Endoscopic Treatment Research Articles

A Newly Reported Late Complication of Endoscopic Fundoplication: A Case Report

Endoscopic methods are emerging as a possible adjunct to surgery in the management of gastroesophageal reflux disease. Initially, endoscopic treatment has failed because of inefficient suturing devices, and although over many years it proved to be safe, it still can result in serious adverse events. In this article, the authors present a rare case of a male patient who experienced severe reflux years following endoscopic fundoplication. Moreover, in this report, we discovered an interesting finding with the patient who was diagnosed and managed laparoscopically. Although considered minimally invasive, endoscopic fundoplication can have significant deleterious consequences, and early recognition of these complications is vital to limit associated morbidities.

22. MINIMALLY INVASIVE TREATMENT OF PILONIDAL SINUS: A SINGLE-CENTER COHORT STUDY ON SHORT-TERM OUTCOMES

Abstract Introduction Pilonidal sinus is a benign condition that causes infections and abscesses in the intergluteal area, but its physiological explanation is still unclear. There are various surgical techniques to treat it, such as excision with marsupialization, primary closure, and endoscopic pilonidal sinus treatment (EPSiT). Methods Forty-six patients between 13 and 23 years of age, who underwent surgery for pilonidal sinus between 01/01/2020 and 31/12/2022, were analyzed. Three techniques were performed: marsupialization, primary closure, and EPSiT by different surgeons in the same hospital complex. A p-value of <0.05 was considered significant. Results Significant differences were observed in terms of gender, with a predominance of males, and in the number of interventions performed. Regarding postoperative results, significant differences were found in bleeding and hematoma formation. Bleeding was greater in the EPSiT group, although hematoma was significantly lower. Furthermore, differences were found in the patient's follow-up time and attendance at healthcare centers for dressing changes. No significant differences were found in other analyzed variables. Conclusion The peak incidence of pilonidal sinus is typically estimated during the second decade of life, with a predominant occurrence in males. The maximum recurrence occurs within the first three years after the intervention. This study suggests that EPSiT offers significant advantages by reducing the risk of hematoma and, therefore, wound infection compared to classical techniques. However, we rely on retrospective data from a new technique, with a learning curve and limited follow-up. Additionally, the sample size is limited. Further research with longer follow-up is needed.

Indications, Techniques and Future Perspectives of Walled-off Necrosis Management.

Necrotizing pancreatitis is a complex clinical condition burdened with significant morbidity and mortality. In recent years, the huge progress of interventional endoscopic ultrasound (EUS) has allowed a shift in the management of pancreatic necrotic collections from surgical/percutaneous approaches to mini-invasive endoscopic internal drainage and debridement procedures. The development of lumen-apposing metal stents (LAMSs), devices specifically dedicated to transmural EUS interventions, further prompted the diffusion of such techniques. Several studies have reported excellent outcomes of endoscopic interventions, in terms of technical success, clinical efficacy and safety compared to surgical interventions, and thus endoscopic drainage of walled-off necrosis (WON) has become a fundamental tool for the management of such conditions. Despite these advancements, some critical unresolved issues remain. Endoscopic therapeutic approaches to WON are still heterogeneous among different centers and experts. A standardized protocol on indication, timing and technique of endoscopic necrosectomy is still lacking, and experts often adopt a strategy based on personal experience more than robust data from well-conducted studies. In this review, we will summarize the available evidence on endoscopic management of WON and will discuss some unanswered questions in this rapidly evolving field.

