Role Of Endoscopy In Management Research Articles

The updated Asia-Pacific consensus statement on the role of endoscopic management in malignant hilar biliary obstruction.

The first Asia-Pacific consensus recommendations for endoscopic and interventional management of hilar cholangiocarcinoma were published in 2013. Since then, new evidence on the role of endoscopy for management of malignant hilar biliary obstruction (MHBO) has emerged. To update the recommendation, we reviewed the literature using a PICO (population/intervention/comparison/outcomes) framework and created consensus statements. The expert panel voted anonymously using the modified Delphi method and all final statements were evaluated for the quality of evidence and strength of recommendation. The important points with inadequate supporting evidence were classified as key concepts. There were seven statements and five key concepts that reached consensus. The statements and key concepts dealt with multiple aspects of endoscopy-based management in MHBO starting from diagnosis, strategies and options for biliary drainage, management of recurrent biliary obstruction, management of cholecystitis after biliary stenting, and adjunctive treatment before stenting. Although the recommendations may assist physicians in planning the treatment for MHBO patients, they should not replace the decision of a multidisciplinary team in the management of individual patients.

The Role of Endoscopic Management in Afferent Loop Syndrome.

Afferent loop syndrome (ALS) is a morbid complication that may occur after gastrectomy and gastrojejunostomy reconstruction. The aim of this article is to review the different endoscopic treatment options of ALS. We describe the evolution of the endoscopic treatment of ALS and its limitations despite the overall propitious profile. We analyze the advantages of endoscopic ultrasound-guided entero-enterostomy (EUS EE) over enteroscopy-guided intervention, and the clinical outcomes of EUS EE. We expound on pre-procedural considerations, intra-procedural techniques and post-procedural care following EUS EE. We conclude that given the simplification of the technique and the ability to place a stent away from the tumor, EUS EE is a promising technique that will likely be established as the treatment of choice for ALS.

Role of Endoscopy in Management of Upper Gastrointestinal Cancers

Upper gastrointestinal (GI) malignancy is a leading cause of cancer-related morbidity and mortality. Upper endoscopy has an established role in diagnosing and staging upper GI cancers, screening for pre-malignant lesions, and providing palliation in cases of advanced malignancy. New advances in endoscopic techniques and technology have improved diagnostic accuracy and increased the therapeutic potential of upper endoscopy. We aim to describe the different types of endoscopic technology used in cancer diagnosis, summarize the current guidelines for endoscopic diagnosis and treatment of malignant and pre-malignant lesions, and explore new potential roles for endoscopy in cancer therapy.

The role of endoscopic management and adjuvant topical therapy for upper tract urothelial cancer.

Upper tract urothelial carcinoma (UTUC) has traditionally been managed with radical nephroureterectomy, and while this approach remains the gold standard for high-risk disease, endoscopic, kidney-sparing management has increasingly been adopted for low-risk disease as it preserves kidney function without compromising oncologic outcomes. Ureteroscopy and percutaneous renal access not only provide diagnoses by tumor visualization and biopsy, but also enable treatment with electrocautery or laser ablation. Several modalities exist for laser ablative treatments including thulium:YAG, neodymium:YAG, holmium:YAG, and combinations of the preceding. Furthermore, due to high recurrence rates after endoscopic management, adjuvant intracavitary instillation of various agents such as mitomycin C and bacillus Calmette-Guerin have been used given benefits seen in non-muscle invasive urothelial bladder cancer. Other formulations also being studied include gemcitabine, anthracyclines, and immunotherapies. More recently, Jelmyto, a mitomycin reverse thermal gel, has been developed to allow for adequate drug delivery time and potency since urine flow could otherwise dilute and washout topical therapy. In this article, the authors review techniques, indications, best practices, and areas of current investigation in endoscopic management and adjuvant topical therapy for UTUC.

The role of endoscopy after upper gastrointestinal bleeding in sub-Saharan Africa: A prospective observational cohort study

BackgroundUpper gastrointestinal (UGI) bleed is a common surgical disease in sub-Saharan Africa where there is often a lack of diagnostic and interventional adjuncts such as endoscopy. This study sought to characterize the role of endoscopy in management of acute UGI bleeding.Materials and MethodsThis is a prospective observational analysis of adults presenting with an UGI bleed to a tertiary center in Lilongwe, Malawi, over two years. Patients were classified as having no endoscopy, diagnostic endoscopy, or endoscopy with variceal banding. Bivariate, survival analysis, and logistic regression analyses were used to compare intervention cohorts.Results293 patients were included with 49 patients (16.7%) receiving endoscopy with banding, 65 (22.2%) patients receiving diagnostic endoscopy only, and 179 (61.1%) receiving no endoscopy. Upon survival analysis comparing to the no endoscopy group, cox hazard modelling showed an adjusted hazard ratio over 30 days of 0.12 (95% CI 0.02, 0.88, p=0.038) for the endoscopic banding group and a hazard ratio of 0.39 (95% CI 0.13, 1.16, p=0.090) for the diagnostic endoscopy only group. Physical exam findings consistent with cirrhosis and decreasing age were independent predictors of an endoscopic diagnosis of variceal bleeding.ConclusionEsophagogastric varices are a common cause of UGI bleeding in sub-Saharan Africa and can be predicted with age and physical exam findings. Endoscopy with variceal banding has a survival benefit for patients presenting with acute UGI bleed even with relatively low utilization. Appropriately triaging patients with likely variceal bleeding and improving endoscopy capacity would likely have a significant impact on mortality.

