important clinical variables such as demographic, size of R-NETs, histological type, presence of lymphovascular invasion or distant metastasis, completeness of the endoscopic resection, recurrence, and procedure related complications were recorded. Results40 ESD procedure on R-NETs from 39 patients from 8 centres were included. Mean R-NETs size was 10.3 mm (SD 4.01). Endoscopic en-bloc resection was achieved in 39/40 ESD (97.5 %), R0 margin resection was obtained in 87.5 % (35/40) of the procedures, one patient was referred to surgery for lymphovascular invasion, two procedures (5 %) reported significant episodes of bleeding, whereas a perforation occurred in one case (1/40, 2.5 %) managed endoscopically. Recurrence occurred in 1 patient (2.5 %). ConclusionESD is an effective and safe treatment for R-NETs in western centres.

Outcomes of asymptomatic common bile duct stones detected at intraoperative cholangiography.

The aim of this study was to investigate the outcome of common bile duct stones (CBDS) in asymptomatic patients at laparoscopic cholecystectomy (LC) and intra-operative cholangiogram (IOC). All patients undergoing LC and IOC at Te Whatu Ora - Health New Zealand Waikato between January 2017 and January 2022 were retrospectively reviewed. Electronic records were screened for asymptomatic CBDS. Exclusion criteria were hyperbilirubinaemia, gallstone pancreatitis, cholangitis and imaging-detected CBDS. IOC reports were reviewed to determine presence of CBDS. A second blinded review was undertaken by a radiologist. Outcomes were use of endoscopic retrograde pancreatography (ERCP), complications and readmission with retained CBDS. Included were 1,297 patients undergoing LC and IOC. Of these, 150 (24.1%) patients had a positive IOC, of which 58 (38.7%) were asymptomatic. Attempted flushing of CBDS was employed in 49 cases, 10 successfully. Common duct exploration was successful in a further six out of seven cases. Of the remaining 42 patients, 18 were offered ERCP. Seven had no stone at endoscopy. Sixteen had imaging, revealing clear ducts in 14. The remaining two then had ERCP confirming choledocholithiasis. Eight patients were managed expectantly, of whom none required readmission with retained stones. Rates of retained asymptomatic stones after positive IOC were low. Acknowledging risks associated with intervention and low rates of readmission with retained CBDS, an expectant approach could be more readily considered.

Upper Gastrointestinal Endoscopy by Pediatric Surgeons: Our Early Experience.

Pediatric upper gastrointestinal (UGI) endoscopy is an important procedure in the management of gastrointestinal pathologies. Conventionally, it has been the forte of medical gastroenterologists. However, unlike adults, the availability of pediatric gastroenterologists is limited, especially during emergency hours. We present our early experience of UGI endoscopy done by the department of pediatric surgery. The aim of this study was to study the feasibility and benefits of UGI endoscopy by pediatric surgeons. A retrospective descriptive study was carried out by the department of pediatric surgery of a tertiary-level medical college, from January 2017 to January 2022. Data were collected from electronic and physical medical records. Parameters included age, gender, indication for endoscopy, and procedures done endoscopically or based on endoscopic findings and complications. One hundred and thirty endoscopies were done in 95 patients aged 1-16 years, from January 2017 to January 2022. The most common indication for UGI endoscopy was esophageal stricture (71 procedures in 41 patients), followed by UGI foreign body (18 cases). All other indications were mostly diagnostic, other than four patients with achalasia. Thirty of these patients underwent UGI endoscopy as an emergency procedure. Seventeen patients were followed through or had added procedures, with UGI endoscopy. There was one perforation when dilating an esophageal stricture who responded to conservative management. UGI endoscopy is a valuable diagnostic and therapeutic procedure, which can be performed by pediatric surgeons after necessary training. It supplements decision-making in management, avoids waste of time in referring, avoids additional anesthesia, and is valuable in emergencies.

Levodopa-Carbidopa-Entacapone Intestinal Gel in Advanced Parkinson Disease: A Multicenter Real-Life Experience.

