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Constantinou BT, Benedicto BC, Porto BC, Belkovsky M, Passerotti CC, Artifon EL, Otoch JP, da Cruz JA. PCNL vs. two staged RIRS for kidney stones greater than 20 mm: systematic review, meta-analysis, and trial sequential analysis. Minerva Urol Nephrol 2024; 76:31-41. [PMID: 38426420 DOI: 10.23736/s2724-6051.23.05577-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Percutaneous nephrolithotomy (PCNL) is considered the gold standard treatment for kidney stones greater than 20 mm. However, retrograde intrarenal surgery (RIRS) may achieve the same stone-free rate with repeated procedures, and potentially fewer complications. This study aimed to compare the efficacy and safety of PCNL and two-staged RIRS. EVIDENCE ACQUISITION We conducted a systematic search in PubMed, Embase, Scopus, Cochrane, and Web of Science for studies comparing PCNL and RIRS for kidney stones greater than 20mm. The primary outcome is stone-free rate (SFR) of PCNL and RIRS (repeated once if needed). Secondary outcomes were SFR of PCNL versus RIRS (single procedure), operative time, hospital stay, need for auxiliary procedures, and complications. We performed a subgroup analysis for randomized trials, non-randomized trials, and patients with solitary kidney. We performed a trial sequential analysis for the main outcome. EVIDENCE SYNTHESIS We included 31 articles, with 1987 patients in the PCNL and 1724 patients in RIRS. We confirmed the traditional result that after a single procedure PCNL has a higher SFR. We also found that comparing the SFR of PCNL and RIRS, repeated up to two times if needed, no difference in SFR was observed. Surprisingly, only 26% (CI95 23%-28%) of the patients required a second RIRS. In the trial sequential analysis, the last point of the z-curve was within futility borders. We observed that PCNL has a higher incidence of complications (RR=1.51; CI95 1.24, 1.83; P<0.0001; I2=28%), specifically CD2 (RR=1.82; CI95 1.30, 2.54; P=0.0004; I2=26%) and longer hospital stay (MD 2.57; 2.18, 2.96; P<0.00001; I2-98%). No difference was observed regarding operative time. CONCLUSIONS RIRS repeated up to two times is equivalent to PCNL in terms of the SFR and may have the same safety.
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Affiliation(s)
| | | | - Breno C Porto
- Department of Surgical Technique and Experimental Surgery, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Mikhael Belkovsky
- Department of Surgical Technique and Experimental Surgery, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Carlo C Passerotti
- Department of Surgical Technique and Experimental Surgery, University of São Paulo School of Medicine, São Paulo, Brazil
- German Hospital Oswaldo Cruz, Specialized Center for Urology, São Paulo, Brazil
| | - Everson L Artifon
- Department of Surgical Technique and Experimental Surgery, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Jose P Otoch
- Department of Surgical Technique and Experimental Surgery, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Jose A da Cruz
- Ninth of July University (UNINOVE), São Paulo, Brazil -
- Department of Surgical Technique and Experimental Surgery, University of São Paulo School of Medicine, São Paulo, Brazil
- German Hospital Oswaldo Cruz, Specialized Center for Urology, São Paulo, Brazil
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Tyberg A, Sarkar A, Shahid HM, Shah-Khan SM, Gaidhane M, Simon A, Eisenberg IA, Lajin M, Karagyozov P, Liao K, Patel R, Zhao E, Martínez MG, Artifon EL, Lino AD, Vanella G, Arcidiacono PG, Kahaleh M. EUS-Guided Biliary Drainage Versus ERCP in Malignant Biliary Obstruction Before Hepatobiliary Surgery: An International Multicenter Comparative Study. J Clin Gastroenterol 2023; 57:962-966. [PMID: 36730114 DOI: 10.1097/mcg.0000000000001795] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 10/07/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Endoscopic ultrasound-guided biliary drainage (EUS-BD) is the procedure of choice for patients who cannot undergo endoscopic retrograde cholangiopancreatography (ERCP). The outcomes of patients undergoing surgery after EUS-BD for malignancy are unknown. METHODS We conducted an international, multicenter retrospective comparative study of patients who underwent hepatobiliary surgery after having undergone EUS-BD or ERCP from 6 tertiary care centers. Patient demographics, procedural data, and follow-up care were collected in a registry. RESULTS One hundred forty-five patients were included: EUS-BD n=58 (mean age 66, 45% male), ERCP n=87 (mean age 68, 53% male). The majority of patients had pancreatic cancer, cholangiocarcinoma, or gallbladder malignancy. In the EUS-BD group, 29 patients had hepaticogastrostomy, 24 had choledochoduodenostomy, and 5 had rendezvous technique done. The most common surgery was Whipple in both groups (n=41 EUS-BD, n=56 ERCP) followed by partial hepatectomy (n=7 EUS-BD, n=14 ERCP) and cholecystectomy (n=2 EUS-BD, n=2 ERCP). Endoscopy clinical success was comparable in both groups (98% EUS-BD, 94% ERCP). Adverse event rates were similar in both groups: EUS-BD (n=10, 17%) and ERCP (n=23, 26%). Surgery technical success and clinical success were significantly higher in the EUS-BD group compared with the ERCP group (97% vs. 83%, 97% vs. 75%). Total Hospital stay from surgery to discharge was significantly higher in the ERCP group (19 d vs. 10 d, P =0.0082). DISCUSSION Undergoing EUS-BD versus ERCP before hepatobiliary surgery is associated with fewer repeat endoscopic interventions, shorter duration between endoscopy and surgical intervention, higher rates of surgical clinical success, and shorter length of hospital stay after surgery.
