Long-term Results Of Endoscopic Treatment Research Articles

Gastrointestinal bleeding in patients with hereditary hemorrhagic telangiectasia: Long-term results of endoscopic treatment.

Background and study aims This longitudinal prospective study evaluated the long-term outcome of endoscopic treatment of gastrointestinal bleeding in hereditary hemorrhagic telangiectases (HHT), its safety and outcome predictors. Patients and methods Consecutive patients with HHT and either anemia disproportionate to epistaxis or overt gastrointestinal bleeding received endoscopic treatment of gastrointestinal telangiectases with argon plasma coagulation (APC). Hemoglobin levels and transfusion requirements were evaluated before and after treatment. Treatment effectiveness was classified as: 1) complete: hemoglobin level during the follow-up ≥9 g/dL; 2) complete with recurrence: hemoglobin ≥9 g/dL for at least 12 months with subsequent drop to <9 g/dL; or 3) absent: no improvement of hemoglobin level. Adverse events (AEs) were classified as mild, moderate, severe or fatal. Correlations were searched between treatment outcome and demographic/genetic characteristics, number, size and site of telangiectases, and hepatic arterio-venous malformations grade. Results Forty-seven patients with HHT were enrolled. At median follow-up of 134 months (range 20-243 months), 41 of 47 patients showed treatment response (complete or with recurrence) after one (14/47) or more (27/47) endoscopic treatments. Median hemoglobin levels were 7.0 g/dL and 11.9 g/dL at baseline and at the end of follow-up, respectively. Transfusion requirement decreased from 22.8 to 7.3 red cell unit/year. A higher baseline number of telangiectases was associated with a lower chance of response ( P =0.008). Only one severe AE (0.4%, jejunal perforation) was recorded. Conclusions Endoscopic treatment of gastrointestinal teleangiectases for gastrointestinal bleeding in patients with HHT is effective in the long term and safe.

ENDOSCOPIC REMOVAL OF A RARE LARGE OCCLUSIVE TRACHEAL TUMOR WITH LIMITED TECHNICAL CAPABILITIES

Relevance: Tracheal tumors often do not cause symptoms until they grow to a size that causes significant airway obstruction, which is the reason for the delay in diagnosis. Diagnosis may also be delayed due to non-specific symptoms, such as cough, wheezing, and shortness of breath, which can occur in other conditions such as asthma and chronic obstructive pulmonary disease. The symptoms that appear may vary depending on the type and location of the tumor. The literature does not sufficiently cover the experience of treating large occlusive tracheal tumors using segmental tracheal resection, endoscopic treatment, or radiation therapy. In scientific literature, the number of published studies with long-term results of endoscopic treatment or radiation therapy of such occlusive tracheal tumors is limited, and this problem requires further study. This article describes the first recorded case of endoscopic removal of a large occlusive tracheal tumor.&#x0D; The study aimed to show the possibility and effectiveness of endoscopic treatment using a minimum set of endoscopic equipment.&#x0D; Methods: This article presents a case of successful minimally invasive endoscopic treatment of a large occlusive tracheal tumor.&#x0D; Results: A large obstructing tumor of the trachea that almost completely blocked the trachea lumen was removed in one block by endoscopic loop resection.&#x0D; Conclusion: The presented clinical case describes the experience of successful endoscopic removal of a rare occlusive tumor of the trachea, which caused shortness of breath at rest and during exercise. For the first time in Kazakhstan, based on the National Scientific Cancer Center, we performed a unique minimally invasive operation to remove a tracheal tumor, while other clinics offered thoracotomic surgical resection methods.

