Endoscopic Therapeutic Interventions Research Articles

Efficacy and Safety of Endoscopic Through-the-Scope Suture System for Gastrointestinal Defects: A Systematic Review and Meta-analysis.

Recently, a through-the-scope suturing (TTSS) system has received FDA approval and has been evaluated for closing mucosal defects postintervention. We hereby performed a systematic review and pooled meta-analysis of available studies to assess the safety and efficacy of this intervention. We queried the following databases through April 26, 2023: Embase, MEDLINE, Cochrane Central Register of Controlled Trials, and Web of Science Core Collection. Endoscopists utilizing TTSS for the following reasons were included: endoscopic mucosal resection, endoscopic submucosal dissection, peroral endoscopic myotomy, perforation, fistula closure, and/or stent fixation. The outcomes assessed were technical success, primary clinical success (closure of defect without additional intervention), and overall clinical success (closure of defect with/without additional intervention). Random effects model with the DerSimonian Laird approach was used to report event rates expressed as proportions with a 95% CI. A total of 12 studies with 512 patients (mean age of 61.5 ± 18.4y, 54.6% females) were included. The technical success rate was 96.0% (CI: 94.3%-97.7%). The primary clinical success rate was 74.8% (CI: 65.5%-84.1%). The overall clinical success rate was 95.4% (CI: 92.6-98.2%). Only 1 mortality case unrelated to intervention was reported. The TTSS appears safe and effective for closing mucosal defects after therapeutic endoscopic interventions. Further cost-effective studies should be performed comparing with endoclips for use in clinical settings.

Endoscopic diagnosis and treatment of primary multiple noninvasive malignant neoplasms of the stomach: clinical case

This clinical case describes a rare combination of early stage cancer and sporadic neuroendocrine tumor in stomach. The patient 57 years old admitted to P. A. Hertsen Moscow Oncology Research Institute for diagnostics and treatment for the gastric adenoma. Upper GI endoscopy performed in P. A. Hertsen Institute, detected two tumors: a sporadic neuroendocrine tumor in the middle part of the body stomach and early cancer in the antrum. With NBI (Narrow-Band Imaging), signs of malignancy were found in both tumors. А plan for therapeutic and diagnostic endoscopic surgical interventions was implemented: two sequential endoscopic submucosal dissection (ESD). This treatment confirmed as radical, according to the results of the pathological examination.

Outcomes and Predictors of Delayed Intervention After Renal Trauma.

Historically, a zone II hematoma mandated exploration after penetrating trauma, but this has been challenged given potentially higher nephrectomy rates and the advent of therapeutic endovascular and endoscopic interventions. We hypothesized penetrating mechanism was not a predictor for delayed intervention in the modern era. This single-center, retrospective study included renal trauma patients from 3/2019 to 6/2022. Our institutional practice is selective exploration of zone II hematomas for active bleeding and expanding hematoma only, regardless of mechanism. Descriptive statistics and multivariable logistic regression (MLR) were performed. One-hundred and forty-four patients were identified, with median age 32 years (IQR:23,49), 66% blunt mechanism, and injury severity score 17(IQR:11,26). Forty-three (30%) required operative intervention, and of the 20 that had a zone II exploration, 3 (15%) underwent renorrhaphy and 17 (85%) underwent nephrectomy. Penetrating patients more frequently underwent immediate operative intervention (67%vs10%,P < .0001), required nephrectomy (27%vs5%,P = .0003), and were less likely to undergo pre-intervention CT (51%vs96%,P < .0001) compared to blunt patients. Delayed renal interventions were higher in penetrating (33%vs13%,P = .004) with no difference in mortality or length of stay compared to blunt mechanism. Ureteral stent placement and renal embolization were the most common delayed interventions. On MLR, the only independent predictor for delayed intervention was need for initial operative intervention (OR 3.803;95%CI:1.612-8.975,P = .0023). Four (3%) required delayed nephrectomy, of which only one underwent initial operative intervention without zone 2 exploration. The most common delayed interventions after renal trauma were renal embolization and ureteral stent. Penetrating mechanism was not a predictor of delayed renal intervention in a trauma center that manages zone II retroperitoneal hematomas similarly regardless of mechanism.