For Parkinson disease (PD) patients who have been diagnosed with advanced disease that can no longer be effectively controlled with optimized oral or transdermal medications, a range of device-aided therapies (DAT) are available, comprising either deep brain stimulation or infusion therapies providing continuous dopaminergic stimulation. Levodopa-entacapone-carbidopa intestinal gel (LECIG) infusion is the latest DAT for advanced PD (APD) that was approved in Romania in 2021. What is the experience to date in real-world clinical practice in Romania regarding the efficacy and tolerability of LECIG in APD? A retrospective evaluation of 74 APD patients treated with LECIG at 12 specialized APD centers in Romania. Demographic data and various clinical parameters were recorded, including Mini Mental State Evaluation score or Montreal Cognitive Assessment Test score. Levodopa-equivalent daily dose and the administered doses of levodopa and other PD medications were evaluated at baseline and after starting LECIG treatment. The efficacy of LECIG in reducing daily hours of off time, motor fluctuations, and dyskinesias were assessed. Any percutaneous endoscopic gastrojejunostomy system or device complications after starting LECIG treatment were noted. At baseline, patients were taking oral levodopa for a mean of 5.3 times per day, with a high proportion also taking concomitant add-on therapies (dopamine agonists, 86%, monoamine oxidase type-B inhibitors, 53%; catechol-O-methyltransferase inhibitors, 64%). LECIG treatment significantly reduced daily off time versus baseline from 5.7 h/d to 1.7 hours per day ( P < 0.01). Duration and severity of dyskinesias was also significantly reduced versus baseline, and improvements were observed in Hoehn and Yahr Scale scores. LECIG treatment also allowed a significant reduction in the use of concomitant oral medications. These findings suggest that LECIG treatment is an effective DAT option in APD that can simplify the treatment regimen.

Why every colorectal surgeon should learn endoluminal surgery

Endoscopic submucosal dissection (ESD) is an advanced therapeutic technique used to remove non-malignant polyps (NMP) and early cancers. Benefits include reducing unnecessary colectomies, cost, and morbidity of NMP treatment. Other roles for ESD and associated skills are likely to expand in the future, including in the non-operative management of rectal cancer. The learning curve is feasible with established training methods. Colorectal surgeons already perform routine endoscopy and manage endoscopic complications and endoscopically incurable lesions- endoluminal surgery (ELS) is a natural extension of this. Expanding technologies will only improve our ability to resect these lesions endoluminally moving forward. Collaboration with gastroenterologists and acquiring, rather than abandoning, this skillset is important and obtainable. Colorectal surgeons have the tools and professional duty to stay at the forefront of managing colorectal diseases endoscopically. Despite substantial barriers to mastering ELS, the value to our patients and profession means all colorectal surgeons should learn these techniques.

Endoscopic treatment of nonoperable large postsurgical esophageal fistulas: retrospective analysis of a single tertiary center cohort

Background and aimsAnastomotic fistulas are a frequent and dreaded complication of esophagectomy. Endoscopic therapy using different techniques is now a well-established first line treatment option. The aim of our study was to evaluate the efficacy of such endoscopic treatments in patients not fit for surgical re-intervention and particularly in case of major tissue defects of more than 10 millimeters. Methods57 patients with post-operative large esophageal fistulas who were not considered for surgical re-intervention were retrospectively analyzed after being treated with different endoscopic techniques in a single tertiary center. The primary endpoint was to evaluate technical and clinical efficacy of endoscopic treatments of those fistulas. The secondary endpoint was to evaluate the endoscopic treatments-related complications. ResultsIn 94.7% (n=54) of patients, the intervention was effectively carried out from a technical point of view. In 77.2% (n=44) of patients, treatment led to successful complete closure of the fistula. If we consider the 54 patients in which technical success was reached, in 75.9% (n=41) of them, clinical success with complete closure of the fistula was achieved. Minor complications related to the procedure occurred in 26.32% (n=15) of patients and major complications in 8.8% (n=5). The mortality rate related to the procedure was 3.5% (n=2). ConclusionsEndoscopic treatment is a technically achievable, highly effective way of treating post-operative large esophageal fistulas in patients who were not considered fit for surgical treatment, including major defects of more than 10 millimeters. It allows patients with high risk of rapid deterioration to safely recover from their condition, avoiding severe and fatal complications without having to resort to debilitating surgical treatment.

