Gastrostomies: experience and complications with three modalities in a tertiary centre over a 26-year period.

Objectives: To describe the complications associated with the different gastrostomy techniques [endoscopic (PEG), radiologic (PRG), and surgical (SG)] performed in the last 26 years in a terciary hospital. Methods: Retrospective observational study. Patients who underwent gastrostomy at the Virgen del Rocío University Hospital between 1995 and 2021 were included. For PEG, the PULL technique was performed until 2018 and subsequently the PUSH technique predominantly. For PRG, a pigtail catheter was used until 2003, a balloon catheter between 2003 and 2009, and a balloon catheter with gastropexy between 2015 and 2021. For SG, the conventional technique (CSG) was performed until 2009 and since then the laparoscopic assisted percutaneous gastrostomy (PLAG) technique. Descriptive analysis was performed obtaining the median and quartiles of the quantitative variables [P50 (P25-P75)] and the frequency for the qualitative variables [n (%)].The comparison of complications between patients who underwent different techniques was performed with Fisher's test. Results: n = 1,070 (PEG = 608, PRG = 344, SG = 118). The three most frequent indications were head and neck tumors, neurological diseases and gastroesophageal tumors. The percentage of patients who had any complication was 48.9% (PEG-PULL), 23.7% (PEG-PUSH), 38.5% (pigtail PRG), 39.2% (balloon PRG), 29.7% (balloon with gastropexy PRG), 87.3% (CSG), and 41.26% (PLAG). 2 (0.18%) patients died from gastrostomy-related complications. 18(1.68%) presented with peritonitis and 5 (0.4%) presented with gastrocolic fistula. The rest of the complications were minor. Conclusion: Gastrostomy in any of its modalities is currently a safe procedure with a low rate of complications, most of which are minor.

Percutaneous Radiology Gastrostomy (PRG)-Associated Complications at a Tertiary Hospital over the Last 25 Years.

OBJECTIVES: We aimed to describe and compare the complications associated with different percutaneous radiologic gastrostomy (PRG) techniques. METHODS: A retrospective and prospective observational study was conducted. Patients who underwent a PRG between 1995-2020 were included. TECHNIQUES: A pigtail catheter was used until 2003, a balloon catheter without pexy was used between 2003-2009 and a balloon catheter with gastropexy was used between 2015-2021. For the comparison of proportions, X2 tests or Fisher's test were used when necessary. Univariate analysis was performed to study the risk factors for PRG-associated complications. RESULTS: n = 330 (pigtail = 114, balloon-type without pexy = 28, balloon-type with pexy = 188). The most frequent indication was head and neck cancer. The number of patients with complications was 44 (38.5%), 11 (39.2%) and 54 (28,7%), respectively. There were seven (25%) cases of peritonitis in the balloon-type without-pexy group and 1 (0.5%) in the balloon-type with-pexy group, the latter being the only patient who died in the total number of patients (0.3%). Two (1%) patients of the balloon-type with-pexy group presented with gastrocolic fistula. The rest of the complications were minor. CONCLUSIONS: The most frequent complications associated with the administration of enteral nutrition through PRG were minor and the implementation of the balloon-type technique with pexy has led to a decrease in them.

Analysis of the Indications and Complications of Vena Cava Filter in Patients with Venous Thromboembolism / Análisis de las indicaciones y complicaciones de los pacientes con enfermedad tromboembólica venosa a los que se ha colocado filtro de vena cava inferior

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Implante percutáneo de válvula pulmonar Melody por vía transhepática en paciente de ocho años / Percutaneous pulmonary Melody valve implantation through the transhepatic route in an 8-year-old patient

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[Selective arterial embolization in the treatment of intractable hematuria]. / Embolización arterial selectiva en el tratamiento de la hematuria incoercible.

OBJECTIVES: Non tractable hematuria has a varied etiology. It may be a complication difficult to treat. We report the case treated in our hospital by selective arterial embolization. METHODS: We report the case of an 86-year-old patient who underwent radiotherapy for transitional cell carcinoma. Later on, she presented with hematuria, not responding to usual therapeutic management. Urinary diversion did not solve the problem either. We decided to proceed with selective arterial embolization of the hypogastric arteries using polyvinylalcohol microspheres and metallic coils. RESULTS: Hematuria disappeared after embolization, without the recurrence after nine months of follow-up. Immediate outcome was characterized by a post-embolization syndrome which was treated with antipyretics, antibiotic and morphine derivatives. It diminished progressively and disappeared in 48 hours. CONCLUSIONS: Arterial selective embolization is a useful therapeutic resource for the management of non tractable hematuria, mainly in cancer patients, which present a deteriorated general status.

Embolización arterial selectiva en el tratamiento de la hematuria incoercible / Selective arterial embolization in the treatment of non tractable hematuria

OBJETIVOS: La hematuria incoercible es uncuadro de etiología diversa. Puede ser una complicacióndifícil de controlar. Nos proponemos presentar un caso tratadoen nuestro hospital con embolización arterial selectiva.MÉTODOS: Comunicamos el caso de una paciente de86 años sometida a tratamiento radioterápico debido aneoplasia urotelial. Presentó posteriormente una hematuriaque no cedió a las medidas terapéuticas habituales.Tampoco la derivación urinaria solucionó el cuadro. Porello optamos por practicar una embolización arterial selectivade arterias hipogástricas, con microesferas de polivinilode alcohol y coils metálicos.RESULTADO: La hematuria desapareció desde el momentode la embolización, sin reaparecer en un tiempo deseguimiento de nueve meses. La evolución inmediata secaracterizó por un “síndrome post-embolización”, tratadocon antitérmicos, antibiótico y derivados mórficos. Cedióprogresivamente hasta desaparecer a las 48h.CONCLUSIONES: La embolización arterial selectiva esun recurso terapéutico útil para el manejo de hematuriasde difícil control, sobre todo en enfermos neoplásicos, yade por sí muy deteriorados

OBJECTIVES: Non tractable hematuria has ;;a varied etiology. It may be a complication difficult to ;;treat. We report the case treated in our hospital by selective ;;arterial embolization. ;;METHODS: We report the case of an 86-year-old patient ;;who underwent radiotherapy for transitional cell carcinoma. ;;Later on, she presented with hematuria, not responding to ;;usual therapeutic management. Urinary diversion did not ;;solve the problem either. We decided to proceed with ;;selective arterial embolization of the hypogastric arteries ;;using polyvinylalcohol microspheres and metallic coils. ;;RESULTS: Hematuria disappeared after embolization, ;;without the recurrence after nine months of follow-up. ;;Immediate outcome was characterized by a post-embolization ;;syndrome which was treated with antipyretics, antibiotic ;;and morphine derivatives. ;;It diminished progressively and disappeared in 48 hours. ;;CONCLUSIONS: Arterial selective embolization is a useful ;;therapeutic resource for the management of non tractable ;;hematuria, mainly in cancer patients, which present a ;;deteriorated general status