Success Rate Of Endoscopic Management Research Articles

Long-term follow-up of a cohort with post sleeve gastrectomy leaks: results of endoscopic treatment and salvage surgery.

Laparoscopic sleeve gastrectomy (LSG) is the most performed bariatric procedure worldwide. The most challenging postoperative complication is gastric leak. The objectives of this study are to examine the efficacy and morbidity of different therapeutic strategies addressing leakage, and the long-term outcomes of a cohort of LSG leaks. A retrospective review of patients treated for LSG leaks between September 2014 and January 2023 at our high-volume bariatric surgery center was performed. The charts of 37 patients (29 women and 8 men) were reviewed, with a mean age of 43years and a median follow-up of 24months. The mean preoperative body mass index was 45.1kg/m2. Overall, 30/37 (81%) patients were successfully treated with endoscopic management, and 7/37 (19%) ultimately underwent salvage surgery. If the leak was diagnosed earlier than 6weeks, endoscopic treatment had a 97% success rate. The median number of endoscopic procedures was 2 per patient, and included internal pigtails, stents, septoplasty, endoluminal vacuum therapy and over-the-scope clips. Complications included stent-related ulcers (10), esophageal stenosis requiring endoscopic dilatations (4), stent migrations (2) and kinking requiring repositioning (1), and internal pigtail migration (3). Revisional surgery consisted of proximal gastrectomy and Roux-en-Y esophago-jejunal anastomosis, Roux-en-Y fistulo-jejunostomy or classic Roux-en-Y gastric bypass proximal to the gastric stricture. In 62% of the cases, the axis/caliber of the LSG was abnormal. Beyond 4 attempts, endoscopy was unsuccessful. The success rate of endoscopic management dropped to 25% when treatment was initiated more than 45days after the index surgery. Purely endoscopic management was successful in 81% of cases; with 97% success rate if diagnosis earlier than 6weeks. After four failed endoscopic procedures, a surgical approach should be considered. Delayed diagnosis appears to be a significant risk factor for failure of endoscopic treatment.

Risk Factors for Failure of Endoscopic Management of Stone-related Ureteral Strictures.

To investigate factors determining the outcomes of endoscopic management for stone-related ureteral stricture. Data of patients who underwent endoscopic surgery for ureteral stricture due to stones from January 2016 to April 2020 were retrospectively analyzed. We compared cases successfully treated with endoscopic surgery with cases that resulted in failure. We focused on factors associated with treatment success, including cause and length of stricture, methods of stricture treatment, surgical time, and duration of hydronephrosis before the treatment. Treatment success was defined as improvement in hydronephrosis status. Nineteen patients were treated for stone-related ureteral stricture. Hydronephrosis was successfully improved in 12 patients (63.2%). Seven patients with failed endoscopic management had ureteroscopic lithotripsy- related stricture, whereas 3/12 (25.0%) patients with ureteroscopic lithotripsy-related stricture and 7/12 (58.3%) patients with impacted stone-related stricture were successfully treated by endoscopic management (P = .004). The prevalence of stricture length > 15 mm was significantly higher in the patients with failed management than in the patients with successful management (71.4 vs 16.6%, P = .046). Intraoperative endoscopic observation demonstrated that the mucosa of the ureteroscopic lithotripsy-related stricture had ischemic appearance with relatively long stricture length (P = 0.13) compared to the impacted stone-related stricture. No association was observed between treatment outcome and method of endoscopic management, including laser incision, balloon dilation, or both. Ureteroscopic lithotripsy as a cause and stricture length > 15 mm could affect the success rate of endoscopic management of ureteral stricture. In such cases, reconstructive management should probably be considered in the early stages.

