Endoscopic Failure Research Articles

Fluoroscopic Gastroduodenal Stent Placement in 55 Patients with Endoscopic Stent Placement Failure.

To evaluate the technical feasibility and clinical effectiveness of fluoroscopic self-expandable metal stent (SEMS) placement in malignant gastroduodenal obstructions after failed endoscopic SEMS placement. Between September 2010 and July 2017, 874 patients underwent endoscopic SEMS placement for dysphagia caused by malignant gastroduodenal obstructions. Endoscopic SEMS placement failed in 55 of 874 patients (6.3%). These patients were referred for fluoroscopic SEMS placement. In case of failed fluoroscopic SEMS placement, combined endoscopic and fluoroscopic SEMS placement was attempted at the same setting. Fluoroscopic SEMS placement was technically successful in 40 of 55 patients (72.7%). Combined endoscopic and fluoroscopic SEMS placement was technically successful in 6 of 15 patients with fluoroscopic SEMS placement failure. Failures in the nine patients were due to complete obstruction (n = 5) and acute angulation at the stricture site (n = 4). The overall technical success rate was 83.6% (46/55). Clinical success was achieved in 95.6% of patients (44/46). Complications occurred in 7 of 46 patients (15.2%), including tumor overgrowth (n = 3), SEMS migration (n = 3), and bleeding (n = 1). The median SEMS patency and patient survival periods were 515 (95% confidence interval (CI), 266.6-761.5) and 83 (95% CI 60.6-105.4) days, respectively. Fluoroscopic SEMS placement is technically feasible and clinically effective in cases of endoscopic SEMS placement failure. A combined endoscopic and fluoroscopic approach increases the technical success rate after failure of the endoscopic or fluoroscopic approach. Level IV.

Misinterpretation or Underestimation of the Appearance, Location, or Size of Non-bleeding Visible Vessels (Forrest Class IIa) as a Cause of Hemostasis Failure

(1) Background: Endoscopy has become the primary diagnostic and treatment technique for non-variceal upper gastrointestinal bleeding. Despite advancements in therapeutic methods and instrumentation, endoscopic hemostatic failure occurs in 10% of patients. This study aimed to analyze endoscopic findings in patients with failed hemostasis and to elucidate strategies for endoscopists and gastroenterologists to facilitate improved treatment outcomes. (2) Methods: A total of 128 patients received hemostatic treatment for non-variceal upper gastrointestinal bleeding. Endoscopic findings in three patients in whom hemostasis could not be achieved after the initial and secondary endoscopies were analyzed. (3) Results: Hemostasis failure occurred in three cases (2.3%). All three cases involved patients with gastric ulcer and belonged to the Forrest class IIa category presenting with a non-bleeding visible vessel in endoscopic findings. Misinterpretation or underestimation of the appearance, location, or size of the vessel resulted in hemostasis failure. (4) Conclusions: Our findings demonstrate that identification of a non-bleeding visible vessel and assessment of the risk of re-bleeding in such vessels is often difficult. Detailed observation of the ulcer floor with awareness of the possibility of a non-bleeding visible vessel will lead to improved hemostatic treatment. The decision regarding hemostatic treatment of a visible vessel with a diameter larger than 2 mm should be made cautiously, and treatment should be followed by an appropriate fasting period under confirmatory endoscopy.

Risk Factors and On-site Rescue Treatments for Endoscopic Variceal Ligation Failure.

The success rate of endoscopic variceal ligation (EVL) is about 85-94%. There is only a few studies attempting to determine the cause of EVL failure, and to date, on-site rescue treatments remains unestablished. This study aimed to elucidate the risk factors for EVL failure and the effectiveness of on-site rescue treatment. Data of 454 patients who underwent emergency EVL at Chonnam National University Hospital were retrospectively analyzed. Enrolled patients were divided into two groups: the EVL success and EVL failure groups. EVL failures were defined as inability to ligate the varices due to poor endoscopic visual field, or failure of hemostasis after band ligation for the culprit lesion. Forty-seven patients experienced EVL failure. In the multivariate analysis, male patients, initial hypovolemic shock, active bleeding on endoscopy, and history of previous EVL were independent risk factors for EVL failure. During endoscopic procedure, we came across the common causes of EVL failure, including unsuctioned varix due to previous EVL-induced scars followed by insufficient ligation of the stigmata and inability to ligate the varix due to poor endoscopic visual field. Endoscopic variceal obturation using N-butyl-2-cyanoacrylate (48.9%) was the most commonly used on-site rescue treatment method, followed by insertion of Sangstaken Blakemore tube (14.9%), and EVL retrial (12.8%). The rescue treatments successfully achieved hemostasis in 91.7% of those in the EVL failure group. The risk factors of EVL failure should be considered before performing EVL, and in case of such scenario, on-site rescue treatment is needed.