ENDOSCOPIC REMOVAL OF A RARE LARGE OCCLUSIVE TRACHEAL TUMOR WITH LIMITED TECHNICAL CAPABILITIES

Relevance: Tracheal tumors often do not cause symptoms until they grow to a size that causes significant airway obstruction, which is&#x0D; the reason for the delay in diagnosis. Diagnosis may also be delayed due to non-specific symptoms, such as cough, wheezing, and shortness&#x0D; of breath, which can occur in other conditions such as asthma and chronic obstructive pulmonary disease. The symptoms that appear may&#x0D; vary depending on the type and location of the tumor. The literature does not sufficiently cover the experience of treating large occlusive&#x0D; tracheal tumors using segmental tracheal resection, endoscopic treatment, or radiation therapy. In scientific literature, the number of&#x0D; published studies with long-term results of endoscopic treatment or radiation therapy of such occlusive tracheal tumors is limited, and this&#x0D; problem requires further study. This article describes the first recorded case of endoscopic removal of a large occlusive tracheal tumor.&#x0D; The study aimed to show the possibility and effectiveness of endoscopic treatment using a minimum set of endoscopic equipment.&#x0D; Methods: This article presents a case of successful minimally invasive endoscopic treatment of a large occlusive tracheal tumor.&#x0D; Results: A large obstructing tumor of the trachea that almost completely blocked the trachea lumen was removed in one block by&#x0D; endoscopic loop resection.&#x0D; Conclusion: The presented clinical case describes the experience of successful endoscopic removal of a rare occlusive tumor of the&#x0D; trachea, which caused shortness of breath at rest and during exercise. For the first time in Kazakhstan, based on the National Scientific&#x0D; Cancer Center, we performed a unique minimally invasive operation to remove a tracheal tumor, while other clinics offered thoracotomic&#x0D; surgical resection methods

Long-term results of endoscopic treatment in vesicoureteral reflux after kidney transplantation.

To assess the long-term clinical outcomes and identify factors predicting success of endoscopic treatment for symptomatic vesicoureteral reflux (VUR) after kidney transplantation. A retrospective chart review of all patients who had a symptomatic VUR after renal transplantation at our centre between January 2000 and December 2020 was performed. VUR was documented by retrograde cystography and was determined by at least one episode of acute graft pyelonephritis (AGPN). Endoscopic injections of polydimethylsiloxane (MacroPlastique™) or dextranomer/hyaluronic acid copolymer (Deflux™) were performed by expert urologists via rigid cystoscopy with a bevelled needle system. The results of endoscopic treatment were evaluated by cystography at three months. The primary endpoint was clinical efficacy as defined by the absence of AGPN during follow-up. Radiological success was defined by the absence of VUR at the three months follow-up cystography. Out of 2135 kidney transplantations, a total of 117 (5.5%) patients had symptomatic VUR: 100 (85.5%) underwent Deflux™ and 17 (14.5%) MacroPlastique™. Preoperative high-grade VUR was recorded in 71% of patients. One postoperative complication was observed, Clavien > II. After a median follow-up of 11.2years (IQR 6.5-14.4), clinical success was achieved in 73 patients (62.4%). Radiological success was obtained in 42 patients (36%). Multivariable analysis failed to identify predictors of endoscopic treatment success, which was independent of the preoperative grade of VUR and the type of bulking agent used. Endoscopic treatment of VUR is a simple and well-tolerated procedure with long-term clinical efficacy.

Endoscopic management of non-anastomotic biliary strictures following liver transplantation: Long-term results from a single-center experience.

Studies on endoscopic treatment of non-anastomotic biliary strictures (NABS) following orthotopic liver transplantation (OLT) are scanty and with a short follow-up. The long-term results of endoscopic treatment with plastic stents of NABS following OLT were analyzed. Retrospective analysis of consecutive enrolled patients who underwent endoscopic treatment for NABS after OLT between 1997 and 2015. Endoscopic treatment success was defined as stricture resolution, without recurrence. During the study period, 33 patients with NABS underwent endoscopic retrograde cholangiopancreatography (ERCP) in our center. A total of 68 ERCP were performed with a 4.4% of procedure-related adverse events. Mortality related to cholangitis secondary to endoscopic procedures was 12%. After median follow-up of 70.3months from stents removal, NABS resolution was obtained in 12 out of 24 (50%) patients. Only one case of late NABS recurrence was observed which was successfully retreated endoscopically. According to our data analysis NABS occurring <12months from OLT showed a worse prognosis (P<0.04). The follow-up of this study confirms that endoscopic treatment of NABS is unsatisfactory. However, patients who respond to endoscopic treatment maintain the response over time. Prompt treatment of acute cholangitis due to stents occlusion is advised in these patients to avoid high mortality rates.

