Low Rate Of Serious Complications Research Articles

Prevalence of complications associated with use of the Henderson equine castrating instrument.

Castration is one of the most common surgical procedures performed in the horse. Complication rate and types of complications associated with use of the Henderson equine castrating instrument have not been determined. To determine the complication rate and type of complications encountered when using the Henderson equine castrating instrument in equine ambulatory practice. Retrospective case series. Medical records of horses undergoing routine castration using the Henderson drill were identified and evaluated for the occurrence of complications. The relationship between potential risk factors and complications was examined using basic descriptive statistics and quantified by means of logistic regression. Of 252 horses in the study population, 27 (10.7%) developed a complication after surgery; 25 of which were nonlife-threatening and responded to medical management. Two complications, one each of wound botulism and evisceration, resulted in euthanasia. Age at the time of castration was significantly associated with the occurrence of (P = 0.005, Wilcoxon rank sum test) complications. Compared to younger horses, the odds of having a complication were significantly greater (OR 2.99, 95% CI 1.27-7.0; P = 0.01) for horses of 4 years of age or more. The retrospective nature of this study. There is also a lack of direct comparison between different castration methods. The Henderson equine castrating instrument is an acceptable alternative to traditional emasculators. Its use is associated with a low rate of complications (8.3%) in young horses (≤3 years of age) compared to older horses (21.3%) and a very low rate of serious complications (0.8%) in all ages of horses.

What is the role of vertebral augmentation for osteoporotic fractures? A review of the recent literature.

Vertebral augmentation procedures such as vertebroplasty and kyphoplasty are utilized in the treatment of vertebral compression fractures (VCFs). However, their capacity for providing analgesia, reducing disability, and improving quality of life in patients with osteoporotic VCFs remains a topic of debate. The objective of this narrative review is to summarize the latest evidence for the safety and efficacy of vertebral augmentation for osteoporotic vertebral compression fractures (VCFs). A systematic literature search was conducted using the PubMed and Cochrane electronic databases for systematic reviews, review articles, meta-analyses, and randomized clinical trials prior to May 2017. The keywords were "vertebroplasty," "kyphoplasty," and "vertebral augmentation." Thirty-three papers (7 systematic reviews, 6 cohort studies, 15 randomized clinical trials, and 5 international guidelines) were included in this narrative review. Vertebral augmentation is a safe procedure, with low rates of serious complications and no increase in subsequent post-treatment fracture risk.

Complications associated with surgical dehorning in goats: A retrospective study of 239 cases.

This article describes complications following surgical dehorning of goats. Retrospective. Medical records of goats that underwent surgical dehorning were reviewed. Two hundred thirty-nine goats. The medical records of 239 goats, not previously dehorned by other methods, that were cosmetically dehorned between January 2006 and April 2016, were reviewed. Data retrieved from the medical records included breed, weight, the surgeon performing the procedure, intraoperative complications, and the occurrence of return visits to the teaching hospital because of complications related to the dehorning procedure. The owner of record then completed a standard questionnaire during a telephone interview. One or more complications following the surgical dehorning procedure were reported in 93/239 (38.91%) of goats. Complications were divided into major and minor categories. Eighty-four of 239 goats (35.14%) had minor complications, 3/239 goats (1.26%) experienced major complications, and 6/239 (2.51%) had both major and minor complications. The mean weight of goats with complications was 29.73 kg compared to 24.91 kg for goats without complications. This difference was statistically significant (P = .015). Surgical dehorning of goats results in a high rate of complications; however, the majority of these complications are minor and do not affect health and performance of the goats. Goats experiencing complications weighed significantly more than goats without complications. Surgical dehorning of goats requires minimal aftercare and results in a low rate of serious complications.