Multiple echocardiography abnormalities associated with endoscopic third ventriculostomy failure.

OBJECTIVE Although endoscopic third ventriculostomy (ETV) with choroid plexus cauterization (CPC) has gained increasing prominence in the management of hydrocephalus caused by intraventricular hemorrhage of prematurity, the rates of long-term shunt independence remain low. Furthermore, limited evidence is available to identify infants who might benefit from the procedure. The authors tested the hypothesis that elevated venous pressure that results from comorbid cardiac disease might predispose patients to ETV/CPC failure and shunt dependence. METHODS A retrospective analysis was performed on a consecutive series of 48 infants with hydrocephalus who underwent ETV/CPC and also underwent preoperative echocardiography between 2007 and 2014. Comorbid cardiac abnormalities that are known to result in elevated right heart pressure were reviewed. Associations between ETV/CPC success and the presence of pulmonary hypertension, right ventricular hypertrophy, left-to-right shunting, ventricular septal defect, or patent ductus arteriosus were determined using multivariate logistic regression analysis. RESULTS Of the 48 children who met the inclusion criteria, ETV/CPC failed in 31 (65%). In univariate analysis, no single echocardiogram abnormality was associated with shunt failure, but the presence of 2 or more concurrent echocardiogram abnormalities was associated with ETV/CPC failure (17 [85%] of 20 vs 14 [50%] of 28, respectively; p = 0.018). In multivariate logistic regression analysis, when the authors adjusted for the child's ETV success score, the presence of 2 abnormalities remained independently associated with poor outcome (2 or more echocardiogram abnormalities, OR 0.13, 95% CI 0.01-0.7, p = 0.032; ETV success score, OR 1.1, 95% CI 1-1.2, p = 0.05). CONCLUSIONS In this study, cardiac abnormalities were inversely associated with the success of ETV/CPC in infants with hydrocephalus of prematurity. ETV/CPC might not be as efficacious in patients with significant cardiac anomalies. These results provide a basis for future efforts to stratify surgical candidacy for ETV/CPC on the basis of comorbid abnormalities. Proper cardiac physiological pressure monitoring might help elucidate the relationship between cardiac abnormalities and hydrocephalus.

Effect of endoscopic failure on the results of internal surgical drainage in pancreatic pseudocyst

BackgroundThe treatment of pancreatic pseudocysts has evolved during the past two decades. Endoscopic treatment (ET) has gradually become used as a first-line management even though it showed no significant superiority to surgical internal drainages (SIDs) in a recent randomized trial. The objective of the present work was to analyze the effect of ET failure on the results of SID in the global management of pancreatic pseudocysts. MethodsA multicenter retrospective study (Clichy, Bordeaux, Nantes, and Rennes) was conducted between January 2000 and December 2012. The main criteria were as follows: (i) major postoperative complications (MPCs) (Clavien ≥ 3) and (ii) treatment failure in the first 12 mo. All factors that may affect these two parameters were tested in univariate and multivariate analyses, when necessary. ResultsOne hundred nineteen patients, with a median age of 52 y (22-83) underwent SID, including 45 procedures (37.8%) performed after ET failure. Mortality and overall morbidity rates were 1.7% and 30.2%, respectively. Eighteen patients (15.1%) presented an MPC. Multivariate analysis revealed that failure of ET (odds ratio 3.04, confidence interval [1.04 to 9.5], P = 0.046) and BMI ≤20 (odds ratio 4.5, confidence interval [1.50; 15.5], P = 0.010) were independent risk factors of MPCs. The success of SID was 92.5% in the first year. In univariate analysis, the occurrence of an MPC was the only factor linked to the failure of SID (P = 0.029). ConclusionsPerforming an SID after ET failure is associated with an increased risk of MPC. Close postoperative monitoring is recommended for these patients.

