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Li X, Ye L, Pan F. Endoscopic radial pyloromyotomy for adult idiopathic hypertrophic pyloric stenosis. GASTROENTEROLOGIA Y HEPATOLOGIA 2024; 47:78-79. [PMID: 36584752 DOI: 10.1016/j.gastrohep.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/11/2022] [Accepted: 12/02/2022] [Indexed: 12/29/2022]
Affiliation(s)
- Xuelian Li
- Department of Gastroenterology, The Affiliated Huai'an No. 1 People's Hospital, Nanjing Medical University, Huai'an, China
| | - Liansong Ye
- Department of Gastroenterology, West China Hospital, Sichuan University, China
| | - Feng Pan
- Department of Gastroenterology, The Affiliated Huai'an No. 1 People's Hospital, Nanjing Medical University, Huai'an, China.
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2
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Rizzo GEM, Carrozza L, Rancatore G, Binda C, Fabbri C, Anderloni A, Tarantino I. The Role of Endoscopy in the Palliation of Pancreatico-Biliary Cancers: Biliary Drainage, Management of Gastrointestinal Obstruction, and Role in Relief of Oncologic Pain. Cancers (Basel) 2023; 15:5367. [PMID: 38001627 PMCID: PMC10670525 DOI: 10.3390/cancers15225367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/20/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
Therapeutic endoscopy permits many and various treatments for cancer palliation in patients with bilio-pancreatic cancers, enabling different options, supporting patients during their route to oncologic treatments, and trying to improve their quality of life. Therefore, both endoscopic and endoscopic ultrasound (EUS)-guided techniques are performed in this scenario. We performed a literature review focusing on the role of endoscopy in the palliation of those advanced pancreatic and biliary cancers developing malignant biliary obstruction (MBO), gastric outlet obstruction (GOO), and pain unresponsive to medical therapies. Therefore, we explored and focused on the clinical outcomes of endoscopic procedures in this scenario. In fact, the endoscopic treatment is based on achieving biliary drainage in the case of MBO through endoscopic retrograde cholangiopancreatography (ERCP) or EUS-guided biliary drainage (EUS-BD), while GOO is endoscopically treated through the deployment of an enteral stent or the creation of EUS-guided gastro-entero-anastomosis (EUS-GEA). Furthermore, untreatable chronic abdominal pain is a major issue in patients unresponsive to high doses of painkillers, so EUS-guided celiac plexus neurolysis (CPN) or celiac ganglia neurolysis (CGN) helps to reduce dosage and have better pain control. Therefore, therapeutic endoscopy in the palliative setting is an effective and safe approach for managing most of the clinical manifestations of advanced biliopancreatic tumors.
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Affiliation(s)
- Giacomo Emanuele Maria Rizzo
- Endoscopy Unit, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT Palermo, 90127 Palermo, Italy; (G.E.M.R.); (L.C.); (G.R.)
- Ph.D. Program, Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, 90133 Palermo, Italy
| | - Lucio Carrozza
- Endoscopy Unit, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT Palermo, 90127 Palermo, Italy; (G.E.M.R.); (L.C.); (G.R.)
| | - Gabriele Rancatore
- Endoscopy Unit, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT Palermo, 90127 Palermo, Italy; (G.E.M.R.); (L.C.); (G.R.)
| | - Cecilia Binda
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, 48100 Forlì-Cesena, Italy; (C.B.); (C.F.)
| | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, 48100 Forlì-Cesena, Italy; (C.B.); (C.F.)
| | - Andrea Anderloni
- Gastroenterology and Digestive Endoscopy Unit, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi 19, 27100 Pavia, Italy;
| | - Ilaria Tarantino
- Endoscopy Unit, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT Palermo, 90127 Palermo, Italy; (G.E.M.R.); (L.C.); (G.R.)