Endoscopic Complications Are More Frequent in Levodopa–Carbidopa Intestinal Gel Treatment via JET-PEG in Parkinson’s Disease Patients Compared to Nutritional PEG in Non-Parkinson’s Disease Patients

Background: To date, no studies comparing complication rates between patients with nutritional percutaneous endoscopic gastrostomy (N-PEG) and Parkinson’s disease (PD) patients with percutaneous endoscopic gastro-jejunostomy (JET-PEG) for treatment administration have been published. Our study aimed to compare complication rates and the number of re-endoscopies between N-PEG and JET-PEG patients. Methods: Individuals requiring N-PEG or JET-PEG insertion between 2014 and 2021 were included in this single-center retrospective observational study. Complications were divided into time-related medical and technical complications. Reasons for post-insertion re-endoscopies and their number were also analyzed. Results: Eighty-seven subjects, 47 (54.02%) in JET-PEG group and 40 (45.98%) in the N-PEG group, were included. Early and technical complications were more frequent in JET-PEG vs. N-PEG subjects (70% vs. 10% [p &lt; 0.001], and 54.5% vs. 5.1% [p &lt; 0.001], respectively). The presence of psychiatric disease was associated with a higher number of early complications (p &lt; 0.002). All three types of complications were significantly more frequent in subjects where a healthcare professional did not handle PEG (p &lt; 0.001). Subjects with JET-PEG required a higher number of re-endoscopies compared to the N-PEG group (57.1% vs. 35%, p = 0.05). Conclusions: Complications are significantly more common in individuals with JET-PEG than those with N-PEG, which can be attributed to higher mobility in PD patients.

Natural Histories and Disease Complications in a Cohort of 151 Children With Gastric or Duodenal Eosinophilia.

Eosinophilic gastritis (EoG) and duodenitis (EoD) are rare conditions that are poorly understood. Our aim was to describe the natural history of children with varying degrees of gastric or duodenal eosinophilia with respect to disease complications and histologic and endoscopic longitudinal trajectories. The electronic medical record at a tertiary children's hospital was queried to identify patients with EoG, EoD, or EoG + EoD who were cared for between January 2010 and 2022. Multiple logistic regression was performed to explore associations between baseline features and persistence/recurrence of eosinophilia or complications remote from diagnosis. We identified 151 patients: 92 with EoG, 24 with EoD, 12 with EoG + EoD, and 23 with tissue eosinophilia but did not meet histologic criteria for EoG or EoD (low grade). The average age at diagnosis was 10.6 years, and average follow-up was 5.8 years. Twenty-five percent of patients with EoG or EoD had persistence/recurrence of eosinophilia; this was associated with increases in the EoG Endoscopic Reference Score (adjusted odds ratio [aOR] 1.34, confidence interval [CI] 1.03-1.74) on diagnostic endoscopy. Eighteen percent suffered from disease complications, and development of late complications was associated with presenting with a complication (aOR 9.63, CI 1.09-85.20), severity of duodenal endoscopic abnormalities (aOR 8.74, CI 1.67-45.60), and increases in the EoG Endoscopic Reference Score (aOR 1.70, CI 1.11-2.63). Patients with gastric and duodenal eosinophilia should be followed closely to monitor for recurrence and complications, especially those presenting with endoscopic abnormalities or complications.

Outcomes and Complications Associated With the Learning Curve for Endoscopic Cervical Foraminotomy: A Systematic Review and Meta-Analysis.