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Affiliation(s)
- Amy Tyberg
- Gastroenterology, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Avik Sarkar
- Gastroenterology, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Haroon M Shahid
- Gastroenterology, Robert Wood Johnson Medical School, New Brunswick, NJ
| | | | - Monica Gaidhane
- Gastroenterology, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Alexa Simon
- Gastroenterology, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Ian A Eisenberg
- Gastroenterology, Robert Wood Johnson Medical School, New Brunswick, NJ
| | | | | | - Kelvin Liao
- Gastroenterology, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Roohi Patel
- Gastroenterology, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Eric Zhao
- Gastroenterology, Robert Wood Johnson Medical School, New Brunswick, NJ
| | | | | | - André D Lino
- Universidade de Sao Paulo Faculdade de Medicina, Sao Paulo, Brazil
| | | | | | - Michel Kahaleh
- Gastroenterology, Robert Wood Johnson Medical School, New Brunswick, NJ
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Abstract
La pancreatitis crónica es un trastorno irreversible y progresivo del páncreas caracterizado por inflamación, fibrosis y cicatrización. Las funciones exocrinas y endocrinas se pierden, lo que a menudo conduce al dolor crónico. La etiología es multifactorial, aunque el alcoholismo es el factor de riesgo más importante en los adultos. Si se sospecha pancreatitis crónica, la tomografía computarizada con contraste es la mejor modalidad de diagnóstico por imágenes. Aunque los narcóticos y los antidepresivos proporcionan el mayor alivio del dolor, más de la mitad de los pacientes eventualmente requiere una intervención por endoscopia o cirugía. La colangiopancreatografía retrógrada endoscópica es una alternativa eficaz para una variedad de terapias en el tratamiento de enfermedades benignas y malignas del páncreas. En los últimos 50 años, la endoterapia ha evolucionado hasta convertirse en la terapia de primera línea en la mayoría de las enfermedades inflamatorias agudas y crónicas del páncreas. A medida que avanza este campo, es importante que los gastroenterólogos mantengan un conocimiento adecuado de la indicación del procedimiento, mantengan el volumen de procedimiento suficiente para manejar la endoterapia pancreática compleja y comprendan enfoques alternativos a las enfermedades pancreáticas, incluidos el tratamiento médico, la terapia guiada por ecografía endoscópica, el manejo de las estenosis sintomáticas y cálculos, las intervenciones sobre el plexo celíaco y el drenaje de los pseudoquistes pancreáticos.