Incidence and Management of Radiation Cystitis After Pelvic Radiotherapy for Prostate Cancer: Analysis From a National Database

ObjectivesTo determine the incidence of radiation cystitis on Prostate Cancer (PCa) patients undergoing pelvic radiotherapy (RT), evaluating the most used management strategies, and identifying potential risk factors associated with the development of this condition. MethodsA retrospective analysis was conducted using the PearlDiver™ Mariner database, containing patient records compiled between 2011 and 2022. International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) codes were employed to identify population and outcomes. We evaluated patients who underwent RT for PCa and subsequently developed radiation cystitis. Primary objective was to determine the overall incidence of radiation cystitis. Furthermore, we investigated its associated risk factors and management. ResultsA total of 274,865 PCa patients underwent RT during the study period. Of these, 48,713 (17.7%) experienced hematuria following RT, while 7,721 (2.8%) were diagnosed with radiation cystitis. After the diagnosis, 2,307 patients (29.9%) received diagnostic or therapeutic endoscopic interventions. Only 59 patients (0.76%) underwent endovascular embolization, while 151 patients (1.95%) required cystectomy. Hyperbaric oxygen therapy, administered to 1,287 patients (16.67%), was the only treatment that displayed a significant upward trend. Multivariate logistic regression identified obesity (OR 1.29; 95% C.I. 1.23 — 1.35), smoking (OR 1.27; 95% C.I. 1.22 — 1.33), and diabetes (OR 1.32; 95% C.I. 1.26 — 1.39), as significant risk factors for radiation cystitis (all p-values < 0.001). ConclusionsRadiation cystitis represents a rare complication after pelvic RT with significant clinical impact. Its incidence has remained stable throughout the study period. The identified risk factors corroborate the pathophysiology of radiation cystitis. Hyperbaric oxygen therapy was the only treatment to show an upward trend during the study period.

Collegial discussion of the formation of informed voluntary consent of the Association of Medical Experts on the Quality of Medical Care on complications and adverse events during diagnostic and therapeutic endoscopic interventions on the upper gastrointestinal tract

Informed voluntary consent (IVC) for endoscopic intervention is a medical and legal document, the purpose of which is to regulate the relationship between the patient, doctor and clinic. This is an information document that reveals the essence and risks for the patient of a specific endoscopic intervention. Such information and details of the risks associated with the provision of medical care should be a mandatory element of the IVC (Federal Law of 21.11.2011 No. 323-FZ "On the Fundamentals of Protecting the Health of Citizens in the Russian Federation"). The reason for organizing and holding a series of events under the auspices of the Association of Medical Experts in the Quality of Medical Care in order to form versions of "Informed Voluntary Consent ..." in the specialty of "endoscopy" that meet modern legal standards was their absence, as such. The result of these events was the creation of IVC in the main areas of endoscopy, including endoscopic interventions in the upper gastrointestinal tract. The principles of formation and filling of the IDS with standardized information related to the nature of diagnostic/therapeutic interventions in the upper gastrointestinal tract and their possible complications form the basis of this report.

Early Feeding Versus Delayed Feeding after Therapeutic Endoscopic Intervention in Upper GI Bleeding:

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Limitations and Success Ratio of ERCP in the Treatment of Obstructive Jaundice

Background: Obstructive jaundice can be instigated by benign or malignant lesions. These problems are treated with biliary decompression, which can be done either endoscopically or surgically. Aim: The aim of the study is to assess the advantages and limitations as well as the therapeutic and diagnostic benefits of ERCP in the treatment of obstructive jaundice. Methods: This cross-sectional study was held in the Departments of General Surgery, Liaquat University of Medical and Health Science, Jamshoro for one-year duration from January 2022 to December 2022. A total of 70 consecutive patients were included with purposive sampling and with the diagnosis of obstructive jaundice done with ERCP. Patients with prior diagnostic or therapeutic endoscopic intervention or gastric outlet obstruction or prior gastric surgery were excluded from this study. The results are summarized in a table and conclusions are made. Results: The study included 70 patients (45 males and 25 females) with mean age of 45 years (21-70 years). The most common malignant causes of obstructive jaundice are papillary carcinoma (8.6%), cholangiocarcinoma (17.1%) and pancreatic Carcinoma (27.1%). The most common benign cause was bile duct stone (30%), followed by round warm biliary tree (5.8%) and papillary stenosis (11.4%). 30(93.8%) of patients done with stenting with 92% of success rate. Biopsies were performed to diagnose 8.6% of papillary tumors. 45.7% of patients done with stenting with 93.8% of success rate. In the remaining cases, the success rate was 100%. the most common reason for not performing ERCP; duodenal stenosis in 2.9%, abnormal papillary position in 4.3%, complete papillary obstruction in 4.3% and ampulla was not found endoscopically in 7.1% of subjects. Acute pancreatitis was the most communal complication occurred in 5.7% of cases. Bleeding occurs in 4.3% of cases; 4.3% have acute cholangitis and perforation in 2.9%. Conclusions: In spite of its complications and limitations, ERCP is a reliable stenting procedure as a palliative and tissue diagnostic tool for blockage due to malignant tumor and in the treatment of obstructive jaundice and most benign diseases. In this study, the effectiveness of ERCP in the treatment of obstructive jaundice is satisfactory. Keywords: Cholangiocarcinoma, pancreatic carcinoma, ERCP, Obstructive jaundice, and Stenting.