The accuracy and characteristics of gastric cancer treatment information in the national data of the hospital-based cancer registry

Abstract Objective The hospital-based cancer registry is used extensively for research to support cancer control activities by providing an overview of how cancer treatments are provided nationwide. This study aimed to shed light on the quality and characteristics of treatment data in the hospital-based cancer registry using the linked dataset on gastric cancer. Methods Using the nationally linked data of the hospital-based cancer registry and the health services utilization data, the treatment data in the hospital-based cancer registry for patients who were newly diagnosed with gastric cancer in 2016 and 2017 and received the first course of treatment at their own institutions were examined. The agreement rates between registry data and utilization data were analyzed by stage, treatment, age, period from the date of diagnosis to the date of treatment and hospital type. Results The sensitivity of open surgery, laparoscopic surgery and endoscopic treatment tended to decrease in advanced stages, whereas the sensitivity of chemotherapy and radiation therapy increased. Specificity was high for all treatments and stages, at ˃90%. Sensitivity by age was slightly different for chemotherapy and radiation therapy, but specificities did not differ. For all treatments, the longer the time from diagnosis to treatment implementation, the higher the coverage rate. Conclusions The hospital-based cancer registry recorded the treatment performed appropriately. It is necessary to interpret the data from the hospital-based cancer registry whilst keeping in mind that, chemotherapy and radiation therapy are registered less frequently than surgical treatments administered.

Laparoscopic sigmoid colectomy for diverticulitis – stricture: A case report with review of literature

Diverticulosis is a common condition in the western world. It is often asymptomatic. However, its inflammation and the occurrence of its complications precipitate symptoms. Uncomplicated diverticulitis can be managed conservatively, most of the times. Complicated diverticulitis may need an endoscopic, interventional radiological, or surgical intervention. Herein, we report the case of a 53-year-old patient with complicated sigmoid diverticulitis, i.e., stricture caused by repetitive attacks of acute diverticulitis, who underwent a laparoscopic sigmoid colectomy followed by primary anastomosis.

In‐office serial intralesional steroid injection for subglottic stenosis: Case series of 14 patients with multiple etiologies

AbstractObjectiveSubglottic stenosis (SGS) is commonly treated with endoscopic dilations or tracheal resection. Since office‐based serial intralesional steroid injections (SILSI) were first reported in 2017, they have been established as an effective, less invasive treatment alternative or adjunct. The aim of this study is to add to the literature investigating the efficacy of office‐based SILSIs for idiopathic and post‐intubation SGS patients, specifically studying surgery‐free intervals (SFIs) and discussing our experience with SILSI treatment order and stenosis grade.MethodsThis study is a retrospective case series of 14 patients with subglottic stenosis treated with in‐office serial intralesional steroid injections as a primary or adjuvant treatment from 2018 to 2022 in an academic tertiary care center.ResultsOf seven patients with calculable SFI, a mean SFI increase of 481.28 days was observed following SILSI treatment (p = 0.042). Ten patients in our cohort presented with idiopathic or post‐intubation grade 2 SGS and were managed successfully with a combination of endoscopic dilation and SILSI. Two patients with post‐intubation grade 1 SGS were managed successfully with SILSI as their primary treatment. Two patients with post‐intubation grade 3 SGS required a tracheal resection and did not benefit from SILSI.ConclusionsWe have found that SFI significantly increased following SILSI initiation. Although statistical power was limited given the small sample size, our findings suggest that SILSI may be an effective primary treatment in low‐grade stenosis. SILSI as an adjuvant to endoscopic dilation may be most effective in intermediate‐grade stenosis. SILSI may not be effective in high‐grade stenosis patients who failed prior endoscopic treatment.

Comparative analysis of early versus late feeding after an EGD-based intervention: meta-analysis