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Chen YI, Levy MJ, Moreels TG, Hajijeva G, Will U, Artifon EL, Hara K, Kitano M, Topazian M, Abu Dayyeh B, Reichel A, Vilela T, Ngamruengphong S, Haito-Chavez Y, Bukhari M, Okolo P, Kumbhari V, Ismail A, Khashab MA. An international multicenter study comparing EUS-guided pancreatic duct drainage with enteroscopy-assisted endoscopic retrograde pancreatography after Whipple surgery. Gastrointest Endosc 2017; 85:170-177. [PMID: 27460390 DOI: 10.1016/j.gie.2016.07.031] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 07/01/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Endoscopic management of post-Whipple pancreatic adverse events (AEs) with enteroscopy-assisted endoscopic retrograde pancreatography (e-ERP) is associated with high failure rates. EUS-guided pancreatic duct drainage (EUS-PDD) has shown promising results; however, no comparative data have been done for these 2 modalities. The goal of this study is to compare EUS-PDD with e-ERP in terms of technical success (PDD through dilation/stent), clinical success (improvement/resolution of pancreatic-type symptoms), and AE rates in patients with post-Whipple anatomy. METHODS This is an international multicenter comparative retrospective study at 7 tertiary centers (2 United States, 2 European, 2 Asian, and 1 South American). All consecutive patients who underwent EUS-PDD or e-ERP between January 2010 and August 2015 were included. RESULTS In total, 66 patients (mean age, 57 years; 48% women) and 75 procedures were identified with 40 in EUS-PDD and 35 in e-ERP. Technical success was achieved in 92.5% of procedures in the EUS-PDD group compared with 20% of procedures in the e-ERP group (OR, 49.3; P < .001). Clinical success (per patient) was attained in 87.5% of procedures in the EUS-PDD group compared with 23.1% in the e-ERP group (OR, 23.3; P < .001). AEs occurred more commonly in the EUS-PDD group (35% vs 2.9%, P < .001). However, all AEs were rated as mild or moderate. Procedure time and length of stay were not significantly different between the 2 groups. CONCLUSIONS EUS-PDD is superior to e-ERP in post-Whipple anatomy in terms of efficacy with acceptable safety. As such, EUS-PDD should be considered as a potential first-line treatment in post-pancreaticoduodenectomy anatomy when necessary expertise is available.
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Affiliation(s)
- Yen-I Chen
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Michael J Levy
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Tom G Moreels
- Division of Gastroenterology and Hepatology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Gulara Hajijeva
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Uwe Will
- Division of Gastroenterology and Hepatology, Municipal Hospital, Gera, Germany
| | | | - Kazuo Hara
- Division of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Masayuki Kitano
- Divisions of Gastroenterology and Hepatology, Kinki University Faculty of Medicine, Osaka, Japan
| | - Mark Topazian
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Barham Abu Dayyeh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Andreas Reichel
- Division of Gastroenterology and Hepatology, Municipal Hospital, Gera, Germany
| | - Tiago Vilela
- Department of Surgery, Ana Costa Hospital, Santos, Brazil
| | - Saowanee Ngamruengphong
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Yamile Haito-Chavez
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Majidah Bukhari
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Patrick Okolo
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Vivek Kumbhari
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Amr Ismail
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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5
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Khashab MA, El Zein MH, Sharzehi K, Marson FP, Haluszka O, Small AJ, Nakai Y, Park DH, Kunda R, Teoh AY, Peñas I, Perez-Miranda M, Kumbhari V, Van der Merwe S, Artifon EL, Ross AS. EUS-guided biliary drainage or enteroscopy-assisted ERCP in patients with surgical anatomy and biliary obstruction: an international comparative study. Endosc Int Open 2016; 4:E1322-E1327. [PMID: 27995197 PMCID: PMC5161123 DOI: 10.1055/s-0042-110790] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 06/13/2016] [Indexed: 02/07/2023] Open
Abstract
Background and study aims: How enteroscopy-assisted ERCP (e-ERCP) and endoscopic ultrasound-guided biliary drainage (EUS-BD) compare in patients with surgically altered upper gastrointestinal anatomy is currently unknown. The aims of this study were to compare efficacy and safety of both techniques and study predictors of these outcomes. Patients and methods: This was an international, multicenter comparative cohort study at 10 tertiary centers. Outcomes data included technical success (biliary access with cholangiography and stent placement [when indicated]), clinical success (resolution of biliary obstruction) and adverse events (AEs) (graded according to the ASGE lexicon). Results: A total of 98 patients underwent EUS-BD (n = 49) or e-ERCP (n = 49). Technical success was achieved in 48 (98 %) patients in the EUS-BD group as compared to 32 (65.3 %) patients in the e-ERCP group (OR 12.48, P = 0.001). Clinical success was attained in 88 % of patients in EUS-BD group as compared to 59.1 % in the e-ERCP group (OR 2.83, P = 0.03). Procedural time was significantly shorter in the EUS-BD group (55 min vs 95 min, P < 0.0001). AEs occurred more commonly in the EUS-BD group (20 % vs. 4 %, P = 0.01). However, the majority (90 %) of AEs were mild/moderate. Length of stay was significantly longer in the EUS-BD group (6.6 d vs. 2.4 d, P < 0.0001). Conclusions: EUS-BD can be performed with a higher degree of clinical efficacy and shorter procedure time than e-ERCP in patients with surgically-altered upper gastrointestinal anatomy. Whether or not this approach should be first-line therapy in this patient population is highly dependent on the indication for the procedure, the patient's anatomy, and local practice and expertise.