Pediatric non-cirrhotic portal fibrosis: role of endoscopic management in determining long-term outcome.

Non-cirrhotic portal fibrosis (NCPF) is a rare cause of pediatric portal hypertension. There is abundant literature in adults but paucity of data in children. We aimed to evaluate and compare the endoscopic and long-term outcomes of children with NCPF. Consecutive children (≤ 18years) diagnosed with NCPF evaluated for clinical and endoscopic profile and outcome. The cohort underwent 3weekly endoscopic sessions until esophageal variceal eradication followed by 6-12monthly endoscopic surveillance. Non-bleeders and bleeders were compared for endoscopic outcome. Forty-five NCPF children with median age of 14.5 (6-18) years and symptom duration 12 (1-120) months presented with spleen-related issues (78%), esophageal varices (96%), primary gastric varices (56%), and portal hypertensive gastropathy (89%). Thirty-three patients undergoing endotherapy (secondary prophylaxis n = 22, primary prophylaxis n = 11) showed primary eradication of varices after 5 (2-12) sessions. 36% showed recurrence of esophageal varices in 11 (6-42) months and secondary gastric varices developed in 12%. Overall 87% patients required endoscopic intervention at onset or follow-up. Poor outcome was observed in ten patients (n = 9 bleeders). Three children died of variceal bleeding before endoscopic eradication of esophageal varices. Three developed decompensation after a median follow-up of 48 (3-120) months and referred for liver transplantation. Four patients required surgery for portal hypertension. Overall, endoscopic outcome of NCPF is favorable. One-third patients have recurrence of esophageal varices. Small proportion of bleeders have poor outcome.

The role of endoscopic management of choanal adenoid in adult with persistent nasal symptoms

The role of endoscopic management of choanal adenoid in adult with persistent nasal symptoms

Neuro-Endoscopic Management of Multiloculated Hydrocephalus

OBJECTIVE: The aim of this study is to evaluate the role of endoscopy in management of multiloculated hydrocephalus. PATIENTS AND METHODS: We reviewed 30 consecutive patients during the period from January 2012 to December 2015 with multiloculated hydrocephalus who underwent neuroendoscopic approach for treatment, in Sohag university Hospital. The patients’ clinical outcomes, and complications were reported. RESULTS: There were 30patients (12male18 female).endoscopic septum pellucidum fenestration was done in 9 cases and endoscopic ventricular septal fenestration was done in 21 cases; The success rate was achieved in 25 cases (83.3%). The remaining 5 cases (16.7%) needed a re-do the procedure due to the presence of residual compartments not opened and not drained by the existing shunts, no immediate or late postoperative complications and there was no mortality. CONCLUSION:Neuroendoscopic management for multiloculated hydrocephalus can restore communication between isolated intraventricular compartments transforming them into single cavity and one intraventricular catheter can be used , reduce the number of surgical procedures, and improving the quality of life of the patient

Changing pattern of laparoscopic internal drainage of pancreatic pseudocyst in the era of endoscopy: Experience from a tertiary centre in South India

Background: Management of symptomatic pancreatic pseudocyst (PPC) underwent major changes from open to laparoscopic and then to endoscopic internal drainage. PPC which are amenable for cystogastrostomy are being managed in increasing numbers by endoscopic methods and those in other locations are still managed by surgical methods mainly by jejunal drainage. Methods: Patients who underwent laparoscopic internal drainage for PPC at our centre from May 2007 until August 2015 were analysed from a prospectively maintained data base. Results: There were 56 patients (50 males and 6 females), average age of 41 years and associated co-morbidity in 28.5%. Alcohol pancreatitis was seen in 20 cases (35.7%), biliary pancreatitis in 16 cases (28.5%), 1 case each of auto immune pancreatitis, traumatic and post ERCP induced pancreatitis. Laparoscopic cystogastrostomy (LCG) was done in 42 cases (75%), laparoscopic cystojejunostomy (LCJ) in 14 cases (25%).The mean operating time was 140 minutes. Mean hospital stay was 6.5 days. Two patients in LCG were re-operated for stomal bleeding and leak from gastrostomy wound. We had no mortality and nil recurrence. During this period, we had 14 cases of PPC done by Endoscopic CG which were excluded from this study. In our previous series, between 1994–2006, of the total 108 cases, LCG was done in 90 cases (83.4%) and LCJ was done in 8 cases (7.4%). Conclusion: Our experience in two different time period shows that there is increasing proportion of LCJ being done compared to LCG due to growing role of endoscopy in management of PPC.