A118 BALLOON-ASSISTED ENTEROSCOPY TIMING INCREASES DIAGNOSTIC YIELD IN PATIENTS WITH OVERT OBSCURE GASTROINTESTINAL BLEEDING: A RETROSPECTIVE STUDY

Abstract Background Obscure gastrointestinal bleeding (OGIB) is defined as bleeding from an unknown etiology despite initial investigations with upper endoscopy and colonoscopy, of which 75-80% is attributed to a small bowel (SB) source. OGIB poses a significant diagnostic and therapeutic challenge, resulting in high morbidity and mortality with increased utilization of health care resources. Balloon-assisted enteroscopy (BAE) is a useful procedure for the evaluation and management of small bowel bleeding, with reported diagnostic and therapeutic rates up to 87% and 80%, respectively. Purpose This retrospective study aims to evaluate the diagnostic and therapeutic yields in a large cohort of adult patients presenting with different subtypes of OGIB who have undergone BAE, as well as to assess for association between various patient and disease factors, and clinical outcomes. Method We performed a retrospective review of 1057 cases of BAE at a large quaternary referral centre between 2016 to 2021 and 158 OGIB cases were identified. Sex, age, and, preprocedural variables including indication, time from video capsule endoscopy (VCE) to BAE and subclassification of SB bleed were collected. Endoscopic modality, findings, and therapeutic interventions were used to calculate diagnostic and therapeutic yields. The association between the timing of BAE relative to VCE and clinical outcomes including rebleeding rate, diagnostics and therapeutic yields were assessed. Bleeding free-survival was estimated using Kaplan-Meier function. All data analyses were performed with SPSS. Result(s) The overall diagnostic yield of BAE was 74%. Patients with active overt bleeding were found to have a statistically significant higher yield compared to those with inactive overt bleeding (94% vs 67%, P= 0.03). The therapeutic yield was 51%, with a significantly higher rate of injection therapy and hemoclip placement in those with active overt bleeding compared to those with inactive overt and occult bleeding (P&amp;lt; 0.001). BAE performed within 72 hours of overt GI bleeding was found to have a statistically significant higher diagnostic yield when compared to procedures performed after 72 hours (94% vs 67%, p =0.05). Univariable analysis revealed higher diagnostic yield in patients requiring transfusion within the past 12 months (P= 0.02) Finally, rebleeding-free survival in all patients at 1 year and 5 years was 98% and 68%, respectively. Image Conclusion(s) Balloon-assisted enteroscopy continues to be an effective diagnostic and therapeutic modality for the investigation of obscure gastrointestinal bleeding. Our retrospective study shows a higher diagnostic yield in those presenting with active overt GI bleed as well as those who underwent BAE within 72 hours of overt GI bleeding. Furthermore, patients who required transfusion within the past 12 months are more likely to have a positive BAE finding. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared

The Majority of Patients Who Undergo ERCP When Large Duct Obstruction Is Evident on Liver Biopsy Have Biliary Findings Amenable to Endoscopic Intervention.