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Affiliation(s)
- Mouen A. Khashab
- Division of Gastroenterology and Hepatology,
The Johns Hopkins Medical Institutions, Baltimore, MD, United
States,Corresponding author Mouen A. Khashab,
MD Associate Professor of
MedicineDirector of Therapeutic
EndoscopyJohns Hopkins
Hospital1800 Orleans St, Suite 7125
BBaltimore, MD
21205+1-443-287-1960
| | - Mohamad H. El Zein
- Division of Gastroenterology and Hepatology,
The Johns Hopkins Medical Institutions, Baltimore, MD, United
States
| | - Kaveh Sharzehi
- Division of Gastroenterology and Hepatology,
Temple University Hospital, Philadelphia, PA, United States
| | | | - Oleh Haluszka
- Division of Gastroenterology and Hepatology,
Temple University Hospital, Philadelphia, PA, United States
| | - Aaron J. Small
- Division of Hepatology and Gastroenterology,
Virginia Mason Medical Center, Seattle, WA, United States
| | - Yousuke Nakai
- Department of Gastroenterology, Graduate
School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Do Hyun Park
- Department of Internal Medicine, University
of Ulsan College of Medicine, Asan Medical Center, Seoul, South
Korea
| | - Rastislav Kunda
- Department of Surgical Gastroenterology,
Aarhus University Hospital, Aarhus, Denmark
| | - Anthony Y. Teoh
- Department of Surgery, The Chinese University
of Hong Kong, Hong Kong, China
| | - Irene Peñas
- Hospital Universitario Rio Hortega,
Valladolid University, Valladolid, Spain
| | | | - Vivek Kumbhari
- Division of Gastroenterology and Hepatology,
The Johns Hopkins Medical Institutions, Baltimore, MD, United
States
| | | | | | - Andrew S. Ross
- Division of Hepatology and Gastroenterology,
Virginia Mason Medical Center, Seattle, WA, United States
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de Moura ET, de Moura EG, Bernardo W, Cheng S, Kondo A, de Moura DT, Bravo J, Artifon EL. Guide wire-a sisted cannulation versus conventional contrast to prevent pancreatitis. A systematic review and meta-analysis based on randomized control trials. Rev Gastroenterol Peru 2016; 36:308-319. [PMID: 28062867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Through this systematic review and meta-analysis, we aim to clarify the differences between these two techniques, thus improving primary success cannulation and reducing complications during endoscopic retrograde cholangiopancreatography, primarily pancreatitis. METHODS A comprehensive search was conducted to search for data available up until June2015from the most important databases available in the health field: EMBASE, MEDLINE (via PubMed), Cochrane, LILACS and CENTRAL (via BVS), SCOPUS, the CAPES database (Brazil), and gray literature. RESULTS Nine randomized clinical trialsincluding2583 people were selected from20,198 studies for meta-analysis. Choledocholithiasis had been diagnosed in mostly (63.8%) of the patients, who were aged an average of 63.15 years. In those patients treated using the guide wire-assisted cannulation technique, provided a significantly lower instance of pancreatitis (RD=0.03; 95% CI: 0.01-0.05; I2= 45%) and greater primary success cannulation (RD=0.07; 95% CI: 0.03-0.12; I2=12%) than conventional contrast cannulation. CONCLUSIONS The guide wire-assisted technique, when compared to the conventional contrast technique, reduces the risk of pancreatitis and increases primary success cannulation rate. Thus, guide wire-assisted cannulation appears to be the most appropriate first-line cannulation technique.