Bladder neck and urethral erosions after Macroplastique injections

To evaluate the presentation, risk factors, diagnostic workup, management, and outcomes of Macroplastique (MPQ) erosions. We performed a retrospective chart review of women experiencing MPQ erosion at two tertiary care centers (United States and United Kingdom). Data collected included age, presenting symptoms, parity, comorbidities, hormone replacement therapy, sexual activity, and smoking status. Previous surgical history, time from MPQ injection, urine culture results, and cystoscopic and imaging findings were also reviewed. Development of stress urinary incontinence (SUI) after MPQ removal and subsequent SUI treatments were recorded. From 2012 to 2018, 18 patients were identified with a median follow-up time of 24 months (interquartile range [IQR] 8-33). All patients presented with recurrent urinary tract infections (rUTI) and had cystoscopic evidence of MPQ erosion. The most common location of erosion was the bladder neck area (72%). Median time to presentation since MPQ injection was 14 months (IQR 11-35). The majority of patients (72%) had a previous history of anti-incontinence surgery. The overall success rate of endoscopic management defined as resolution of presenting symptoms including rUTI was 80%. The majority of patients (80%) developed recurrent SUI following MPQ resection with 33% requiring a subsequent autologous fascial sling placement. MPQ erosions present predominantly with UTI, sometimes years after the original injection, and may necessitate endoscopic management with satisfactory results in most patients. Following excision of MPQ, these patients are highly likely to experience SUI recurrence and need to be appropriately counseled. Some may require additional subsequent autologous fascial sling placement for treatment of their SUI symptoms.

Role of ERCP in Diagnosis and Treatment of Type I Mirizzi Syndrome: A Case Series with Review of Literature

Background/aim: Mirizzi syndrome is a rare condition complicating long-standing gallstones disease. The aim of this study is to define, through a 17 year-experience, the role of Endoscopic Retrograde Cholangiopancreatography in the diagnosis and the treatment of Mirizzi syndrome type I according to Csendes classification. Materials and Methods: A retrospective study including patients diagnosed with Mirizzi syndrome type I, between 2002 and 2019 was conducted in the department of digestive endoscopy of our university hospital. Data collected included demographic, clinical, biological and imaging findings. Endoscopic characteristics and procedures used for treatment were collected. Statistical analysis was performed using SPSS 20.0. Results: Type I Mirizzi syndrome was diagnosed during ERCP in 0,48% of patients with gallstone disease, the median age was 55.5 (46-69.5) without gender difference. 50% of our cases were diagnosed before surgery. Endoscopic therapeutic procedures included biliary decompression techniques using nasal bile drainage or plastic stents, balloon sweeping after selective catheterization of cystic duct and large balloon papillary dilation with double cannulation. The success rate of endoscopic management was 66,6%. Surgical treatment was performed at the same time as laparoscopic cholecystectomy in patients with lithiasic gall bladder. Conclusions: Mirizzi syndrome remains a fascinating and rare condition complicating gallstone disease with no uniform guidelines to date. Our study emphasizes the role of ERCP as a diagnostic and therapeutic procedure in the management of type I Mirizzi syndrome.

The Morbidity of Ureteral Strictures in Patients with Prior Ureteroscopic Stone Surgery: Multi-Institutional Outcomes.

Nephrolithiasis is an increasingly common ailment in the United States. Ureteroscopic management has supplanted shockwave lithotripsy as the most common treatment of upper tract stone disease. Ureteral stricture is a rare but serious complication of stone disease and its management. The impact of new technologies and more widespread ureteroscopic management on stricture rates is unknown. We describe our experience in managing strictures incurred following ureteroscopy for upper tract stone disease. Records for patients managed at four tertiary care centers between December 2006 and October 2015 with the diagnosis of ureteral stricture following ureteroscopy for upper tract stone disease were retrospectively reviewed. Study outcomes included number and type (endoscopic, reconstructive, or nephrectomy) of procedures required to manage stricture. Thirty-eight patients with 40 ureteral strictures following URS for upper tract stone disease were identified. Thirty-five percent of patients had hydronephrosis or known stone impaction at the time of initial URS, and 20% of cases had known ureteral perforation at the time of initial URS. After stricture diagnosis, the mean number of procedures requiring sedation or general anesthesia performed for stricture management was 3.3 ± 1.8 (range 1-10). Eleven strictures (27.5%) were successfully managed with endoscopic techniques alone, 37.5% underwent reconstruction, 10% had a chronic stent/nephrostomy, and 10 (25%) required nephrectomy. The surgical morbidity of ureteral strictures incurred following ureteroscopy for stone disease can be severe, with a low success rate of endoscopic management and a high procedural burden that may lead to nephrectomy. Further studies that assess specific technical risk factors for ureteral stricture following URS are needed.

