1
|
Staudenmann DA, Kaffes AJ, Saxena P. Endoscopic Ultrasound-Guided Vascular Procedures: A Review. Clin Endosc 2020; 53:519-524. [PMID: 33027582 PMCID: PMC7548160 DOI: 10.5946/ce.2020.222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 09/03/2020] [Indexed: 12/02/2022] Open
Abstract
Since the 1980s, endoscopic ultrasound has advanced from being purely diagnostic to an interventional modality. The gastrointestinal tract offers an exceptional window for assessing the vascular structures in the mediastinum and in the abdomen. This has led to a rapidly growing interest in endoscopic ultrasound-controlled vascular interventions as a minimally invasive alternative to surgical and radiological procedures.
Collapse
Affiliation(s)
- Dominic A Staudenmann
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, Australia
| | - Arthur J Kaffes
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, Australia.,The University of Sydney, Sydney, Australia
| | - Payal Saxena
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, Australia.,The University of Sydney, Sydney, Australia
| |
Collapse
|
2
|
Kozieł S, Pawlak K, Błaszczyk Ł, Jagielski M, Wiechowska-Kozłowska A. Endoscopic Ultrasound-Guided Treatment of Gastric Varices Using Coils and Cyanoacrylate Glue Injections: Results after 1 Year of Experience. J Clin Med 2019; 8:jcm8111786. [PMID: 31731504 PMCID: PMC6912414 DOI: 10.3390/jcm8111786] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 10/18/2019] [Accepted: 10/23/2019] [Indexed: 12/14/2022] Open
Abstract
Background and Aims: Gastric varices (GVs) occur in 20% of patients with portal hypertension. GVs are associated with a 65% risk of bleeding over the course of 2 years and have a mortality rate of up to 20%. The standard treatment for GVs is obliteration with cyanoacrylate (CYA). This study presents our experience with combined therapy (vascular coils and CYA) under endoscopic ultrasound (EUS) guidance. Methods: 16 patients (9 male and 7 female) were included into our study. Etiology of portal hypertension included: portal vein thrombosis (PVT) (31.0%), isolated splenic vein thrombosis (SVT) (25.0%), alcoholic cirrhosis (12.5%), hepatitis C cirrhosis (19.0%), and alcoholic cirrhosis with PVT (12.5%). Varices type GOV-2 were diagnosed in 8 patients, type IGV-1 and IGV-2 in 6 and 2 patients, respectively. Indications for treatment were based on endoscopic and endosonographic evaluations of GVs. Inclusion and exclusion criteria were also specified. Technique depended on the size of varices (different size of coils + CYA additionally). The results were based on the achievement of technical success, therapeutic effects, and number of adverse events. Average follow-up period was 327 days. Results: From January to August 2017, 16 patients were treated with EUS-guided obliteration of GVs using vascular coils only or coils with CYA injections. 6 (37.5%) and 10 (62.5%) patients underwent primary and secondary prophylaxis for hemorrhage, respectively. Technical success was achieved in 15 patients (94.0%). Mean numbers of implanted coils and CYA volume during one procedure were 1.7 and 2 mL, respectively. Therapeutic success was achieved in all patients treated with the combination. There were no serious complications such as embolization or death due to the procedure. Three patients (19.0%) had transient abdominal pain and two (12.5%) had transient fever. 1 patient had clinical symptoms of gastrointestinal bleeding. Conclusions: Based on our retrospective research we have concluded, that EUS-guided implantation of intravascular coils combined with cyanoacrylate injections is an effective method of treatment with an acceptable number of complications.
Collapse
Affiliation(s)
- Sławomir Kozieł
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, 02-097 Warsaw, Poland;
| | - Katarzyna Pawlak
- Department of Gastroenterology, Hospital of the Ministry of Internal Affairs in Szczecin, 70-382 Szczecin, Poland (A.W.-K.)
- Correspondence: ; Tel.: +48-914-329-563; Fax: +48-914-329-501
| | - Łukasz Błaszczyk
- Department of Gastroenterology, Hospital of the Ministry of Internal Affairs in Szczecin, 70-382 Szczecin, Poland (A.W.-K.)
| | - Mateusz Jagielski
- Department of General, Gastroenterological and Oncological Surgery, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 87-100 Torun, Poland;
| | - Anna Wiechowska-Kozłowska
- Department of Gastroenterology, Hospital of the Ministry of Internal Affairs in Szczecin, 70-382 Szczecin, Poland (A.W.-K.)