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Affiliation(s)
- Eduardo T de Moura
- Gastrointestinal Endoscopy Unit, University of São Paulo. São Paulo, Brazil
| | - Eduardo G de Moura
- Gastrointestinal Endoscopy Unit, University of São Paulo. São Paulo, Brazil
| | - Wanderley Bernardo
- Gastrointestinal Endoscopy Unit, University of São Paulo. São Paulo, Brazil
| | - Spencer Cheng
- Gastrointestinal Endoscopy Unit, University of São Paulo. São Paulo, Brazil
| | - Andre Kondo
- Gastrointestinal Endoscopy Unit, University of São Paulo. São Paulo, Brazil
| | - Diogo T de Moura
- Gastrointestinal Endoscopy Unit, University of São Paulo. São Paulo, Brazil
| | - Jose Bravo
- Gastrointestinal Endoscopy Unit, University of São Paulo. São Paulo, Brazil
| | - Everson L Artifon
- Gastrointestinal Endoscopy Unit, University of São Paulo. São Paulo, Brazil
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de Moura DT, Guedes H, Tortoretto V, Arataque TP, de Moura EG, Román JP, Rodela GL, Artifon EL. [Comparison of colon-cleansing methods in preparation for colonoscopy-comparative of solutions of mannitol and sodium picosulfate]. Rev Gastroenterol Peru 2016; 36:293-297. [PMID: 28062864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVES The purpose of the present study is to compare intestinal preparation with mannitol and sodium picosulphate, assessing patient's acceptance, side effects and cleaning capacity. MATERIAL AND METHODS This is a prospective, nom randomized, blind study, in which the evaluator had no information about the preparation applied. The sample obtained was divided into two groups according to the bowel preparation applied, with 153 patients prepared with 10% mannitol and 84 patients with sodium picosulfate. The evaluation of colon preparation was done using the Boston Scale (Boston Bowel Preparation Scale - BBP) through a three-point scoring system for each of the three regions of the colon: right, left and transverse colon. RESULTS Of the 237 patients that were evaluated, 146 (61.60%) were female and 91 (38.4%) were male. Regarding the group that used mannitol, 98 were female (64.05%) and 55 were male (35.95%). Among the patients who used sodium picosulfate, 48 were female (57.14%) and 36 were male (42.86%), with no statistical differences between both groups (p> 0.32). Considering that an adequate preparation scores ≥ 6 in the Boston Scale, the bowel cleansing preparation was satisfactory in both groups. 93% of the patients who used mannitol and 81% of the patients who used sodium picosulfate had adequate preparation (score of ≥ 6). Moreover, we consider that the average score in the preparation with Mannitol was 9, while the sodium picosulfate score was 7. There were no significant differences between the two groups. CONCLUSION There is consensus among authors who state that colonoscopy's safety and success are highly related to the cleansing outcome, regardless of the method used. The same can be observed in the present study, on which both preparations were proved safe and effective for bowel cleansing, according to the Boston scale, as well as accepted by patients and free of complications.
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Affiliation(s)
- Diogo Turiani de Moura
- Departamento de Endoscopia Gastrointestinal, Escuela de Medicina, Universidad de Sao Paulo. Sao Paulo, Brasil
| | - Hugo Guedes
- Departamento de Endoscopia Gastrointestinal, Escuela de Medicina, Universidad de Sao Paulo. Sao Paulo, Brasil
| | | | | | - Eduardo Guimarães de Moura
- Departamento de Endoscopia Gastrointestinal, Escuela de Medicina, Universidad de Sao Paulo. Sao Paulo, Brasil
| | - Juan Pablo Román
- Departamento de Endoscopia Gastrointestinal, Escuela de Medicina, Universidad de Sao Paulo. Sao Paulo, Brasil
| | - Gustavo Luis Rodela
- Departamento de Endoscopia Gastrointestinal, Escuela de Medicina, Universidad de Sao Paulo. Sao Paulo, Brasil
| | - Everson L Artifon
- Departamento de Endoscopia Gastrointestinal, Escuela de Medicina, Universidad de Sao Paulo. Sao Paulo, Brasil
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8
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Farias GF, Otoch JP, Guedes HG, Artifon EL. Recurrent acute pancreatitis caused by pancreatic biliary maljunction due to long common channel. Rev Gastroenterol Peru 2016; 36:363-364. [PMID: 28062875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The pancreatic biliary maljunction is a rare anomaly that affects mainly females, defined as an anatomical maljunction of the pancreatic duct and the biliary duct confluence, and may be a rare cause of recurrent acute pancreatitis. In order to early diagnosis and prompt treatment, ERCP has an important role in it.