Long-term outcomes of endoscopic treatment of aberrant hepatic duct injuries after cholecystectomy

Right aberrant hepatic ducts are an anatomic variant with clinical relevance because of the risk of injury during cholecystectomy. Treatment options for aberrant hepatic duct injuries are not standardized. This study aims to analyze the long-term results of endoscopic treatment of aberrant hepatic duct lesions. Patients who underwent ERCP for aberrant hepatic duct lesions were retrospectively identified. Demographic data, type of aberrant duct lesion according to the Strasberg classification, type of treatment (number of plastic stents inserted, treatment duration, and number of ERCPs), and adverse events were recorded. Follow-up was obtained by telephone contact or medical examinations. Between January 1996 and March 2019, 32 patients (78% women, mean age 51.7 years) with aberrant hepatic duct injuries underwent ERCP at our Endoscopy Unit. Six patients had Strasberg type B lesions, 11 patients had type C, and 8 patients had type E5, and 7 patients had a stenosis of the aberrant duct. A mean of 3.7 biliary plastic stents per patient were used; mean treatment duration was 6.3 months. All patients with isolated aberrant duct stenosis and 1 of 6 patients (17%) with type B Strasberg lesions achieved patency. Ten of 11 patients (91%) with type C Strasberg lesions achieved duct recanalization. After a mean follow-up of 109.3 ± 61.2 months, 29 of 32 patients (91%) were asymptomatic; 1 underwent surgery for recurrent cholangitis, 1 received a new endoscopic procedure because of cholangitis, and 1 reported episodic biliary colic without an increase in liver function test values and was successfully managed with a low-fat diet. An endoscopic approach to aberrant hepatic duct lesions after cholecystectomy can be considered an effective first-line therapy.

Endoscopic treatment of vesico-ureteric reflux in children of early age

The purpose of the study was to study the long-term results of endoscopic treatment of infants and young children with vesicoureteral reflux (VUR). Materials and methods . The analysis of the long-term results of endoscopic correction of reflux in infants and young children operated in the hospital from January 2015 to December 2018. Of these, up to 3 years there were 115 patients (67%), up to a year – 56 children (33%). The duration of follow-up was from 2 to 4 years. Polyacrylamide gel DAM+was used as an implant in 70% of cases (191 ureters). Endoscopic treatment with DAM+ was performed in 77 (70%) children from one to 3 years, as well as 23 patients (41%) of infancy. In other cases, used collagen, uradex. Introduction was carried out by methods of STING, HIT 1 and HIT 2. Results and discussion . Evaluation of the effectiveness of the use of drugs: collagen, DAM+, urodex. The type, degree of reflux, kidney function, presence of concomitant pathology were taken into account in the analysis of the correction results, and the effectiveness was evaluated by changing the degree of reflux and the course of the inflammatory process after 6 months – year after endoscopic correction. The disappearance of reflux after a single application of DAM+ took place in 86% of cases. Re-introduction of the implant was performed in 55 children, 3-fold – 20 at 3–4th degree of reflux. Neoimplantation of the ureter was performed in 9 patients with 4–5th degree of reflux, concomitant pathology of the upper urinary tract and signs of reflux nephropathy. Conclusion. The analysis of long-term results showed that the use of endoscopic techniques of reflux correction with the use of the domestic drug DAM+, including in infants, allows to completely cure reflux or reduce its degree to 1–2, providing optimal conditions for the maturation of the uretero-vesical segment.

Tu1215 - How Aggressive ‘High-Risk’ Early Esophageal Cancer (EEC) Really is? Long-Term Results of Endoscopic Treatment of Patients with ‘High-Risk’ EEC and Detailed Analysis of Lymph Nodes Status of Surgically Treated Patients

Tu1215 - How Aggressive ‘High-Risk’ Early Esophageal Cancer (EEC) Really is? Long-Term Results of Endoscopic Treatment of Patients with ‘High-Risk’ EEC and Detailed Analysis of Lymph Nodes Status of Surgically Treated Patients

Immediate and long-term results of endoscopic treatment of cicatrical tracheal stenosis

Immediate and long-term results of endoscopic treatment of cicatrical tracheal stenosis

Endoscopic treatment of patients with bile duct stricture after cholecystectomy: factors predicting recurrence in the long term.