(1) Background: Abnormal liver function tests are commonly encountered in clinical practice, often leading to additional workup to determine the underlying etiology of these abnormal laboratory studies. As part of this evaluation, if less invasive imaging studies are performed and are without evidence of biliary obstruction, liver biopsy may be performed, and the finding of large duct obstruction on liver biopsy is commonly encountered. The utility of endoscopic retrograde cholangiopancreatography (ERCP) for evaluation and management of possible biliary obstruction in patients with large duct obstruction on liver biopsy has not been studied to date. (2) Methods: To assess the utility of ERCP in patients with large bile duct obstruction on liver biopsy, we retrospectively evaluated patients with large duct obstruction on liver biopsy from 2010-2019 at our tertiary care and transplant center. Demographic and clinical characteristics were evaluated for all patients, with sub-group analysis for patients who underwent ERCP and those who had intervenable findings at the time of ERCP. Descriptive statistics with proportions, means, and standard deviations were performed for demographics and clinical variables using absolute standardized difference. (3) Results: During the study period, 189 liver biopsies with evidence of large duct obstruction were performed. After exclusion criteria were applied, 166 unique patients were eligible for the study. Ninety-one patients with evidence of large duct obstruction on liver biopsy underwent ERCP and 75 did not. Of the 91 patients who underwent ERCP, 76 patients (84%) had an intervenable finding at ERCP. Patients who underwent ERCP were overall more likely to have had a liver transplant (65% ASD 0.63), have previously undergone cholecystectomy (80%, ASD 0.56), and be immunocompromised (80%, ASD 0.56). (4) Conclusions: ERCP is high yield when large duct obstruction is apparent on liver biopsy, with the majority of patients (84%) who undergo ERCP in this clinical context having a biliary finding necessitating therapeutic endoscopic intervention.

Endoluminal Suture-technique for the Stomach Closure of an Experimental Model.

In the modern minimally invasive era, diagnostic and therapeutic endoscopic interventions are one of the most emerging fields. For the new operational techniques, it is a major aim to develop reliable instruments, such as suturing devices for flexible endoscopes. The aim of this study was to assess the feasibility of a safe and reproducible suturing technique with an endoluminal suturing device. The evaluation of the technique was performed in twenty explanted special prepared porcine stomachs. Three different techniques were compared, single stitches, figure-of-eight, or Z-pattern and running sutures in terms of suturing time and bursting pressure. After verification of the reliability of the method, a 3 cm long full thickness incision on the stomach was closed with the endoscopic suturing device in four surviving animals. In our ex vivo studies, we have shown that the figure of 8 or Z- technique is the most optimal for stomach closure without considerable time-cost, thus this technique was chosen as the standard method for the in vivo study. The endoscopic stomach wall suturing was successful in all four cases, the postoperative period was uneventful and ended on the tenth postoperative day with autopsy. With the applied suturing device, the endoscopic suturing of the stomach is safe and reproducible, thus a human application may also be justified.

Evaluation of the Sheffield score, clinical characteristics, and the therapeutic approach in children with upper gastrointestinal system bleeding.

Unlike adults, there is no valid and reliable scoring system for upper gastrointestinal system bleeding (UGB) in children. The Sheffield scoring system, which is awaiting confirmation, is the single scoring system which can be predictive for children who require high-risk, endoscopic therapeutic intervention. The aim of this study was to evaluate the efficacy of the Sheffield scoring system, the clinical characteristics of patients, and the treatments applied. Evaluation was made of a total of 86 children with UGB who underwent esophagogastroduodenoscopy and for whom the Sheffield score was calculated. The decision for therapeutic intervention was made according to the clinical status independently of the score. The demographic data of the patients, clinical symptoms and findings, risk factors, and treatments were examined retrospectively. The Sheffield score was calculated as ≤8 in 67.4% of the patients and >8 in 32.6%. Endoscopic hemostatic intervention was applied to 15.1% of the patients. The rate of therapeutic endoscopy was significantly high in the high-score group. In 11 patients with Sheffield score >8, the bleeding was brought under control with octreotide treatment administered before endoscopy and no invasive intervention was applied. The sensitivity and specificity of the Sheffield score were determined to be at a good level in the prediction of the requirement for therapeutic endoscopy and octreotide treatment. The Sheffield score can reliably predict the need for endoscopic treatment with high sensitivity and specificity. In children with a high score, the need for an invasive intervention can be reduced with the administration of vasoactive treatment before esophagogastroduodenoscopy. The Sheffield score can thus be of guidance in the determination of the need for vasoactive treatment.