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Wu J, Chen C, Hu B. Treatment of efferent loop syndrome after pancreatoduodenectomy with a fully covered self‐expandable metal stent: A case report. DEN OPEN 2023; 3:e156. [PMID: 35919281 PMCID: PMC9338343 DOI: 10.1002/deo2.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/15/2022] [Accepted: 06/25/2022] [Indexed: 11/18/2022]
Abstract
Efferent loop syndrome is a very rare complication following pancreatoduodenectomy. The treatment of efferent loop syndrome varies depending on the cause of the syndrome. Conservative treatment methods, including nasogastric drainage and enteral nutrition, are adopted that are effective in most of patients; however, surgical treatment is usually required in patients with complete loop obstruction. Herein, we report a case of severe efferent loop obstruction that occurred after pancreatoduodenectomy, which was refractory to conservative treatment and successfully resolved by insertion of a fully covered self‐expandable metal stent.
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Affiliation(s)
- Jun Wu
- Department of Gastroenterology, Eastern Hepatobiliary Hospital Naval Military Medical University Shanghai China
| | - Cui Chen
- Department of Gastroenterology, Eastern Hepatobiliary Hospital Naval Military Medical University Shanghai China
| | - Bing Hu
- Department of Gastroenterology, Eastern Hepatobiliary Hospital Naval Military Medical University Shanghai China
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4
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Ribas PHBV, De Moura DTH, Proença IM, Do Monte Júnior ES, Yvamoto EY, Hemerly MC, De Oliveira VL, Ribeiro IB, Sánchez-Luna SA, Bernardo WM, De Moura EGH. Endoscopic Ultrasound-Guided Gastroenterostomy for the Palliation of Gastric Outlet Obstruction (GOO): A Systematic Review and Meta-analysis of the Different Techniques. Cureus 2022; 14:e31526. [PMID: 36540454 PMCID: PMC9754671 DOI: 10.7759/cureus.31526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2022] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Gastric outlet obstruction (GOO) is usually associated with a poor prognosis and a significant decrease in a patient's quality of life. Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) using lumen-apposing metal stents (LAMS) has emerged as a safe and effective palliation procedure for GOO in patients that are unfit for surgery. Without an exclusive gold-standard technique for EUS-GE, we aimed to compare the currently available ones in this systematic review and meta-analysis, the first on this subspecialty. METHODS A comprehensive search from multiple electronic databases was performed. The search had a particular emphasis on the techniques used in performing EUS-GE. We identified all the studies in which EUS-GE was performed as palliation for GOO from its inception to the current date. The outcomes analyzed were the following: technical and clinical success, total and severe adverse events (AEs), procedure duration, and length of hospital stay (LOHS). RESULTS Twenty studies involving 863 patients were the basis of this statistical analysis. Patients underwent the following techniques: direct gastroenterostomy (DGE) (n=718), balloon-assisted gastroenterostomy (BAGE) (n=27), and endoscopic ultrasound (EUS)-guided double-balloon-occluded gastrojejunostomy bypass (n=118). In comparison to balloon-assisted techniques, DGE had a lower rate of AEs, -0.121 (95% CI -0.191 to -0.051 p=0.001); and LOHS for the DGE group, -2.684 (95% CI -1.031 to -4.337 p=0.001). The other analyzed outcomes presented no statistically significant differences. On a sub-analysis, BAGE showed a lower rate of AEs than EUS-guided double-balloon-occluded gastrojejunostomy bypass, -0.196 (95% CI -0.061 to -0.331 p=0.004). CONCLUSIONS EUS-GE is a safe and effective procedure for palliating GOO. When correctly administered, any of the analyzed techniques may be used to palliate GOO with similar technical and clinical outcomes. DGE had significantly lower rates of AEs and LOHS, which can be inferred as a safer procedure. These results should be interpreted cautiously due to the limited few studies that are available and accessible. Therefore, further well-designed, randomized clinical studies on the topic are warranted to compare the different techniques from more sources.
