Objectives
Endoscopic retrograde cholangiopancreatography (ERCP) represents the gold standard for jaundice palliation in patients with distal malignant biliary obstruction (DMBO). Biliary drainage ...using electrocautery lumen apposing metal stent (EC‐LAMS) is currently a well‐established procedure when ERCP fails. In a palliative setting the endoscopic ultrasound‐guided gallbladder drainage (EUS‐GBD) could represent an easy and valid option. We performed a prospective study with a new EC‐LAMS with the primary aim to assess the clinical success rate of EUS‐GBD as a first‐line approach to the palliation of DMBO.
Methods
In all, 37 consecutive patients undergoing EUS‐GBD with a new EC‐LAMS were prospectively enrolled. Clinical success was defined as bilirubin level decrease >15% within 24 h and >50% within 14 days after EC‐LAMS placement.
Results
The mean age was 73.5 ± 10.8 years; there were 17 male patients (45.9%). EC‐LAMS placement was technically feasible in all patients (100%) and the clinical success rate was 100%. Four patients (10.8%) experienced adverse events, one bleeding, one food impaction, and two cystic duct obstructions because of disease progression. No stent‐related deaths were observed. The mean hospitalization was 7.7 ± 3.4 days. Median overall survival was 4 months (95% confidence interval 1–8).
Conclusion
Endoscopic ultrasound‐guided gallbladder drainage with the new EC‐LAMS is a valid option in palliative endoscopic biliary drainage as a first‐step approach in low survival patients with malignant jaundice unfit for surgery. A smaller diameter EC‐LAMS should be preferred, particularly if the drainage is performed through the stomach, to avoid potential food impaction, which could result in stent dysfunction.
Background
Peroral endoscopic myotomy for the treatment of Zenker’s diverticulum (Z-POEM) is a novel technique that has been described in several recent reports. This method utilizes the third space ...(submucosal layer) to create a tunnel to facilitate complete visualization of the septum and hence cutting it entirely. Conventional endoscopic septotomy carries the risk of recurrence due to incomplete visualization of the septum. While surgical correction is a risky and lengthy procedure in old comorbid patients with Zenker’s diverticulum. The aim of this study is to assess the efficacy and safety of Z-POEM.
Methods
The study enrolled 24 patients diagnosed with Zenker’s diverticulum (ZD) who underwent Z-POEM at seven independent endoscopy centers in five different countries.
Results
Mean patient age ± standard deviation (SD) was 74.3 ± 11 years. Most of the patients were males (
n
= 20, 83.3%); four (16.7%) were females. More than 50% of the patients (
n
= 14, 58.3%) had associated comorbidities. The mean size of the diverticula was 4 cm (range 2–7 cm). The Kothari-Haber Score was used to assess clinical symptoms; values ranged from 6 to 14 (median = 9). We achieved 100% technical success with a median procedure time of 61 min and no adverse events. Median hospital stay was 1 day (range 1–5 days). There is a significant reduction in the Kothari-Haber Score after Z-POEM (
P
< 0.0001). Technical success was achieved in 100% of the patients. Clinical success was achieved in 23/24 (95.8%) of the patients with a median follow-up of 10 months (range 6–24 months).
Conclusion
Z-POEM is a safe and effective modality for managing ZD.
Endoscopic ultrasound-guided liver biopsy (EUS-LB) has been proposed as a novel technique that could offer some advantages over traditional methods, especially regarding specimen adequacy. A ...systematic review that included 32 studies evaluating the quality of percutaneous hepatic biopsies (PC-LB) demonstrated that the average number of portal tracts with this technique was 7.5 +/-3.4. (1) The objective of our study was to determine if EUS-LBs meet AASLD quality criteria, defined by the presence of more than 11 portal tracts.
A retrospective study was carried out from a prospectively created EUS-LB database. The primary objective was to evaluate the sample quality, using as a parameter the number of portal tracts. The secondary objective was to determine the security profile of the procedure and evaluate the rate of complications.
