Initial experience with endoscopic ultrasound-guided gallbladder drainage.

INTRODUCTION: Patients with acute cholecystitis who are unsuitable for cholecystectomy undergo conservative treatment or percutaneous transhepatic gallbladder drainage. As these two methods are not always successful, further treatment options are needed. One increasingly popular method is endoscopic ultrasound-guided gallbladder drainage (EUSGBD), whereby stents are placed so as to create a permanent fistula connecting the gallbladder to the stomach or the duodenal bulb, thus enabling drainage of its contents to the gastrointestinal tract. AIM: To present our early experience with EUSGBD for the treatment of cholecystitis in patients who are not suitable for cholecystectomy. MATERIAL AND METHODS: The procedure was performed in 5 patients with acute cholecystitis. Two patients also had symptoms of biliary obstruction due to pancreatic head cancer. An ultrasound endoscope was used to create a fistula between the gallbladder and the stomach or between the gallbladder and the duodenal bulb, in which a self-expandable metallic stent (SEMS) was placed. RESULTS: All procedures were performed with no perioperative complications. In all patients, the clinical symptoms of cholecystitis subsided within 3-15 days. In those patients who also showed symptoms of biliary obstruction, these symptoms subsided within 3-6 days following the procedure. CONCLUSIONS: The EUSGBD seems to be an effective and safe treatment for acute cholecystitis in patients unsuitable for cholecystectomy. It can also be used to treat jaundice caused by obstruction of the common bile duct, when no other methods can be used. The method is particularly promising in cases of concurrent acute cholecystitis and common bile duct obstruction.

Initial experience with endoscopic sleeve gastroplasty in Poland.

INTRODUCTION: Obesity is becoming one of the major public health problems. Bariatric procedures are considered the most effective methods of treating this condition but they are costly and entail a high risk of complications. Thus, there is a need to look for better bariatric treatment solutions. One of the newest, highly promising bariatric methods is endoscopic sleeve gastroplasty (ESG), which is comparably effective to other bariatric procedures in terms of weight loss but at the same time it is much less invasive. MATERIALS AND METHODS: Eight obese patients underwent ESG. Under general anaesthesia, an endoscope was inserted into the stomach, where a row of 4-5 running stitches was placed (from the pyloric part towards the GE junction). Each of the stitches was cinched tight, which resulted in gastric lumen reduction comparable to that achieved with laparoscopic sleeve gastrectomy. RESULTS: The procedures were performed without any severe peri-operative complications. The only adverse event was a minor haemorrhage in one of the patients, which did not require any surgical intervention. After the surgery, the patients reported a substantial weight loss. Mean %TBWL was 8.6%, 15.4% and 19.6% at 1, 2 and 3 months, respectively. CONCLUSIONS: Minimally invasive and highly effective in body weight reduction, endoscopic sleeve gastroplasty is a promising method of treating obesity. The procedure requires appropriate tools and equipment. The method guarantees gastric volume reduction comparable to that achieved with sleeve resection. The initial results confirm that the effectiveness of the surgery in terms of body weight loss is similar to that seen in other forms of bariatric treatment. DISCUSSION: Compared to laparoscopic sleeve gastrectomy, endoscopic sleeve gastroplasty is substantially less invasive. Also, it requires shorter procedure time and shorter hospital stay. Data from other medical centres demonstrate somewhat lower dynamics of total body weight loss but these results need to be verified in a long-term follow-up.

Initial experience with endoscopic sleeve gastroplasty in Poland.

INTRODUCTION: Obesity is becoming one of the major public health problems. Bariatric procedures are considered the most effective methods of treating this condition but they are costly and entail a high risk of complications. Thus, there is a need to look for better bariatric treatment solutions. One of the newest, highly promising bariatric methods is endoscopic sleeve gastroplasty (ESG), which is comparably effective to other bariatric procedures in terms of weight loss but at the same time it is much less invasive. MATERIALS AND METHODS: Eight obese patients underwent ESG. Under general anaesthesia, an endoscope was inserted into the stomach, where a row of 4-5 running stitches was placed (from the pyloric part towards the GE junction). Each of the stitches was cinched tight, which resulted in gastric lumen reduction comparable to that achieved with laparoscopic sleeve gastrectomy. RESULTS: The procedures were performed without any severe peri-operative complications. The only adverse event was a minor haemorrhage in one of the patients, which did not require any surgical intervention. After the surgery, the patients reported a substantial weight loss. Mean %TBWL was 8.6%, 15.4% and 19.6% at 1, 2 and 3 months, respectively. CONCLUSIONS: Minimally invasive and highly effective in body weight reduction, endoscopic sleeve gastroplasty is a promising method of treating obesity. The procedure requires appropriate tools and equipment. The method guarantees gastric volume reduction comparable to that achieved with sleeve resection. The initial results confirm that the effectiveness of the surgery in terms of body weight loss is similar to that seen in other forms of bariatric treatment. DISCUSSION: Compared to laparoscopic sleeve gastrectomy, endoscopic sleeve gastroplasty is substantially less invasive. Also, it requires shorter procedure time and shorter hospital stay. Data from other medical centres demonstrate somewhat lower dynamics of total body weight loss but these results need to be verified in a long-term follow-up.

Trans-hepatic technique and intraluminal Pulsed Dose Rate (PDR-BT) brachytherapy in treatment of locally advanced bile duct and pancreas cancer.

PURPOSE: To assess the feasibility of intraluminal palliative Pulsed Dose Rate (PDR-BT) brachytherapy in the treatment of locally advanced bile duct and pancreas cancer. MATERIAL AND METHODS: Forty-eight patients with advanced bile duct or pancreas cancer, disqualified from surgery or radical external beam radiation therapy (EBRT), were treated with trans-hepatic technique and intraluminal PDR-BT: 29 patients with bile duct cancer and 19 - pancreas cancer. Forty-four patients were treated exclusively with PDR-BT, 4 with PDR-BT and concomitant chemotherapy or surgery. Percutaneous trans-hepatic technique was used to implant the catheter into bile ducts. Most of patients (38/48, 79%) received 25 pulses of 0.8 Gy hourly with the total dose of 20 Gy. In 8 cases PDR was repeated after one week. Target volume encompassed tumor visualized at cholangiography with one or two cm margin measured proximally and distally. Dose was prescribed at 10-15 mm from the source axis. RESULTS: In all cases trans-hepatic technique allowed insertion of BT catheter into bile duct and safe application of PDR-BT. In 19 out of 29 (65.5%) of bile duct cancer cases and in 10 out of 19 (52.6%) of pancreas cancer patients clinical improvement (decrease of jaundice) was noted in first control after 4 weeks. Median overall survival time (OS) for bile ducts cancer patients was 11.2 months and for pancreas cancer patients - 5.2 months. CONCLUSIONS: 1. It has been established, that the use of PDR-BT was feasible and had a low early complication rate. A new percutaneous trans-hepatic technique allowed the treatment (insertion of catheter, PDR brachytherapy) to be performed in one day. 2. In most cases a satisfied palliative effect was achieved, however it was more apparent in bile duct cancer patients then in pancreas cancer patients.