Analysis of 784 Surgically Treated Distal Biceps Tendon Ruptures

The surgical repair of distal biceps tendon ruptures has an overall low rate of serious complications, regardless of approach or technique. However, two-incision technique has a higher rate of posterior interosseous nerve palsy, heterotopic bone formation, and re-operation rate. To examine clinical and surgical outcomes for distal biceps tendon repairs in a large, multi-specialty, integrated healthcare system. Retrospective cohort study of distal biceps tendon repairs performed from January 1, 2008 through December 31, 2015. The repair methods were classified as: two-incision approach using bone tunnel-suture fixation, or anterior single incision approach. Anterior single incisions were further classified according to the fixation method: cortical button alone, cortical button and interference screw, or suture anchors alone. Patient demographics, surgeon characteristics, surgical outcomes, and complications were analyzed for all repair types. Of the 784 repairs that met our inclusion criteria, 639 (81.5%) were single incision approaches. When comparing two-incision and single incision repairs, there was a significantly higher rate of posterior interosseous nerve palsy (3.4% vs. 0.8% respectively, P: 0.010), heterotopic bone formation (7.6% vs 2.7%, respectively. P: 0.004), and re-operations (8.3% vs 2.3%, respectively. P<0.001). When excluding lateral antebrachial cutaneous nerve palsies, there was no significant difference in the overall nerve palsies between single incision and two-incision (5.8% vs. 6.9%, respectively, P: 0.612). The overall rate of tendon re-rupture was 1.9% (single incision: 1.6%, two-incision: 2.8%, P: 0.327). The overall rate of post-operative wound infection was 1.5% (single incision: 1.3%, two-incision: 2.8%, P: 0.182). The average time from surgery to release from medical care was 14.4 weeks (single incision: 14.0 weeks, two-incisions: 16.0 weeks, P: 0.286). Patients treated with cortical button + interference screw were released significantly sooner than other single incision repair types (13.1±8.01 weeks, P: 0.011). There were no significant differences in rates of motor neuropraxia, infection, re-rupture, re-operation in regards to surgeon’s years of practice, fellowship training, or case volume. The surgical repair of distal biceps tendon ruptures has an overall low rate of serious complications, regardless of approach or technique. However, two-incision technique has a higher rate of posterior interosseous nerve palsy, heterotopic bone formation, and re-operation rate. Surgeon’s years of practice, fellowship training, and case volume do not affect the rate of major complications.

Surgical Treatment of Distal Biceps Tendon Ruptures: An Analysis of Complications in 784 Surgical Repairs

Background: Distal biceps brachii tendon ruptures lead to substantial deficits in elbow flexion and supination; surgical repair restores muscle strength and endurance. Purpose: To examine clinical and surgical outcomes for distal biceps tendon repairs in a large, multispecialty, integrated health care system. Study Design: Cohort study; Level of evidence, 3. Methods: Retrospective cohort study of distal biceps tendon repairs performed between January 1, 2008, and December 31, 2015. The repair methods were classified as double-incision approach using bone tunnel–suture fixation or anterior single-incision approach. Anterior single incisions were further classified according to the fixation method: cortical button alone, cortical button and interference screw, or suture anchors alone. Patient demographics, surgeon characteristics, range of motion, and complications were analyzed for all repair types. Results: Of the 784 repairs that met the inclusion criteria, 639 (81.5%) were single-incision approaches. When comparing double-incision and single-incision repairs, there was a significantly higher rate of posterior interosseous nerve palsy (3.4% vs 0.8%, P = .010), heterotopic bone formation (7.6% vs 2.7%, P = .004), and reoperation (8.3% vs 2.3%, P < .001). The most common nerve complication encountered was a lateral antebrachial cutaneous nerve palsy (n = 162), which was significantly more common in the single-incision repairs than in the double-incision repairs (24.4% vs 4.1%, P < .001). When excluding lateral antebrachial cutaneous nerve palsies, there was no significant difference in the overall nerve palsies between single-incision and double-incision (5.8% vs 6.9%, P = .612). The overall rate of tendon rerupture was 1.9% (single incision, 1.6%; double incision, 2.8%; P = .327). The overall rate of postoperative wound infection was 1.5% (single incision, 1.3%; double incision, 2.8%; P = .182). The average time from surgery to release from medical care was 14.4 weeks (single incision, 14 weeks; double incision, 16 weeks; P = .286). Patients treated with cortical button plus interference screw were released significantly sooner than were patients with other single-incision repair types (13.1 ± 8.01 weeks, P = .011). There were no significant differences in rates of motor neurapraxia, infection, rerupture, and reoperation with regard to surgeon’s years of practice, fellowship training, or case volume. Conclusion: The surgical repair of distal biceps tendon ruptures has an overall low rate of serious complications, regardless of approach or technique. However, the double-incision technique has a higher rate of posterior interosseous nerve palsy, heterotopic bone formation, and reoperation rate. Surgeon’s years of practice, fellowship training, and case volume do not affect the rate of major complications.