S649 Early Feeding vs Delayed Feeding After Therapeutic Endoscopic Intervention in Upper GI Bleeding: A Systematic Review and Meta-Analysis

Introduction: Multiple endoscopic interventions are used to treat upper GI bleeding. Early feeding after endoscopic intervention in upper GI bleeding was always thought to be associated with higher mortality rate and worse outcomes. Recent studies have investigated the role of early post procedural feeding after endoscopic interventions in patients with upper GI bleeding. Methods: We performed a comprehensive search in the databases of PubMed/MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials from inception through May 25th, 2022. We considered randomized controlled trials. We excluded abstracts, animal studies, case reports, reviews, editorials, and letters to editors. From each study, we collected the number of patients with upper GI bleeding who were started early on regular diet after the endoscopic intervention and the number of patients with delayed feeding. The primary outcome was the mortality rate. The secondary outcomes were the occurrence of early bleeding (within 7 days), late bleeding (after 7 days) and the length of hospital stay. The random-effects model was used to calculate the risk ratios (RR), mean differences (MD), and confidence intervals (CI). A p value < 0.05 was considered statistically significant. Heterogeneity was assessed using the Higgins I2 index. Results: Eight randomized controlled trials involving 818 patients were included in the meta-analysis. The mortality rate was not statistically different between the early feeding and the delayed feeding groups (RR 0.60, 95% CI 0.32-1.14, p =0.12, I2 = 0%) (Figure a). Also, the rates of both early and late bleeding were not statistically different between the two groups (RR 1.17, 95% CI 0.60-2.26, p =0.64, I2 = 0%) and (RR 0.74, 95% CI 0.25-2.14, p =0.58, I2 = 17%), respectively. However, the length of hospital stay was significantly shorter in the early feeding group (MD -0.99 days, 95% CI -1.15- -0.83, p < 0.00001, I2 = 70%) (Figure b). Conclusion: Our meta-analysis demonstrated that early feeding after endoscopic interventions in patients with upper GI bleeding appears to be relatively safe. There was no statistical difference in mortality rates and in early or late bleeding rates. Moreover, it was associated with a shorter hospital stay. Further randomized controlled trials are needed to confirm our findings.Figure 1.: a) mortality rate b) the duration of hospital stay.

Disease recurrence in patients with Crohn’s disease after biologic therapy or surgery: a meta-analysis

BackgroundRelapse is a problem in patients with Crohn’s disease (CD) after medical therapy (including biologics) and after surgery to treat acute inflammation. It is unclear whether the recurrence rate over time is higher after surgical therapy than after continuous drug treatment.AimWe sought to compare clinical relapse rates and the need for re-interventions (resection or therapeutic endoscopic intervention) in patients with CD.MethodsA meta-analysis was performed according to PRISMA guidelines.ResultsThe need for re-intervention with medication or surgery due to surgical or clinical recurrence increased over time. The recurrence rates in patients after ileocecal resection were lower than the rates under biologic therapy. The odds ratio for clinical recurrence under biologics versus after surgical treatment was 2.50 (95% confidence interval [CI] 1.53–4.08, p-value < 0.001). The odds ratio for surgical recurrence under biologics versus after surgery was 3.60 (95% CI 1.06–12.3, p-value 0.041).ConclusionThese findings support surgical resection as a treatment option in patients with CD with limited disease.

The Spectrum of Upper Gastrointestinal Endoscopic Findings and Therapeutic Interventions in Patients Presenting with Upper Gastrointestinal Complaints

Background: Endoscopy has a great role in the diagnosis, surveillance, and management of various gastrointestinal (GI) ailments. Aims: This study aimed to evaluate the spectrum of upper GI (UGI) symptoms and correlate them with the findings on UGI endoscopic examination. Patients and Methods: This observational cross-sectional study was carried out from August 2019 to December 2020 in the adult patients presenting with UGI complaints. The patients underwent UGI endoscopy at Yenepoya Medical College Hospital, Mangalore, a tertiary care centre in southern Indian state of Karnataka. Endoscopies were performed as per the standard protocol with diagnosis based on accepted criteria. Results: A total of 450 subjects (mean age: 49.14 ± 13.9; range, 19–89; 322 [71.5%] men) were included. Among the diagnostic indications, dyspeptic symptom seen in 176 (39.1%) patients was the most frequent indication in this study cohort, followed by reflux in 73 (16.2%) patients, UGI bleeding in 69 (15.34%) patients (portal hypertensive bleeding was found to be more common than nonvariceal bleed (49:20). Antral gastritis was seen in 112 (24.9%) patients. Ninety (20%) patients were found to have esophageal varices and 47 (10.4%) had esophagitis. Biopsy showed 25.3% to be positive for Helicobacter pylori. Forty-seven (10.45%) patients with a mean age 32 ± 6.8 years with dyspeptic symptoms but no alarming symptoms had normal endoscopic examination. Conclusion: Antral gastritis was the most common endoscopic finding in patients with dyspeptic symptoms. Portal hypertension was a more common cause of UGI bleeding compared to duodenal ulcers. While the majority of the patients presenting with heartburn had esophagitis, nonerosive esophagitis was observed in 3.2% of patients.