The outcomes of endoscopic management in young children with subglottic stenosis

Subglottic stenosis (SGS) is a common cause of obstructed airway in children, and the treatment of pediatric SGS, especially congenital SGS, remains a challenge for the otolaryngologist. ObjectiveTo analyze the outcomes of endoscopic management in young children with SGS. MethodsWe performed a retrospective review of treatment with endoscopic balloon dilation (EBD) or EBD combined with endoscopic anterior cricoid split (EACS) for young SGS children, from December 2008 to December 2015. The ages of patients ranged from 2 days to 12 years, median age was 5 months. The grade of them ranged from II to IV. ResultsFor acute acquired SGS, 19 cases received EBD alone and the other 3 cases received EBD and EACS, the success rate was about 95.5%; For chronic acquired SGS, EBD and EACS was performed in 6 patients with a success rate of 66.7%; For congenital SGS, EBD and EACS was performed in 28 patients with a success rate of 85.7%. Overall, the success rate of endoscopic management in 56 young children was about 87.5%. Besides, No procedure-related complications were observed in any patients. ConclusionsEndoscopic surgical technique offers a safe and effective approach for treatment of young children with SGS, especially in congenital SGS.

An Update on Endoscopic Management of Post-Liver Transplant Biliary Complications.

Biliary complications are the most common post-liver transplant (LT) complications with an incidence of 15%–45%. Furthermore, such complications are reported more frequently in patients who undergo a living-donor LT compared to a deceased-donor LT. Most post-LT biliary complications involve biliary strictures, bile leakage, and biliary stones, although many rarer events, such as hemobilia and foreign bodies, contribute to a long list of related conditions. Endoscopic treatment of post-LT biliary complications has evolved rapidly, with new and effective tools improving both outcomes and success rates; in fact, the latter now consistently reach up to 80%. In this regard, conventional endoscopic retrograde cholangiopancreatography remains the preferred initial treatment. However, percutaneous transhepatic cholangioscopy is now central to the management of endoscopy-resistant cases involving complex hilar or multiple strictures with associated stones. Many additional endoscopic tools and techniques—such as the rendezvous method, magnetic compression anastomosis , and peroral cholangioscopy—combined with modified biliary stents have significantly improved the success rate of endoscopic management. Here, we review the current status of endoscopic treatment of post-LT biliary complications and discuss conventional as well as the aforementioned new tools and techniques.

EUS-Guided Interventions for Walled-off Pancreatic Necrosis

In recent years, evidence suggests that a minimally invasive step-up approach is superior to conventional open necrosectomy, with decreased rates of the composite end point of major complications or death among patients with necrotizing pancreatitis and walled-off necrosis (WON). Since first described in 1992, EUS-guided transluminal drainage for pancreatic fluid collection has played a pivotal role and spread worldwide as a minimally invasive alternative to surgical and percutaneous drainage with reportedly high technical and clinical success rates. However, the clinical response rate of the conventional single transluminal gateway technique with single stenting for treating WON is not satisfactory (described as 45%–63%). Recently, various techniques, such as the use of wide-caliber lumen-apposing metal stents, multiple transluminal gateway technique and direct endoscopic necrosectomy have improved the clinical success rate of endoscopic management of WON. When conventional EUS fails to depict the WON reflecting solid necrotic components, contrast-enhanced EUS may be useful to clearly visualize target lesions and to decisively puncture them. We evaluated the clinical outcomes of the algorithmic step-up approach based on EUS-guided drainage for WON. The result shows the step-up approach based on EUS-guided drainage is an effective strategy for the management of WON, particularly in patients with serious comorbid conditions or in those with WON cavity extending to the pelvis, who are difficult to manage with endoscopy alone. More options, such as surgical necrosectomy should be considered. In conclusion, EUS-guided intervention has become an essential treatment method of WON. The development of new dedicated devices for EUS-guided drainage would help make it a more sophisticated and promising procedure.