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Affiliation(s)
| | - Diogo Turiani H De Moura
- Gastroenterology, Hospital das Clínicas HCFMUSP Faculdade de Medicina, Universidade de São Paulo, São Paulo, BRA
| | - Igor M Proença
- Gastroenterology, Hospital das Clínicas HCFMUSP Faculdade de Medicina, Universidade de São Paulo, São Paulo, BRA
| | - Epifânio S Do Monte Júnior
- Gastroenterology, Hospital das Clínicas HCFMUSP Faculdade de Medicina, Universidade de São Paulo, São Paulo, BRA
| | - Erika Y Yvamoto
- Gastroenterology, Hospital das Clínicas HCFMUSP Faculdade de Medicina, Universidade de São Paulo, São Paulo, BRA
| | - Matheus C Hemerly
- Gastroenterology, Hospital das Clínicas HCFMUSP Faculdade de Medicina, Universidade de São Paulo, São Paulo, BRA
| | - Victor L De Oliveira
- Gastroenterology, Hospital das Clínicas HCFMUSP Faculdade de Medicina, Universidade de São Paulo, São Paulo, BRA
| | - Igor B Ribeiro
- Gastroenterology, Hospital das Clínicas HCFMUSP Faculdade de Medicina, Universidade de São Paulo, São Paulo, BRA
| | - Sergio A Sánchez-Luna
- Gastroenterology, University of Alabama at Birmingham Marnix E. Heersink School of Medicine, Birmingham, USA
| | - Wanderley M Bernardo
- Gastroenterology, Hospital das Clínicas HCFMUSP Faculdade de Medicina, Universidade de São Paulo, São Paulo, BRA
| | - Eduardo Guimarães H De Moura
- Gastroenterology, Hospital das Clínicas HCFMUSP Faculdade de Medicina, Universidade de São Paulo, São Paulo, BRA
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Kumar A, Chandan S, Mohan BP, Atla PR, McCabe EJ, Robbins DH, Trindade AJ, Benias PC. EUS-guided gastroenterostomy versus surgical gastroenterostomy for the management of gastric outlet obstruction: a systematic review and meta-analysis. Endosc Int Open 2022; 10:E448-E458. [PMID: 35433208 PMCID: PMC9010090 DOI: 10.1055/a-1765-4035] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/25/2021] [Indexed: 12/14/2022] Open
Abstract
Background and study aims Surgical gastroenterostomy (SGE) has been the mainstay treatment for gastric outlet obstruction (GOO). The emergence of endoscopic ultrasound-guided gastroenterostomy (EUS-GE) presents a less invasive alternative for palliation of GOO. We conducted a comprehensive review and meta-analysis to compare the effectiveness and safety of EUS-GE compared to SGE. Methods Multiple electronic databases and conference proceedings up to April 2021 were searched to identify studies that reported on safety and effectiveness of EUS-GE in comparison to SGE. Pooled odds ratios (ORs) of technical success, clinical success, adverse events (AE) and recurrence, and pooled standardized mean difference (SMD) of procedure time and post-procedure length of stay (LOS) were calculated. Study heterogeneity was assessed using I 2 and Cochran Q statistics. Results Seven studies including 625 patients (372 EUS-GE and 253 SGE) were included. EUS-GE had lower pooled odds of technical success compared with SGE (OR 0.19, 95 % confidence interval [CI] 0.06-0.60, I 2 0 %). Among the technically successful cases, EUS-GE was superior in terms of clinical success (OR 4.73, 95 % CI 1.83-12.25, I 2 18 %), lower overall AE (OR 0.20, 95 % CI 0.10-0.37, I 2 39 %), and shorter procedure time (SMD -2.4, 95 % CI -4.1, -0.75, I 2 95 %) and post-procedure LOS (SMD -0.49, 95 % CI -0.94, -0.03, I 2 78%). Rates of severe AE (0.89, 95 % CI 0.11-7.36, I 2 67 %) and recurrence (OR 0.49, 95 % CI 0.18-1.38, I 2 49 %) were comparable. Conclusions Our results suggest EUS-GE is a promising alternative to SGE due to its superior clinical success, overall safety, and efficiency. With further evolution EUS-GE could become the intervention of choice in GOO.
