Outcomes Of Endoscopic Therapy Research Articles

Outcomes of Endoscopic Therapy in Patients with Peptic Ulcer Bleeding

Outcomes of Endoscopic Therapy in Patients with Peptic Ulcer Bleeding

Outcomes of endoscopic therapy in donation after cardiac death liver transplant biliary strictures

BackgroundBiliary strictures after donation-after-cardiac-death (DCD) liver transplantation (LT) require multiple endoscopic retrograde cholangiopancreatographies (ERCP). The outcomes of endoscopic dilation and maximal stenting are not well-characterized in this high-risk population. MethodsDCD LT recipients who underwent LT and ERCP from 2012–2018 were selected. Anastomotic and non-anastomotic strictures were treated with balloon dilation and maximal stenting. A successful stent-free trial was defined as absence of biochemical, clinical or imaging evidence of strictures on follow-up exceeding 6 months. Adverse events were defined as unplanned admission or inpatient evaluation within 7 days of ERCP. ResultsForty-nine DCD LT recipients underwent ERCP and 34 patients were diagnosed with strictures (20 anastomotic). Stent-free trial was successful in 27 patients. Adverse events occurred after 20 ERCPs. Patients with anastomotic strictures required fewer stents (1.43 ± 1.37 vs 2.63 ± 1.66; P < 0.001), shorter procedure and fluoroscopy times (34.15 ± 20.9 vs 59.6 ± 30.7 minutes, P < 0.001; 5.99 ± 7.4 vs 14.73 ± 10.74 minutes, P < 0.001), fewer relapses (10% vs 57%, P = 0.003), shorter intervals between initial ERCP and stent-free success (136.9 ± 118.3 vs 399.56 ± 234.7; P = 0.003), and between LT and stent-free success (227.8 ± 171.9 vs 464.1 ± 224.6 days; P = 0.005) compared to non-anastomotic strictures. ConclusionEndoscopic dilation and maximal stenting resolves biliary strictures in DCD LT recipients with sustained success and relatively few adverse events.

Su1999 - Barrett's Esophagus Dysplasia Burden Measured by Volumetric Laser Endomicroscopy Predicts Clinical Outcomes of Endoscopic Therapy

Su1999 - Barrett's Esophagus Dysplasia Burden Measured by Volumetric Laser Endomicroscopy Predicts Clinical Outcomes of Endoscopic Therapy

Clinical Outcomes of Endoscopic Hemostasis in Marginal Ulcer Bleeding.

The usefulness of endoscopy in marginal ulcer bleeding has rarely been studied, and the optimal method for preventing rebleeding is unclear. Here we assessed the efficacy of endoscopy in marginal ulcer bleeding and examined the efficacy of proton pump inhibitors (PPIs) in the prevention of rebleeding. A total of 28 patients with marginal ulcer bleeding (21 men, 7 women; median age 58.5 years) were treated by endoscopy. We analyzed the clinical characteristics, results of endoscopic therapy, characteristics of rebleeding patients, and relation between the use of PPIs and the duration of rebleeding. Sixteen patients had active bleeding. Initial hemostasis was achieved in all patients. There were no procedure-related adverse events. Rebleeding occurred in one patient within the first month and in 7 patients thereafter. There was a significant difference in the rebleeding rate between the patients who received a PPI and those who did not. In a multivariate analysis, the non-use of PPIs was a risk factor for rebleeding (hazard ratio, 6.22). Therapeutic endoscopy is effective in achieving hemostasis from marginal ulcer bleeding. PPIs may prevent rebleeding from marginal ulcers.

PTH-030 How Does Delivery of Appropriate Endotherapy at Index Endoscopy Affect Outcome in Patients with Non-Variceal Bleeding?