Background & AimsThe right time to re-start feeding after esophagogastroduodenoscopic (EGD interventions is not well established. However, impaired nutrition from prolonged fasting may lead to unfavorable clinical outcomes. Herein, we performed a systematic review and meta-analysis to study the impact of early feeding (within 24 hours) vs. late feeding (more than 24 hours) in patients undergoing acute therapeutic EGD interventions. MethodsMultiple databases, including Medline, Scopus, and Embase, were searched (in May 2022) using specific terms for studies evaluating the outcomes of early vs. late feeding after EGD interventions. Outcomes of interest were early rebleed (< 7 days), late rebleed (> 7 days), mortality rates, length of hospital stay, and rate of blood transfusion. Standard meta-analysis methods were employed using the random-effects model. I2% heterogeneity was used to assess the heterogeneity. The GRADE working group approach was used to assess the certainty of evidence. ResultsEight studies (813 patients) were included in the final analysis. The ‘Early feeding’ cohort included 411 patients, 31% females, with a mean age of 58 years, and the ‘late feeding’ cohort included 402 patients, 26.4% females, with a mean age of 57 years. Four studies (283 patients) evaluated patients with band ligation/sclerotherapy in acute variceal bleeding (224 patients), two studies (309 patients) with endoscopic treatment of peptic ulcer bleeding, and two studies in endoscopic mucosal dissection for gastric mucosal epithelial neoplasia. The pooled risk ratio (RR) of early rebleed in ‘early feeding’ vs. ‘late feeding’ was 1.6 (95% confidence interval (CI) [0.7-3.7; I2=0%, p=0.2]. Similarly, the RR of late rebleed was 0.9 [0.4-2.3; I2=0%, p= 0.9]. The pooled RR of total rebleed was 1.2 [0.7-2.2; I2=0%, p=0.3]. The pooled RR of mortality between the ‘early feeding’ and ‘late feeding’ groups was 0.6 [0.3-1.2; I2=0%, p=0.16]. The Pooled rate of standard difference of mean length of hospital stay was -1.184 (-1.5 - -0.81, I2 = 92%, p=0.00) between early and late feeding groups. The Pooled rate of mean difference in blood transfusion between early and late feeding groups was 0.1 [-0.4 - 0.41; I2= 77.6%, p=0.96]. ConclusionOur meta-analysis demonstrates early enteral feeding within 24 hours does not appear to have a higher risk of rebleeding and mortality than delayed enteral feeding in patients undergoing EGD therapeutic interventions. However, early feeding is associated with a shorter length of hospital stay compared to late feeding.

Being a Female Gastroenterologist in Turkey.

Our aim is to examine the representation of woman gastroenterologists in both work and social life in Turkey and to elucidate the difficulties they encounter during their career pathways or while actively practicing their profession. A self-structured survey consisting of 25 questions was sent via email to all 152 female gastroenterologists. Survey results were received from 140 participants. Sixty percent of the woman gastroenterologists had marriage-career conflicts, and 74% of them stated that they could not manage work-life balance with their children. Among these woman gastroenterologists, 46.6% of them reported that they had faced carrier-related barriers and challenges while applying for an academic rise or expecting a promotion in their job, 58.5% were exposed to gender mobbing, and 35.6% were subjected to verbal or physical violence. On the other hand, woman gastroenterologists are found to be underrepresented in endoscopic interventions where only one-third of the participants perform invasive endoscopic procedures, and the percentage of those who perform advanced endoscopy such as endoscopic submucosal dissection and endoscopic mucosal resection remains even less as 8.9%. The number of women in leadership positions during their careers is found to be low, and only 2 women were selected as the president of the society since 1959, the establishment time of the Turkish Society of Gastroenterology. More effort is needed to keep a fair gender balance in Turkish gastroenterology society and to increase the women's representation in therapeutic endoscopy options and also in leadership positions.

Can Endothelin-1 Levels in Patients with Esophageal Variceal Bleeding at Admission Predict Rebleeding Within 5 Days?

