Endoscopic Management Of Complications Research Articles

Endoscopic management of complications after sleeve gastrectomy: a narrative review

Endoscopic management of complications after sleeve gastrectomy: a narrative review

Acute Gastric Volvulus with Gangrene, a Rare and Potentially Fatal Complication Post Laparoscopic Fundoplication, Endoscopic Management of Complications

Acute Gastric Volvulus with Gangrene, a Rare and Potentially Fatal Complication Post Laparoscopic Fundoplication, Endoscopic Management of Complications

Endoscopic management of complications—Ovesco/stent for management of anastomotic leaks: a narrative review

Background and Objective: Despite the surgical approach, esophagectomy is associated with high overall morbidity and significant mortality rates. Leak at the esophagic anastomosis is one of the most common and feared complications, which may occur in 5–20% of patients according to published studies. We discuss the advancements in endoscopic management of post esophagectomy anastomotic defects focused in preserving the gastric tube, using the full-thickness clips closure system and combined therapies.

Endoscopic management of complications—endovacuum for management of anastomotic leakages: a narrative review

Endoscopic management of complications—endovacuum for management of anastomotic leakages: a narrative review

Endoscopic Management of Complications in Chronic Pancreatitis

Management of complications in patients with chronic pancreatitis is often suboptimal. This review discusses detailed endoscopic approaches for managing complications in CP. CP is characterized by progressive and irreversible destruction of pancreatic parenchyma and ductal system resulting in fibrosis, scarring, and loss of glandular function. Abdominal pain remains is the most common symptom of the disease and the main aim of medical, endoscopic, and surgical therapy is to help relieve symptoms, prevent disease progression, and manage complications related to CP. In fact, advances in our understanding of CP have improved medical care and quality of life in these patients. With significant sequela, morbidity and a progressive nature, a thorough understanding of the pathophysiology, natural course, diagnostic approaches, and optimal management strategies for this disease is warranted. The existing modalities and new innovations in this field are safe, effective, and likely to have a positive impact on management of complication in CP whenever used in the right context.

Principles and techniques of interventional IBD: Endoscopic management of complications

Principles and techniques of interventional IBD: Endoscopic management of complications

Bariatric endoscopy: current primary therapies and endoscopic management of complications and other related conditions

The steady increase in bariatric surgery has led to room for innovation. Endoscopy has become an important tool for evaluation, diagnosis, management of complications, and even for primary bariatric interventions. Leaks are the most feared complication and new endoscopic therapies have been developed such as septotomy, double-pigtail stents, and endoscopic vacuum therapy. Additionally, primary bariatric endoscopic procedures are gaining popularity and the new procedures include intragastric balloons, stoma reduction, aspiration therapy, among others. The altered anatomy and reoperation increase the risk of complications after bariatric surgery, especially when managing conditions like achalasia, gastroparesis, and cholelithiasis. Per-oral endoscopic myotomy, per-oral pyloromyotomy, and endoscopic ultrasound-guided transgastric endoscopic retrograde cholangiopancreatography provide a less invasive approach to address these conditions. This narrative review article intends to expose current endoscopic therapies for the management of primary bariatric procedures, complications and related conditions.

How to Incorporate Bariatric Training Into Your Fellowship Program.

How to Incorporate Bariatric Training Into Your Fellowship Program.

Review article including treatment algorithm: endoscopic treatment of luminal complications after bariatric surgery.

The worldwide number of performed bariatric surgeries is increasing continuously, whereas laparoscopic Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy are conducted most frequently. Alongside with the usual post-operative and metabolic complications, luminal complications such as anastomotic bleeding, ulceration, leakage, fistula formation, enlargement and stenosis of the anastomosis may occur. Evolution of interventional endoscopy frequently allows endoscopic management of complications, avoiding surgical interventions in most cases. Here, we review the various luminal complications after bariatric surgery with a focus on their endoscopic management.

Endoscopic resection of advanced and laterally spreading duodenal papillary tumors.

Historically, neoplasia of the duodenal papilla has been managed surgically, which may be associated with substantial morbidity and mortality. In the absence of invasive cancer, even lesions with extensive lateral duodenal wall involvement, or limited intraductal extension may be cured endoscopically with a superior safety profile. Endoscopic papillectomy is associated with greater risks of adverse events such as bleeding than resection elsewhere in the gastrointestinal tract. Additionally site-specific complications such as pancreatitis exist. A structured approach to lesion assessment, adherence to technical aspects of resection, endoscopic management of complications and post-resection surveillance is required. Advances have been made in all facets of endoscopic papillary resection since its introduction in the 1980s; extending the boundaries of endoscopic cure, optimizing outcomes and enhancing patient safety. These will be the focus of the present review.

Endoscopic management of complications in digestive surgery

Endoscopy has an ever-increasing role in the treatment of complications in digestive surgery. Endoscopic treatment is essentially used for (i) fistula or intra-abdominal collection secondary to anastomotic dehiscence and (ii) anastomotic stricture, especially esophagogastric, but also sometimes after colorectal surgery. First intention treatment of fistula following esophagogastric surgery is the insertion of an extractable self-expandable metallic stent (partially or entirely covered); this is supported by a low level of scientific evidence, but clinical experience has been satisfactory. Other techniques for treatment of anastomotic leak have also been reported anecdotally (clip placement, sealing with glue). There are few data available in the literature on endoscopic management (stents essentially) of postoperative colonic fistula. Whatever the approach chosen to treat a postoperative digestive tract fistula, management is medico-surgical and cannot be limited to simple closure of the digestive tube wall defect. Drainage of any collections by endoscopic, radiologic or surgical approach, systemic treatment of infection and nutritional support are essential adjuvant treatment modalities. Treatment of postoperative esophageal or colonic strictures is essentially endoscopic and is based on initial dilatation (endoscopic with hydrostatic balloon or bougie), and placement of extractable metallic stents (partially or entirely covered) in case of refractory outcome.