Role of endoscopy in management of gastrointestinal complications of portal hypertension.

The management of patients with gastrointestinal complications of portal hypertension is often complex and challenging. The endoscopy plays an important role in the management of these patients. The role of endoscopy is both diagnostic and interventional and in the last years the techniques have undergone a rapid expansion with the advent of different and novel endoscopic modalities, with consequent improvement of investigation and treatment of these patients. The choice of best therapeutic strategy depends on many factors: baseline disease, patient's clinical performance and the timing when it is done if in emergency or a prophylactic approaches. In this review we evaluate the endoscopic management of patients with the gastrointestinal complications of portal hypertension.

Hypopharyngeal diverticulum after cervical spine surgery; The role of endoscopic management

PurposeThe purpose of this study was to assess the role of minimally invasive endoscopic diverticulostomy in patients who develop hypopharyngeal diverticulum after cervical spine surgery/fixation. Materials and methodsThis is a retrospective case series of seven patients who underwent endoscopic management of a symptomatic hypopharyngeal diverticulum. The patients were analyzed for diverticulum size, pre-operative and post-operative dysphagia and regurgitation scores, and complications. The overall success with the endoscopic approach was compared to the prior experience with traditional Zenker's diverticulum. ResultsOf the seven patients with hypopharyngeal diverticulum, four were successfully managed with minimally invasive endoscopic diverticulostomy (57%). These four patients all demonstrated clinically significant improvement in both dysphagia and regurgitation scores at a minimum of 6months postoperatively. Complications were minimal and consisted of one case with postoperative subcutaneous air. There were no cases of fistula, mediastinitis, or nerve injury. ConclusionsMinimally invasive endoscopic diverticulotomy can be successfully applied to patients who develop hypopharyngeal diverticulum after cervical spine surgery/fixation.

Is There a Role for Endoscopic Therapy as a Definitive Treatment for Post-Laparoscopic Bile Duct Injuries?

Excellent results of surgical reconstruction of major bile duct injuries (BDIs) have been well-documented. Reports of successful definitive management of central bile duct leakage and stenoses have been reported infrequently. The aim of this study was to assess treatment and outcomes for operative and endoscopic treatment of BDI after laparoscopic cholecystectomy (LC) and define the role of endoscopy in management. All patients undergoing treatment for post-laparoscopic BDI from 1998 to 2007 at Mayo Clinic, Rochester, Minnesota were reviewed. Outcomes of surgical and endoscopic intervention were analyzed. BDI was identified in 159 patients (mean age 51 years). Injury was recognized intraoperatively in 39 (25%) patients. Primary intervention was surgical in 59 (37%) and endoscopic in 100 (63%) patients. Class A BDIs (n = 77) were successfully treated endoscopically in 76 (99%) patients. Seven had class D BDIs; 4 were managed surgically, and 3 endoscopically. Of 66 patients with E1 to E4 BDI, 44 (67%) were initially managed surgically and 22 (33%) endoscopically. Thirteen of the latter 22 underwent sustained endoscopic therapy (median stent time 7 months), which was successful in 10 (77%). Four patients with E5 were managed surgically. Median follow-up was 45 months. Sixty-three patients underwent Roux-en-Y hepaticojejunostomy reconstruction at Mayo; 3 (5%) failed and required stenting. None required operative revision. Endoscopic management of class A BDI has excellent outcomes. Although surgical management remains the preferred therapy, short-term endoscopic treatment for class E1 to E4 can optimize the patient and operative field for reconstruction. Prolonged stenting in select patients with E1 to E4 characterized by stenosis is successful in the majority.

Biliary complications after orthotopic liver transplantation (OLT): the role of endoscopic management

Biliary complications after orthotopic liver transplantation (OLT): the role of endoscopic management

Biliary complications after orthotopic liver transplantation (OLT): the role of endoscopic management

Biliary complications after orthotopic liver transplantation (OLT): the role of endoscopic management

Frontiers of Biliary Endoscopy

The value of endoscopic retrograde cholangiography has been expanded recently by attention to technical detail and new methods for tissue diagnosis. Diagnostic information has been complemented by the new techniques of peroral choledochoscopy and endoscopic ultrasonography. The indications for endoscopic management of bile duct stones have become clearer, especially in patients with the gallbladder in situ. Techniques for distintegration and removal of large stones have improved. In patients with benign and malignant strictures recent emphasis has focused on the role of endoscopic management when compared with percutaneous and surgical approaches. Expandable metal stents are an interesting new option. The latest frontier is the gallbladder, which can now be reached with endoscopic catheters, and even directly with choledochoscopes through the papilla.