Systematic Review of Endoscopic Obliteration Techniques for Managing Congenital Piriform Fossa Sinus Tracts in Children.

Piriform fossa sinus tracts (PFSTs) are a recognized cause of recurrent deep neck infections in the pediatric population. Conventional management has historically required open resection, but over recent years minimally invasive endoscopic approaches to obliterate the pharyngeal opening of the sinus have been performed in many centers. However, there is a lack of clear evidence regarding the success rate and safety of these approaches. To determine the success rate of endoscopic management of PFST through a systematic review of the existing literature. MEDLINE (1964-2014) and bibliographies of identified papers. Two authors independently reviewed 170 abstracts and identified relevant studies for full-text review. Data were independently extracted from those studies, and the Oxford Centre for Evidence-Based Medicine guidelines were used to classify the level of evidence. Thirteen studies met the inclusion criteria, comprising a total of 84 patients. All included studies were evidence level 4 (case series). Various methods of obliterating the PFST were described: electrocautery (n = 39), laser (n = 19), trichloroacetic acid (n = 19), silver nitrate (n = 4), combination of silver nitrate and laser (n = 2), and fibrin glue (n = 1). The success rate for endoscopic management of PFST was 89.3% overall (90.5% in primary cases and 85.7% in revision cases). The only adverse event reported was temporary vocal cord immobility in 2.4% (n = 2) of cases. Endoscopic management of pediatric PFST appears to be safe and effective, as a primary option and for revision after open surgery.

Use of transanastomotic double-pigtail stents in the management of grade B colorectal leakage: a pilot feasibility study.

Anastomotic leakage (AL) is a major complication of colorectal surgery. The leakage is classified as grade B when the patient's clinical condition requires an active therapeutic intervention but does not require further surgery. The management of grade B AL commonly includes administration of antibiotics and/or the placement of a pelvic drainage performed under radiological guidance or transanal drain. The objective of this study was to evaluate the feasibility and the efficacy of endoscopic transanastomotic drainage using double-pigtail stents (DPSs) in the management of grade B AL in colorectal surgery. Between September 2011 and December 2014, 650 patients underwent a colorectal procedure in our university hospital; 8.7% presented with AL, including 42.8% with grade B. Fourteen patients required endoscopic management and constituted the study population. The study's primary objective was to assess the feasibility and efficacy of DPS placement for the treatment of grade B AL after colorectal surgery. The secondary endpoints were the requirement for radiological drainage, the DPS placement failure rate, the rate of stoma closure and, lastly, feasibility of chemotherapy (if indicated). DPS placement was feasible in 92.8% of the 14 patients (n=13). The overall success rate for endoscopic management was 78.5% (n=11). The median length of hospitalization after DPS placement was 5days (3-17). The average duration of drainage through a DPS was 62days (28-181). Five patients (35.7%) also underwent drainage with radiological guidance. Of the 10 patients with stoma, closure occurred in 80%. All patients that required adjuvant chemotherapy were able to receive it. The treatment of AL requires multidisciplinary collaboration to save the anastomosis. DPS placement under endoscopic control is associated with AL healing, good clinical tolerance and the ability to undergo chemotherapy and is an alternative to repeat laparotomy when radiological drainage is unfeasible or inefficient.

Simultaneous stenting in bile duct and duodenum under endoscope for treatment of malignant biliary and duodenal obstruction

