Endoscopic management of migrated biliary stent causing sigmoid perforation.

Endoscopically deployed biliary stents are a well established method for dealing with biliary diseases. Perforation of the gut secondary to migrated biliary stent is reported in less than 1% cases. The authors present the first case of a colonic perforation from migrated biliary stent which was managed endoscopically. An 82-year-old female had a biliary stent for a postcholecystectomy bile leak and presented 6 months later with left iliac fossa pain. Barium enema showed a stent perforating the sigmoid colon. In view of the patient's frailty and absence of peritonitis, an endoscopic retrieval of stent was attempted. Flexible sigmoidoscopy showed a stent partially embedded within the sigmoid diverticulum which was successfully removed and the defect was closed endoscopically using three titanium clips. She had an uncomplicated recovery following the procedure and was discharged home on the second day following the procedure.

Medium-term outcome of endoluminal gastroplication with the EndoCinch device in children.

OBJECTIVE: Endoluminal gastroplication (EG) is emerging as a minimally invasive procedure for the treatment of gastroesophageal reflux disease (GERD). The aim of this study is to evaluate the medium-term outcomes after EG in a pediatric patient population. PATIENTS AND METHODS: Seventeen children with a median age of 12.4 years (range 6.1-15.9 years) with GERD underwent EG using a flexible endoscopic sewing device (EndoCinch) over a period of 3 years. Three plications were placed in the gastric tissue below the lower esophageal sphincter. Drug dose requirement, pH measurements, symptom severity and frequency, and validated Quality of Life in Reflux and Dyspepsia (QOLRAD) scores were compared before EG and 1 and 3 years after EG. Statistical analysis was performed using a Wilcoxon rank-sum test and P < 0.05 was the threshold for significance. RESULTS: All patients showed an immediate posttreatment improvement in symptom severity, symptom frequency, and quality of life scores. Completed 1- and 3-year data were obtained from 16 patients. Four cases (25%) required a repeat procedure as a result of recurrence of symptoms after 2 to 24 months. Fourteen patients (88%) at 1 year and 9 patients (56%) at 3 years remained without a need for any antireflux medication. A sustained improvement in heartburn (P = 0.004), regurgitation (P = 0.017), and vomiting (P = 0.018) was seen at 3 years. The total QOLRAD score (maximum of 175) improved from a median of 87 (range 69-142) to 156 (range 111-175) at 1 year (P < 0.0001) and 153.5 (range 55-174) at 3 years (P = 0.002). CONCLUSIONS: EG is an effective and safe procedure in children. It is a viable option for the treatment of GERD refractory to or dependent on antireflux medications.

Colonic stenting: an alternative to surgery in the elderly.

This case report describes the management of a frail older patient presenting with a rare case of an obstructing right-sided colonic lesion, combined with complex co-morbidities. The report briefly discusses use of colonic stenting in right colonic lesions as well as palliative management of colonic tumours in general.

Federal funding of endoscopic research in the United States: 1972-2002.

BACKGROUND: Funding for research is critical to the determination of appropriate applications for endoscopy in clinical practice. We sought to evaluate trends in funding provided by the National Institutes of Health (NIH) for endoscopic research from 1972 through 2002. METHODS: The NIH database of funded biomedical projects for the years 1972 through 2002 was searched using the Computerized Retrieval of Information on Scientific Projects (CRISP) and the keyword "endoscopy." Grants were included if a start date, title, and/or specific aims were available. Grants were classified as primary endoscopy if the title or specific aim had an endoscopy focus. Endoscopy funding was compared with other nonendoscopic funding for the same period. RESULTS: From 1972 through 2002, 133 endoscopy-related grant applications were funded and 98 met inclusion criteria. Funding for endoscopic research increased from one grant (1972-1982) to 4 grants (1983-1992) to 93 grants (1993-2002), a 2325% increase for the 1993-2002 decade alone. Despite this increase, there were substantially fewer funded endoscopy-related applications compared with liver disease (61,804 grants), Helicobacter pylori (866 grants), and cardiac catheterization (1547 grants). Among endoscopic grants, colorectal cancer projects accounted for the largest portion (34%), followed by advanced optical technologies (18%) and Barrett's esophagus (17%). CONCLUSIONS: Funding for endoscopic research by the NIH has increased dramatically over the past 30 years, but it still lags behind funding in other fields. Projects focused on colorectal cancer, Barrett's esophagus, and optical technologies were most common among those funded, and the National Cancer Institute was the primary source of funding.