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Affiliation(s)
- Anand Kumar
- Division of Gastroenterology, Lenox Hill Hospital, New York, New York, United States
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Saurabh Chandan
- Division of Gastroenterology, CHI Creighton University Medical Center, Omaha, Nebraska, United States
| | - Babu P. Mohan
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - Pradeep R. Atla
- Palmdale Regional Medical Center, Palmdale, California, United States
| | - Evin J. McCabe
- Division of Gastroenterology, Lenox Hill Hospital, New York, New York, United States
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - David H. Robbins
- Division of Gastroenterology, Lenox Hill Hospital, New York, New York, United States
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Arvind J. Trindade
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Division of Gastroenterology, North Shore University Hospital, Manhasset, New York, United States
| | - Petros C. Benias
- Division of Gastroenterology, Lenox Hill Hospital, New York, New York, United States
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Division of Gastroenterology, North Shore University Hospital, Manhasset, New York, United States
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6
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Li J, Li S, Xi H, Liu P, Liang W, Gao Y, Wang C, Wei B, Chen L, Tang Y, Qiao Z. Effect of preoperative nutrition therapy type and duration on short-time outcomes in gastric cancer patient with gastric outlet obstruction. Chin J Cancer Res 2021; 33:232-242. [PMID: 34158742 PMCID: PMC8181873 DOI: 10.21147/j.issn.1000-9604.2021.02.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective To avoid perioperative complications caused malnutrition, nutrition therapy is necessary in gastric outlet obstruction (GOO) patients. Compared to parenteral nutrition (PN), enteral nutrition (EN) is associated with many advantages. This study aimed to investigate whether preoperative EN has beneficial clinical effects compared to preoperative PN in gastric cancer patients with GOO undergoing surgery. Methods According to the methods of preoperative nutrition therapy, 143 patients were divided into EN group (n=42) and PN group (n=101) between January 2013 and December 2017 at the Chinese People’s Liberation Army General Hospital. Multiple logistic regression models were used to assess the association between the methods of preoperative nutrition therapy and postoperative day of flatus passage. The generalized additive model and two-piecewise linear regression model were used to calculate the inflection point of the preoperative nutritional therapy time on the postoperative day of flatus passage in the PN group. Results EN shortened the postoperative day of flatus passage in gastric cancer patients with GOO, which is a protective factor, especially in patients who underwent non-radical operations and the postoperative day of flatus passage reduced when the preoperative PN therapy was up to 3 d and a longer PN therapy (>3 d) did not accelerate the postoperative recovery of gastrointestinal functions. Conclusions Preoperative EN therapy would benefit gastric cancer patients with GOO by accelerating postoperative recovery. For patients with absolute obstruction, no more than 3-day PN therapy is recommended if patients can tolerate general anesthesia and surgery.
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Affiliation(s)
- Jiyang Li
- Department of General Surgery, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China.,Liposuction Center of Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, China
| | - Shaoqing Li
- Department of General Surgery, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Hongqing Xi
- Department of General Surgery, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Peifa Liu
- Department of General Surgery, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Wenquan Liang
- Department of General Surgery, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Yunhe Gao
- Department of General Surgery, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Chuang Wang
- Department of General Surgery, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Bo Wei
- Department of General Surgery, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Lin Chen
- Department of General Surgery, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Yun Tang
- Department of General Surgery, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Zhi Qiao
- Department of General Surgery, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
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Fan W, Tan S, Wang J, Wang C, Xu H, Zhang L, Liu L, Fan Z, Tang X. Clinical outcomes of endoscopic ultrasound-guided gastroenterostomy for gastric outlet obstruction: a systematic review and meta-analysis. MINIM INVASIV THER 2020; 31:159-167. [PMID: 32672479 DOI: 10.1080/13645706.2020.1792500] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Wentao Fan