Objective To investigate the therapeutic strategies,methods,safety and efficacy of simultaneous placement of self-expanding metallic stent(SEMS) in the bile duct and duodenum under endoscope for treatment of malignant biliary and duodenal obstruction. MethodsThe clinical data of patients with obstructive jaundice combined with severe duodenal stricture,who were treated with simultaneous placement of biliary SEMS and duodental SEMS under endoscope during January 2009 to June 2012,were retrospectively analyzed.The success rate of endoscopic management,complications,relief of jaundice and results of gastric outlet obstruction scoring system(GOOSS) were analyzed. ResultsTotally ten patients meeting the criteria were analyzed in this study.The patients included 5 cases with pancreatic cancer,2 with gallbladder cancer,2 with cancer of bile duct and one with duodenal papilla caner.Five patients with type Ⅰ duodenal stricture (without invading duodenal papilla) successfully received biliary stents through endoscopic retrograde cholangiopancreatography(ERCP) after placement of duodenal stents. One patient with type Ⅰ duodenal stricture was implanted with a 9 cm duodenal stent before endoscopic anterograde cholangiopancreatography(EACP),then a SEMS was implanted in the bile duct through endoscopic ultrasonography-guided biliary drainage(EUS-BD).Three patients with type Ⅱ duodenal stricture(with invading duodenal papilla) underwent EACP and biliary stent placement through EUS-BD,and then the duodenal stent was deployed in duodenum after EACP. The patient with type Ⅲ(away from the duodenal papilla) was implanted with biliary and duodenal stents.The success rate of endoscopic management was 100%.Two patients had self-controlled bleeding of intestinal mucosa,which was caused by endoscope friction when passing through the duodenal stricture,but without any continuous bleeding or perforation.Symptoms of jaundice and gastric outlet obstruction were greatly relieved after treatment. ConclusionFor patients with unresectable malignant biliary obstruction combined with duodenal stricture,endoscopic placement of SEMS in the bile duct and duodenum simultaneously is a safe and effective method to palliate dual malignant obstruction via different endoscopic managements.

Endoscopic Management of Urologic Complications Following Renal Transplantation: Impact of Ureteral Anastomosis

Objective To evaluate the success of ureteral stent placement to treat or prepare for surgical treatment of urologic complications after renal transplantation, according to a type of ureteral anastomosis. Patient and methods From May 1989 to December 2006, we performed 703 kidney transplantations including 412 extravesical ureteroneocystostomy (according to Lich-Gregoire technique) and 265 transvesical ureteroneocystostomy (according to Politano-Leadbetter technique). We retrospectively analyzed our endoscopic management of urinary leaks and ureteral strictures. The criteria of success were the feasibility to place a ureteral stent, permitting good drainage of the upper renal graft tract before further endoscopic or surgical treatment. Results Forty-three urinary leaks or ureteral strictures occurred after extravesical ureteroneocystostomy ( n = 21) or after Politano-Leadbetter anastomosis ( n = 22). The success rate of endoscopic management was 75% ( n = 16) for Politano-Leadbetter anastomosis versus 53% ( n = 11) for the Lich-Gregoire anastomosis. There was no statistical difference ( P = .1). Conclusion Ureteroneocystostomy according to Lich-Gregoire procedure were twice less complicated than those according to the Politano-Leadbetter technique, but were associated with a rate of failure of ureteral stent placement in urgency higher to 25%.

Acute cholangiopancreatic diseases with situs inversus totalis treated with endoscopic sphincterotomy: Report of two cases

Acute cholangiopancreatic diseases with situs inversus totalis treated with endoscopic sphincterotomy: Report of two cases

Erratum

TO THE EDITOR: We appreciate recent correspondence from Dr. Tada et al. (the Kyoto group) regarding our recent article on endoscopic management of biliary complications after living donor liver transplantation (LDLT). Our initial success rate of endoscopic management of biliary strictures after LDLT (71%, 12 of 17 patients) seems to be comparable to that by the Kyoto group (68%, 54 of 80 patients) (1). As stated in their correspondence, however, there is a considerable difference in the strategy for endoscopic management of biliary strictures between the two institutions.