Introduction NICE recommends that patients with non-variceal acute upper gastrointestinal bleeding (AUGIB) and stigmata of recent haemorrhage (SRH) are offered endoscopic treatments (combination or mechanical method).1 We audited the appropriateness and outcomes of endoscopic therapy in patients with non-variceal bleeding in a University Hospital with a dedicated consultant led out of hours endoscopy service. Methods AUGIB patients who underwent an emergency endoscopy (OGD) were identified from endoscopy, theatre and electronic records between 01.01.15 and 30.04.15. Our electronic clinical database was used to ascertain clinical details and outcomes. Results A total of 116 patients received an emergency OGD. Rebleeding occurred in 18 (15.5%) and 30 day mortality was 11%. 24 patients had non-variceal bleeding with SRH. 22 (92%) of these patients received endotherapy. Haemostasis was achieved after endotherapy in 20 (91%) patients.Two patients required CT angiography/embolization of the gastroduodenal artery. Two received no therapy. 19/24 (79%) patients received at least dual endoscopic therapy with 9/24 (37.5%) patients >2 modalities. 5/24 (9%) patients did not receive minimal recommended therapy; 3 patients (13%) received single (non-mechanical) modality. 2 patients received no treatment. In patients with endoscopic therapy, haemostasis was achieved in 13/22 (59%) patients at first OGD, 5/22 (27%) at second OGD and 2 (9%) at third OGD. In the two patients who failed endoscopic therapy, haemostosis was achieved at CTA. 7/22 patients (32%) did not achieve haemostasis at index endoscopy and required repeat endoscopy. Of these patients 5 (71%) had suboptimal endoscopic therapy at index endoscopy. In the 15 patients who achieved haemostasis 3 (20%) had suboptimal therapy at index endoscopy. (p = 0.05, Fisher’s exact test) Conclusion In this audit he failure to deliver effective endoscopic therapy at the index endoscopy led to ongoing bleeding in patients with non-variceal bleeding and SRH. In this audit we found 37% of patients needed triple endoscopic therapy to achieve haemostasis. The impact of such intensive endotherapy requires further study. Reference 1 NICE: https://www.nice.org.uk/guidance/gs38 Disclosure of Interest K. Waddell: None Declared, G. White: None Declared, A. Stanley Conflict with: Cook Medical, Boston Scientific, A. Morris Conflict with: Cook Medical, Boston Scientific.

Predictors of Outcome of Endoscopic Therapy in the Management of Patients With Pancreas Divisum: A Systematic Review and Meta-Analysis

Predictors of Outcome of Endoscopic Therapy in the Management of Patients With Pancreas Divisum: A Systematic Review and Meta-Analysis

Sa1481 Outcomes of Endoscopic Therapy for Barrett'S High Grade Dysplasia and Early Esophageal Cancer in a Community Hospital Setting

Sa1481 Outcomes of Endoscopic Therapy for Barrett’S High Grade Dysplasia and Early Esophageal Cancer in a Community Hospital Setting Riad H. Al Natour*, Andrew Catanzaro, Eugene Zolotarevsky, Anthony T. Debenedet, Naresh T. Gunaratnam Internal Medicine, St. Joseph Mercy Hospital, Ann Arbor, MI; Huron Gastroenterology Associates, Ypsilanti, MI Background: Barrett’s high grade dysplasia (BEHGD) and early (T1a) esophageal adenocarcinoma (eEAC) can be successfully treated endoscopically by radiofrequency ablation (RFA) and mucosal resection (EMR). These treatment modalities have been proven successful in high-volume academic medical centers. Effectiveness of endoscopic therapy for BEHGD and eEAC in a community hospital setting is unknown. Methods: All consecutive patients (pts) with BEHGD and eEAC treated endoscopically at our institution between August 2007 and August 2014 were prospectively enrolled in a database. All pts had biopsy proven BEHGD or eEAC confirmed by two expert GI pathologists. All pts were treated by EMR and/or RFA every 2-3 months until complete eradication of dysplasia (ED) and intestinal metaplasia (CEIM). Once therapeutic end-point was reached, pts were enrolled in surveillance program with serial endoscopies per protocol. Results: A total of 194 pts underwent endoscopic therapy for dysplastic BE. Sixty-four (33%) pts had advanced dysplasia (BEHGD 34 and eEAC 30) with median length Barrett’s of 4 cm (Interquartile range (IQR), 2-7 cm). Forty-eight pts had EMR. Median treatment interval was 9 months (IQR, 4-24 months). Median follow up was 3 years (IQR, 1.4-4.4 years). Fifty-nine (92%) pts maintained long-term remission of dysplasia and 52 (81%) pts intestinal metaplasia. One pt failed to regress BEHGD six months into therapy. Dysplasia was downstaged in 4 (6%) pts. Relapse after CEIM occurred in 9 (14%) pts with NDBE (6), BELGD (1), BEHGD (1) and eECA (1). After retreatment, CEIM was again achieved in 5 pts, and ED in 3 pts. Pts with long segment BEO6 cm were more likely to relapse (OR 4.2; pZ0.03). There were no procedure-related esophageal perforation, severe hemorrhage, or complications requiring hospitalization. Twelve pts (10 having prior EMR) developed a symptomatic stricture, which responded to dilatation. There was no procedure or disease-related mortality. Conclusions: Endoscopic management of BEHGD and eEAC can be provided effectively in a community hospital setting. Complete eradication and long-term remission of dysplasia and intestinal metaplasia can be achieved in majority of pts without major morbidity or mortality.

