ABSTRACT
BACKGROUND: Endoscopic Ultrasound (EUS) represents the gold standard for initial drainage of pancreatic fluid collections (PFC) due to various etiologies. However, data concerning salvage EUS drainage after initial percutaneous drainage are limited. The purpose of our study was to evaluate the clinical outcomes and safety of EUS-guided drainage of pancreatic collections after failure of percutaneous drainage. METHODS: This retrospective study was conducted in a single, tertiary university center from August 2013 to January 2020. Indication was pancreatic collection after acute pancreatitis with PFC requiring EUS-guided drainage after failure of percutaneous drainage. RESULTS: Twenty-two patients with PFC after acute pancreatitis were included (mean age 64.1 ± 11.3 years) of which 4/22 (18.2%) had pancreatic pseudocyst and 18/22 (81.8%) presented with a walled-off necrosis. Seventy-six interventions were performed among the 22 patients. Lumen-Apposing Metal Stent (LAMS) were used in 5/22 (22.7%) and double pigtail plastic stents in 17/22 (77.3%) of interventions with a median number intervention of 3 per patient (range 1 to 7). Technical success rate was 98.7% (75/76) with an overall clinical success of 81.8% (18/22). Procedure related adverse events rate was 9.1% (2/22) including one bleeding and one pancreatic fistula. Two non-procedure related deaths were observed. CONCLUSION: EUS-guided pancreatic collection drainage is clinically effective and safe after clinical/technical failure of radiological percutaneous management.
Subject(s)
Pancreatic Pseudocyst , Pancreatitis , Humans , Middle Aged , Aged , Pancreatitis/etiology , Pancreatitis/surgery , Retrospective Studies , Acute Disease , Treatment Outcome , Pancreatic Pseudocyst/diagnostic imaging , Pancreatic Pseudocyst/surgery , Pancreatic Pseudocyst/etiology , Drainage/methods , Necrosis/etiology , Necrosis/surgery , Ultrasonography, InterventionalABSTRACT
Several new techniques have recently been introduced in digestive endoscopy. Among these are anti-reflux mucosectomy (ARMS) or mucosal ablation (ARMA) which have demonstrated efficacy in the treatment of patients with refractory gastro-esophageal reflux disease. Both can be considered in the absence of a large hiatal hernia. Comparable to the well-established peroral endoscopic myotomy (POEM) for the treatment of achalasia, gastric POEM (G-POEM), an endoscopic antro-pyloromyotomy, represents an endoscopic technique for the treatment of gastroparesis, including diabetic, post-surgical and idiopathic subtypes. Finally, endoscopic ultrasound-guided radiofrequency ablation (EUSRA) can be considered as alternative to surgery in selected patients with small tumoral lesions of the pancreas.
Parmi les avancées récentes en endoscopie digestive, de nouvelles techniques de mucosectomie antireflux (ARMS, Anti-Reflux Mucosectomy) ou d'ablation de muqueuse antireflux (ARMA, Anti-Reflux Mucosal Ablation) ont montré leur efficacité pour les patients avec reflux gastro-Åsophagien réfractaire aux traitements médicamenteux et sans hernie hiatale de grande taille. Par analogie au POEM (Peroral Endoscopic Myotomy), procédure bien établie pour le traitement de l'achalasie, le Gastric POEM permet une antropyloromyotomie endoscopique pour le traitement de la gastroparésie, qu'elle soit d'origine diabétique, postchirurgicale ou idiopathique. La radiofréquence par voie échoendoscopique (EUSRA, Endoscopic Ultrasound-Guided Radiofrequency Ablation) peut être envisagée comme alternative à la chirurgie pour le traitement de lésions tumorales pancréatiques.
Subject(s)
Esophageal Achalasia , Gastroparesis , Pyloromyotomy , Endoscopy, Gastrointestinal , Humans , Treatment OutcomeABSTRACT
Hepatocellular adenomas (HA) are rare benign liver tumors known to affect mainly women of reproductive age taking oral contraception. They can be complicated by hemorrhage or malignant transformation to hepatocellular carcinoma, especially when the size of the lesion exceeds 5 cm. Magnetic resonance imaging is the most specific tool for the non-invasive characterization of HA. The discovery of mutations underlying different specific HA phenotypes has allowed the establishment of a molecular classification that modified the management of this pathology.
Les adénomes hépatocellulaires (AH) sont des tumeurs bénignes du foie rares et connues pour affecter principalement les femmes en âge de procréer prenant une contraception orale. Ils peuvent se compliquer d'hémorragie ou de transformation en carcinome hépatocellulaire, en particulier lorsque la taille de la lésion dépasse 5 cm. L'imagerie par résonance magnétique est la technique la plus spécifique pour caractériser les AH de manière non invasive. La découverte de mutations spécifiques témoignant de l'existence de différents phénotypes d'AH a permis l'établissement d'une classification moléculaire qui a modifié la prise en charge de cette pathologie.
Subject(s)
Adenoma, Liver Cell , Liver Neoplasms , Adenoma, Liver Cell/diagnosis , Adenoma, Liver Cell/genetics , Adenoma, Liver Cell/pathology , Adenoma, Liver Cell/therapy , Female , Humans , Liver Neoplasms/diagnosis , Liver Neoplasms/genetics , Liver Neoplasms/pathology , Liver Neoplasms/therapy , Magnetic Resonance Imaging , MutationSubject(s)
Betacoronavirus/isolation & purification , Coronavirus Infections , Fibrinogen/analysis , Hepatitis , Inclusion Bodies/pathology , Liver , Pandemics , Pneumonia, Viral , COVID-19 , Coronavirus Infections/diagnosis , Coronavirus Infections/physiopathology , Diagnosis, Differential , Glycogen Storage Disease Type IV/diagnosis , Hepatitis/etiology , Hepatitis/pathology , Hepatitis/physiopathology , Hepatitis B, Chronic/diagnosis , Humans , Lafora Disease/diagnosis , Liver/diagnostic imaging , Liver/pathology , Liver Function Tests/methods , Male , Middle Aged , Patient Care Management/methods , Pneumonia, Ventilator-Associated/therapy , Pneumonia, Viral/diagnosis , Pneumonia, Viral/physiopathology , Pulmonary Embolism/diagnosis , Pulmonary Embolism/etiology , Pulmonary Embolism/physiopathology , Respiration, Artificial/adverse effects , Respiration, Artificial/methods , SARS-CoV-2 , Treatment OutcomeABSTRACT
Upper gastrointestinal bleeding is an urgent entity associated with a high mortality of about 10â %. Its urgent management includes medical interventions such as volume repletion, blood transfusions, the use of proton pump inhibitors, as well as upper gastrointestinal endoscopy. Whilst the benefit of esophago-gastro-duodenoscopy is clearly demonstrated, the ideal timing for this intervention is less well established. Initial management and pharmacological interventions are important and well-integrated into protocols.
L'hémorragie digestive haute est une entité urgente bien connue du gastroentérologue avec une mortalité élevée avoisinant les 10â %. Sa prise en charge inclut des moyens médicaux, comme la réanimation liquidienne, les transfusions sanguines ou les inhibiteurs de la pompe à protons, et l'endoscopie digestive. Alors que le bénéfice de l'Åsophago-gastro-duodénoscopie a depuis longtemps été démontré, le délai idéal pour sa réalisation reste peu clair. La prise en charge initiale et les interventions médicamenteuses sont également importantes et intégrées dans des protocoles.
