ABSTRACT
BACKGROUND AND AIM: This study aimed to determine safety and risk factors for adverse events (AEs) of endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) with long-term indwell of lumen-apposing metal stents (LAMS). METHODS: This study is a multicenter prospective observational study on consecutive high surgical-risk patients requiring gallbladder drainage who underwent EUS-GBD with LAMS over 12 months. Centralized telephone follow-up interviews were conducted every 3 months for 1 year. Patients were censored at LAMS removal, cholecystectomy, or death. AE-free survival was determined using log-rank tests. Cumulative risks were estimated using life-table analysis. RESULTS: Eighty-two patients were included (53.7% male, median [interquartile range] age of 84.6 [76.5-89.8] years, and 85.4% with acute cholecystitis). Technical success was achieved in 79 (96.3%), and clinical success in 73 (89%). No patient was lost to follow-up; 45 patients (54.9%) completed 1-year follow-up with in situ LAMS. Median (interquartile range) LAMS indwell time was 364 (47-367) days. Overall, 12 (14.6%) patients presented 14 AEs, including 5 (6.1%) recurrent biliary events (3 acute cholangitis, 1 mild acute pancreatitis, and 1 acute cholecystitis). Patients with pancreatobiliary malignancy had an increased risk of recurrent biliary events (33% vs 1.5%, P = 0.001). The overall 1-year cumulative risk of recurrent biliary events was 9.7% (4.1-21.8%). The 1-year risk of AEs and of severe AEs was 18.8% (11-31.2%) and 7.9% (3.3-18.2%), respectively. Pancreatobiliary malignancy was the single risk factor for recurrent biliary events; LAMS misdeployment was the strongest risk factor for AEs. CONCLUSIONS: Long-term LAMS indwell does not increase the risk of delayed AEs following EUS-GBD.
Subject(s)
Cholecystitis, Acute , Neoplasms , Pancreatitis , Humans , Male , Aged , Aged, 80 and over , Female , Acute Disease , Prospective Studies , Treatment Outcome , Pancreatitis/epidemiology , Pancreatitis/etiology , Endosonography/adverse effects , Endosonography/methods , Drainage/adverse effects , Drainage/methods , Stents , Ultrasonography, Interventional , Neoplasms/etiologyABSTRACT
A case of a patient with symptoms of gastric obstruction secondary to cholecystogastric fistula is presented and a brief review of the literature is done.
Subject(s)
Biliary Fistula , Gallbladder Diseases , Gastric Fistula , Humans , Endosonography , Biliary Fistula/diagnostic imaging , Biliary Fistula/etiology , Biliary Fistula/surgery , Gallbladder Diseases/diagnostic imaging , Gallbladder Diseases/surgery , Gastric Fistula/diagnostic imaging , Gastric Fistula/etiologyABSTRACT
We present the case of a 73-year-old woman who was admitted to hospital with a 6-day history of complete constipation, abdominal pain and vomiting. An abdominal CT scan is performed that shows a large colonic dilatation. In the sigmoid colon identifying a 43x20mm gallstone impaction and a solution of continuity between the gallbladder and the hepatic flexure with pneumobilia associated. Because the obstruction is located at the sigmoid colon, it was decided to perform an urgent colonoscopy. During the endoscopy, the gallstone was observed, which was successfully extracted using a Roth Net. The surrounding mucosa showed signs of mucosal damage and an extensive decubitus ulcer. After endoscopy, the patient presented resolution of the obstructive condition. During her admission, surgery was performed to resection the cholecystocolic fistula, cholecystectomy, and primary closure of the colon. However, the patient presented a torpid evolution with ascending colon perforation and necrotizing fasciitis in the surgical wound, finally dying of abdominal septic shock.
Subject(s)
Gallstones , Ileus , Intestinal Obstruction , Sigmoid Diseases , Humans , Female , Aged , Gallstones/complications , Ileus/etiology , Sigmoid Diseases/diagnosis , Intestinal Obstruction/etiology , Colonoscopy/adverse effectsABSTRACT
An 85-year-old female with situs inversus totalis was admitted due to obstructive jaundice, secondary to multiple choledocholithiasis and distal biliary stenosis due to adenocarcinoma of the head of the pancreas, with duodenal infiltration and metastatic liver disease. An endoscopic retrograde cholangiopancreatography (ERCP) was attempted in the supine position but bile duct cannulation was not possible due to duodenal infiltration. Finally, a palliative biliary stent was placed percutaneously, with resolution of the jaundice.
Subject(s)
Choledocholithiasis , Jaundice, Obstructive , Situs Inversus , Aged, 80 and over , Cholangiopancreatography, Endoscopic Retrograde , Choledocholithiasis/complications , Choledocholithiasis/diagnostic imaging , Choledocholithiasis/surgery , Duodenum , Female , Humans , Jaundice, Obstructive/diagnostic imaging , Jaundice, Obstructive/etiology , Situs Inversus/complications , Situs Inversus/diagnostic imagingABSTRACT
A endoscopically treated Boerhaave's syndrome is reported and a brief review of related literature is made.