Portal hypertension complicating liver cirrhosis is associated with vascular resistance, possibly due to overexpression of humoral vasoconstrictors, including endothelin. The study aimed to evaluate the efficacy of serum endothelin-1 levels as a noninvasive predictor of early esophageal rebleeding (within 5 days) following endoscopic treatment. Of the patients presented to the endoscopy unit at Mansoura University Hospital, 50 patients were chosen for this study on the basis of endoscopically proven acute esophageal variceal bleeding consequent to hepatitis C viral infection complicated by liver cirrhosis and portal hypertension. Routine laboratory parameters and serum endothelin-1 levels were assessed prior to endoscopic treatment. Patients were divided into 2 groups depending on the development of early postendoscopic rebleeding. Group A consisted of 16 patients who developed rebleeding, while group B included 34 patients who did not. Statistical analysis was performed to determine the predictors of rebleeding. Multivariate logistic regression demonstrated that endothelin-1 level (P < .001) and serum albumin level (P = .04) were independent risk factors for early rebleeding. The most efficient cutoff value for endothelin-1 levels in predicting variceal rebleeding within the 5 days after endoscopic intervention was 65.29, which had an 88.2% specificity, 87.5% sensitivity, 88% accuracy, and area under the curve value of 0.89. In addition, hemoglobin, albumin, and creatinine levels were significantly different between bleeding and nonrebleeding groups (P = .03, P = .014, and P <.001, respectively), as was the duration of hospital stay (P < .001). Serum endothelin-1 levels appear to be a reliable, practical, noninvasive predictor of early variceal rebleeding and related comorbidities such as the severity of kidney affection and duration of hospital stay.

Conservative management of an early abdominal complication during a Tullio percutaneous endoscopic excision of renal pelvis urothelial carcinoma: A case report

BACKGROUND Upper tract urothelial carcinoma (UTUC) representing only a small fraction of all urothelial tumors. It predominantly affects the renal pelvis in men, often coexisting with bladder carcinoma. UTUC displays a more aggressive genetic profile compared to bladder neoplasms, with the majority of patients presenting with advanced disease. Histologically, about a quarter of UTUC cases exhibit high-grade subtypes, associated with a worse prognosis. Tobacco use and past exposure to aromatic amines are significant risk factors for UTUC. Imaging modalities such as Uro-computed tomography and magnetic resonance imaging play crucial roles in diagnosis. Ureterorenoscopy is vital for direct visualization and biopsy sampling, but its limited sampling capacity presents challenges in determining tumor depth and staging. Traditionally, nephroureterectomy with bladder cuff excision has been the gold-standard treatment for UTUC. Endoscopic conservative treatment has recently emerged as a viable option for selected patients, offering comparable oncological outcomes to radical surgery. Percutaneous access is also feasible for larger intrarenal tumors. CASE SUMMARY We present a case of an 84-year-old woman who underwent percutaneous endoscopic excision of a renal pelvis neoplasm using the Tullio laser. Despite successful tumor removal, the patient experienced a postoperative complication with abdominal fluid leakage. Conservative management effectively resolved the complication. Given the patient's age and refusal for radical surgery, the conservative approach proved to be a valid therapeutic choice. CONCLUSION Overall, UTUC remains a diagnostic and therapeutic challenge due to its rarity. However, advances in endoscopic and percutaneous techniques provide valuable alternatives for selected patients, warranting further exploration in this evolving field.

Insulated tip/needle-knife endoscopic stricturotomy is safe and effective for treatment of non-traversable anorectal strictures.

Background and study aims The treatment of anorectal strictures is particularly challenging and historically focused on surgical resection and/or diversion. There are a number of endoscopic options, but repeat interventions are common. The use of the needle knife stricturotomy technique as an alternative to surgery in the treatment of a variety of strictures has been described, but its use for the treatment of severe anorectal and anopouch strictures has not been studied. Patients and methods Our Inflammatory Bowel Disease department's records were queried to identify patients with endoscopic non-traversable anorectal/anopouch strictures. Consecutive patients that underwent insulated tip/needle-knife endoscopic stricturotomy treatment were included. Primary outcome was immediate traversability of the treated stricture by the endoscope. Other outcomes included need for reintervention, 30-day post-procedure events, and follow-up period events. Results All strictures were immediately successfully traversed following endoscopic stricturotomy treatment. The mean time to endoscopic reintervention was 5.3 months, with the majority of these patients undergoing repeat stricturotomy. Over a mean follow-up period of 12.8 months, two patients (8%) required surgical intervention (resection with coloanal anastomosis with a colostomy and complete proctectomy) for refractory stricture disease following initial endoscopic stricturotomy. Seven patients (29%) in our study have not required any further reintervention throughout the study period. There were no 30-day post-procedure adverse events and no adverse post-procedure events. Conclusions Endoscopic stricturotomy is safe and effective in treating severe anorectal/anopouch strictures.