Endoscopic treatment is effective in the treatment of patients with bile duct injury after cholecystectomy. We aimed to investigate the long-term results of endoscopic treatment, factors predicting the recurrence of the stricture, and to determine the optimal endoscopic treatment. The study was a retrospective cohort analysis and conducted at a tertiary referral center in patients with major bile duct injury (Strasberg E1-4 and E5 patients with main bile duct injury). Patients with minor injury (Luschka and cystic duct leakage), complete transection, and isolated aberrant bile duct injuries were excluded. The study group included 156 patients. The median follow-up period after stent removal was 6.5 years (range 1-16.5). Recurrence was seen in 18 patients (11 %) after a median duration of 9 months (range 2-96). Multivariate regression analysis revealed that the most important factors predicting the success of endoscopic treatment were: Rome type of treatment (inserting increasing number of stents every 3-4 months) (odds ratio 23.8, 95 % CI 1.46-390.7, p = 0.026) instead of Amsterdam-type treatment (replacing two 10F biliary stents every 3-4 months) and dilation of the stricture diameter to at least 76 % of the common bile duct diameter at the end of stent treatment (odds ratio 25.9, 95 % CI 2.46-272.7, p = 0.007). Endoscopic treatment is an effective method in the treatment of patients with bile duct stricture after cholecystectomy. Inserting multiple stents as much as possible without leaving a scar in the bile ducts should be aimed.

Exam 2: Efficacy, Safety, and Long-term Results of Endoscopic Treatment for Early Stage Adenocarcinoma of the Esophagus With Low-risk sm1 Invasion

Exam 2: Efficacy, Safety, and Long-term Results of Endoscopic Treatment for Early Stage Adenocarcinoma of the Esophagus With Low-risk sm1 Invasion

Efficacy, Safety, and Long-term Results of Endoscopic Treatment for Early Stage Adenocarcinoma of the Esophagus With Low-risk sm1 Invasion

Patients with early-stage mucosal (T1a) esophageal adenocarcinoma (EAC) are increasingly treated by endoscopic resection. EACs limited to the upper third of the submucosa (pT1b sm1) could also be treated by endoscopy. We assessed the efficacy, safety, and long-term effects of endoscopic therapy for these patients. We analyzed data from 66 patients with sm1 low-risk lesions (macroscopically polypoid or flat, with a histologic pattern of sm1 invasion, good-to-moderate differentiation [G1/2], and no invasion into lymph vessels or veins) treated by endoscopic therapy at the HSK Hospital Wiesbaden from 1996 through 2010. The efficacy of endoscopic therapy was assessed on the basis of rates of complete endoluminal remission (CER), metachronous neoplasia, lymph node events, and long-term remission (LTR). Safety was assessed on the basis of rate of complications. Remissions were assessed in 61 of the 66 patients; 53 of the 61 achieved CER (87%). Of patients with small focal neoplasias ≤2 cm, 97% achieved CER (for those with tumors ≥2 cm, 77%; P = .026). Metachronous neoplasias were observed in 10 of 53 patients (19%; 9 of the 10 underwent repeat endoscopic resection). One patient developed a lymph node metastasis (1.9%). Fifty-one patients achieved LTR (84%); 90% of those with focal lesions ≤2 cm achieved LTR after a mean follow-up period of 47 ± 29.1 months (range, 8-120 months). No tumor-associated deaths were observed, and the estimated 5-year survival rate was 84%. The rate of major complications from endoscopic resection was 1.5%, and no patients died. Endoscopic therapy appears to be a good alternative to esophagectomy for patients with pT1b sm1 EAC, on the basis of macroscopic and histologic analyses. The risk of developing lymph node metastases after endoscopic resection for sm1 EAC is lower than the risk of surgery.