Shockwave lithotripsy: techniques for improving outcomes.

Shock wave lithotripsy (SWL) remains the only effective truly non-invasive treatment for nephrolithiasis. While single-treatment success rates may not equal those of ureteroscopy and percutaneous nephrolithotomy, it has an important role to play in the management of stones. In this paper, we outline the latest evidence-based recommendations for maximizing SWL outcomes, while minimizing complications. A comprehensive review of the current literature was performed regarding maximizing SWL outcomes. Several different considerations need to be made regarding patient selection with respect to body habitus, body mass index, anatomical location and underlying urologic abnormalities. Stone composition and stone density (Hounsfield Units) are important prognostic variables. Patient positioning is critical to allow for adequate stone localization with either fluoroscopy or ultrasound. Coupling should be optimized with a low viscosity gel applied to the therapy head first and patient movement should be limited. SWL energy should be increased slowly and shockwave rates of 60 or 90Hz should be used. Medical expulsive therapy with alpha-blockers after SWL treatment has shownbenefit, particularly with stones greater than 10mm. While single-treatment success rates may not equal those of ureteroscopy or percutaneous nephrolithotomy, with proper patient selection, optimization of SWL technique, and use of adjunctive treatment after SWL, success rates can be maximized while further reducing the already low rate of serious complications. SWL remains an excellent treatment option for calculi even in 2017.

Management of Uterine Fibroids: A Focus on Uterine-sparing Interventional Techniques.

Uterine fibroids occur in approximately 50% of women over the age of 40 years, and an estimated 50% of those are symptomatic. Menorrhagia is the most common symptom and the primary indication for treatment, although bulk symptoms often occur and can be treated. Pharmacotherapy is typically inadequate unless it can be expected to successfully bridge to menopause or allow for a less-invasive intervention. However, hormonal therapies have risks. Hysterectomy is still the most commonly performed procedure for symptomatic fibroids and has the lowest rate of reintervention (compared with myomectomy or uterine artery embolization [UAE]), but rates of more serious complications are higher and patient satisfaction and ability to return to normal activities may also be less favorable. Myomectomy is not necessarily less morbid than hysterectomy and may have a greater failure rate than UAE. Techniques and devices vary with little standardization, and operator experience is crucial to success. The largest studies of UAE show very low rates of serious complications and rapid recovery. UAE significantly improves symptoms related to uterine fibroids in 85%-90% of patients. Herein, this article will discuss the nature of fibroids and their diagnosis, pharmacotherapy, surgical treatment, and nonsurgical interventional treatment, including UAE and magnetic resonance-guided focused ultrasound. (©) RSNA, 2016.

A Retrospective Study of Success, Failure, and Time Needed to Perform Awake Intubation.

Awake intubation is the standard of care for management of the anticipated difficult airway. The performance of awake intubation may be perceived as complex and time-consuming, potentially leading clinicians to avoid this technique of airway management. This retrospective review of awake intubations at a large academic medical center was performed to determine the average time taken to perform awake intubation, its effects on hemodynamics, and the incidence and characteristics of complications and failure. Anesthetic records from 2007 to 2014 were queried for the performance of an awake intubation. Of the 1,085 awake intubations included for analysis, 1,055 involved the use of a flexible bronchoscope. Each awake intubation case was propensity matched with two controls (1:2 ratio), with similar comorbidities and intubations performed after the induction of anesthesia (n = 2,170). The time from entry into the operating room until intubation was compared between groups. The anesthetic records of all patients undergoing awake intubation were also reviewed for failure and complications. The median time to intubation for patients intubated post induction was 16.0 min (interquartile range: 13 to 22) from entrance into the operating room. The median time to intubation for awake patients was 24.0 min (interquartile range: 19 to 31). The complication rate was 1.6% (17 of 1,085 cases). The most frequent complications observed were mucous plug, endotracheal tube cuff leak, and inadvertent extubation. The failure rate for attempted awake intubation was 1% (n = 10). Awake intubations have a high rate of success and low rate of serious complications and failure. Awake intubations can be performed safely and rapidly.