- Digestive Endoscopy Department and General Surgery Department, The First Affiliated Hospital with Nanjing Medical University and Jiangsu Province Hospital, Nanjing, China
| | - Shali Tan
- Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jiankun Wang
- Digestive Endoscopy Department and General Surgery Department, The First Affiliated Hospital with Nanjing Medical University and Jiangsu Province Hospital, Nanjing, China
| | - Chengfan Wang
- Digestive Endoscopy Department and General Surgery Department, The First Affiliated Hospital with Nanjing Medical University and Jiangsu Province Hospital, Nanjing, China
| | - Huan Xu
- Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Lu Zhang
- Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Li Liu
- Digestive Endoscopy Department and General Surgery Department, The First Affiliated Hospital with Nanjing Medical University and Jiangsu Province Hospital, Nanjing, China
| | - Zhining Fan
- Digestive Endoscopy Department and General Surgery Department, The First Affiliated Hospital with Nanjing Medical University and Jiangsu Province Hospital, Nanjing, China
| | - Xiaowei Tang
- Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou, China
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Shah J, Shahidullah A. Gastric Outlet Obstruction due to Malposition of Gastrostomy Tube: A Rare and Commonly Misdiagnosed Condition. Case Rep Gastroenterol 2020; 14:409-414. [PMID: 32884518 PMCID: PMC7443687 DOI: 10.1159/000508908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/19/2020] [Indexed: 11/19/2022] Open
Abstract
Nearly all disease processes worsen with malnutrition. However, providing adequate and optimal nourishment can be challenging in individuals who are not able to eat. Insertion of a gastrostomy tube is a well-established method for providing enteral access for long-term nutritional support. Although enteral tube feedings are generally well tolerated, gastrostomy tube placement is associated with several complications. An uncommon, and often initially misdiagnosed, complication of gastrostomy tube placement is gastric outlet obstruction (GOO), which refers to the clinical outcome of any disease process that mechanically obstructs gastric emptying. GOO is a clinical syndrome characterized by nausea, postprandial nonbilious vomiting, epigastric pain, early satiety, abdominal distention, and insidious weight loss due to mechanical obstruction in the distal stomach, pylorus, or duodenum. Rarely, migration and malposition of a gastrostomy tube can lead to this condition. Therefore, physicians should be aware of GOO as a rare complication of gastrostomy tube placement. Often, simple adjustment of the tube can lead to rapid improvement and resolution of the patient's clinical condition as well as prevent needless medical tests, overly aggressive management, and further complications. Here, we present an interesting case of a woman who developed a GOO after unintended migration of a gastrostomy tube.
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Affiliation(s)
- Jamil Shah
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Brooklyn Hospital Center, Academic Affiliate of The Icahn School of Medicine at Mount Sinai, Clinical Affiliate of The Mount Sinai Hospital, Brooklyn, New York, USA
| | - Abul Shahidullah
- Department of Medicine, Henry J. Carter Specialty Hospital and Nursing Facility, New York, New York, USA
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Sethi P, Narayana Gowda S, Motapothula U, Baloun B, Atiq M. Use of lumen apposing metal stent for pyloric stenosis refractory to balloon dilatation. J Dig Dis 2019; 20:663-664. [PMID: 31648417 DOI: 10.1111/1751-2980.12828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 10/14/2019] [Accepted: 10/22/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Prince Sethi
- Department of Internal Medicine, University of South Dakota, Sanford School of Medicine, Sioux Falls, South Dakota, USA
| | - Smitha Narayana Gowda
- Department of Internal Medicine, University of South Dakota, Sanford School of Medicine, Sioux Falls, South Dakota, USA
| | - Uma Motapothula
- Department of Internal Medicine, University of South Dakota, Sanford School of Medicine, Sioux Falls, South Dakota, USA
| | - Brett Baloun
- Department of Gastroenterology, University of South Dakota, Sanford School of Medicine, Sioux Falls, South Dakota, USA
| | - Muslim Atiq
- Department of Gastroenterology, University of South Dakota, Sanford School of Medicine, Sioux Falls, South Dakota, USA
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10
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McCarty TR, Garg R, Thompson CC, Rustagi T. Efficacy and safety of EUS-guided gastroenterostomy for benign and malignant gastric outlet obstruction: a systematic review and meta-analysis. Endosc Int Open 2019; 7:E1474-E1482. [PMID: 31673620 PMCID: PMC6811354 DOI: 10.1055/a-0996-8178] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 07/31/2019] [Indexed: 02/08/2023] Open
Abstract