A systematic review and meta-analysis. The objective of this study is to examine the impact of the learning curve for endoscopic cervical foraminotomy for clinical outcomes and patient safety. Endoscopic cervical foraminotomy is a minimally invasive surgical technique emerging in the literature for surgical management of cervical radiculopathy without the use of open incision. The adoption of endoscopic cervical foraminotomy may be hindered by the learning curve, although no review and meta-analysis exists to date on the topic. A systematic review and meta-analysis was performed using PubMed, CINAHL, and MEDLINE from database inception until July 11, 2023. Inclusion criteria were articles that examined endoscopic cervical foraminotomy, reported outcomes, and/or complications for endoscopic cervical spine surgery relevant to the learning curve and had full-text. A random effects meta-analysis was performed for outcomes and complications. A total of three articles (n=203 patients) were included from 792 articles initially retrieved. The learning curves from four surgeons were examined with a FWM 21 procedures until the competency phase. There was no significant difference in the postoperative hospitalization length ( P =0.669), postoperative recovery room time ( P =0.415), intraoperative blood loss ( P =0.064), and total complication rates (10.9% vs . 1.2%, P =0.139) between endoscopic cervical foraminotomy procedures performed in the learning phase as compared with the competency phase of the learning curve. There was a significant decrease in operative time from the learning phase to the competency phase ( P =0.005). Competency was achieved on the learning curve for endoscopic cervical foraminotomy after about 21 procedures. There is no significant difference in postoperative hospitalization time, postoperative recovery room time, intraoperative blood loss, and complication rates between the learning phase and the competency phase of the learning curve for endoscopic cervical foraminotomy, noting the relatively small sample size of this study that may underpower this finding.

Small intestinal mucosal abnormalities using video capsule endoscopy in intestinal lymphangiectasia

BackgroundIntestinal lymphangiectasia (IL) is a rare protein-losing enteropathy caused by disorders of the intestinal lymphatics. There are only a few case reports and case series concerning the VCE (video capsule endoscopy) findings of IL. This work aimed to evaluate the VCE characteristics of small intestinal mucosal abnormalities in patients with IL, and to investigate the relationship between clinical and VCE characteristics.MethodsConsecutive patients with IL who underwent VCE were enrolled in this retrospective study. The cases were classified into the white villi group and non-white villi group according to mucosal abnormalities detected by VCE. Clinical and endoscopic characteristics were investigated and analyzed.ResultsA total of 98 patients with IL with a median onset age of 26.3 ± 19.2 years were included. VCE revealed the following small intestinal lesions: (i) white villi type (57/98, 58.2%), i.e.: white-tipped or granular villi, white nodular villi or plaques; (ii) non-white villi type (41/98, 41.8%), i.e.: diffused low and round villi; (iii) complications (46/98, 46.9%), i.e.: bleeding, ulcers, protruding or vesicular-shaped lesions, stenosis and lymphatic leakage. A total of 58.2% (57) and 41.8% (41) of the cases were classified into the white villi and non-white villi groups respectively. The percentage of chylothorax in the white villi group was significantly lower than that in the non-white villi group (12/57 vs. 19/41, p = 0.008). In VCE, there were no significant differences in the involved segments and total detected rate of complications between the white villi and non-white villi groups (p > 0.05), while the detected rate of lymphatic leakage in the white villi group was significantly higher than that in the non-white villi group (31.6% vs. 12.2%, p = 0.026).ConclusionsOur study evaluated the entire small intestinal mucosal abnormalities of IL by VCE, especially endoscopic complications. IL has specific VCE abnormalities in addition to classical endoscopic findings.

Our experience with peroral endoscopic myotomy complications: A case series

Abstract Achalasia is characterized by the failure of smooth muscle relaxation in the lower part of the esophagus. During peroral endoscopic myotomy (POEM), creating a submucosal tunnel and performing a myotomy can inadvertently create openings between the submucosal space and the mediastinum, retroperitoneal cavity, and intraperitoneal cavity. When carbon dioxide (CO2) is insufflated during the procedure, it can pass through these openings, leading to conditions such as capnothorax, capnomediastinum, capnoperitoneum, or subcutaneous emphysema. In some cases, emergency management may be required. Three of our four patients who experienced these complications developed subcutaneous emphysema, while one had pneumoperitoneum and pneumothorax. Only one of these patients needed medical intervention, while the other three did not. It is now recognized that these complications are an expected part of the procedure rather than unexpected outcomes. Therefore, it is recommended to manage them conservatively unless they cause significant cardiorespiratory distress. In conclusion, having a good understanding of the procedure and remaining vigilant can help ensure the safe execution of POEM, even when these complications arise.

Accidental ingestion of foreign bodies/harmful materials in children from Bahrain: A retrospective cohort study.