Endoscopic Techniques and Management of Foreign Body Ingestion and Food Bolus Impaction in the Upper Gastrointestinal Tract: A Retrospective Analysis of 139 Cases

Ingested foreign bodies and food bolus impaction are frequently seen in endoscopic practice. Successful foreign body and food bolus removal may depend on the method used, the choice of device, and the experience level of the endoscopist, although few papers report experience and outcome of tertiary centers. To investigate the effectiveness of our protocol designed for removal of ingested foreign bodies and food boluses. We retrospectively reviewed all patients with a diagnosis of foreign body ingestion and food bolus impaction from 1994 to 2005 identified by computer search. Patients were excluded if medical record was incomplete. The analysis included 171 patients. Foreign bodies and impacted food boluses were found in 77 and 62 patients, respectively. In 32 cases (23%), the foreign bodies passed spontaneously through the gastrointestinal tract. The overall success rate for endoscopic management was obtained in 137 patients (98.6%). Surgical removal of a foreign body was required in only 2 cases (1.4%). According to the type and location of the foreign object and food bolus we used Dormia baskets, retrieval forceps, polypectomy snares, and all sizes of Roth net. No complications relating to the endoscopic procedure were observed; 50 patients (35.2%) had an underlying esophageal disease. Endoscopic removal of upper gastrointestinal tract foreign bodies and food bolus impaction is efficacious and safe. Especially the Roth net is the best device for safe retrieval of food boluses and button disc batteries.

Management of foreign bodies in the gastrointestinal tract: an analysis of 104 cases in children.

Ingested foreign bodies may be managed by endoscopy, observation, or surgery. The aim of the study was to investigate the methods of removal of foreign bodies according to type and location, success rates, and complications. The charts of 104 children who had ingested foreign bodies were retrospectively reviewed. Of the patients, 80 (76.9%) were managed endoscopically. The overall success rate for endoscopic management was 98.8%. There were no complications during endoscopic interventions. In 23 cases the foreign bodies spontaneously passed through the gastrointestinal tract (22.1%). Surgical removal of a foreign body was done in only one case (0.96%). The majority of the foreign bodies which were located in the upper gastrointestinal tract could be removed endoscopically regardless of the nature of the material. Foreign bodies in the small and large intestine tended to pass through spontaneously without complications. It appears that the endoscopic approach is the preferable method for the extraction of upper gastrointestinal foreign bodies in child patients because of its high success rate, and that foreign bodies in the small and large intestine tend to be passed spontaneously without complications.

A prospective assessment of results for needle-knife papillotomy and standard endoscopic sphincterotomy

Results from studies evaluating needle-knife papillotomy are conflicting. The aim of this prospective trial was to assess the safety and efficacy of needle-knife papillotomy and compare the results with those of standard endoscopic sphincterotomy. During a period of 6 years, ERCP was performed 1680 times. Four hundred fifty-six patients had biliary obstruction and were candidates for endoscopic sphincterotomy. Cholangiography was successful in 414 subjects (91%). These individuals underwent endoscopic sphincterotomy, which was successful in 395; overall success rate for endoscopic sphincterotomy was 87% (395 of 456). Forty complications occurred (9.7%), but only 21 (5.1 %) were serious. No procedure-related mortality occurred. Fifty-two of 456 patients (11%) were managed by needle-knife papillotomy. In 42 of these subjects, cholangiograms had failed or were incomplete, and endoscopic sphincterotomy was not attempted; in 10 individuals endoscopic sphincterotomy had failed. Needle-knife papillotomy was successful in 47 of 52 patients (90%). Three complications occurred (5.7%), only 2 of which (3.8%) were serious. Morbidity rates for needle-knife papillotomy and endoscopic sphincterotomy were not significantly different. No procedure-related mortality occurred. Needle-knife papillotomy increased the overall success rate for endoscopic management with sphincterotomy from 87% (success rate for endoscopic sphincterotomy alone) to 97% (success rate for endoscopic sphincterotomy and needle-knife papillotomy). These results show that (1) only a small proportion of obstructed patients (11%) require treatment with the needle knife; (2) the needle knife can be used to achieve biliary access in most patients (90%) when endoscopic sphincterotomy fails or is not possible; (3) needle-knife papillotomy can improve the overall success rate for endoscopic management with sphincterotomy by approximately 10%; (4) needle-knife papillotomy can be performed with a morbidity and mortality rate equivalent to that of endoscopic sphincterotomy; (5) needle-knife papillotomy is safe and effective, but its use should be reserved for obstructed patients who require endoscopic therapeutic intervention. (Gastrointest Endosc 1995;41:25-32.)