Complications of external cephalic version: a retrospective analysis of 1121 patients at a tertiary hospital in Sydney.

To report the complication rate associated with external cephalic version (ECV) at term. Single-centre retrospective study. A major tertiary hospital in Sydney, Australia. All women who underwent an ECVatRoyal Prince Alfred Hospital from 1995-2013 were included. ECV was attempted on all consenting women with a breech presentation at term in the absence of contraindications. Complications were classified as minor (transient cardiotocography abnormalities, ruptured membranes, small antepartum haemorrhage) or serious (fetal death, placental abruption, fetal distress requiring emergency caesarean section, fetal bone injury, cord prolapse). ECV success rates and rate of reversion to breech were recorded. The primary outcome was the incidence of serious complications. Secondary outcome measures were the rate of minor complications and reversion to breech. Of 1121 patients that underwent ECV, five (0.45%) experienced a serious complication. There was one placental abruption, one emergency caesarean section for fetal distress and two cord prolapses. There was one fetal death attributable to a successful ECV. Forty-eight women (4.28%) experienced a minor complication. Reversion to the breech occurred in sixteen patients (3.32%). ECV at term is associated with a low rate of serious complications. Study of 1121 consecutive ECV attempts shows low rate of complications although one fetal death reported.

A primer on intraosseous access: History, clinical considerations, and current devices

Intraosseous (IO) access is a method recommended by the American Heart Association and the European Resuscitation Council to administer resuscitative drugs and fluids when intravenous (IV) access cannot be rapidly or easily obtained. Many clinicians have limited knowledge or experience with the IO route. The purpose of this review was to provide the reader with a succinct review of the history, clinical considerations, and devices associated with IO access. Narrative review. University-based academic research cell. Not applicable. Not applicable. IO access is a lifesaving bridge to definitive vascular access that may be considered when an IV cannot be rapidly attained and the patient's outcome may be negatively affected without prompt circulatory access. The IO route has few contraindications for use and a low rate of serious complications. Multiple manual and powered devices that may be placed in several anatomic sites are commercially available. All clinicians who provide acute care or respond to cardiovascular emergencies should obtain training and maintain proficiency in placing and using IO devices as the IO route is recommended by the major resuscitation organizations as the preferred route of infusion when rapid, reliable IV access is unavailable.

Sustained Weight Loss with Vagal Nerve Blockade but Not with Sham: 18-Month Results of the ReCharge Trial.

Background/Objectives. Vagal block therapy (vBloc) is effective for moderate to severe obesity at one year. Subjects/Methods. The ReCharge trial is a double-blind, randomized controlled clinical trial of 239 participants with body mass index (BMI) of 40 to 45 kg/m or 35 to 40 kg/m with one or more obesity-related conditions. Interventions were implantation of either vBloc or Sham devices and weight management counseling. Mixed models assessed percent excess weight loss (%EWL) and total weight loss (%TWL) in intent-to-treat analyses. At 18 months, 142 (88%) vBloc and 64 (83%) Sham patients remained enrolled in the study. Results. 18-month weight loss was 23% EWL (8.8% TWL) for vBloc and 10% EWL (3.8% TWL) for Sham (P < 0.0001). vBloc patients largely maintained 12-month weight loss of 26% EWL (9.7% TWL). Sham regained over 40% of the 17% EWL (6.4% TWL) by 18 months. Most weight regain preceded unblinding. Common adverse events of vBloc through 18 months were heartburn/dyspepsia and abdominal pain; 98% of events were reported as mild or moderate and 79% had resolved. Conclusions. Weight loss with vBloc was sustained through 18 months, while Sham regained weight between 12 and 18 months. vBloc is effective with a low rate of serious complications.