| |
Collapse
|
3
|
Wang S, Sun S, Liu X, Ge N, Wang G, Guo J, Liu W, Wang S. Endoscopic diagnosis of primary anorectal melanoma. Oncotarget 2018; 8:50133-50140. [PMID: 28412758 PMCID: PMC5564836 DOI: 10.18632/oncotarget.15495] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 02/07/2017] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE The present study retrospectively analyzed case data from 12 patients diagnosed with anorectal melanoma, with the purpose of identifying key diagnostic features at endoscopy. MATERIALS AND METHODS Images from colonoscopy were reviewed for all patients in order to establish the endoscopic features of primary anorectal melanoma. For the patients whose colonoscopic examinations included endoscopic ultrasound, images were examined to characterize lesions and the depth of infiltration, the results of which were compared with pathological findings after operative resection. RESULTS At colonoscopy, superficial melanin pigmentation was identified in 10 patients with anorectal melanoma, with morphology including spots, patches, or sheets of pigmentation. In patients who underwent endoscopic ultrasound, lesions appeared as masses on the mucosal side with inhomogeneous or low-level internal echoes or ulcer-type lesions invading the muscularis propria. Lesions diagnosed as anorectal melanoma also demonstrated irregular margins and varying degrees of submucosal infiltration. Infiltration depth of melanoma via endoscopic ultrasound (EUS) was concordant with surgical pathology results in 100% of patients. CONCLUSION Colonoscopy combined with biopsy and subsequent pathological examination can accurately diagnose primary anorectal melanoma. Moreover, EUS is a reliable tool for assessing the depth of infiltration of this disease.
Collapse
Affiliation(s)
- Sheng Wang
- Endoscopic Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Siyu Sun
- Endoscopic Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiang Liu
- Endoscopic Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Nan Ge
- Endoscopic Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Guoxin Wang
- Endoscopic Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jintao Guo
- Endoscopic Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Wen Liu
- Endoscopic Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Shupeng Wang
- Endoscopic Center, Shengjing Hospital of China Medical University, Shenyang, China
| |
Collapse
|
4
|
Yu Y, Qi SL, Zhang Y. Role of combined propofol and sufentanil anesthesia in endoscopic injection sclerotherapy for esophageal varices. World J Gastroenterol 2017; 23:7875-7880. [PMID: 29209128 PMCID: PMC5703916 DOI: 10.3748/wjg.v23.i44.7875] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 09/04/2017] [Accepted: 09/13/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the efficacy and safety of a combination of sufentanil and propofol injection in patients undergoing endoscopic injection sclerotherapy (EIS) for esophageal varices (EVs).
METHODS Patients with severe EVs who underwent EIS with sufentanil and propofol anesthesia between April 2016 and July 2016 at our hospital were reviewed. Although EIS and sequential therapy were performed under endotracheal intubation, we only evaluated the efficacy and safety of anesthesia for the first EIS procedure. Patients were intravenously treated with 0.5-1 μg/kg sufentanil. Anesthesia was induced with 1-2 mg/kg propofol and maintained using 2-5 mg/kg per hour of propofol. Information, regarding age, sex, weight, American Association of Anesthesiologists (ASA) physical status, Child-Turcotte-Pugh (CTP) classification, indications, preanesthetic problems, endoscopic procedure, successful completion of the procedure, anesthesia time, recovery time, and anesthetic agents, was recorded. Adverse events, including hypotension, hypertension, bradycardia, and hypoxia, were also noted.
RESULTS Propofol and sufentanil anesthesia was provided in 182 procedures involving 140 men and 42 women aged 56.1 ± 11.7 years (range, 25-83 years). The patients weighed 71.4 ± 10.7 kg (range, 45-95 kg) and had ASA physical status classifications of II (79 patients) or III (103 patients). Ninety-five patients had a CTP classification of A and 87 had a CTP classification of B. Intravenous anesthesia was successful in all cases. The mean anesthesia time was 33.1 ± 5.8 min. The mean recovery time was 12.3 ± 3.7 min. Hypotension occurred in two patients (1.1%, 2/182). No patient showed hypertension during the endoscopic therapy procedure. Bradycardia occurred in one patient (0.5%, 1/182), and hypoxia occurred in one patient (0.5%, 1/182). All complications were easily treated with no adverse sequelae. All endoscopic procedures were completed successfully.
CONCLUSION The combined use of propofol and sufentanil injection in endotracheal intubation-assisted EIS for EVs is effective and safe.