Background and study aims Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is a novel endoscopic procedure designed to facilitate sustained luminal patency in patients with gastric outlet obstruction. The primary aim of this study was to evaluate the efficacy and safety of EUS-GE for treatment of gastric outlet obstruction. Methods Searches of PubMed, EMBASE, Web of Science, and Cochrane Library databases were performed through April 2019. Patients with benign and malignant gastric outlet obstruction were included. Measured outcomes included: immediate technical and clinical success as well as rate of serious adverse events (AEs). Heterogeneity was assessed with Cochran Q test and I 2 statistics. Publication bias was ascertained by funnel plot and Egger regression testing. Results A total of five studies (n = 199 patients; 45.73 % male) were included in this study. Four retrospective studies and one prospective study were analyzed. Mean age of patients that underwent the EUS-GE procedure was 64.52 ± 1.37 years with a pooled mean follow-up period of 4.32 ± 1.65 months. In 21 % of patients (n = 43), gastric outlet obstruction was due to benign causes. Immediate technical success was 92.90 % (95 % CI; 88.26 - 95.79; I 2 = 0.00 %) and reported in all studies. The clinical success rate of EUS-GE was 90.11 % (95 % CI; 84.64 - 93.44; I 2 = 0.00 %). Serious AEs occurred in 5.61 % (95 % CI; 2.87 - 10.67; I 2 = 1.67 %) of cases and were related to peritonitis, perforation, bleeding, and abdominal pain. Re-intervention rate was 11.43 % (95 % CI; 7.29 - 17.46; I 2 = 17.38 %). Conclusions EUS-GE appears to provide an effective and safe minimally invasive alternative for treatment of benign and malignant gastric outlet obstruction.
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Affiliation(s)
- Thomas R. McCarty
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Boston, Massachusetts, United States,Harvard Medical School, Boston, Massachusetts, United States
| | - Rajat Garg
- Cleveland Clinic, Cleveland, Ohio, United States
| | - Christopher C. Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Boston, Massachusetts, United States,Harvard Medical School, Boston, Massachusetts, United States
| | - Tarun Rustagi
- Division of Gastroenterology and Hepatology, University of New Mexico, Albuquerque, New Mexico, United States
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11
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Then EO, John F, Catalano C, Lopez M, Gaduputi V. An Unexpected Surprise: Delayed Gastric Outlet Obstruction from Coin Ingestion. Clin Pract 2019; 9:1153. [PMID: 31205642 PMCID: PMC6547025 DOI: 10.4081/cp.2019.1153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 05/03/2019] [Indexed: 11/23/2022] Open
Abstract
Gastric outlet obstruction (GOO) is characterized by postprandial vomiting due to mechanical obstruction. Rarely it can occur due to ingestion of a foreign body. Most cases of foreign body ingestion are benign, with passage of the ingested object into the stool with no clinical sequelae. We describe a case of an 80-year-old woman with GOO occurring secondary to ingestion of two coins (American quarters). Rarely will such a small object cause a true gastric outlet obstruction. To our knowledge this makes the second such case reported in the medical literature.
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12
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Sarani B, Paspulati RM, Hambley J, Efron D, Martinez J, Perez A, Bowles-Cintron R, Yi F, Hill S, Meyer D, Maykel J, Attalla S, Kochman M, Steele S. A multidisciplinary approach to diagnosis and management of bowel obstruction. Curr Probl Surg 2018; 55:394-438. [PMID: 30526888 DOI: 10.1067/j.cpsurg.2018.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 09/11/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Babak Sarani
- Center for Trauma and Critical Care, George Washington University School of Medicine, Washington, DC.
| | | | - Jana Hambley
- Department of Trauma and Acute Care Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - David Efron
- Division of Acute Care Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jose Martinez
- Division of Minimally Invasive Surgery, Minimally Invasive Surgery/Flexible Endoscopy Fellowship Program, University of Miami Miller School of Medicine, Miami, FL
| | - Armando Perez
- University of Miami Miller School of Medicine, Miami, FL
| | | | - Fia Yi
- Brooke Army Medical Center, San Antonio, TX
| | - Susanna Hill
- University of Massachusetts Medical Center, Worcester, MA
| | - David Meyer
- Division of Colon and Rectal Surgery, University of Massachusetts Medical Center, Worcester, MA
| | - Justin Maykel
- Division of Colon and Rectal Surgery, University of Massachusetts Medical Center, Worcester, MA
| | - Sara Attalla
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Michael Kochman
- Division of Gastroenterology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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