Fusion via transpsoas lateral approach: considerations and initial results

OBJECTIVE: To present some technical considerations about interbody fusion by direct lateral retroperitoneal transpsoas approach and its initial results. METHODS: Non-randomized prospective study of 14 patients undergoing interbody fusion via lateral approach, with evaluation of initial results and complications. RESULTS: We collected and analyzed data from 14 patients with a total of 27 levels operated. The average operative time was 146 minutes and blood loss was on average less than 50 ml. Ten patients required supplemental percutaneous fixation with pedicle screws. VAS scores for the lumbar region and lower limbs and ODI had significant improvement in the postoperative period. There was an associated case of postoperative infection and thromboembolism that required reoperations. CONCLUSION: This technique has revolutionized the care of patients requiring fusion of T6-7 to L4-5. Following the five basic steps and using intraoperative monitoring, this technique is safe and reproducible with encouraging clinical results and low rate of serious complications.

Local resection of early rectal cancer.

The introduction of the National Danish screening programme for colorectal cancer will result in the detection of more early rectal cancers (ERC), which may be considered for local excision. For the low risk≤T1 cancer, the oncological outcome at local excision in smaller patient series has shown similar results to conventional surgery, but with a significantly lower rate of serious complications, morbidity and mortality. The challenge is correct preoperative staging, and a meticulous systematic histopathological staging of the excised specimen to distinguish the low risk from high-risk cases, where rescue surgery may be considered. The establishment of a regional or national clinical database is necessary to improve the local treatment of ERC.

Effects of Age, Parity, and Device Type on Complications and Discontinuation of Intrauterine Devices

To conduct an analysis of intrauterine device (IUD)-related outcomes including expulsion, contraceptive failure, and early discontinuation and to compare these outcomes in regard to age, parity, and IUD type. This was a multicenter retrospective chart review of adolescents and women aged 13-35 years who had an IUD inserted for contraception between June 2008 and June 2011. A total of 2,523 patients' charts were reviewed. Of these, 2,138 patients were included in our analysis. After a mean follow-up of 37±11 months, the overall rates of IUD expulsion and pregnancy were 6% and 1%, respectively, and were not significantly different by age or parity. Intrauterine device discontinuation rates were 19% at 12 months and 41% after a mean follow-up of 37 months. Despite similar rates of IUD discontinuation between age groups at 12 months of use, teenagers and young women aged 13-19 years were more likely to request early discontinuation at the end of the total follow-up period. No significant difference was noted in pelvic inflammatory disease rates (2%) based on age. After adjusting for age and parity, we found that copper IUD users were more likely to experience expulsion and contraception failure compared with levonorgestrel intrauterine system users (hazard ratios 1.62, 95% confidence interval [CI] 1.06-2.50 and hazard ratios 4.89, 95% CI 2.02-11.80, respectively). Similar to adults, IUD use in adolescents and nulliparous women is effective and associated with low rates of serious complications. Health practitioners should therefore consider IUDs for contraception in all females. Teenagers and young women are more likely to request premature discontinuation of their IUDs and may benefit from additional counseling.

Spontaneous Hemoperitoneum due to Rupture of Uterine Varicose Veins during Labor Successfully Treated by Percutaneous Embolization.

Hemoperitoneum during pregnancy is a rare but potentially lethal clinical condition. Improvements in antenatal and intrapartum care, especially in surgical and anesthetic techniques, have reduced maternal mortality; perinatal mortality remains very high (31%). Treatment is based on the systemic correction of hypovolemia and immediate surgery via laparotomy or laparoscopy in cases in the first trimester of pregnancy for hemostatic purposes. Sometimes, hysterectomy is needed. A 35-year-old Asiatic primigravid woman at 37 weeks' gestation with otherwise uneventful pregnancy came to the hospital referring abrupt-onset lumbar and abdominal pain. A bleeding uterine superficial varicocele of about 7 cm was found on the left uterine horn during Caesarean section. Interventional radiologic embolization of both uterine arteries was successfully performed. Posterior evolution of the patient was favorable. Percutaneous vascular embolization of the uterine arteries is an effective alternative treatment for many obstetrical and gynecological causes of bleeding. The main advantage of this technique is the low rate of serious complications and the preservation of reproductive function. To our knowledge, this is the first case of spontaneous intrapartum hemoperitoneum treated with this technique. An early diagnosis and a rapid indication of this therapeutic option are essential. Hemodynamic stability is needed to decide this conservative management.