Management of endoscopic complications, in particular perforation

Management of endoscopic complications is a pertinent aspect of patient care that has received great attention in the past decade due to advancements and increases in complexity of therapeutic endoscopy. Working groups from various institutions such as American Society for Gastrointestinal Endoscopy (ASGE) and European Society of Gastrointestinal Endoscopy have devised detailed guidelines and management algorithms. Three main factors that contribute to endoscopic complications are patient, operator, and type of procedure. No one rule suits all;hence endoscopic complication management must be customized to individual patients. Comprehensive knowledge of patient, machine/device, and its interrelationship must be in place to manage endoscopic complications.

Endoscopic Management of Complications After Gastrointestinal Weight Loss Surgery

As more patients undergo bariatric surgery, gastroenterologists will increasingly encounter variant postsurgical anatomies and postoperative complications. We discuss the diagnosis and management of bleeding, ulcers, foreign bodies, stenoses, leaks, fistulas, pancreaticobiliary diseases, weight regain, and dilated outlets.

Sa1690 Endoscopic Management of Complications After Laparoscopic Sleeve Gastrectomy for Morbid Obesity: Experience From 19 Consecutive Patients

Sa1690 Endoscopic Management of Complications After Laparoscopic Sleeve Gastrectomy for Morbid Obesity: Experience From 19 Consecutive Patients

PTU-020 Endoscopy-related litigation in UK: causes, costs and outcome

<h3>Introduction</h3> When endoscopy-related complications occur, patients may seek legal redress. Although the majority of complaints in the UK are resolved locally by NHS Trusts, since its inception in 1995 approx 4% of cases referred to the NHS litigation authority (NHSLA) required settlement in the court. <h3>Aims</h3> To investigate the annual frequency of endoscopy-related claims, the endoscopic procedures and complications that result, and the outcome of claims handled by NHSLA. To assess how these claims may inform risk management strategies. <h3>Methods</h3> A search of the computerised NHSLA database was undertaken to extract the endoscopy related claims handled between 1995 and 2008. Search keywords used were “endoscopy”, “ERCP”, “colonoscopy”, “gastroscopy” and “PEG”. Details available included year of incident and claim, incident summary, clinical outcome, success/failure of claim, and financial settlement. <h3>Results</h3> 418 endoscopy-related negligence claims submitted to NHSLA during this period, which comprised 17% of total NHSLA claims requiring settlement in court. Of 353 claims that have been settled to date, 175 (49.6%) were successful, resulting in total costs of £6 773 686 and 178 (51.4%) were unsuccessful but still incurred legal costs of £258 656. Claims reached a peak in 2002–2003. Upper GI endoscopy and colonoscopy were associated with 65% of settled claims, but ERCP was the procedure most frequently linked to the 74/353 (21%) of claims related to a fatal outcome. Factors underlying claims following fatal complications included: inappropriate endoscopic treatment/direct complication (51%); delay in recognising complication±its management (39%); consent issues (6%); and medication issues (4%), including incorrect management of anticoagulation. <h3>Conclusion</h3> As &gt;500 000 endoscopies/year are performed in UK, the proportion of endoscopies that result in court proceedings through the NHSLA is tiny but the relative human and financial cost is high. Although the data suggest that claims are falling this may be misrepresentative, as claims can be made several years after the incident and the NHSLA has recently revised policies. Although successful claims resulted from direct endoscopic complications (eg, perforation, haemorrhage), many related to delays in the diagnosis and appropriate management of endoscopic complications, with adverse, and sometimes fatal, consequences. The findings may further inform the need for robust systems within endoscopy units to identify early and in particular late endoscopic complications.

Endoscopic Management of Complications After Bariatric Surgery

Introduction: Bariatric surgery represents a good option for the management of morbid obesity and associated co-morbidities. Therapeutic options include gastroplasty, banding and gastric bypass. Patients may develop post-surgical complications that are amenable to endoscopic management. Patients and Methods: A total of 107 pts were identified. These represented 9.4% of all pts who had undergone bariatric surgery (107/1137). There were 61 women and 46 men. Mean age was 39 years. Ten pts were hospitalized, 97 were ambulatory.

Endoscopic management of complications of continent urinary diversion

The Kock pouch continent ileal reservoir has become a therapeutic option for those patients requiring urinary diversion. Complications of this procedure do occur but fortunately many of these may be managed endoscopically without need for open surgical exploration. This report describes experience with 55 patients treated by endoscopic surgery for complications of Kock pouch urinary diversion. This includes 45 patients with stones, 3 with stenotic afferent nipple valves, 3 with suspicion of ureteral or renal pelvic tumor, and 4 with retained upper urinary tract stents. These patients may be treated with intravenous sedation only on an outpatient basis. The procedure was successful in all but 2 patients. One complication occurred when extravasation was noted from the afferent limb. The patient was treated by internal diversion, and follow-up urogram done in forty-eight hours was normal. This experience confirms that endoscopic surgery is an attractive option for treatment of many of the complications resulting from creation of a Kock pouch ileal reservoir.