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Affiliation(s)
- Galileu F Farias
- Department of Surgery, University of Sao Paulo Medical School. Sao Paulo, Brazil
| | - Jose P Otoch
- Department of Surgery, University of Sao Paulo Medical School. Sao Paulo, Brazil
| | - Hugo G Guedes
- Department of Surgery, University of Sao Paulo Medical School. Sao Paulo, Brazil
| | - Everson L Artifon
- Department of Surgery, University of Sao Paulo Medical School. Sao Paulo, Brazil
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9
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Kahaleh M, Perez-Miranda M, Artifon EL, Sharaiha RZ, Kedia P, Peñas I, De la Serna C, Kumta NA, Marson F, Gaidhane M, Boumitri C, Parra V, Rondon Clavo CM, Giovannini M. International collaborative study on EUS-guided gallbladder drainage: Are we ready for prime time? Dig Liver Dis 2016; 48:1054-7. [PMID: 27328985 DOI: 10.1016/j.dld.2016.05.021] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 05/19/2016] [Accepted: 05/23/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Cholecystectomy remains the gold standard treatment of cholecystitis. Endoscopic treatment of cholecystitis includes transpapillary gallbladder drainage. Recently, endoscopic ultrasound-guided transmural drainage of the gallbladder (EUS-GBD) has been reported. This study reports the cumulative experience of an international group performing EUS-GBD. METHODS Cases of EUS-GBD from January 2012 to November 2013 from 3 tertiary-care institutions were captured in a registry. Patient demographics, disease characteristics, procedural and clinical outcomes were recorded. RESULTS 35 patients (15 malignant, 20 benign) were included. Median age was 81 years (SD=13.76 years), sixteen (46%) were males. Median follow-up was 91.5 days (SD=157 days). Transmural access was obtained from the stomach (n=17) or duodenum (n=18). Stents placed included plastic (n=6), metal (n=20), or combination (n=7). Technical success was achieved in 91.4% (n=32). Immediate adverse events (14%) included: bleeding, stent migration, cholecystitis and hemoperitoneum. Delayed adverse events (11%) included abscess formation and recurrence of cholecystitis. Long-term clinical success rate was 89%. Stent type and puncture site were not associated with immediate (p=0.88, p=0.62), or long-term (p=0.47, p=0.27) success. CONCLUSIONS EUS-GBD appears to be feasible, safe, and effective. Prospective studies are needed to confirm these findings and identify the best technique to use. CLINICAL TRIAL REGISTRATION NCT01522573.
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Affiliation(s)
- Michel Kahaleh
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, United States.
| | | | | | - Reem Z Sharaiha
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, United States
| | - Prashant Kedia
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, United States
| | - Irene Peñas
- Hospital del Rio Hortega, Rio Hortega, Spain
| | | | - Nikhil A Kumta
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, United States
| | | | - Monica Gaidhane
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, United States
| | | | - Viviana Parra
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, United States
| | - Carlos M Rondon Clavo
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, United States
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Khashab MA, Van der Merwe S, Kunda R, El Zein MH, Teoh AY, Marson FP, Fabbri C, Tarantino I, Varadarajulu S, Modayil RJ, Stavropoulos SN, Peñas I, Ngamruengphong S, Kumbhari V, Romagnuolo J, Shah R, Kalloo AN, Perez-Miranda M, Artifon EL. Prospective international multicenter study on endoscopic ultrasound-guided biliary drainage for patients with malignant distal biliary obstruction after failed endoscopic retrograde cholangiopancreatography. Endosc Int Open 2016; 4:E487-96. [PMID: 27092334 PMCID: PMC4831932 DOI: 10.1055/s-0042-102648] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 01/22/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND AIMS Endoscopic ultrasound-guided biliary drainage (EUS-BD) has emerged as an alternative to traditional radiologic and surgical drainage procedures after failed endoscopic retrograde cholangiopancreatography (ERCP). However, prospective multicenter data are lacking. The aims of this study were to prospectively assess the short- and long-term efficacy and safety of EUS-BD in patients with malignant distal biliary obstruction. PATIENTS AND METHODS Consecutive patients at 12 tertiary centers (5 US, 5 European, 1 Asian, 1 South American) with malignant distal biliary obstruction and failed ERCP underwent EUS-BD. Technical success was defined as successful stent placement in the desired position. Clinical success was defined as a reduction in bilirubin by 50 % at 2 weeks or to below 3 mg/dL at 4 weeks. Adverse events were prospectively tracked and graded according to the American Society for Gastrointestinal Endoscopy (ASGE) lexicon's severity grading system. Overall survival and duration of stent patency were calculated using Kaplan-Meier analysis. RESULTS A total of 96 patients (mean age 66 years, female 45 %, pancreatic cancer 55 %) underwent EUS-BD. Stent placement (technical success) was achieved in 92 (95.8 %) patients (metallic stent 84, plastic stent 8). Mean procedure time was 40 minutes. Clinical success was achieved in 86 (89.5 %) patients. A total of 10 (10.5 %) adverse events occurred: pneumoperitoneum (n = 2), sheared wire (n = 1), bleeding (n = 1), bile leak (n = 3), cholangitis (n = 2), and unintentional perforation (n = 1); 4 graded as mild, 4 moderate, 1 severe, and 1 fatal (due to perforation). A total of 38 (44 %) patients died of disease progression during the study period. The median patient survival was 167 days (95 %CI 112 - 221) days. The 6-month stent patency rate was 95 % (95 %CI 94.94 - 95.06 %) and the 1-year stent patency was 86 % (95 %CI 85.74 - 86.26 %). CONCLUSION This study on EUS-BD demonstrates excellent efficacy and safety of EUS-BD when performed by experts. STUDY REGISTRATION NCT01889953.