82 patients were included (average age 55). The main indication for tissue acquisition was elevated transaminases. Steatosis/steatohepatitis was the most common histological diagnosis. The average number of portal tracts was 19.23 +/- 7.2. All the samples had at least 11 portal tracts. The rate of adverse events was 9.75%. The majority were minor complications (post-procedure pain). Only one patient presented a severe complication, bleeding secondary to an arterio-biliary fistula, that required embolization by interventional radiology.
EUS-LBs meet quality criteria established by AASLD, have an excellent security profile, and might be considered the method of choice for liver tissue acquisition in the centers where the resource is available.
Pancreatic adenocarcinoma is the most common malignancy of the pancreas; on rare occasions, metastatic tumors are present. Differentiating a primary neoplasm from a metastatic one is important for ...ensuring adequate treatment for the patient. We present a case of metastatic melanoma to the pancreas. A 60-year-old man presented with a history of weight loss, vague abdominal pain, jaundice, and pruritus. Laboratory tests showed increased total bilirubin, with a direct fraction predominance, as well as increased alkaline phosphatase and gamma glutamyl transferase. Imaging studies revealed a mass in the head of the pancreas. Endoscopic ultrasound (EUS)-guided fine needle biopsy was performed, and histologic examination confirmed the diagnosis of metastatic melanoma. This case report illustrates the invaluable use of EUS-guided tissue acquisition in the study of pancreatic solid lesions to obtain an accurate diagnosis. Melanomas should always be part of a differential diagnosis when evaluating patients with pancreatic masses.
Aims: Lumen-apposing metal stents (LAMSs) in ultrasonography-guided gallbladder drainage (EUS-GBD) have become increasingly important for high-risk surgical patients. Our study aims to evaluate the ...technical and clinical success, safety, and feasibility of endoscopic ultrasonography-guided gallbladder drainage using a new dedicated LAMS. Methods: This is a retrospective multicenter study that included all consecutive patients not suitable for surgery who were referred to a tertiary center for EUS-GBD using a new dedicated electrocautery LAMS for acute cholecystitis at eight different centers. Results: Our study included 54 patients with a mean age of 76.48 years (standard deviation: 12.6 years). Out of the 54 endoscopic gallbladder drainages performed, 24 (44.4%) were cholecysto-gastrostomy, and 30 (55.4%) were cholecysto-duodenostomy. The technical success of LAMS placement was 100%, and clinical success was achieved in 23 out of 30 patients (76.67%). Adverse events were observed in two patients (5.6%). Patients were discharged after a median of 5 days post-stenting. Conclusions: EUS-GBD represents a valuable option for high-surgical-risk patients with acute cholecystitis. This new dedicated LAMS has demonstrated a high rate of technical and clinical success, along with a high level of safety.
Endoscopic ultrasound (EUS)-guided drainage of symptomatic pancreatic fluid collections (PFCs) using the Hot-Axios device has recently been associated with a significant risk of bleeding. This ...adverse event (AE) seems to occur less frequently with the use of a different device, the Spaxus stent. The aim of the current study was to compare the rates of bleeding between the two stents.
Patients admitted for treatment of PFCs by EUS plus lumen-apposing metal stent in 18 endoscopy referral centers between 10 July 2019 and 28 February 2022 were identified and their outcomes compared using a propensity-matching analysis.
363 patients were evaluated. After a 1-to-1 propensity score match, 264 patients were selected (132 per group). The technical and clinical success rates were comparable between the two groups. Significantly more bleeding requiring transfusion and/or intervention occurred in the Hot-Axios group than in the Spaxus group (6.8% vs. 1.5%;
= 0.03); stent type was a significant predictor of bleeding in both univariate and multivariate regression analyses (
= 0.03 and 0.04, respectively). Bleeding necessitating arterial embolization did not however differ significantly between the two groups (3.0% vs. 0%;
= 0.12). In addition, the Hot-Axios was associated with a significantly higher rate of overall AEs compared with the Spaxus stent (9.8% vs. 3.0%;
= 0.04).
Our study showed that, in patients with PFCs, bleeding requiring transfusion and/or intervention occurred significantly more frequently with use of the Hot-Axios stent than with the Spaxus stent, although this was not the case for bleeding requiring embolization.
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