The tortuous course of the anterior ethmoidal artery in the orbit: A cadaveric study

AimThe study aimed to define the coursing pattern of the anterior ethmoidal artery (AEA) in the orbit to minimize complications during endoscopic interventions. Materials and methodsA total of ten formalin-fixed cadaveric halves were included in the study. Orbital regions were shown with a superior approach. The superior rectus and superior oblique muscles, as well as the connective tissue and vessels were removed to observe the path of the anterior ethmoidal artery. Measurements such as the width of the artery, the anterior-posterior length of the U formation, the length of the intraorbital part of the ophthalmic artery, and the distance of the AEA from its opthalmic origin to the anterior ethmoidal foramen were made. ResultsTen of the AEAs originated from the ophthalmic artery. The AEA branches originated from the ophthalmic artery approximately 18.4 mm after the orbital artery entered the orbital, and the mean width of the AEAs was 0.82 mm. In seven of the total anterior ethmoidal arteries, they coursed in the intraethmoidal cavities below the cranial base. The mean distance from the origin of AEAs to the medial wall of the orbit was 4.9 mm. After leaving the ophthalmic artery, seven of the AEAs were coursing forward and turned back ('U' turn formation), which have proximately 1.5 mm in anteroposterior direction. ConclusionThe anterior ethmoidal artery is 0.8 mm wide, originates from the distal part of the ophthalmic artery, entering the orbit after a 1.5 mm U-turn.

Protocolo de evaluación de las lesiones premalignas gástricas

Gastric carcinogenesis is associated with Helicobacter pylori(H. pylori) infection and occurs through histologic gastric cancer precursor lesions (GCPL). This protocol will discuss intestinal gastric cancer. It does not cover prevention of diffuse and cardia gastric cancer, neuroendocrine tumors, or hereditary syndromes. The most significant factors that cause an increased risk of gastric cancer are family history of the disease and the presence of GCPL. The two strategies evaluated to reduce the incidence and/or mortality of gastric cancer are eradication of H. pylori and monitoring and/or endoscopic treatments.

Efficacy and safety of piecemeal submucosal tunneling endoscopic resection for giant esophageal leiomyoma

Background and AimsGiant esophageal leiomyoma usually requires a thoracotomy or thoracoscopic surgery, which is more invasive than an endoscopic treatment. The purpose of this study is to evaluate the efficacy and safety of piecemeal submucosal tunneling endoscopic resection (P-STER) for giant leiomyoma originating from the muscularis propria (MP) layer of the esophagus. MethodsThis is a retrospective study. Patients with giant esophageal leiomyoma (transverse diameter ≥ 3 cm) who underwent P-STER were enrolled from November 2012 to May 2023. Clinical data and results were investigated. ResultsA total of 16 patients were enrolled for analysis. The lesion mean transverse diameter and longitudinal diameter were 4.22 ± 1.20 cm and 6.20 ± 1.57 cm, respectively. Our mean operation time was 195.38 ± 84.99 min. The mean number of piecemeal resected was 4.31 ± 2.36. An adverse event noted was an esophageal fistula that occurred in one case (6.25%) and was treated conservatively. The mean length of hospital stay was around 11.81 ± 7.30 days. The mean total hospitalization cost was U.S. dollars (USD) $5976.50 ± 2866.39. No recurrence or metastasis was found during the follow-up period. ConclusionsP-STER can be an effective and safe treatment for giant leiomyoma originating from the MP layer of the esophagus.