Comparison of Two Endoscopic Therapeutic Interventions as Primary Treatment for Anastomotic Leakages after Total Gastrectomy.

Simple SummaryAn esophagojejunal anastomotic leak after oncological gastrectomy is a life-threatening complication. Endoscopic treatment offers the possibility of minimally invasive diagnosis and immediate effective therapy in one session. A retrospective, single-center analysis of two different endoscopic strategies as first-line treatment options was performed.Introduction: An esophagojejunal anastomotic leak following an oncological gastrectomy is a life-threatening complication, and its management is challenging. A stent application and endoscopic negative pressure therapy are possible therapeutic options. A clinical comparison of these strategies has been missing until now. Methods: A retrospective analysis of 14 consecutive patients endoscopically treated for an anastomotic leak after a gastrectomy between June 2014 and December 2019 was performed. Results: The mean time of the diagnosis of the leakage was 7.14 days after surgery. Five patients were selected for a covered stent, and nine patients received endoscopic negative pressure therapy. In the stent group, the mean number of endoscopies was 2.4, the mean duration of therapy was 26 days, and the mean time of hospitalization was 30 days. In patients treated with endoscopic negative pressure therapy, the mean number of endoscopies was 6.0, the mean days of therapy duration was 14.78, and the mean days of hospitalization was 38.11. Treatment was successful in all patients in the stent-based therapy group and in eight of nine patients in the negative pressure therapy group. Discussion: Good clinical results in preserving the anastomosis and providing sepsis control was achieved in all patients. Stent therapy resulted in anastomosis healing with a lower number of endoscopies, a shorter time of hospitalization, and rapid oral nutrition.

A93 USEFULNESS OF A NOVEL SMARTPHONE APP IN GASTROINTESTINAL ENDOSCOPY TO TRACK PROCEDURE NUMBERS AND THERAPEUTIC INTERVENTIONS

BackgroundEndoscopy teaching is an integral part of gastroenterology (GI) training. Though the number of completed endoscopic procedures does not equate competency, procedure tracking is useful for monitoring an individual’s learning progress. Currently, procedure tracking is typically done on an informal basis using paper or electronic spreadsheets. These methods are non-standardized and may not be shareable between trainees and their programs.Endostation is a smartphone app created by the University of Alberta Therapeutic Endoscopy Program to facilitate the tracking of endoscopic procedures. The app allows trainees to record the number of endoscopies and details such as cecal intubation (CI), ERCP cannulation, and therapeutic interventions. Data can be accessed by users via the app and website (www.endostation.ca), allowing for close monitoring of trainees’ learning progress.AimsOur primary objective was to evaluate the usefulness of the app for tracking the number of endoscopic procedures and therapeutic interventions. Our secondary objective was to evaluate the acquisition of endoscopy skills based on quality endoscopic parameters such as CI rate and ERCP cannulation rate.MethodsOne therapeutic endoscopy fellow and two GI residents were recruited for the study. Participants were asked to document their procedures over the study period (9-month for therapeutic endoscopy fellow, 12-month for GI residents). Total number of procedures was summed for each trainee. Acquisition of endoscopy skills was tracked by comparing success rates of CI and ERCP cannulation at different points within the study period.ResultsThe therapeutic endoscopy fellow recorded 415 cannulation attempts, 209 sphincterotomies, 282 stone extractions, 71 plastic stent placements, and 37 metal stent placements. There was a significant difference in the cannulation success rate when comparing the 1st trimester and the 3rd trimester of the study period (68% vs 85%; p= 0.0012) (Fig 1).The two GI residents respectively recorded 335 and 170 colonoscopies plus 454 and 305 gastroscopies. Resident 1 recorded 58 polypectomies, 9 esophageal variceal banding, and 16 non-variceal hemostasis. Resident 2 recorded 17 polypectomies, 12 esophageal variceal banding, and 9 non-variceal hemostasis. The CI success rate was significantly higher for both residents when comparing the first 4 months of training vs the last 4 months [24% vs 88% for resident 1 (p=0.00001); 15% vs 42% for resident 2 (p= 0.001)] (Fig 1).ConclusionsThe smartphone app (Endostation) was a useful tool for endoscopic procedure tracking. Data from the app was useful in demonstrating improvement in CI rate and ERCP cannulation rate over the study period. Funding AgenciesNone