Subject(s)
Esophageal Perforation/surgery , Gastroscopy , Mediastinal Diseases/surgery , Female , Humans , Middle AgedABSTRACT
Duodenal diverticula are an uncommon cause of upper gastrointestinal bleeding. Until recently, it was primarily managed with surgery, but advances in the field of endoscopy have made management increasingly less invasive. We report a case of duodenal diverticular bleeding that was endoscopically managed, and review the literature about the various endoscopic therapies thus far described.
Subject(s)
Diverticular Diseases/complications , Duodenal Diseases/etiology , Duodenal Diseases/surgery , Endoscopy, Gastrointestinal/methods , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/surgery , Aged, 80 and over , Female , Hemostasis, Endoscopic , Humans , Recurrence , Treatment OutcomeABSTRACT
Diverticular disease is the most frequent cause of lower gastrointestinal bleeding. Most of the times, bleeding stops without any intervention but in 10-20% of the cases it is necessary to treat the hemorrhage. Several modalities of endoscopic treatment have been described after purging the colon. We present five cases of severe diverticular bleeding treated with injection of epinephrine and hemoclips. All the colonoscopies were performed without purging of the colon in an emergency setting, with correct visualization of the point of bleeding. Patients recovered well avoiding other aggressive procedures such as angiography or surgery.
Subject(s)
Colonic Diseases/surgery , Diverticulum/surgery , Endoscopy, Gastrointestinal/methods , Epinephrine/therapeutic use , Gastrointestinal Hemorrhage/surgery , Vasoconstrictor Agents/therapeutic use , Aged , Diverticulum/complications , Gastrointestinal Hemorrhage/etiology , Humans , Male , Surgical InstrumentsSubject(s)
Endoscopy, Gastrointestinal , Esophageal Fistula/surgery , Fistula/surgery , Heart Atria , Heart Diseases/surgery , Adult , Atrial Fibrillation/surgery , Catheter Ablation/adverse effects , Esophageal Fistula/etiology , Fistula/etiology , Heart Diseases/etiology , Humans , Male , Retreatment , Self Expandable Metallic Stents , Treatment FailureSubject(s)
Colitis, Ulcerative/complications , Colitis, Ulcerative/diagnosis , Intestinal Perforation/complications , Intestinal Perforation/diagnosis , Pneumoperitoneum/diagnosis , Aged, 80 and over , Colitis, Ulcerative/pathology , Colon/pathology , Colonoscopy , Humans , Intestinal Perforation/pathology , Male , Pneumoperitoneum/pathology , Radiography, AbdominalSubject(s)
Duodenal Neoplasms/complications , Gastrointestinal Hemorrhage/etiology , Sarcoma, Kaposi/complications , Stomach Neoplasms/complications , Adult , Antibiotics, Antineoplastic/therapeutic use , Antiretroviral Therapy, Highly Active , Colonoscopy , Combined Modality Therapy , Doxorubicin/therapeutic use , Duodenal Neoplasms/pathology , Duodenal Neoplasms/therapy , Gastrointestinal Hemorrhage/pathology , Gastrointestinal Hemorrhage/therapy , HIV Infections/complications , Homosexuality , Humans , Male , Rectum/pathology , Sarcoma, Kaposi/pathology , Sarcoma, Kaposi/therapy , Stomach Neoplasms/pathology , Stomach Neoplasms/therapy , Ulcer/pathologyABSTRACT
A case of a patient with symptoms of gastric obstruction secondary to cholecystogastric fistula is presented and a brief review of the literature is done.(AU)
Subject(s)
Humans , Male , Aged , Biliary Fistula/diagnostic imaging , Gallbladder Diseases/diagnostic imaging , Gastric Fistula , Endosonography , Gastroscopy , Esophagitis , Biliary Fistula/etiology , Biliary Fistula/surgery , Gallbladder Diseases/surgery , Inpatients , Physical Examination , Symptom AssessmentABSTRACT
Melanoma is a cancer that frequently metastasises to the small bowel, but most cases are asymptomatic and are diagnosed postmortem. Therefore, CT and PET CT cannot detect all lesions and conventional endoscopic study only detects 10-20% of lesions. In this study, we present the case of a 68-year-old patient with a history of cutaneous melanoma and a diagnosis of intestinal melanoma. Thanks to capsule endoscopy, two lesions compatible with cutaneous melanoma metastasis to the small bowel were detected, allowing a much more effective surgical planning. Capsule endoscopy is an innovative technique that improves preoperative diagnosis, as it is able to detect bowel segments that cannot be inspected by conventional endoscopy. It also has a better resolution than conventional CT, improving sensitivity in the detection of lesions.(AU)
Subject(s)