A406 - Laparoscopic Stricturoplasty for Gastric Sleeve Stenosis

Gastric stenosis in patients who have undergone prior sleeve gastrectomy is a rare complication of sleeve gastrectomy with an incidence of less than one percent. Despite its rarity, it can cause significant morbidity with poor per oral tolerance. Ongoing investigations are exploring endoscopic and surgical therapies for sleeve stenosis, however abundant literature is lacking. While endoscopic therapies may be successful in relieving patient symptoms, there is a subset that will fail endoscopic management. Typically, the next step after endoscopic failure is to offer gastric bypass. Here we present a case of sleeve stenosis successfully treated with laparoscopic gastric stricturoplasty. Gastric stricturoplasty offers a safe, effective, and less technically challenging alternative to gastric bypass.

Right hepatic artery injury: an unusual complication of penetrated duodenal ulcer disease

Peptic ulcers generally appear in the stomach and the first segment of the duodenum as a result of mucosal erosion caused by pepsin and gastric acid secretion, with up to 70% of these occurring amongst patients aged 25-64. Currently, endoscopic procedures combined with proton pump inhibitors are considered the gold standard for managing complicated peptic ulcers, leaving surgical management as an option for endoscopic management failure or in scenarios such as incoercible bleeding, perforation, penetration and intestinal occlusion. Penetration of a gastric ulcer to adjacent organs is a rare complication; penetration to the liver and endoscopic diagnosis is even rarer. We have presented the case of a 54 year old diabetic male, who presented to the emergency room with upper gastrointestinal bleeding due to a chronic duodenal ulcer, with haemodynamic instability, requiring surgical management, revealing penetration to the liver with rupture of the right hepatic artery. The patient successfully recovered after surgery and was discharged 7 days after surgical intervention. We did not find any similar case reports in the current literature

Partington-Rochelle Pancreaticojejunostomy for Chronic Pancreatitis Combined with Cholangioenterostomy Treatment of Chronic Pancreatitis and Biliary Strictures: Case Report and Review of the Literature

Chronic pancreatitis (CP) is a kind of pancreatic disease with irreversible morphological changes, can lead to impaired endocrine and exocrine function of the inflammatory process. CP simultaneously accompanied with bile duct stricture (BDS) is a rare condition. At present, the treatment of CP tend to be individualized by the surgeons.Here, we reported the case of a plastic stent inserted two times into the main pancreatic duct and common bile duct. During the last 5 years, the patient hospitalized several times due to recurrent abdominal pain, till Partington-Rochelle pancreatojejunostomy(PRP) procedure combined with cholangioenterostomy was treated without complications. After 4 years of follow-up, the patient showed abnormal glucose metabolism without the need for additional enzymes, and he was in good condition without pain. Partington-Rochelle procedure combined with cholangioenterostomy provided a promising result of pancreatitis with BDS endoscopic papillary and stent failure

Percutaneous biliary approach as a successful rescue procedure after failed endoscopic therapy for drainage in advanced hilar tumors.

Palliative endoscopic or percutaneous biliary drainage is used for unresectable advanced hilar cancer (HC). The best option for drainage in Bismuth type III or IV HC has not been established. The aims of this study are to identify factors predictive of endoscopic stenting failure and evaluate the effectiveness of rescue percutaneous stenting in patients with advanced HC. Data from 110 patients with inoperable advanced HC were retrospectively reviewed. All received bilateral self-expandable metallic stents. Patients were divided into three groups: I, successful initial endoscopic stenting; II, unsuccessful initial endoscopic stenting, followed by percutaneous stenting; and III, initial percutaneous stenting. We analyzed clinical results and radiologic tumor characteristics. Baseline characteristics and clinical outcomes of all groups were similar, except the hospital stay was longer in group III than group I. Technical success rate was higher in groups II and III (100%) than in group I (72.4%). The functional success rate, stent patency time, patient survival time, and complication rate were similar between groups. Endoscopic stenting failed because of guide-wire passage failure (n = 12) or stent passage failure (n = 7). The only factor significantly associated with endoscopic failure was a smaller left intrahepatic duct-common bile duct angle. As clinical outcomes were generally similar between approaches, percutaneous stenting is recommended for patients with Bismuth type III or IV advanced HC. Acute left intrahepatic duct-common bile duct angulation predicts endoscopic stenting failure. If endoscopic stenting fails, immediate conversion to the percutaneous approach is a necessary and effective rescue method.