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Affiliation(s)
- Mouen A. Khashab
- Johns Hopkins Medical Institute, Baltimore, MD, USA,Corresponding author Mouen A. Khashab, MD Johns Hopkins Hospital – Gastroenterology1800 Orleans Street Suite 7125BBaltimoreMD 21287USA+1-443-683-8335
| | - Schalk Van der Merwe
- Department of Hepatology, Division of Liver, and Pancreatico-Biliary Disorders, University Hospital Gastuisberg, University of Leuven, Leuven Belgium
| | | | | | - Anthony Y. Teoh
- Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | | | - Carlo Fabbri
- Unit of Gastroenterology and Digestive Endoscopy, AUSL Bologna Bellaria-Maggiore Hospital, Bologna, Italy
| | - Ilaria Tarantino
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy
| | | | | | | | - Irene Peñas
- Hospital Universitario Rio Hortega, Valladolid, Spain
| | | | | | - Joseph Romagnuolo
- Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, SC, USA
| | - Raj Shah
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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de Moura EGH, Furuya CK, Mestieri LHM, Medrado BF, Carneiro FO, Artifon EL, Herman P, Sakai P. Biliary stenosis extreme endoscopy treatment-very large balloon dilation: a new concept. Gastrointest Endosc 2015; 81:227-8. [PMID: 24836748 DOI: 10.1016/j.gie.2014.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Accepted: 04/02/2014] [Indexed: 12/11/2022]
Affiliation(s)
- Eduardo G H de Moura
- Gastrointestinal Endoscopy Unit, University of São Paulo Medical School, São Paulo, Brazil
| | - Carlos K Furuya
- Gastrointestinal Endoscopy Unit, University of São Paulo Medical School, São Paulo, Brazil
| | - Luiz H M Mestieri
- Gastrointestinal Endoscopy Unit, University of São Paulo Medical School, São Paulo, Brazil
| | - Bruno F Medrado
- Gastrointestinal Endoscopy Unit, University of São Paulo Medical School, São Paulo, Brazil
| | - Fred O Carneiro
- Gastrointestinal Endoscopy Unit, University of São Paulo Medical School, São Paulo, Brazil
| | - Everson L Artifon
- Gastrointestinal Endoscopy Unit, University of São Paulo Medical School, São Paulo, Brazil
| | - Paulo Herman
- Gastrointestinal Endoscopy Unit, University of São Paulo Medical School, São Paulo, Brazil
| | - Paulo Sakai
- Gastrointestinal Endoscopy Unit, University of São Paulo Medical School, São Paulo, Brazil
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Moura EG, Couto-Júnior DS, Alvarado-Escobar H, da Costa-Martins B, Sallum RA, Artifon EL, Sakai P. [Epidermolysis bullosa acquisita complicated by esophageal stenosis. Endoscopic treatment with thermoplastic dilators and intralesional steroid injection]. Rev Gastroenterol Mex 2011; 76:279-285. [PMID: 22041322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Epidermolysis bullosa acquisita (EBA) is a rare auto-immune dermatologic disease, produced by auto-antibodies against colagen VII. We report a 44 years old male patient with EBA diagnosed 15 years before, who presented with progressive disphagia, being diagnosed an esophageal involvement of EBA. The patient was submitted to endoscopic treatment with thermoplastic bougie dilation and intralesional corticosteroid injection. The patient improved clinically with recovery of nutritional status. Esophageal involvement in EBA is very rare and its reason is still unknown. Endoscopic approach must be cautiously performed with the use of small diameter endoscopes, small caliber dilators, intralesional injection of corticosteroid and enteral tube in order to minimize the risks of complications, as well as esophageal rest from food trauma and better reparatory molding of the epithelium.