Indicaciones de la biopsia cardiaca

Endomyocardial biopsy is a common procedure for the evaluation of cardiac tissue for transplant monitoring, myocarditis, drug toxicity, CMP, arrhythmia, secondary cardiac involvement by systemic diseases, and cardiac masses. It is the gold standard for the diagnosis of cardiac rejection, myocarditis, and infiltrative/storage disorders and can be crucial for differential diagnosis in heart failure and ventricular arrhythmias. Currently, in skilled hands, has a very low rate of serious complications. In the last years, several Scientific Societies have published consensus documents about its indications.

Complications of Carbon Dioxide Laser Resurfacing

The carbon dioxide laser has been shown to be an effective tool in the treatment of photodamaged skin since its introduction over 20 years ago. Scars, premalignant, and malignant skin lesions of the face have all been treated successfully with the carbon dioxide laser. While improvements in laser technology have facilitated the use of the carbon dioxide laser in the oral and maxillofacial surgery office, there is a paucity of literature describing the incidence of postoperative complications following laser resurfacing in the OMS literature. Previous studies have reported a relatively common occurrence of bacterial infections, viral infections, and inflammatory reactions in the early postoperative period, and scarring and facial pigment changes in the long term, as well as—rarely—iatrogenic damage during treatment. A retrospective study of 110 patients, who underwent laser resurfacing with a carbon dioxide laser between 1999 and 2013, examined the rates of complications after treatment. Complications were separated into early (within one week) and late (one to three weeks post-procedure), and categorized by complication subtype (eg infectious, inflammatory, etc). Additionally, laser settings, Fitzpatrick skin type, immunocompromising conditions (diabetes, AIDS, etc), postoperative pain, and smoking history were all assessed. The results of this study indicate a 3% early complication rate consisting of herpes zoster and bacterial dermatologic infections. There was an 8% late complication rate, including mostly minor dermatologic sequelae such as milia/acneiform lesions and contact dermatitis and one late HSV outbreak. All complications quickly and fully resolved with proper intervention. Despite the high rates of postoperative hypoand hyperpigmentation found in many studies, we found a much lower incidence in ours. This is most likely due to our selection criteria for laser treatment, which includes patients only with Fitzpatrick skin types I, II and III, who are less likely to suffer these complications than patients with darker skin. This study will help clinicians understand and anticipate complications that are most likely to follow carbon dioxide laser resurfacing, and plan to treat these adverse outcomes appropriately. Furthermore, our confirmation of low rates of serious complications should encourage

Is the Magnitude of Maxillomandibular Advancement Correlated With Long-Term Changes in the Apnea-Hypopnea Index in Patients With Obstructive Sleep Apnea?