1022 - Predictive factors of Sachse endoscopic urethrotomy failure

1022 - Predictive factors of Sachse endoscopic urethrotomy failure

Abstract No. 78 - Efficacy of CTA in diagnosing non-traumatic non-variceal gastrointestinal bleeding prior to transarterial embolization after endoscopic failure in managing acute gastrointestinal bleeding

Abstract No. 78 - Efficacy of CTA in diagnosing non-traumatic non-variceal gastrointestinal bleeding prior to transarterial embolization after endoscopic failure in managing acute gastrointestinal bleeding

Relevance of surgery in patients with non-variceal upper gastrointestinal bleeding.

Upper GI bleeding remains one of the most common emergencies with a substantial overall mortality rate of up to 30%. In severe ill patients, death does not occur due to failure of hemostasis, either medical or surgical, but mainly from comorbidities, treatment complications, and decreased tolerated blood loss. Management strategies have changed dramatically over the last two decades and include primarily endoscopic intervention in combination with acid-suppressive therapy and decrease in surgical intervention. Herein, we present one of the largest patient-based analysis assessing clinical parameters and outcome in patients undergoing endoscopy with an upper GI bleeding. Data were further analyzed to identify potential new risk factors and to investigate the role of surgery. In this retrospective study, we aimed to analyze outcome of patients with an UGIB and data were analyzed to identify potential new risk factors and the role of surgery. Data collection included demographic data, laboratory results, endoscopy reports, and details of management including blood administration, and surgery was carried out. Patient events were grouped and defined as "overall" events and "operated," "non-operated," and "operated and death" as well as "non-operated and death" where appropriate. Blatchford, clinical as well as complete Rockall-score analysis, risk stratification, and disease-related mortality rate were calculated for each group for comparison. Overall, 253 patients were eligible for analysis: endoscopy was carried out in 96% of all patients, 17% needed surgical intervention after endoscopic failure of bleeding control due to persistent bleeding, and the remaining 4% of patients were subjected directly to surgery. The median length of stay to discharge was 26days. Overall mortality was 22%; out of them, almost 5% were operated and died. Anticoagulation was associated with a high in-hospital mortality risk (23%) and was increased once patients were taken to surgery (43%). Patients taking steroids presented with a risk of death of 26%, once taken to surgery the risk increased to 80%. Patients with liver cirrhosis had a risk of death of 42%; we observed a better outcome for these patients once taken to theater. Clinically, once scored with Blatchford score, statistical correlation was found for initial need for blood transfusion and surgical intervention. Clinical as well as complete Rockall score revealed a correlation between need for blood transfusion as well as surgical intervention in addition with a decreased outcome with increasing Rockall scores. Risk factor analysis including comorbidity, drug administration, and anticoagulation therapy introduced the combination of tumor and non-steroidal antirheumatic medication as independent risk factors for increased disease-related mortality. UGIB remains challenging and endoscopy is the first choice of intervention. Care must be taken once a patient is taking antirheumatic non-steroidal pain medication and suffers from cancer. In patients with presence of liver cirrhosis, an earlier surgical intervention may be considered, in particular for patients with recurrent bleeding. Embolization is not widely available and carries the risk of necrosis of the affected organ and should be restricted to a subgroup of patients not primarily eligible for surgery once endoscopy has failed. Taken together, an interdisciplinary approach including gastroenterologists as well as surgeons should be used once the patient is admitted to the hospital to define the best treatment option.

Comparing endoscopic intervention against fully covered self-expanding metal stent placement for post-endoscopic sphincterotomy bleed (CEASE Study).

Background and study aims: Limited data exist for the use of fully covered self-expanding metal stent (FCSEMS) as an intervention for immediate bleeds post-endoscopic sphincterotomy (ES) after primary endoscopic intervention failure or to reduce the number of delayed bleeding events in patient with increased risk of bleeding post-ES. Patients and methods: We evaluated a retrospective cohort of individuals who had ES performed from 2011 to 2014. A total of 700 patients were identified with 67 patients having post-ES bleeding. The FCSEMS treatment group included 23 patients and the non-FCSEMS treatment group included 44 patients. The primary end point was rate of change of Hgb at 72 hours after ES in the FCSEMS group and the primary endoscopic intervention-only group. A comparison also was made between the FCSEMS and non-FCSEMS group with regards to proportion of coagulopathy and number of delayed bleeding events. Results: The FCSEMS treatment group had a lower bleeding rate at 72 hours (0.66 g/dL vs 1.98 g/dL P < 0.001), increased proportion of patients at high risk of bleeding (40 % vs 9 % P value 0.008), and increased frequency of bleeding events that were moderately severe (52 % vs 9 % P = 0.0002) compared to the non-FCSEMS treatment group. The FCSEMS group included 9 patients at increased risk of bleeding and no patients with delayed bleed compared to the non-FCSEMS group, in which all 4 patients at increased risk of bleeding developed a delayed bleed. Conclusion: FCSEMS can provide homeostasis after primary endoscopic intervention failure, thus reducing the need for high-risk procedures. FCSEMS can reduce delayed bleeding events in patients at high risk of post-ES bleeding.

