Limited data exist evaluating lumen-apposing metal stents (LAMSs) with endoscopic balloon dilation (EBD) for the treatment of benign colorectal anastomotic strictures (BCASs). This study compares ...outcomes of both interventions.
Patients with left-sided BCAS treated with LAMSs versus EBD were identified retrospectively. The primary outcome was a composite of crossover to another intervention to achieve clinical success or recurrence requiring reintervention.
Twenty-nine patients (11 LAMS and 18 EBD) were identified with longer follow-up in the EBD group (734 vs 142 days; P = .003). No significant differences were found in the composite outcome, technical success, clinical success, or components of composite outcome. With LAMS, there was a nonsignificant trend toward fewer procedures (2.4 vs 3.3; P = .06) and adverse events (0% vs 16.7%; P = .26).
LAMS appears to be as effective as EBD for the treatment of BCAS but may require fewer procedures and may be safer than EBD.
Full metal jacket: salvage of EUS-guided gallbladder drainage Platt, Kevin D.; Kankotia, Ravi J.; Schulman, Allison R.
VideoGIE : an official video journal of the American Society for Gastrointestinal Endoscopy,
11/2023, Letnik:
8, Številka:
11
Journal Article
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Video 1Full metal jacket: salvage of EUS-guided gallbladder drainage.
To prospectively test in a porcine model the hypothesis that bariatric embolization with commercially available calibrated microspheres can result in substantial suppression of systemic ghrelin ...levels and affect weight gain over an 8-week period.
The institutional animal care and use committee approved this study. Twelve healthy growing swine (mean weight, 38.4 kg; weight range, 30.3-47.0 kg) were evaluated. Bariatric embolization was performed by infusion of 40-μm calibrated microspheres selectively into the gastric arteries that supply the fundus. Six swine underwent bariatric embolization, while six control animals underwent a sham procedure with saline. Weight and fasting plasma ghrelin and glucose levels were obtained in animals at baseline and at weeks 1-8. Statistical testing for differences in serum ghrelin levels and weight at each time point was performed with the Wilcoxon signed rank test for intragroup differences and the Wilcoxon rank sum test for intergroup differences.
The pattern of change in ghrelin levels over time was significantly different between control and experimental animals. Weekly ghrelin levels were measured in control and experimental animals as a change from baseline ghrelin values. Average postprocedure ghrelin values increased by 328.9 pg/dL ± 129.0 (standard deviation) in control animals and decreased by 537.9 pg/dL ± 209.6 in experimental animals (P = .004). The pattern of change in weight over time was significantly different between control and experimental animals. The average postprocedure weight gain in experimental animals was significantly lower than that in control animals (3.6 kg ± 3.8 vs 9.4 kg ± 2.8, respectively; P = .025).
Bariatric embolization can significantly suppress ghrelin and significantly affect weight gain. Further study is warranted before this technique can be used routinely in humans.
INTRODUCTION:
The initial endoscopic treatment of ascending cholangitis is controversial. It has been proposed that management should be limited to decompression alone while the alternative is to ...additionally perform sphincterotomy and/or stone removal to address the underlying etiology. Our aim was to compare the effectiveness and safety of endoscopic decompression alone to decompression combined with other endotherapy for ascending cholangitis.
METHODS:
We systematically searched Embase, Medline, the Cochrane Library, and ClinicalTrials.gov from inception to April 22, 2019. Studies were screened by two independent reviewers using Covidence software and standardized extraction forms. We included trials that compared endoscopic decompression and decompression combined with other endotherapy. Our primary outcome was the odds of effective decompression by decompression alone versus combined with other endotherapy. Our secondary outcome was the odds of adverse events (post ERCP pancreatitis, hemorrhage, mortality). Pooled odds ratios and proportions were estimated using the random effects model for the two approaches.
RESULTS:
10,508 abstracts and 256 full text documents were reviewed. Six comparative reports of decompression alone versus decompression with other endotherapy were included in the meta-analysis. These studies capture the results for 462 patients; 205 underwent endoscopic (stent or nasobiliary) decompression alone and 257 decompression plus other endotherapy.
There was no difference in success of cholangitis therapy for decompression combined with sphincterotomy and other therapeutic maneuvers as opposed to decompression alone (OR 1.3 95% CI 0.3-5.6); there was also no difference in mortality (OR 0.4 0.4-7.3). There were more adverse events for decompression combined with sphincterotomy and other maneuvers (OR 2.5 1.0-6.5) driven by a higher rate of bleeding (OR 9.1 2.4-34.7)(Figure 1); there was no difference in rates of post ERCP pancreatitis (OR 0.7 0.2-2.1).
CONCLUSION:
In cholangitic patients, the addition of therapeutic maneuvers including sphincterotomy to biliary decompression is associated with higher rates of adverse events and particularly bleeding compared to decompression alone. Nevertheless, the included studies did not account for adverse events during subsequent ERCP to remove biliary stones in those initially managed with decompression alone. In cholangitic patients who are coagulopathic or would not tolerate adverse events, decompression alone should be considered.
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