Children like to discover their environment by putting substances in their mouths. This behavior puts them at risk of accidentally ingesting foreign bodies (FBs) or harmful materials, which can cause serious morbidities. To study the clinical characteristics, diagnosis, complications, management, and outcomes of accidental ingestion of FBs, caustics, and medications in children. We conducted a retrospective cohort study of all children admitted for accidental ingestion to the Department of Pediatrics, Salmaniya Medical Complex, Bahrain, between 2011 and 2021. Demographic data, type of FB/harmful material ingested, and investigations used for diagnosis and management were recorded. The patients were divided into three groups based on the type of ingested material (FBs, caustics, and medications). The three groups were compared based on patient demographics, socioeconomic status (SES), symptoms, ingestion scenario, endoscopic and surgical complications, management, and outcomes. The FB anatomical location was categorized as the esophagus, stomach, and bowel and compared with respect to symptoms. The Fisher's exact, Pearson's χ2, Mann-Whitney U, and Kruskal-Wallis tests were used for comparison. A total of 161 accidental ingestion episodes were documented in 153 children. Most children were boys (n = 85, 55.6%), with a median age of 2.8 (interquartile range: 1.8-4.4) years. Most participants ingested FBs (n = 108, 70.6%), 31 (20.3%) ingested caustics, and the remaining 14 (9.2%) ingested medications. Patients with caustic ingestion were younger at the time of presentation (P < 0.001) and were more symptomatic (n = 26/31, 89.7%) than those who ingested medications (n = 8/14, 57.1%) or FBs (n = 52/108, 48.6%) (P < 0.001). The caustic group had more vomiting (P < 0.001) and coughing (P = 0.029) than the other groups. Most FB ingestions were asymptomatic (n = 55/108, 51.4%). In terms of FB location, most esophageal FBs were symptomatic (n = 14/16, 87.5%), whereas most gastric (n = 34/56, 60.7%) and intestinal FBs (n = 19/32, 59.4%) were asymptomatic (P = 0.002). Battery ingestion was the most common (n = 49, 32%). Unsafe toys were the main source of batteries (n = 22/43, 51.2%). Most episodes occurred while playing (n = 49/131, 37.4%) or when they were unwitnessed (n = 78, 57.4%). FBs were ingested more while playing (P < 0.001), caustic ingestion was mainly due to unsafe storage (P < 0.001), and medication ingestion was mostly due to a missing object (P < 0.001). Girls ingested more jewelry items than boys (P = 0.006). The stomach was the common location of FB lodgment, both radiologically (n = 54/123, 43.9%) and endoscopically (n = 31/91, 34%). Of 107/108 (99.1%) patients with FB ingestion, spontaneous passage was noted in 54 (35.5%), endoscopic removal in 46 (30.3%), laparotomy in 5 (3.3%) after magnet ingestion, and direct laryngoscopy in 2 (1.3%). Pharmacological therapy was required for 105 (70.9%) patients; 79/105 (75.2%) in the FB group, 22/29 (75.9%) in the caustic group, and 4/14 (28.8%) in the medication group (P = 0.001). Omeprazole was the commonly used (n = 58; 37.9%) and was used more in the caustic group (n = 19/28, 67.9%) than in the other groups (P = 0.001). Endoscopic and surgical complications were detected in 39/148 (26.4%) patients. The caustic group had more complications than the other groups (P = 0.036). Gastrointestinal perforation developed in the FB group only (n = 5, 3.4%) and was more with magnet ingestion (n = 4) than with other FBs (P < 0.001). In patients with FB ingestion, patients aged < 1 year (P = 0.042), those with middle or low SES (P = 0.028), and those with more symptoms at presentation (P = 0.027) had more complications. Patients with complications had longer hospital stays (P < 0.001) than those without. Accidental ingestion in children is a serious condition. Symptomatic infants from middle or low SES families have the highest morbidity. Prevention through parental education and government legislation is crucial.

Safety of endoscopic ultrasound-guided hepaticogastrostomy in patients with malignant biliary obstruction and ascites.

