RESUMEN
Background and aim: A 40-year-old male was referred to our institute for the management of a percutaneous pancreatic fistula after acute pancreatitis due to SARS-COV2 infection. He developed a peripancreatic collection(PPC) which was percutaneously drained due to infection. After the resolution of PPC, a percutaneous leakage of the main pancreatic duct (MPD) was observed, so he underwent Endoscopic Retrograde ColangioPancreatography(ERCP) with biliary plus pancreatic sphincterotomy and placement of both pancreatic and biliary stent without resolution of the leak. Material(s) and Method(s): Then he was referred to our institution, where initial management included ERCP with placement of two trans-papillary pancreatic stents and the removal of percutaneous catheter, but the fistula kept to drain. Result(s): A multidisciplinary-board decided to perform a rendezvous with interventional radiology to facilitate an endoscopic ultrasound(EUS) trans-gastric drainage of the pancreatic area draining in the percutaneous fistula. Conclusion(s): The procedure included an initial ERCP with replacement of the two pancreatic stents while the radiologist places percutaneously a guidewire through the fistula to the pancreatic point of leakage into MPD. After that, EUS identified the point in which the percutaneous guidewire was getting into the MPD and a trans-gastric EUS-guided insertion of a guidewire achieved the MPD through a 19-Gauge needle. The latter guidewire crossed the percutaneous fistula and came out. At that point, a dilation up to 10 mm was performed to create a trans-gastric pancreatic fistula. The next step was to insert percutaneously a double pigtail(10 Fr) releasing the distal side into the stomach and the proximal side into the main pancreatic duct in order to stabilize the neo-fistula. Another trans-gastric plastic stent was endoscopically placed through the pancreato-gastric neo-fistula. At the end, injection of contrast dye through the percutaneous fistula showed a complete drainage into stomach. In conclusion, the procedure achieved the complete exclusion and resolution of the pancreatic-cutaneous fistula.Copyright © 2023. Editrice Gastroenterologica Italiana S.r.l.
RESUMEN
Purpose: Telemedicine has been successfully employed in a wide range of specialties. We hereby present the results of a pivotal study we ran in our centre just before the COVID19 pandemic. Methods: This was a prospective study including all adult cystic fibrosis patients who underwent lung transplant (LuTx) from September 2017 to August 2019. Patients were randomized into two groups;patients assigned to the first arm (intervention) received a home medical assistant (HMA) system device, to which a pulse oximeter and a spirometer with reusable turbine were integrated;they were asked to perform a spirometry and register their SpO2 at rest and on effort on a twice-weekly basis. All the data were digitally transmitted to our centre, where physiotherapists and physicians were able to analyse them real-time. Both the groups received traditional hospital-based follow-up. Results: 32 patients were enrolled, 16 in each group. No statistically significant difference was found between the two groups (see Table 1).With reference to the telemonitoring group:- Adherence to telemonitoring significantly decreased during the 12months period of follow up (see figure 1).- Hospital reported data were consistent with the last being registered with the HMA device.- Of note, two patients were requested to anticipate their hospital routine visit because of a FEV1 decrease being reported on their HMA device, in order to rule out possible acute lung allograft dysfunction.- 13 out of 16 patients reported a high degree of satisfaction with the telemonitoring experience. Conclusion: The COVID19 pandemic highlighted the necessity to investigate alternative practices to treat chronically ill individuals. In our study, telemonitoring proved to be a valuable tool to improve quality health care to LuTx recipients, especially for those who live far from the transplant centre. We are now implementing this approach scheduling online video consultations. Further research should be focused on standardizing quality of telemedicine services.