Collapse
Affiliation(s)
- Yang Yu
- Department of Anesthesiology, the Sixth People’s Hospital of Dalian, Dalian 116000, Liaoning Province, China
| | - Sheng-Lin Qi
- Endoscopy Center, the Sixth People’s Hospital of Dalian, Dalian 116000, Liaoning Province, China
| | - Yong Zhang
- President Office, the Sixth People’s Hospital of Dalian, Dalian 116000, Liaoning Province, China
| |
Collapse
|
5
|
Gastroduodenal Artery Psuedoaneurysm Bleed through a Spontaneous Pancreaticoduodenal Fistula as a Result of Acute Necrotizing Pancreatitis. ACG Case Rep J 2017; 4:e105. [PMID: 28879210 PMCID: PMC5577032 DOI: 10.14309/crj.2017.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 07/27/2017] [Indexed: 11/17/2022] Open
Abstract
Spontaneous pancreaticoduodenal fistulization and arterial psuedoaneurysm formation are both complications of acute pancreatitis. We present a 27-year-old man with hematemesis who was found to be bleeding from a gastroduodenal artery psuedoaneurysm through a spontaneous pancreaticoduodenal fistula as a result of severe alcohol-related necrotizing pancreatitis. This is the first reported case in the literature to describe this occurrence.
Collapse
|
6
|
Săftoiu A, Vilmann P. EUS targeting of vascular thrombosis: Risky business? Gastrointest Endosc 2017; 86:156-160. [PMID: 28610855 DOI: 10.1016/j.gie.2016.11.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 11/21/2016] [Indexed: 12/11/2022]
Affiliation(s)
- Adrian Săftoiu
- Endoscopy Department, GastroUnit, Copenhagen University Hospital, Herlev, Denmark; Gastroenterology Department, Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy, Craiova, Romania
| | - Peter Vilmann
- Endoscopy Department, GastroUnit, Copenhagen University Hospital, Herlev, Denmark
| |
Collapse
|
7
|
Lesmana CRA, Gani RA, Hasan I, Sulaiman AS, Lesmana LA. Therapeutic Interventional Endoscopic Ultrasound Based on Rare Cases in Indonesia: A Single-Center Experience in Unselected Patients. Case Rep Gastroenterol 2017; 11:72-77. [PMID: 28611556 PMCID: PMC5465756 DOI: 10.1159/000456606] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 01/16/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Endoscopic ultrasound (EUS) is still not widely available and has a barrier in most Southeast Asian countries due to lack of training program, high cost, and hospital investment. In this study, we would like to show the impact of therapeutic interventional EUS procedures in gastroenterology practice in Indonesia, which represents the biggest Southeast Asian country. METHODS Patients who underwent interventional EUS procedure in Medistra Hospital were prospectively recruited within 1 year. RESULTS Of 147 patients who underwent EUS procedures, 39 patients underwent fine needle aspiration. Most of the cases suffered from pancreatic cancer (47.5%) followed by ampullary cancer (20%), gastric subepithelial mass (10%), and other conditions. There were 4 rare cases that underwent therapeutic interventional EUS procedures. Patients with large mesenteric cyst attached to the gastric wall and large left liver lobe cyst with gastric compression who were previously suspected with gastrointestinal stromal tumor were successfully managed by cyst aspiration. One patient with a large pseudocyst due to chronic pancreatitis was successfully managed by plastic stent placement. Another patient with duodenal duplication cyst causing duodenal obstruction was managed by inserting a plastic stent through the cyst. No complications were observed during and after the therapeutic EUS procedures. CONCLUSIONS Innovation in interventional EUS has a high impact in gastroenterology practice as well as in a developing country like Indonesia, which represents the biggest Southeast Asian country. Further developments are needed regarding the cost, investment, and especially the necessary training curriculum to make this technology available in tertiary referral centers.