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Affiliation(s)
- E G Moura
- Unidad de Endoscopia Gastrointestinal, Departamento de Gastroenterología, Escuela de Medicina de Universidad de Sao Paulo Sä Paulo, Brasil.
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Bertolini GRF, Artifon EL, Silva TS, Cunha DM, Vigo PR. Low-level laser therapy, at 830 nm, for pain reduction in experimental model of rats with sciatica. Arq Neuro-Psiquiatr 2011; 69:356-9. [DOI: 10.1590/s0004-282x2011000300017] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Accepted: 11/25/2010] [Indexed: 11/22/2022]
Abstract
Chronic pain, resulting from nerve compression, is a common clinical presentation. One means of conservative treatment is low-level laser therapy, although controversial. The aim of this study was to evaluate the effects of two doses of low-level laser, at 830 nm, on pain reduction in animals subjected to sciatica. Eighteen rats were used, divided into three groups: GS (n=6), sciatica and simulated treatment; G4J (n=6), sciatica and treatment with 4 J/cm²; and G8J (n=6), sciatica and irradiation with 8 J/cm². The right sciatic nerve was exposed and compressed using catgut thread. Five days of treatment were started on the third postoperative day. Pain was assessed by means of the paw elevation time during gait: before sciatica, before and after the first and second therapies, and the end of the fifth therapy. Low-level laser was effective in reducing the painful condition.
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Affiliation(s)
| | | | - T S Silva
- Western Paraná State University, Brazil
| | - D M Cunha
- Western Paraná State University, Brazil
| | - P R Vigo
- Western Paraná State University, Brazil
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da Silveira EB, Artifon EL, Garcia RT. EUS-guided FNA for GI stromal tumors: caveat lector. Gastrointest Endosc 2010; 71:659-60; author reply 660-1. [PMID: 20189532 DOI: 10.1016/j.gie.2009.07.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Accepted: 07/22/2009] [Indexed: 02/08/2023]
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Abstract
INTRODUCTION Different modalities of palliation for obstructive symptoms in patients with unresectable esophageal cancer (EC) exist. However, these therapeutic alternatives have significant differences in costs and effectiveness. METHODS A Markov model was designed to compare the cost-effectiveness (CE) of self-expandable stent (SES), brachytherapy and laser in the palliation of unresectable EC. Patients were assigned to one of the strategies, and the improvement in swallowing function was compared given the treatment efficacy, probability of survival, and risks of complications associated to each strategy. Probabilities and parameters for distribution were based on a 9-month time frame. RESULTS Under the base-case scenario, laser has the lowest CE ratio, followed by brachytherapy at an incremental cost-effectiveness ratio (ICER) of $4,400.00, and SES is a dominated strategy. In the probabilistic analysis, laser is the strategy with the highest probability of cost-effectiveness for willingness to pay (WTP) values lower than $3,201 and brachytherapy for all WTP yielding a positive net health benefit (NHB) (threshold $4,440). The highest probability of cost-effectiveness for brachytherapy is 96%, and consequently, selection of suboptimal strategies can lead to opportunity losses for the US health system, ranging from US$ 4.32 to US$ 38.09 million dollars over the next 5-20 years. CONCLUSION Conditional to the WTP and current US Medicare costs, palliation of unresectable esophageal cancers with brachytherapy provides the largest amount of NHB and is the strategy with the highest probability of CE. However, some level of uncertainly remains, and wrong decisions will be made until further knowledge is acquired.
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Affiliation(s)
- Eduardo B da Silveira
- Division of Gastroenterology, Portland VA Medical Center, Oregon Health and Science University, 3710 SW US Veterans Hospital Road, P3GI, Portland, OR, 97239, USA.
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Affiliation(s)
- E L Artifon
- Gastrointestinal Endoscopy Unit, São Paulo University Medical School, São Paulo, Brazil.
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