The carbon dioxide laser has been shown to be an effective tool in the treatment of photodamaged skin since its introduction over 20 years ago. Scars, premalignant, and malignant skin lesions of the face have all been treatedsuccessfullywith thecarbondioxidelaser. While improvements in laser technology have facilitated the use of the carbon dioxide laser in the oral and maxillofacialsurgeryoffice,thereisapaucityof literaturedescribing the incidence of postoperative complications following laser resurfacing in the OMS literature. Previous studies have reported a relatively common occurrence of bacterial infections, viral infections, and inflammatory reactions in the early postoperative period, and scarring and facial pigment changes in the long term, as well as—rarely—iatrogenic damage during treatment. A retrospective study of 110 patients, who underwent laser resurfacing with a carbon dioxide laser between 1999 and 2013, examined the rates of complications after treatment. Complications were separated into early (within one week) and late (one to three weeks post-procedure), and categorized by complication subtype (eg infectious, inflammatory, etc). Additionally, laser settings, Fitzpatrick skin type, immunocompromising conditions (diabetes, AIDS, etc), postoperative pain, and smoking history were all assessed. The results of this study indicate a 3% early complication rate consisting of herpes zoster and bacterial dermatologic infections. There was an 8% late complication rate, including mostly minor dermatologic sequelae such as milia/acneiform lesions and contact dermatitis and one late HSV outbreak. All complications quickly and fully resolved with proper intervention. Despite the high rates of postoperative hypo- and hyperpigmentation found in many studies, we found a much lower incidence in ours. This is most likely due to our selection criteria for laser treatment, which includes patients only with Fitzpatrick skin types I, II and III, who are less likely to suffer these complications than patients with darker skin. This study will help clinicians understand and anticipate complications that are most likely to follow carbon dioxide laser resurfacing, and plan to treat these adverse outcomes appropriately. Furthermore, our confirmation of low rates of serious complications should encourage

Meta-analysis: the safety and efficacy of dilation in eosinophilic oesophagitis

Oesophageal dilation is one of the most effective options in the management of symptoms of eosinophilic oesophagitis (EoE). However, earlier reports described an increased rate of complications. To perform a meta-analysis of population-based studies of the risks associated with dilation and the clinical efficacy and duration of response to dilation in EoE. Using MEDLINE and EMBASE, a systematic search was performed for published articles since 1977 describing cohort or randomised controlled trials of dilation in EoE. Summary estimates, including 95% confidence interval (CI), were calculated for the occurrence of complications associated with dilations (perforations, haemorrhage, chest pain, lacerations) and percentage of patients with symptom improvement following dilation. Heterogeneity was calculated using the I² statistic. The search resulted in 232 references, of which 9 studies were included in the final analysis. The studies described 860 EoE patients, of whom 525 patients underwent at least one oesophageal dilation and a total of 992 dilations. There were three cases of perforation (95% CI 0-0.9%, I² 0%) and one haemorrhage (95% CI 0-0.8%, I² 0%). Six studies reported postprocedural chest pain in 2% of cases (95% CI 1-3, I² 53%). Clinical improvement from dilation occurred in 75% of patients (95% CI 58-93%, I² 86%). Dilation in patients with eosinophilic oesophagitis is a safe procedure with a low rate of serious complications (<1%), and seems to result in at least a short-term improvement of symptoms in the majority of patients.

Outcomes of endoscopic pyloric stenting in malignant gastric outlet obstruction: a retrospective study

BackgroundUp to 30% of patients with pancreatic cancer and more than 50% of patients with gastric cancer already have incurable disease, with distressing symptoms of gastric outlet obstruction at the time of presentation which require effective palliation. We decided to test the clinical outcomes of endoscopic stent placement in malignant gastric outlet obstruction.MethodsIn a retrospective single institution-based study, the charts of patients who had self-expandable metal stents placed to alleviate malignant gastric outlet obstruction were reviewed. Charts were reviewed to assess improvement in oral intake according to the Gastric Outlet Obstruction Scoring System (GOOSS), and in order to also evaluate technical success and complications of the procedure.Results69 patients with successful stent placement were retrospectively evaluated. Within 7 and 28 days after stent placement respectively, 85.5% and 80% benefited from stent insertion, with an increase in the GOOSS score of > 1. Resumption of soft or low residue diet (GOOSS 2-3) was achieved in 53.6% at day 7 and in 62% of patients at day 28, respectively. Of the patients achieving a GOOSS score of 2-3, 17.3% remained on a soft or low residue diet at 24 weeks or at last follow up, while 46% died. Stent related adverse events occurred in 10 patients (14%), including stent blockade in 7 and stent migration in 3 patients.ConclusionEndoscopic enteral stenting promptly increases oral intake in the majority of patients with malignant gastric outlet obstruction and is a safe procedure with a low rate of serious complications.