Rate of transesophageal echocardiography related complications during 1229 TEE-guided structural heart disease procedures

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction: Transesophageal echocardiography (TEE) has long provided excellent diagnostic imaging of left-sided valvular pathology with an excellent safety profile; however, recent data has suggested an increased risk of injury related to TEE guidance. Purpose This study aims to evaluate the incidence and nature of TEE-related oropharyngeal or esophageal complications in patients undergoing TEE-guided structural heart procedures and identify associated risk factors. Methods We reviewed consecutive patients undergoing TEE-guided structural heart procedures from 2005-2020. All procedures were performed under general anesthesia. TEE-related oropharyngeal or esophageal complications were defined as those occurring within 30 days of the procedure resulting in i) persistent dysphagia, odynophagia, or upper gastrointestinal bleeding requiring prolonged endotracheal intubation, therapeutic endoscopic or surgical intervention, or diagnostic imaging that demonstrated oropharyngeal or esophageal injury. ii) upper gastrointestinal bleed requiring transfusion, hemodynamic compromise warranting mechanical or pharmacologic support; or iii) oropharyngeal or esophageal complications leading to death. For multivariate analysis, all variables with a p &amp;lt; 0.15 at univariate analysis were included in the model. Results Among 1229 adult patients undergoing TEE-guided structural heart procedures between 2005-2020, 274 underwent a transcatheter aortic valve replacement (TAVR) with the remaining 955 undergoing either mitral valve transcatheter edge-to-edge repair (mTEER, n = 278), mitral paravalvular leak closure (PVLC, n = 354), mitral valve-in-valve replacement (VIV, n = 41), or left atrial appendage closure (LAAO, n = 282). Of these, 6 (0.5 %) had TEE-related complications; 0% TAVR, 0% VIV, 0.36% LAAO, 0.28% PVLC, 1.41% mTEER (p = 0.14). Of the six patients with complications 3 required at least one day of prolonged tracheal intubation and one a blood transfusion. None required surgical repair. Factors associated with increased complication risk (Table) included a prior history of gastrointestinal bleed (Odds ratio 5.44 [0.98-30.04; p = 0.05]) and longer procedural time (OR per 30 min 1.15 [1.01-1.31, p = 0.03]). Patients undergoing mTEER had an increased risk of complication (OR 6.76 [1.23-37.1 p = 0.03]) and longer procedural time (OR per 30 mins 1.15[1.01-1.31, p = 0.04]) compared to other all other procedures. Conclusion(s): In a large series of patients undergoing cardiac structural interventions under general anesthesia with TEE-guidance, rates of TEE-induced injury were low. Risk of oropharyngeal or esophageal complications was increased with longer procedure times, prior gastrointestinal bleeding history, increased age, increased pre-procedural creatinine, procedural type being mTEER and in male patients, lower height. Abstract Table

Study of patients undergoing Endoscopic Retrograde Cholangiopancreatography (ERCP) at Tishreen University Hospital in Lattakia – Syria

Objective: The aim of this study is to evaluate the indications, findings, and complications of performing Endoscopic Retrograde Cholangiopancreatography (ERCP). Patients and Methods: A Prospective Observational Descriptive study conducted for the period from January 2020 to January 2021, 167 consecutive ERCP were performed at Tishreen University Hospital in Lattakia-Syria. Results: The median age was 58 years, 59.30% of patients were female. The most common indications for ERCP were common bile duct stones (44.9%) and obstructive jaundice (44.3%). The median number of attempts for cannulation was 2 counts, and 74.3% of the procedures were graded as with difficulty grade 1. The most common abnormal findings were common bile duct dilation (50.3%) and bile duct stones (43.7%). The most therapeutic endoscopic interventions were sphincterotomy (64.7%) and stone extraction balloons (68.9%). The therapeutic success rate was 93.5% with repeated the procedure and complications occurred in (10.8%) of patients. The most frequent complication was mild pancreatitis (6%). Death was reported in five cases (3%), one of them (0.6%) was due to ERCP. Conclusion: ERCP is a potential risk for complications, so physicians should be adept at recognizing and treating any complications as soon as they arise.