Commentary to ‘Long-term results of endoscopic treatment of vesicoureteral reflux in children with different materials’

Commentary to ‘Long-term results of endoscopic treatment of vesicoureteral reflux in children with different materials’

Long-term results of endoscopic treatment of vesicoureteral reflux in children: Comparison of different bulking agents

ObjectiveTo determine the long-term effect in children of endoscopic treatment of vesicoureteral reflux (VUR) using different bulking agents. VUR status, recurrence of urinary tract infection (UTI), and recurrence of febrile UTI were evaluated as endpoints. MethodsFrom 1993 to 2005, we injected 229 refluxive ureters (VUR grade II–IV) in 135 children. Mean age of the children was 55.7 months. We used collagen in 98 (years 1993–2000), polydimethylsiloxane in 32 (years 1999–2000), and dextranomer/hyaluronic acid copolymer (Dx/HA) in 99 ureters (years 2000–2005). Of the 135 children, 127 underwent a voiding cystourethrogram (VCUG) (radiologic or nuclid) 3 months after the first injection, and 88 children a second VCUG (nuclid) after 37 months (mean) postoperatively. Clinically, patients were monitored for non-febrile or febrile UTI. Data were collected and analyzed retrospectively by chart review. ResultsAfter first injection with collagen, polydimethysiloxane and Dx/HA, 52%, 55% and 81.5% of the children were without VUR, respectively. Repeated injections were successful in only 21% (collagen) to 42% (Dx/HA). Of the 88 with a second VCUG, 48.5% of the initially reflux-free children developed relapse VUR after collagen, 45.5% after polydimethylsiloxane and 21.5% after Dx/HA injection. Clinically, there was a significant difference in postoperative UTI occurrence in favor of the Dx/HA group. ConclusionsClinically and radiologically, Dx/HA exhibited the best results, giving better protection against UTIs and a better VUR cure rate. There was still a risk of VUR recurrence in successfully treated children after 3 years of follow up.

Long-term results of endoscopic treatment of vesicoureteric reflux with different tissue-augmenting substances

To review the current literature regarding the outcome of endoscopic treatment of vesicoureteric reflux (VUR) using different tissue-augmenting substances, with special emphasis on long-term efficacy. The current literature, including our own experience, on long-term results after endoscopic treatment was reviewed by MEDLINE/PubMed search. The short-term results are similar in the majority of series to those of open surgery, but there is a high recurrence rate with use of dextranomer/hyaluronic acid (Deflux) as a tissue-augmenting material. There is a significant shortage of evidence-based literature on long-term follow-up after endoscopic correction of VUR utilizing dextranomer/hyaluronic acid. The high recurrence rate that has been reported after Deflux injection highlights a need for close observation beyond routine protocols and appropriate parental counseling upon endoscopic correction, and also the need to search further for alternative tissue-augmenting substances. The algorithm for treating VUR is yet to be finally determined.

Long-term results of endoscopic balloon dilatation of lower gastrointestinal tract strictures in Crohn’s disease: A prospective study

To examine the long-term results of endoscopic treatment in a prospective study conducted over a period of 10 years, 1997 to January 2007. A total of 25 patients (20 female and five male: aged 18-75 years), with at least one symptom of stricture not passable with the standard colonoscope and with a confirmed scarred Crohn's stricture of the lower gastrointestinal tract, were included in the study. The main symptom was abdominal pain. The endoscopic balloon dilatation was performed with an 18 mm balloon under endoscopic and radiological control. Eleven strictures were located in the colon, 13 at the anastomosis after ileocecal resection, three at the Bauhin valve and four in the ileum. Four patients had two strictures and one patient had three strictures. Of the 31 strictures, in 30 was balloon dilatation successful in a single endoscopic session, so that eventually the strictures could be passed easily with the standard colonoscope. In one patient with a long stricture of the ileum involving the Bauhin valve and an additional stricture of the ileum which were 15 cm apart, sufficient dilatation was not possible. This patient therefore required surgery. Improvement of abdominal symptoms was achieved in all cases which had technically successful balloon dilatation, although in one case perforation occurred after dilatation of a recurrent stricture. Available follow-up was in the range of 54-118 mo (mean of 81 mo). The relapse rate over this period was 46%, but 64% of relapsing strictures could be successfully dilated again. Only in four patients was surgery required during this follow-up period. We conclude from these initial results that endoscopic balloon dilatation, especially for short strictures in Crohn's disease, can be performed with reliable success. Perforation is a rare complication. It is our opinion that in the long-term, the relapse rate is probably higher than after surgery, but usually a second endoscopic treatment can be performed successfully, leading to a considerable success rate of the endoscopic procedure.

