The standard treatment duration for acute cholangitis (AC) involves a 4–7-day antimicrobial treatment post-biliary drainage; however, recent studies have suggested that a ≤ 2–3 days is sufficient. ...However, clinical practice frequently depends on body temperature as a criterion for discontinuing antimicrobial treatment. Therefore, in this study, we assessed whether patients with AC can achieve successful outcomes with a ≤ 7-day antimicrobial treatment, even with a fever, assuming the infection source is effectively controlled. We conducted a single-center retrospective study involving patients with AC, defined following the Tokyo Guidelines 2018 for any cause, who underwent successful biliary drainage and completed a ≤ 7-day antimicrobial treatment. Patients were categorized into the febrile and afebrile groups based on their body temperature within 24 h before completing antimicrobial treatment. The primary outcome was the clinical cure rate, defined as no initial presenting symptoms by day 14 post-biliary drainage without recurrence or death by day 30. The secondary outcome was a 3-month recurrence rate. Logistic regression with inverse probability of treatment weighting was used. Overall, 408 patients were selected, among whom 40 (9.8%) were febrile. The two groups showed no significant differences in the clinical cure and 3-month recurrence rates. Notably, the subgroups limited to patients with a ≤ 3-day antibiotic treatment duration also showed no differences in these outcomes. Therefore, our results suggest that discontinuing antibiotics within the initially planned treatment period was sufficient for successful drainage cases of AC, regardless of the patient's fever status during the 24 h leading up to termination.
The indications for endoscopic submucosal dissection (ESD) in superficial nonampullary duodenal epithelial tumors (SNADETs) remain controversial because the procedure is technically challenging. ...Moreover, the effectiveness of clip-and-thread traction-assisted ESD (TA-ESD) for SNADETs has not been assessed. The aim of the current study was to compare the effectiveness of duodenal TA-ESD and conventional ESD for SNADETs.
SNADETs treated with conventional ESD or TA-ESD between April 2017 and March 2021 at Saitama Medical University International Medical Center were evaluated retrospectively.
There were 49 cases of conventional ESD and 32 cases of TA-ESD for SNADETs. Using a propensity score–matched design, we selected 26 pairs of cases with conventional ESD and TA-ESD. In the unmatched cohort, patients treated with TA-ESD were characterized by a higher R0 (no tumor identified at the lateral or vertical margins) resection rate (P = .004), more frequent poor submucosal lifting because of fibrosis (P = .014), and shorter follow-up period (P = .0004) than patients treated with conventional ESD. In the propensity score–matched pairs, patients treated with TA-ESD were characterized by a higher rate of R0 resection (P = .021) and a shorter follow-up period (P = .0061). The findings regarding R0 resection rates were confirmed by multivariate logistic regression models, which found a higher odds ratio (OR) for R0 resection in patients who underwent TA-ESD than in patients who underwent conventional ESD both in the unmatched cohort (OR, 17.0; 95% confidence interval, 1.6-178.8; P = .018) and in the propensity score–matched pairs (OR, 26.7; 95% confidence interval, 1.5-460.2; P = .024).
Our findings suggest TA-ESD may increase the rate of R0 resection in patients with SNADETs in comparison with conventional ESD.
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Objectives
This study aimed to evaluate the trainees’ practice and learning curve in short‐type single‐balloon enteroscopy (short SBE)‐assisted endoscopic retrograde cholangiopancreatography (ERCP) ...for patients with surgically altered anatomy (SAA) and determine how to train these trainees.
Methods
The data of short SBE‐assisted ERCP procedures between September 2011 and June 2021 were analyzed.
Results
Three trainees and 180 cases were included in the analysis. Each trainee performed 60 cases between April 2016 and June 2021. The trainees' completion rate was 73.9% (95% confidence interval CI, 66.8‐80.1%). Adverse events occurred in 5.0% of cases (95% CI, 2.3‐9.3%). The trainee who experienced colonoscopy and ERCP the most achieved better outcomes of enteroscopy success (reaching the target site) and trainee’s completion rates than those of the others (P = .03 and .02, respectively). The learning curve for trainee’s completion showed a significant improvement after 60 cases (P = .001). Multiple logistic regression analysis indicated that Roux‐en‐Y reconstruction was the factor affecting trainees’ completion failure.
Conclusions
Short SBE‐assisted ERCP trainees has a substantial learning curve. If trainees do not have much experience with colonoscopy and ERCP procedures, it may be beneficial for them to start performing short SBE‐assisted ERCP procedures on non‐Roux‐en‐Y reconstruction cases.
Evaluation of trainees' practice and learning curves in short‐type single‐balloon enteroscopy‐assisted ERCP for patients with surgically altered anatomy revealed that trainees' successful completion rates significantly improved after 60 cases. Tanisaka et al. conclude that short‐type single‐balloon enteroscopy‐assisted ERCP poses a substantial learning curve for trainees.
ABSTRACT
Metastatic breast cancer can spread to the bone, brain, liver and lung. However, metastasis to the stomach is rare. Gastric metastasis mostly presents within 10 years from the diagnosis of ...the primary breast cancer. We present a rare case of gastric metastasis occurring 20 years after mastectomy, diagnosed through immunohistochemistry.
Key clinical message
Endoscopic hemostasis is the first step in cessation of gastrointestinal bleeding. Although IVR may sometimes be required for preventing rebleeding, prophylactic IVR was not ...considered necessary in this case because of complete endoscopic hemostasis.
Key Clinical Message
Gastric metastases derived from breast carcinomas and type 4 advanced gastric cancers are often difficult to distinguish because of their similar endoscopic and pathologic ...findings. Therefore, immunohistochemical analyses are key to diagnosis.
Gastric metastases originating from breast carcinomas and type 4 advanced gastric cancers are often difficult to distinguish because of their similar endoscopic and pathologic characteristics. This often delays early intervention and accordingly affects prognosis. Immunohistochemical analyses are important for both diagnosis and treatment of breast carcinomas.
Immunohistochemical features of metastatic invasive lobular mammary carcinoma to the stomach.
Abstract
Colorectal endoscopic submucosal dissection (ESD) is a difficult procedure, and its introduction to trainees has been debated. Although the criteria for performing colorectal ESD vary among ...institutions, it is often allowed after gaining experience performing surgeries in animals and upper gastrointestinal ESD. This pilot study aimed to compare the treatment outcomes of ESD performed by trainees using the multi-loop traction device (MLTD group) and those of conventional ESD performed by experts (control group). It also aimed to determine whether the MLTD can be used to safely introduce colorectal ESD to trainees. We included 26 colorectal ESD patients (13 in the MLTD group and 13 in the control group) treated at our hospital from October to December 2021. There were no significant differences in the procedure time (50 min vs. 30 min), dissection speed (19.9 mm
2
/min vs. 28.7 mm
2
/min), and intraoperative perforation (0% vs. 0%) of the two groups. Furthermore, the rate of ESD self-completion in the MLTD group was 100%. Therefore, the use of the MLTD allowed the safe introduction of colorectal ESD, even among endoscopists with no experience performing colorectal ESD. Consequently, the use of the MLTD may replace animal and upper gastrointestinal ESD when introducing colorectal ESD to trainees.