Role of the artificial intelligence in the management of T1 colorectal cancer

Approximately 10% of submucosal invasive (T1) colorectal cancers demonstrate extraintestinal lymph node metastasis, necessitating surgical intervention with lymph node dissection. The ability to identify T1b (submucosal invasion depth ≥ 1000 µm) as a risk factor for lymph node metastasis via pre-treatment endoscopy is crucial in guiding treatment strategies. Accurately distinguishing T1b from T1a (submucosal invasion depth < 1000 µm) or dysplasia remains a significant challenge for artificial intelligence (AI) systems, which require high and consistent diagnostic capabilities. Moreover, as endoscopic therapies like endoscopic full-thickness resection and endoscopic intermuscular dissection evolve, and the focus on reducing unnecessary surgeries intensifies, the initial management of T1 colorectal cancers via endoscopic treatment is anticipated to increase. Consequently, the development of highly accurate and reliable AI systems is essential, not only for pre-treatment depth assessment but also for post-treatment risk stratification of lymph node metastasis. While such AI diagnostic systems are still under development, significant advancements are expected in the near future to improve decision-making in T1 colorectal cancer management.

Development and validation of machine learning models to predict the need for haemostatic therapy in acute upper gastrointestinal bleeding.

Acute upper gastrointestinal bleeding (AUGIB) is a major cause of morbidity and mortality. This presentation however is not universally high risk as only 20-30% of bleeds require urgent haemostatic therapy. Nevertheless, the current standard of care is for all patients admitted to an inpatient bed to undergo endoscopy within 24 h for risk stratification which is invasive, costly and difficult to achieve in routine clinical practice. To develop novel non-endoscopic machine learning models for AUGIB to predict the need for haemostatic therapy by endoscopic, radiological or surgical intervention. A retrospective cohort study. We analysed data from patients admitted with AUGIB to hospitals from 2015 to 2020 (n = 970). Machine learning models were internally validated to predict the need for haemostatic therapy. The performance of the models was compared to the Glasgow-Blatchford score (GBS) using the area under receiver operating characteristic (AUROC) curves. The random forest classifier [AUROC 0.84 (0.80-0.87)] had the best performance and was superior to the GBS [AUROC 0.75 (0.72-0.78), p < 0.001] in predicting the need for haemostatic therapy in patients with AUGIB. A GBS cut-off of ⩾12 was associated with an accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 0.74, 0.49, 0.81, 0.41 and 0.85, respectively. The Random Forrest model performed better with an accuracy, sensitivity, specificity, PPV and NPV of 0.82, 0.54, 0.90, 0.60 and 0.88, respectively. We developed and validated a machine learning algorithm with high accuracy and specificity in predicting the need for haemostatic therapy in AUGIB. This could be used to risk stratify high-risk patients to urgent endoscopy.

Minimally Invasive Pilonidal Sinus Treatment: EPSIT Versus PEBAI Method.

We aimed to compare endoscopic pilonidal sinus treatment (EPSIT) and pit/sinus punch needle excision, brushing, ablation and irrigation (PEBAI) method that was performed with principles similar to EPSIT but without fistuloscope and vision in the treatment of pilonidal sinus disease (PSD). Patients who underwent EPSIT and PEBAI methods for PSD in a single center between January 2020 and October 2021 were retrospectively analyzed. The primary endpoint was healing, the secondary endpoints were operative time, pain, wound closure, quality of life, cosmetic results, and cost. One hundred 4 patients who underwent EPSIT and 184 patients who underwent PEBAI were included in the study. Age ( P =0.871), sex ( P =0.669), BMI ( P =0.176), number of pits ( P =0.99) were similar in both groups. The operative time for PEBAI [20min (18 to 32)] was shorter than EPSIT [32min (24 to 44)] ( P <0.0000, u value=3096, z-score=-9.459). Postoperative first ( P =0.147) and 14th day( P =0.382) pain scores, postoperative analgesic requirements ( P =0.609), time to return to daily activities ( P =0.747), time to return to work ( P =0.345), and wound complications ( P =0.816) were similar, whereas the wound closure time was earlier after EPSIT [32d (24 to 41)] than after PEBAI [37d (26 to 58)] ( P <0.00001, u value=5344, z-score=6.22141). The median follow-up was 24 (12 to 34) months. Complete wound healing ( P =0.382), recurrence rate ( P =0.533), quality of life at first month and (Wound evaluation scale score at first year ( P =0.252) were similar in both groups. However, the cost of PEBAI [54.8 € (50.13 to 64.96)] was significantly lower than cost of EPSIT [147.36 € (132.53 to 169.60)] ( P <0.00001, u value=0, z-score=7.210). PEBAI method is a cheaper alternative to EPSIT with similar surgical principles and clinical outcomes.