Tu1571 Title: Outcomes of Endoscopic Therapy for High-grade Dysplasia(HGD) and Esophageal Adenocarcinoma(EAC) in Long and Short Segment Barrett's Esophagus

Tu1571 Title: Outcomes of Endoscopic Therapy for High-grade Dysplasia(HGD) and Esophageal Adenocarcinoma(EAC) in Long and Short Segment Barrett's Esophagus

Efficiency of pancreatic duct stenting therapy in children with chronic pancreatitis

Chronic pancreatitis (CP) is a rare disease in childhood. Although ERCP is commonly performed in children, the effect of pancreatic duct stenting therapy in children with CP is unknown. To investigate the efficacy of pancreatic duct stenting in children with CP. Retrospective analysis. National referral center. A total of 208 children with CP hospitalized between 1988 and 2012. ERCP with pancreatic duct stenting. Results of endoscopic therapy and number of pancreatitis episodes per year before and after treatment. A total of 223 pancreatic duct stenting procedures were performed in 72 children. The median number of stent replacements was 3 (range 1-21). A statistically significant decrease in the number of pancreatitis episodes per year was observed: from 1.75 to 0.23 after endoscopic treatment (P < .05). Pancreatic duct stenting was performed more frequently in patients with hereditary pancreatitis (61.5%) and in children with CP and anatomic anomalies of the pancreatic duct (65%; P < .05). Retrospective analysis with the assessment of adverse events based on medical history. Pancreatic duct stenting therapy is a safe and effective procedure in children with CP. This therapy should be recommended especially for children with hereditary pancreatitis and patients with anatomic anomalies of the pancreatic duct.

Mo1244 Outcomes of Endoscopic Therapy of Luminal Strictures in Crohn's Disease

Mo1244 Outcomes of Endoscopic Therapy of Luminal Strictures in Crohn's Disease

Outcomes of Endoscopic Therapy in Treating Barrettʼs Esophagus with Dysplasia and Superficial Adenocarcinoma

Outcomes of Endoscopic Therapy in Treating Barrettʼs Esophagus with Dysplasia and Superficial Adenocarcinoma

Importance of small intestinal bacterial overgrowth in chronic pancreatitis

Importance of small intestinal bacterial overgrowth in chronic pancreatitis

Clinical presentation and outcome of endoscopic therapy in patients with symptomatic chronic pancreatitis associated with pancreas divisum.

The results of endoscopic drainage in pancreas divisum with chronic pancreatitis have been debatable.To evaluate clinical presentation and long term results of endoscopic therapy in patients of calcific and non-calcific chronic pancreatitis with pancreas divisum.Between 1996 and 2011, 48 patients (32 males and 16 females) with chronic pancreatitis and pancreas divisum were treated endoscopically. Patients were considered to have clinical success if they had resolution of symptoms and did not require surgery.All patients presented with abdominal pain and symptoms were present for 36.6 ± 40.5 months. Pseudocyst, diabetes, pancreatic ascites, pancreatic pleural effusion, segmental portal hypertension and steatorrhea were seen in 13 (27.1%), 6 (12.5%), 3 (6.3%), 2 (4.2%), 2 (4.2%) and 1 (2.1%) patients, respectively. Ductal calculi and strictures were noted in 3 (6.3%) and 2 (4.2%) patients, respectively. In 47 patients, an endoprosthesis (5 or 7 Fr) was successfully placed in the dorsal duct. Following pancreatic endotherapy, 45/47 (95.7%) patients had successful outcome. The mean number of stenting sessions required to have clinical success was 2.6 ± 0.9. One patient each had mild post ERCP pancreatitis, inward migration of stent and precipitation of diabetic ketoacidosis. Over a follow up of 2-174 months (median: 67 months), 12 out of 31 patients with pain only and no local complications (38.7%) required restenting for recurrence of pain and none of these patients required surgery.Intensive pancreatic endotherapy is safe and effective both in patients with chronic calcific, as well as non-calcific, pancreatitis associated with pancreas divisum. It gives good long term response in patients having abdominal pain and/or dorsal ductal disruptions.

