Asunto(s)
Anastomosis en-Y de Roux/efectos adversos , Conductos Biliares Intrahepáticos , Colangiopancreatografia Retrógrada Endoscópica/métodos , Colangitis Esclerosante/cirugía , Cálculos Biliares , Derivación Gástrica/métodos , Litotricia/métodos , Complicaciones Posoperatorias , Adulto , Conductos Biliares Intrahepáticos/diagnóstico por imagen , Conductos Biliares Intrahepáticos/cirugía , Femenino , Cálculos Biliares/diagnóstico por imagen , Cálculos Biliares/etiología , Cálculos Biliares/cirugía , Humanos , Trasplante de Hígado/efectos adversos , Trasplante de Hígado/métodos , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/cirugía , Reoperación/métodos , Resultado del TratamientoRESUMEN
Background and study aims The use of lumen apposing metal stents (LAMS) during EUS-guided transmural drainage (EUS-TD) of pancreatic walled-off necrosis (WON) has gained popularity. Data supporting their use in WON over plastic stents (PS), however, remain scarce. The aim of this study was to compare the clinical efficacy of LAMS (Axios, Boston Scientific) with PS in WON. Patients and methods This was a multicenter, retrospective study involving 14 centers. Consecutive patients who underwent EUS-TD of WON (2012â-â2016) were included. The primary end point was clinical success defined as WON size ≤â3 cm within a 6-month period without need for percutaneous drainage (PCD) or surgery. Results A total of 189 patients (mean age 55.2â±â15.6 years, 34.9â% female) were included (102 LAMS and 87 PS). Technical success rates were similar: 100â% in LAMS and 98.9â% in PS ( P â=â0.28). Clinical success was attained in 80.4 % of LAMS and 57.5â% of PS ( P â=â0.001). Rate of PCD was similar (13.7â% LAMS vs. 16.3â% PS, P â=â0.62), while PS was associated with a greater need for surgery (16.1â% PS vs. 5.6â% LAMS, P â=â0.02). Adverse events (AEs) were observed in 9.8â% of LAMS and 10.3â% of PS ( P â=â0.90) and were rated as severe in 2.0â% and 6.9â%, respectively ( P â=â0.93). After excluding patients with <â6 months follow-up, the rate of WON recurrence following initial clinical success was greater with PS (22.9â% PS vs. 5.6â% LAMS, P â=â0.04). Conclusions When compared to PS, LAMS in WON is associated with higher clinical success, shorter procedure time, lower need for surgery, and lower rate of recurrence.
RESUMEN
BACKGROUND: Afferent loop syndrome (ALS) is traditionally managed surgically and, more recently, endoscopically. The role of endoscopic ultrasound-guided entero-enterostomy (EUS-EE) has not been well described. The aim of this study was to assess the technical and clinical success and safety of EUS-EE. METHODS: This was a multicenter, retrospective series at six centers in patients with ALS treated by EUS-EE. Data on patients treated with enteroscopy-assisted luminal stenting (EALS) at a single center were also collected. RESULTS: 18 patients (mean age 64.2 years, 72â% post-pancreaticoduodenectomy, 10 female) underwent EUS-EE. The most common symptoms were vomiting (27.8â%) and jaundice (33.3â%). Clinical success included resolution of symptoms in 88.9â% and improvement to allow hospital discharge in 11.1â%. Technical success was achieved in 100â% of cases, with a mean procedure time of 29.7 minutes. The most common procedure was a gastro-jejunostomy (72.2â%). Three adverse events (16.7â%) occurred (two mild, one moderate). When compared with data on EALS, patients treated with EUS-EE needed fewer re-interventions (16.6â% vs. 76.5â%; Pâ<â0.001). CONCLUSION: EUS-EE seems to be safe and effective in the treatment of ALS.âIndirect comparison with EALS suggested that EUS-EE is associated with a reduced need for re-intervention.
Asunto(s)
Síndrome del Asa Aferente , Endosonografía/métodos , Enterostomía , Complicaciones Posoperatorias , Reoperación , Stents , Síndrome del Asa Aferente/epidemiología , Síndrome del Asa Aferente/etiología , Síndrome del Asa Aferente/fisiopatología , Síndrome del Asa Aferente/cirugía , Enterostomía/efectos adversos , Enterostomía/instrumentación , Enterostomía/métodos , Femenino , Humanos , Ictericia/diagnóstico , Ictericia/etiología , Masculino , Persona de Mediana Edad , Evaluación de Procesos y Resultados en Atención de Salud , Pancreaticoduodenectomía/efectos adversos , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/cirugía , Reoperación/métodos , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Evaluación de Síntomas/métodos , Evaluación de Síntomas/estadística & datos numéricos , Resultado del Tratamiento , Estados Unidos/epidemiología , Vómitos/diagnóstico , Vómitos/etiologíaRESUMEN
BACKGROUND & AIMS: It is not clear whether digital single-operator cholangioscopy (D-SOC) with electrohydraulic and laser lithotripsy is effective in removal of difficult biliary stones. We investigated the safety and efficacy of D-SOC with electrohydraulic and laser lithotripsy in an international, multicenter study of patients with difficult biliary stones. METHODS: We performed a retrospective analysis of 407 patients (60.4% female; mean age, 64.2 years) who underwent D-SOC for difficult biliary stones at 22 tertiary centers in the United States, United Kingdom, or Korea from February 2015 through December 2016; 306 patients underwent electrohydraulic lithotripsy and 101 (24.8%) underwent laser lithotripsy. Univariate and multivariable analyses were performed to identify factors associated with technical failure and the need for more than 1 D-SOC electrohydraulic or laser lithotripsy session to clear the bile duct. RESULTS: The mean procedure time was longer in the electrohydraulic lithotripsy group (73.9 minutes) than in the laser lithotripsy group (49.9 minutes; P < .001). Ducts were completely cleared (technical success) in 97.3% of patients (96.7% of patients with electrohydraulic lithotripsy vs 99% patients with laser lithotripsy; P = .31). Ducts were cleared in a single session in 77.4% of patients (74.5% by electrohydraulic lithotripsy and 86.1% by laser lithotripsy; P = .20). Electrohydraulic or laser lithotripsy failed in 11 patients (2.7%); 8 patients were treated by surgery. Adverse events occurred in 3.7% patients and the stone was incompletely removed from 6.6% of patients. On multivariable analysis, difficult anatomy or cannulation (duodenal diverticula or altered anatomy) correlated with technical failure (odds ratio, 5.18; 95% confidence interval, 1.26-21.2; P = .02). Procedure time increased odds of more than 1 session of D-SOC electrohydraulic or laser lithotripsy (odds ratio, 1.02; 95% confidence interval, 1.01-1.03; P < .001). CONCLUSIONS: In a multicenter, international, retrospective analysis, we found D-SOC with electrohydraulic or laser lithotripsy to be effective and safe in more than 95% of patients with difficult biliary stones. Fewer than 5% of patients require additional treatment with surgery and/or extracorporeal shockwave lithotripsy to clear the duct.