Humans , Male , Middle Aged , Capsule Endoscopes , Intestine, Small , Melanoma/diagnostic imaging , Endoscopy, Gastrointestinal , Intestinal Neoplasms/surgery , Inpatients , Physical Examination , Treatment OutcomeABSTRACT
Presentamos el caso de una mujer de 73 años que acude por estreñimiento desde hace 6 días, dolor abdominal y vómitos. Se realiza un TAC abdominal que muestra una dilatación del marco colónico hasta sigma, identificándose una litiasis de 43x20mm a ese nivel y una solución de continuidad entre la pared vesicular y el ángulo hepático con aerobilia asociada. Dada la obstrucción a nivel de sigma se decide realizar una colonoscopia urgente. Durante la endoscopia se objetiva el cálculo biliar que se extrae con éxito mediante cesta de Roth.La mucosa circundante presentaba datos de sufrimiento mucoso y una extensa úlcera por decúbito. Tras la endoscopia la paciente presenta resolución del cuadro obstructivo. Durante su ingreso se realiza una cirugía de resección de la fístula colecistocólica, colecistectomía y cierre primario de colon. Sin embargo la paciente presenta un postoperatorio tórpido con perforación a nivel del colon ascendente y fascitis necrotizante en la herida quirúrgica, falleciendo finalmente por shock séptico abdominal. (AU)
Subject(s)
Humans , Female , Aged , Endoscopy , Abdominal Pain , Colonoscopy , CholecystectomyABSTRACT
La hemorragia diverticular duodenal es una causa infrecuente de hemorragia digestiva alta. Hasta hace unos años su manejo era eminentemente quirúrgico, pero con los avances en el campo de la endoscopia el tratamiento tiende a ser cada vez menos invasivo. Se presenta el caso de una hemorragia diverticular duodenal tratada endoscópicamente y se realiza una revisión de la literatura sobre las diferentes terapias endoscópicas descritas hasta la fecha (AU)
Duodenal diverticula are an uncommon cause of upper gastrointestinal bleeding. Until recently, it was primarily managed with surgery, but advances in the field of endoscopy have made management increasingly less invasive. We report a case of duodenal diverticular bleeding that was endoscopically managed, and review the literature about the various endoscopic therapies thus far described (AU)
Subject(s)
Humans , Female , Aged, 80 and over , Hemorrhage/complications , Hemorrhage , Diverticulum/complications , Diverticulum , Duodenal Diseases/complications , Duodenal Diseases , Endoscopy/trends , Duodenum/pathology , Duodenum , Gastroscopy/instrumentation , Gastroscopy/methods , Hemostasis , Hemostasis, Surgical/methodsSubject(s)
Humans , Female , Aged, 80 and over , Cholangiopancreatography, Endoscopic Retrograde , Choledocholithiasis/complications , Choledocholithiasis/diagnostic imaging , Choledocholithiasis/surgery , Situs Inversus/complications , Situs Inversus/diagnostic imaging , Duodenum , Jaundice, Obstructive/diagnostic imaging , Jaundice, Obstructive/etiologyABSTRACT
Complications following endoscopic procedures have been rarely reported and spontaneous rupture of a normal spleen is an exceptional complication following a gastroscopy. This paper reports a case of a spontaneous rupture of a normal spleen following a gastroscopy.
ABSTRACT
No disponible
Subject(s)
Humans , Female , Middle Aged , Lacerations/surgery , Esophageal Diseases/diagnostic imaging , Esophageal Perforation/diagnostic imaging , Esophageal Mucosa/injuries , Drug-Eluting StentsABSTRACT
La enfermedad diverticular en la causa más frecuente de hemorragia digestiva baja. En la mayoría de las ocasiones el sangrado cesa sin ninguna intervención, pero en un 10-20 % de los casos es necesario tratar la hemorragia. Se han descrito varias modalidades de tratamiento endoscópico tras preparar el colon. Presentamos cinco casos de hemorragia diverticular severa tratados con inyección de adrenalina y hemoclips. Todas las colonoscopias se realizaron de urgencia y sin preparación del colon, con correcta visualización del punto de sangrado. Los pacientes evolucionaron favorablemente evitando otros procedimientos agresivos como una arteriografía o cirugía (AU)
Diverticular disease is the most frequent cause of lower gastrointestinal bleeding. Most of the times, bleeding stops without any intervention but in 10-20 % of the cases it is necessary to treat the hemorrhage. Several modalities of endoscopic treatment have been described after purging the colon. We present five cases of severe diverticular bleeding treated with injection of epinephrine and hemoclips. All the colonoscopies were performed without purging of the colon in an emergency setting, with correct visualization of the point of bleeding. Patients recovered well avoiding other aggressive procedures such as angiography or surgery (AU)