Use of Biliary Stents in the Surgical Management of Bouveret Syndrome After Endoscopic Failure

Use of Biliary Stents in the Surgical Management of Bouveret Syndrome After Endoscopic Failure

Airway stenting in the management of iatrogenic tracheal injuries: 10-Year experience.

Iatrogenic tracheal injury (ITI) is a rare yet severe complication of endotracheal tube (ETT) placement or tracheostomy. ITI is suspected in patients with clinical and/or radiographic signs or inefficient mechanical ventilation (MV) following these procedures. Bronchoscopy is used to establish a definitive diagnosis. We conducted a retrospective, single-centre chart review of 35 patients between 2004 and 2014. Depending on the nature and location of ITI and need for MV, patients were triaged to surgical repair, endoscopic management with airway stents or conservative treatment consisting of ETT or tracheotomy cannula (TC) placement distal to the wound and bronchoscopic surveillance. Three of the four patients (11.43%) presenting with tracheoesophageal fistula (TEF) underwent surgery. Seven patients (20%) who did not require MV underwent endoscopic surveillance. Of the 24 ventilated patients (68.57%), 7 with ITI in the lower trachea were treated with silicone Y-stent (ETT or TC was placed inside the stent) and 17 patients with ITI in the upper trachea were managed by placing ETT or TC cuff distal to the injury. Overall management success, defined as complete healing of the ITI, was seen in 88.57% of patients. Four patients (11.43%) died of non-ITI-related comorbidities. Conservative management should be considered in non-ventilated patients with ITI and when ITI is located in the upper trachea of ventilated patients where ETT or TC bypasses the injury. Airway stenting should be considered in ventilated patients with ITI located in the lower trachea. Surgery should be reserved for TEF and conservative and endoscopic management failure.

The outcome of endoscopic management of bile leakage after hepatobiliary surgery.

Background/AimsDespite improvements in surgical techniques and postoperative patient care, bile leakage can occur after hepatobiliary surgery and may lead to serious complications. The aim of this retrospective study was to evaluate the efficacy of endoscopic treatment of bile leakage after hepatobiliary surgery.MethodsThe medical records of 20 patients who underwent endoscopic retrograde cholangiopancreatography because of bile leakage after hepatobiliary surgery from August 2009 to September 2014 were reviewed retrospectively. Endoscopic treatment included insertion of an endoscopic retrograde biliary drainage stent after endoscopic sphincterotomy.ResultsMost cases of bile leakage presented as percutaneous bile drainage through a Jackson-Pratt bag (75%), followed by abdominal pain (20%). The sites of bile leaks were the cystic duct stump in 10 patients, intrahepatic ducts in five, liver beds in three, common hepatic duct in one, and common bile duct in one. Of the three cases of bile leakage combined with bile duct stricture, one patient had severe bile duct obstruction, and the others had mild strictures. Five cases of bile leakage also exhibited common bile duct stones. Concerning endoscopic modalities, endoscopic therapy for bile leakage was successful in 19 patients (95%). One patient experienced endoscopic failure because of an operation-induced bile duct deformity. One patient developed guidewire-induced microperforation during cannulation, which recovered with conservative treatment. One patient developed recurrent bile leakage, which required additional biliary stenting with sphincterotomy.ConclusionsThe endoscopic approach should be considered a first-line modality for the diagnosis and treatment of bile leakage after hepatobiliary surgery.

Temporary duodenal stenting as a bridge to ERCP for inaccessible papilla due to duodenal obstruction: a retrospective study.