Endoscopic ultrasound (EUS)-guided hepaticogastrostomy (EUS-HGS) is useful for patients with biliary cannulation failure or inaccessible papillae. However, it can lead to serious complications such as bile peritonitis in patients with ascites; therefore, development of a safe method to perform EUS-HGS is important. Herein, we evaluated the safety of EUS-HGS with continuous ascitic fluid drainage in patients with ascites. Patients with moderate or severe ascites who underwent continuous ascites drainage, which was initiated before EUS-HGS and terminated after the procedure at our institution between April 2015 and December 2022, were included in the study. We evaluated the technical and clinical success rates, EUS-HGS-related complications, and feasibility of re-intervention. Ten patients underwent continuous ascites drainage, which was initiated before EUS-HGS and terminated after completion of the procedure. Median duration of ascites drainage before and after EUS-HGS was 2 and 4 days, respectively. Technical success with EUS-HGS was achieved in all 10 patients (100%). Clinical success with EUS-HGS was achieved in 9 of the 10 patients (90 %). No endoscopic complications such as bile peritonitis were observed. In patients with ascites, continuous ascites drainage, which is initiated before EUS-HGS and terminated after completion of the procedure, may prevent complications and allow safe performance of EUS-HGS.

Dental trauma in endoscopy: A systematic review and experience of a tertiary endoscopy centre.

Dental injury is the leading cause of litigation in anaesthesia but an underrecognized preventable complication of endoscopy. To determine frequency and effects of dental injury in endoscopy, we present findings from an audit of outpatient endoscopy procedures conducted at a tertiary university hospital and a systematic review of literature. Retrospective review of 11265 outpatient upper endoscopy procedures over the period of 1 June 2019 to 31 May 2021 identified dental related complications in 0.284% of procedures. Review of literature identified a similar rate of 0.33%. Pre-existing dental pathology or the presence of prostheses makes damage more likely but sound teeth may be affected. Pre-endoscopic history and tooth examination are key for risk stratification and may be conducted succinctly with limited time outlay. Tooth retrieval should be prioritized in the event of dental injury to minimize aspiration and be followed by prompt dental consultation for specific management. Dental complications occur in approximately 1 in 300 of upper endoscopy cases. These are easily preventable by pre-endoscopy screening. Protocols to mitigate dental injury are also suggested.

Safety and efficacy of endoscopic retrograde cholangiopancreatography in previously treated liver cancer patients: a survival analysis.

The prognosis and medication response for liver malignancies are both dismal and highly heterogeneous. For this diverse malignancy, multimodality therapies such as drugs, surgical management, and/or l+iver transplantation are available. Biliary complications remain a major problem after liver cancer treatment especially in those patients who undergo liver transplantation for their end stage liver disease. Although, most biliary complications can be successfully managed with endoscopic retrograde cholangiopancreatography. However, biliary complications still considered an important factor influencing long-term results in liver cancer treatment patients. The aim of this study was to evaluate the effect of biliary complications on the overall patient's survival rate after the endoscopic retrograde cholangiopancreatography. We retrospectively analyzed data of consecutive patients who were treated for liver cancer at our tertiary care hospital from January 2015 to July 2020. We focused on the biliary complications and procedural data, including post-endoscopic retrograde cholangiopancreatography complications, survival rate, and complementary or alternative treatments to endoscopic retrograde cholangiopancreatography. We identified 967 cases (mean age 49; range 11-75), 84% men. During the mean follow up of 25 months (range 1 to 66 months), 102 patients developed biliary complications; 68/102 underwent 141 therapeutics endoscopic retrograde cholangiopancreatography procedures. The rest 34/102 patients were managed with percutaneous transhepatic cholangiography, conservative management, and/or surgery. Post- endoscopic retrograde cholangiopancreatography complications occurred in 79.4%, including anastomotic strictures in 25, non-anastomotic strictures in 5, stones in 5, cholangitis in 4, post-sphinctretomy bleeding in 3, pancreatitis in 2, and bile leakage in 1 patient. Seven (13.0%) patients died after ERCP due to multiple organ dysfunction syndrome. Although the survival rate of patients who underwent ERCP and those without ERCP was similar, patients with biliary complications fared significant worse. Although endoscopic retrograde cholangiopancreatography is useful for the management of post liver cancer treatment biliary complications; the need for multiple rounds of endoscopic retrograde cholangiopancreatography and even post endoscopic retrograde cholangiopancreatography complications is relatively high, and often results in increased mortality. However, the survival following endoscopic or surgical therapy in liver cancer treatment patients is similar.