Collapse
Affiliation(s)
- Cosmas Rinaldi A Lesmana
- aDigestive Disease & GI Oncology Center, Medistra Hospital, Jakarta, Indonesia.,bDepartment of Medicine, Hepatobiliary Division, Cipto Mangunkusumo Hospital, Universitas Indonesia, Jakarta, Indonesia
| | - Rino A Gani
- bDepartment of Medicine, Hepatobiliary Division, Cipto Mangunkusumo Hospital, Universitas Indonesia, Jakarta, Indonesia
| | - Irsan Hasan
- bDepartment of Medicine, Hepatobiliary Division, Cipto Mangunkusumo Hospital, Universitas Indonesia, Jakarta, Indonesia
| | - Andri Sanityoso Sulaiman
- bDepartment of Medicine, Hepatobiliary Division, Cipto Mangunkusumo Hospital, Universitas Indonesia, Jakarta, Indonesia
| | | |
Collapse
|
8
|
Sun B, Guo J, Ge N, Sun S, Wang S, Liu X, Wang G, Feng L. Endoscopic ultrasound-guided puncture suture device versus metal clip for gastric defect closure after endoscopic full-thickness resection: A randomized, comparative, porcine study. Endosc Ultrasound 2016; 5:263-8. [PMID: 27503160 PMCID: PMC4989409 DOI: 10.4103/2303-9027.187891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective: The secure closure of the wall defect is a critical stage of endoscopic full-thickness resection (EFTR). The aim of this study was to compare the closure of post-EFTR defects using an endoscopic ultrasound-guided puncture suture device (PSD) with the metal clip (MC) technique in a randomized, comparative, porcine study. Methods: We performed a randomized comparative survival study that included 18 pigs. The circular EFTR defects with a diameter of approximately 20 mm were closed with either a PSD or MC. Serum levels of interleukin-6 (IL-6) were determined preoperatively and on a postoperative day (POD) 1, 3, and 7. Three animals from each group were sacrificed at the end of the 7th, 14th, and 30th POD. Tissue samples retrieved from the closure sites were examined macroscopically and microscopically. Results: Resection and closure were performed in 18 pigs (100%) without major perioperative complications. The mean closure time was significantly longer in the MC group than in the PSD group (25.00 ± 3.16 min vs. 1.56 ± 0.39 min; P < 0.05). Preoperative and POD 7 serum levels of IL-6 did not differ between the two groups. However, on POD 1, the IL-6 levels were observed to be significantly greater in the MC group than in the PSD group (P < 0.005). No significant differences between the PSD and MC groups were observed at necropsy. Conclusion: In this in vivo porcine model, PSD is a feasible device that achieves post-EFTR defect closure with a much shorter closure time and with less immunological responses than the MC technique.
Collapse
Affiliation(s)
- Beibei Sun
- Endoscopy Center, Shengjing Hospital, China Medical University, Liaoning Province, China
| | - Jintao Guo
- Endoscopy Center, Shengjing Hospital, China Medical University, Liaoning Province, China
| | - Nan Ge
- Endoscopy Center, Shengjing Hospital, China Medical University, Liaoning Province, China
| | - Siyu Sun
- Endoscopy Center, Shengjing Hospital, China Medical University, Liaoning Province, China
| | - Sheng Wang
- Endoscopy Center, Shengjing Hospital, China Medical University, Liaoning Province, China
| | - Xiang Liu
- Endoscopy Center, Shengjing Hospital, China Medical University, Liaoning Province, China
| | - Guoxin Wang
- Endoscopy Center, Shengjing Hospital, China Medical University, Liaoning Province, China
| | - Linlin Feng
- Endoscopy Center, Shengjing Hospital, China Medical University, Liaoning Province, China
| |
Collapse
|
9
|
Park TY, Seo DW, Kang HJ, Cho MK, Song TJ, Park DH, Lee SS, Lee SK, Kim MH. Endoscopic ultrasonography-guided placement of a transhepatic portal vein stent in a live porcine model. Endosc Ultrasound 2016; 5:315-319. [PMID: 27803904 PMCID: PMC5070289 DOI: 10.4103/2303-9027.191611] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background and Objectives: Percutaneous portal vein (PV) stent placement is used to manage PV occlusion or stenosis caused by malignancy. The use of endoscopic ultrasonography (EUS) has expanded to include vascular interventions. The aim of this study was to examine the technical feasibility and safety of EUS-guided transhepatic PV stent placement in a live porcine model. Materials and Methods: EUS-guided transhepatic PV stent placement was performed in six male miniature pigs under general anesthesia using forward-viewing echoendoscope. Under EUS guidance, the left intrahepatic PV was punctured with a 19-gauge fine-needle aspiration (FNA) needle and a 0.025 inch guidewire inserted through the needle and into the main PV. The FNA needle was then withdrawn and a needle-knife inserted to dilate the tract. Under EUS and fluoroscopic guidance, a noncovered metal stent was inserted over the guidewire and released into the main PV. Results: A PV stent was placed successfully in all six pigs with no technical problems or complications. The patency of the stent in the main PV was confirmed using color Doppler EUS and transhepatic portal venography. Necropsy of the first three animals revealed no evidence of bleeding and damage to intra-abdominal organs or vessels. No complications occurred in the remaining three animals during the 8 weeks observation period. Conclusions: EUS-guided transhepatic PV stent placement can be both technically feasible and safe in a live animal model.
Collapse
Affiliation(s)
- Tae Young Park
- Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Dong Wan Seo
- Department of Internal Medicine, Division of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyeon-Ji Kang
- Department of Gastroenterology, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea
| | - Min Keun Cho
- Department of Internal Medicine, Division of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Jun Song
- Department of Internal Medicine, Division of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Do Hyun Park
- Department of Internal Medicine, Division of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Soo Lee
- Department of Internal Medicine, Division of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Koo Lee
- Department of Internal Medicine, Division of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Myung-Hwan Kim
- Department of Internal Medicine, Division of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|