Sa1636 Outcomes of Endoscopic Therapy for Squamous Cell Carcinoma of the Esophagus

Sa1636 Outcomes of Endoscopic Therapy for Squamous Cell Carcinoma of the Esophagus

Long‐term outcome of endoscopic therapy in patients with bile duct injury after cholecystectomy

Bile duct lesions, including leaks and strictures, are immanent complications of open or laparoscopic cholecystectomy. Endoscopic procedures have gained increasing potential as the treatment of choice in the management of postoperative bile duct injuries. Between January 1996 and December 2006, 44 patients with biliary leakages and 12 patients with biliary strictures after cholecystectomy were identified by analyzing the endoscopic retrograde cholangiopancreatography database, clinical records, and cholangiograms. The long-term follow up of endoscopic treatment in biliary lesions after cholecystectomy was evaluated by this retrospective study. In 34 of 35 patients (97%) with peripheral bile duct leakages, endoscopic therapy was successful. Transpapillary endoprothesis and/or nasobiliary drainage were removed after 31 (5-399) days. After stent removal, the median follow-up period was 81 (11-137) months. In patients with central bile duct leakages, the success rate after median 90 (4-145) days of endoscopic therapy was 66.7% (6/9 patients). The median follow up after stent removal in six successfully treated patients was 70 (48-92) months. Eleven of 12 patients (91.6%) with bile duct strictures had successfully completed stent therapy. The follow-up period of this patient group was 99 (53-140) months. Endoscopic treatment of bile duct lesions after cholecystectomy is effective, particularly in patients with peripheral bile duct leakages and bile duct strictures. Therefore, it should be the first-line therapy used in these patients. Although endoscopic management is less successful in patients with central bile duct leakages, an attempt is warranted.

Pancreatic Stent-Induced Ductal Injury: Clinical Presentation and Outcomes of Endoscopic Therapy

Pancreatic Stent-Induced Ductal Injury: Clinical Presentation and Outcomes of Endoscopic Therapy

Outcome of endoscopic therapy of complex hydrocephalus

Outcome of endoscopic therapy of complex hydrocephalus

Are Patients with “Low Risk” Submucosal Invasion of Early Barrett's Carcinoma Eligible for Curative Endoscopic Therapy? Outcomes of Endoscopic Therapy and Surgery in 80 Patients with Suspected Or Definite Diagnosis of Submucosal Barrett's Cancer

Background: Recently published surgical series have shown that even in case of incipient submucosal invasion of Barrett's cancer (BC), the risk for lymph node (LN) metastasis appears to be very low. Recently presented results of our group have shown that endoscopic resection (ER) might be associated with favourable outcomes even in these patients. Study aims: To show selection of patients with submucosal (sm) BC for different treatment approaches; to analyse lymph node (LN) status of patients referred to surgery; to evaluate long-term results after ER in “low risk” sm BC. Methods: From 09/96 to 09/03, the endosonographic suspicion or definite diagnosis of sm BC by ER or surgery was made in 80 pt referred to our department. 28 pt were referred to surgery after initial ER (n = 22) or because of the tumor's macroscopic or endosonographic appearance (n = 6). 30 pt were treated endoscopically with palliative intent, and one pt by photodynamic therapy and ER. 21 pt fulfilled the definition of “low risk” sm cancer: Invasion of the upper sm third (sm1), absence of infiltration into lymphatic (nor blood) vessels, histological grade G1/2, and gross type I/II. In these pt, ET was carried out using ER with the suck-and-cut technique. Results: In 8/28 pt primarily referred to surgery, LN status was positive. One of the 21 pt fulfilling our low-risk criteria was referred to surgery directly after detection of sm1 invasion at the beginning of the study. One pt died (not tumour-related) before completion of ET. Using definitive ET, complete remission (CR) was achieved in 18/19 pt (95%) after a mean of 5.3 months (range 1-18) and a mean of 2.9 resections (range 1-9). Only one minor complication (bleeding without drop of haemoglobin > 2 g/dl) occurred (5% of pt). During a mean follow-up (FU) of 69 months (range 48-103), recurrent or metachronous carcinomas were found in 5 pt (28%). Repeat ET was carried out successfully using ER (4 pt) and APC (1 pt). In one of the 19 pt (5%), tumour-freedom had not been achieved after a total of 2 ER. This patient died of a heart-attack before surgery could be performed. The calculated 5-year survival rate of all 21 pt was 66%. Metastatic disease in Barrett's cancer or tumour-related death were not observed. Conclusions: As in mucosal Barrett's cancer, ER is associated with favourable outcomes even in case of “low risk” submucosal Barrett's cancer. Further and larger clinical trials are required, before a general recommendation for ER as the treatment of choice in “low risk” submucosal Barrett's cancer can be given.