Long-term results of endoscopic treatment of vesicoureteral reflux with the sub-ureteric injection of calcium hydroxyapatite

To review our long-term results of the sub-ureteric injection of calcium hydroxyapatite in the endoscopic management of vesicoureteral reflux (VUR) in children. A sub-ureteric injection of calcium hydroxyapatite was given to 14 children (23 ureteral units) affected by VUR grades I-V. All children were followed-up with monthly urine cultures, and a renal ultrasound was done on the postoperative 4th week, while the first voiding cysto-urethrogram (VCUG) control was performed on postoperative week 12. The children were followed-up with yearly renal ultrasound and monthly urine cultures, thereafter. Data from the patients' charts were retrospectively analyzed regarding the outcome of the procedures. Mean follow-up time was 52 months (47-60 months). VUR was cured in 47.4% of cases after a single injection. After the second injection the global success rate was 52.1%. Ureteroneocystostomy was performed on seven refluxing ureters of five children unresponsive to sub-ureteric injection therapy. One patient underwent nephroureterectomy because of a non-functioning kidney secondary to ureteral obstruction due to migration of material at the 23rd month postoperatively. Although favorable short-term success rates have been reported with the sub-ureteric injection of calcium hydroxyapatite without any side effects, our long-term results showed a low success rate, with the only reported serious morbidity.

Evolution of the Treatment of Vesicoureteral Reflux in Spain

We determined the changes in the treatment of vesicoureteral reflux (VUR) at children's hospitals in Spain as well as the long-term results of endoscopic treatment (ET) with polytetrafluoroethylene, namely with STING (subureteral polytetrafluoroethylene injection). A survey was performed of all pediatric urology units in Spain to determine changes in the diagnosis and treatment of VUR in the last 10 years. Also, a conjoint study was made of STING case records at 5 Spanish hospitals where there is expertise in the technique. The response rate was 34 of 44 cases (78%). The most significant changes were the introduction of urodynamics and the progressive establishment of ET as a substitute for open surgery and prolonged medical treatment. At more than 90% of the units ET is now done with different materials with a cure rate of 75% after 1 injection and a low index of complications. The results of the STING study in 2,035 refluxing ureters showed a cure rate of about 90% for 2 or 3 injections for grades I to IV reflux and just under 70% for grade V. Also, the cure rate for complex reflux was 60% and the index of complications was less than 1.2% with some intravesical migration. There have been many changes in the approach to VUR with an increasing use of urodynamics and ET. Since the long-term results of STING are reliable and no long-term complications have been observed, polytetrafluoroethylene appears to be the product with the best quality/price ratio for use in ET. However, it is being replaced.

Endoscopic management of vesicoureteral reflux: does it stand the test of time?

Endoscopic subureteral injection of tissue-augmenting substances, a 15-minute outpatient procedure has become an alternative to long-term antibiotic prophylaxis and surgical intervention in the treatment of vesicoureteral reflux (VUR) in children. This paper reviews the long-term results of endoscopic treatment of reflux using various tissue-augmenting substances presently available. In terms of effectiveness and long-term successful results, polytetrafluoroethylene is still the most reliable injectable material for the endoscopic treatment of VUR.

ENDOSCOPIC TREATMENT OF VESICOURETERAL REFLUX:

Endoscopic subureteral injection of tissue-augmenting substances, a 15-minute outpatient procedure has become an alternative to long-term antibiotic prophylaxis and surgical intervention in the treatment of vesicoureteral reflux (VUR) in children.We searched MEDLINE using the words: vesicoureteral reflux, treatment, the long-term results of endoscopic treatment of reflux. We summarized the worldwide data regarding endoscopic treatment of VUR using various tissue-augmenting substances presently available.In terms of effectiveness and long-term successful results, polytetrafluoroethylene is still the most reliable injectable material for the endoscopic treatment of VUR. However, Dextranomer/hyaluronic acid copolymer (Deflux) is a new promising tissue augmenting substance which might be able to replace Teflon in the endoscopic treatment of reflux in terms of a similar to Teflon reflux cessation rate and exhibiting no evidence of migration.Endoscopic subureteral polytetrafluoroethylene injection is a simple and effective outpatient procedure for in the treatment of vesicoureteral reflux. No long-term morbidity was observed in our patients with small amounts of injectable polytetrafluoroethylene.