Background and study aims: Duodenal obstruction may prevent performance of endoscopic retrograde cholangiopancreatography (ERCP). Percutaneous transhepatic biliary drainage (PTBD) or Endoscopic ultrasonograhy-guided biliary access (EUS-BD) are alternative treatments but are associated with a higher morbidity and mortality rate. The aim of the study is to report overall technical success rate and clinical outcome with deployment of temporary fully or partially covered self-expanding duodenal stent (pc/fcSEMS) as a bridge to ERCP in case of inaccessible papilla due to duodenal strictures. Patients and methods: This retrospective study included 66 consecutive patients presenting with a duodenal stricture impeding the ability to perform an ERCP. Provisional duodenal stenting was performed as a bridge to ERCP. A second endoscopic session was performed to remove the provisional stent and to perform an ERCP. Afterward, a permanent duodenal stent was delivered if necessary. Results: Sixty-six duodenal stents (17 pcSEMS and 49 fcSEMS) were delivered with a median indwelling time of 3.15 (1 – 7) days. Two migrations occurred in the pcSEMS group, 1 of which required lower endoscopy for retrieval. No other procedure-related complications were observed. At second endoscopy a successful ERCP was performed in 56 patients (85 %); 10 patients (15 %) with endoscopic failure underwent PTBD or EUS-BD. Forty patients needed permanent duodenal stenting. Conclusions: Provisional removable covered duodenal stenting as a bridge to ERCP for duodenal obstruction is safe procedure and in most cases allows successful performance of therapeutic ERCP. This technique could be a sound option as a step up approach before referring such cases for more complex techniques such as EUS-BD or PTBD.

Tu1548 Temporary Placement of a Covered Duodenal Stent Allows Secondary Access to the Papilla and Retrograde Biliary Stenting After Initial Endoscopic Retrograde Cholangiopancreatography Failure Due to Duodenal Stenosis

Tu1548 Temporary Placement of a Covered Duodenal Stent Allows Secondary Access to the Papilla and Retrograde Biliary Stenting After Initial Endoscopic Retrograde Cholangiopancreatography Failure Due to Duodenal Stenosis

V1-08 PRIMARY ROBOTIC URETEROENTERIC ANASTOMOTIC REVISION IN STUDER NEOBLADDER: OPERATIVE TECHNIQUE AND CASE SERIES

You have accessJournal of UrologyRobotics-Bladder/Reconstruction1 Apr 2016V1-08 PRIMARY ROBOTIC URETEROENTERIC ANASTOMOTIC REVISION IN STUDER NEOBLADDER: OPERATIVE TECHNIQUE AND CASE SERIES Jaspreet Parihar, Greg Gin, Clayton Lau, Kevin Chan, and Jonathan Yamzon Jaspreet PariharJaspreet Parihar More articles by this author , Greg GinGreg Gin More articles by this author , Clayton LauClayton Lau More articles by this author , Kevin ChanKevin Chan More articles by this author , and Jonathan YamzonJonathan Yamzon More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2122AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Ureteroenteric strictures occur in 3-13% of urinary diversions. Endoscopic treatment has a low long-term success rate and may subject the patient to multiple interventions and nephrostomy tubes. Open repair is considered the gold standard but is commonly avoided because of morbidity or utilized mostly after endoscopic failure. We report our technique and experience of primary robot-assisted ureteroenteric anastomotic revision in Studer neobladders (RUAR) METHODS We describe our operative techniques. Results of total four cases that underwent primary robot assisted revision in patients with Studer neobladders from 2013-2015 are presented. Data was collected retrospectively from medical records. RESULTS Two patients had right sided revisions, and two patients had left-sided revisions. The median OR time was 180 min (range 180-300). The median length of stay was 3 days (2-4). With a median follow up of 11.2 months (1.3-20.3), all patients were free of recurrent stricture. The median time to stricture after neobladder reconstruction was 2.5 months (1.3-1301), and the median time with a stent or nephrostomy tube was 3 months (1.5-6). CONCLUSIONS Primary robot-assisted revision is a feasible solution for ureteroenteric strictures in Studer neobladders with excellent intermediate success rate. As a primary repair, RUAR may avoid multiple endoscopic interventions and decrease the patient’s time with a nephrostomy or stent. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e63-e64 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Jaspreet Parihar More articles by this author Greg Gin More articles by this author Clayton Lau More articles by this author Kevin Chan More articles by this author Jonathan Yamzon More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Endoscopic ultrasound-guided hepaticogastrostomy using a 6-F cystotome and 12-cm covered metal stent

Background and study aims: An iincreasing number of reports describe endoscopic ultrasound-guided hepaticogastrostomy for malignant biliary obstruction in patients with endoscopic retrograde cholangiopancreatography failure. However, this procedure has not yet been standardized; as a result, the rate of adverse events, including bile leakage and stent migration, is relatively high. Here, we report our experience with four cases of endoscopic ultrasound-guided hepaticogastrostomy performed according to our institutional procedure.