Risk of recurrence with or without plastic stent after EUS-guided treatment of peripancreatic fluid collections: A systematic review and meta-analysis.

Background and study aims Recent advances in endoscopic transmural treatment have improved the clinical outcomes of patients with pancreatic fluid collections (PFCs). However, there is still a debate about the preventive effect of long-term placement of a transmural plastic stent (PS) on recurrence after successful endoscopic ultrasound (EUS)-guided treatment of PFCs. We conducted a systematic review and meta-analysis to evaluate PFC recurrence rates with and without a transmural PS after EUS-guided treatment. Patients and methods A systematic literature search of PubMed, Embase, and the Cochrane database was conducted to identify clinical studies comparing outcomes with and without transmural PS published until September 2022. Data on PFC recurrence and adverse events (AEs) were pooled using a random-effects model. Results Nine studies including 380 patients with long-term transmural PS and 289 patients without PS were identified. The rate of PFC recurrence was significantly lower in patients with transmural PS (pooled odds ratio [OR] = 0.23, 95% confidence interval [CI] [0.08-0.65], P = 0.005). In a subgroup analysis limited to studies focusing on patients with disconnected pancreatic duct syndrome, which has been reported to be a risk factor for PFC recurrence, the OR was numerically lower than that for the entire cohort (OR = 0.14, 95% CI [0.04-0.46]). The rate of AEs was significantly higher with long-term transmural PS (OR = 14.77, 95% CI [4.21-51.83]). Conclusions In this meta-analysis, long-term PS placement reduced the risk of PFC recurrence. Given the potential AEs of indwelling PS, further research is required to evaluate the overall benefits of long-term PS placement.

Usefulness of the hybrid technique of interventional radiology and endoscopic treatment for intestinal bleeding after pancreaticoduodenectomy: a case report

Introduction and importance: In endovascular treatment of ruptured pseudoaneurysm after pancreaticoduodenectomy (PD) with gastrointestinal bleeding, treatment for vasospasm of the culprit vessel from haemorrhagic shock and subsequent reperfusion has not been determined before. Case presentation: The authors hereby present you with a case of a 59-year-old man with unknown operative method upon arrival at the Emergecy room and who had hematemesis and collapse 6 months post-PD surgery. Clinical discussion: An initial contrast-enhanced computed tomography (CT) revealed no obvious source of bleeding, so an upper gastrointestinal endoscope was performed. Rebleeding occurred during the examination, and interventional radiology was performed because haemostasis was difficult. Coil embolization was performed for leakage of contrast material from the gastroduodenal artery stump into the gastrointestinal tract. However, because the embolization was uncertain due to vasospasm of the common hepatic artery, endoscopic clipping of the perforation site was also performed to prevent rebleeding due to reperfusion after improvement of vasospasm. A CT scan 5 days later showed reperfusion of the coil-implanted vessel. No rebleeding or hepatic infarction occurred postoperatively. Conclusion: In this case, the haemostasis by coil embolization was uncertain due to the presence of vasospasm, and clipping was used in combination with the procedure to prevent rebleeding.

Evaluation of the risk of lymph node metastases in superficial T1 rectal cancer: the current role of endoscopic treatment and future perspective

Evaluation of the risk of lymph node metastases in superficial T1 rectal cancer: the current role of endoscopic treatment and future perspective