Outcomes of variceal upper gastrointestinal bleeding: A prospective, multicenter, population-based study from West Hungary

Acute variceal gastrointestinal bleeding is associated with significant morbidity and mortality. Our aim was to evaluate the characteristics and prognostic factors in the management of acute upper gastrointestinal bleeding in a large multi-center study from Hungary. This prospective one-year study (between January 1, 2016 and December 31, 2016) involved six community hospitals in Western Hungary. Data collection included demographic characteristics, vital signs at admission, comorbidities, medications, time to hospital admission and endoscopy, laboratory results, endoscopic management, risk assessment using Glasgow-Blatchford Score (GBS), Rockall Score (RS) and the American Society of Anesthesiologists (ASA) Physical Status Score, transfusion requirements, length of hospital stay and mortality. 108 cases (male: 69.4%) of acute variceal gastrointestinal bleeding were registered during the 1-year period. Endoscopic therapeutic intervention was performed in 57.4%. On initial endoscopy, 39.8% of the patients were treated with sclerotherapy and 18.5% had ligation. 76.9% of the patients required blood transfusion. The overall mortality (including in-hospital bleedings) was 24.1%. The GBS predicted transfusions (AUC: 0.793; cut-off: GBS >8 points). The ASA Score was associated with transfusion (OR 7.6 [CI 95% 2.7-21.6]; p<0.001), endoscopic intervention (OR 12.6 [CI 95% 3.4-46.5]; p = 0.033), and showed similar trend with mortality (OR 3.6 [0.8-16.7]; p = 0.095). The increased international normalized ratio (INR) and creatinine levels were associated with mortality (p = 0.001 and p = 0.002). Incidence rates of acute variceal gastrointestinal bleeding in Western Hungary are high. The ASA Score, GBS predicted outcomes and transfusion requirements. The observed high mortality rates, coupled with relatively low rates of endoscopic ligation, warrant optimization of management strategies in acute variceal gastrointestinal bleeding. Orv Hetil. 2021; 162(31): 1252-1259.

Esophageal Food Impaction: A Retrospective Chart Review.

BackgroundEsophageal food impaction (EFI) is the third most common non-biliary emergency in gastroenterology, with an annual incidence rate of 13 episodes per 100,000 person-years and 1,500 deaths per year. Patients presenting with food impaction often have underlying esophageal pathology. We evaluated the possible risk factors for EFI in our study.MethodsWe performed a retrospective chart review of 455 patients at Staten Island University Hospital (SIUH) that presented with symptoms of food impaction from 1999 to 2017. We analyzed relevant clinical data such as age, risk factors, type of food bolus, location, administration of glucagon, endoscopic technique and complications.ResultsOverall, 174 patients had endoscopically confirmed EFI. The majority were males 102/174 (58.6%). Esophageal pathological findings included esophagitis in 58/174 (33.3%), strictures in 43/174 (24.7%), hiatal hernias in 29/174 (16.6%) and Schatzki’s rings in 15/174 (8.6%). Thirty-two out of 174 (18.3%) had normal endoscopic findings. Diabetes mellitus (DM) was reported in 20/174 (11.4%) patients. The type of food impacted was mostly meat in 73/174 (41.9%) cases. The location of EFI was mainly in the lower one-third of the esophagus in 94/174 (54%). The endoscopic push technique was used in 95/174 (54.5%) patients and the pull technique in 83/174 (47.7%) cases. The endoscopic therapeutic intervention was successful as a first attempt in 165/175 (94.8%) patients. Complications were reported in only 5/174 (2.8%), and these mostly comprised of perforations and tears. Glucagon was given to 74/174 (42.5%) patients. The median door-to-scope time (time of presentation at the emergency department to endoscopic intervention) was 7 h (range 1.5 - 24 h) in patients who had received glucagon as opposed to 7 h (range 1 - 24 h) in patients who did not receive it.ConclusionEFI is more common in males. Esophageal strictures and hiatal hernias were the most common pathologies found in endoscopy. Esophagitis was evident in 33.3% of patients, but if it was the cause or consequence of EFI is not clearly understood. DM was associated with food impaction in only 11.4% of patients, but more studies are needed to determine if DM has a stronger association with EFI. The door-to-scope time was shorter in patients who had received glucagon. Endoscopy is a safe and effective therapeutic intervention for EFI, and complications reported were minimal.