Long-Term Results of Endoscopic Therapy for BE

Endoscopic therapy is gaining ground over esophagectomy as the preferred treatment for patients who have Barrett esophagus with high-grade dysplasia (HGD) or early esophageal adenocarcinoma (EAC). However, studies supporting the use of endoscopic therapy have been limited by incomplete data capture and short follow-up (JW Gastroenterol Sep 26 2008). To further evaluate the efficacy of endoscopic therapy, researchers prospectively studied 349 patients in Germany with BE; 61 had HGD and 288 had EAC. Patients …

The Role of Multiple Parallel Stents in the Management of Post-Orthotopic Liver Transplantation (OLT) Biliary Anastomotic Strictures (AS)

Background: Efficacy of multiple parallel biliary stents for post-OLT AS has not been reported. Methods: We conducted a retrospective study of ERCP post-OLT to characterize biliary strictures and outcome of endoscopic therapy. Initial management of strictures was single stent placement. If the stricture persisted at the time of stent removal, parallel stents were placed, generally after balloon dilation. The number of parallel stents was increased every 4-8 weeks until the maximum number felt to be safely accommodated by the duct was reached. Biliary reconstruction (BR) was undertaken for endoscopic failures or progressive liver dysfunction. Results: From 3/01 to 11/06, OLT was performed in 301 patients of whom 75 (25%) underwent 194 ERCPs (mean 2.6 ERCP per patient). Bile duct cannulation at initial ERCP was successful in 72 (96%). There were no cases of post-ERCP pancreatitis or major complications. Biliary strictures were seen in 48 of 72 patients (67%), of which 21 (44%) were early (<90 days) and 27 (55%) were late. 45 patients had AS. Associated findings were intra-hepatic strictures (IHS) in 5, filling defects in 18 and bile leak in 2. 3 had only IHS. 6 AS were diagnosed after an initial normal ERCP with a mean interval from initial to diagnostic ERCP of 581 days. Initial management of AS was single stent in 41 (91%), conservative management in 1 (2%) which resolved, and direct surgery in 3 (7%): 1 re-OLT, 2 BR for high-grade eccentric strictures precluding guide wire passage. Outcome of single stent was resolution in 23 (56%), parallel stenting in 12 (29%) and surgery in 6 (15%, 4 re-OLT, 2 BR for large stones proximal to high-grade strictures). 68% of early strictures resolved with single stent versus 39% of late strictures. Parallel stents were generally 10 Fr and the mean maximum number of stents was 3.25 (range 3-5). Outcome of parallel stents was resolution in 6 (50%), currently ongoing stenting in 3 (25%) and surgery in 3 (25%; 2 re-OLT, 1 BR for persistent AS and IHS). Overall, 12/45 (27%) patients had surgery: 7 (16%) re-OLT and 5 (11%) BR. In no case was failure of multiple parallel stents the indication for surgery. All 8 patients with IHS (5 with and 3 without AS) required re-OLT. Conclusions: 1. ERCP is a safe and effective approach to diagnosis and management of post-OLT biliary AS; 2. An initial normal ERCP does not exclude a subsequent stricture development; 3. Early AS may be primarily related to edema and frequently resolve with single stent; 4. Parallel stent placement is an effective therapeutic option in patients with persistent AS; 5. Patients with IHS likely representing ischemic bile duct injury frequently require re-OLT.