Endoscopic ultrasound-guided biliary drainage versus percutaneous transhepatic biliary drainage: predictors of successful outcome in patients who fail endoscopic retrograde cholangiopancreatography.

BACKGROUND: Patients with failed endoscopic retrograde cholangiopancreatography (ERCP) are conventionally offered percutaneous transhepatic biliary drainage (PTBD). While PTBD is effective, it is associated with catheter-related complications, pain, and poor quality of life. Endoscopic ultrasound-guided biliary drainage (EUS-BD) is a minimally invasive endoscopic option increasingly offered as an alternative to PTBD. We compare outcomes of EUS-BD and PTBD in patients with biliary obstruction at a single tertiary care center. METHODS: A retrospective review was performed in patients with biliary obstruction who underwent EUS-BD or PTBD after failed ERCP from June 2010 through December 2014 at a single tertiary care center. Patient demographics, procedural data, and clinical outcomes were documented for each group. The aim was to compare efficacy and safety of EUS-BD and PTBD and evaluate predictors of success. RESULTS: A total of 60 patients were included (mean age 67.5 years, 65 % male). Forty-seven underwent EUS-BD, and thirteen underwent PTBD. Technical success rates of PTBD and EUS-BD were similar (91.6 vs. 93.3 %, p = 1.0). PTBD patients underwent significantly more re-interventions than EUS-BD patients (mean 4.9 versus 1.3, p < 0.0001), had more late (>24-h) adverse events (53.8 % vs. 6.6 %, p = 0.001) and experienced more pain (4.1 vs. 1.9, p = 0.016) post-procedure. In univariate analysis, clinical success was lower in the PTBD group (25 vs. 62.2 %, p = 0.03). In multivariable logistic regression analysis, EUS-BD was the sole predictor of clinical success and long-term resolution (OR 21.8, p = 0.009). CONCLUSION: Despite similar technical success rates compared to PTBD, EUS-BD results in a lower need for re-intervention, decreased rate of late adverse events, and lower pain scores, and is the sole predictor for clinical success and long-term resolution. EUS-BD should be the treatment of choice after a failed ERCP.

Endoscopic gallbladder drainage compared with percutaneous drainage.

BACKGROUND: High-risk patients with cholecystitis have conventionally been offered percutaneous gallbladder drainage (PGBD) for treatment. A growing experience of endoscopic gallbladder drainage (EGBD) has been reported to be effective and safe. OBJECTIVE: To compare the short- and long-term outcomes of EGBD and PGBD. DESIGN: A retrospective review. SETTING: Single academic tertiary care center. PATIENTS: Inpatients diagnosed with cholecystitis. INTERVENTIONS: Any patient deemed a nonsurgical candidate and who has undergone either PGBD or EGBD was included in the analysis. MAIN OUTCOME MEASUREMENTS: Patient demographics along with procedural and clinical outcomes were recorded for each group. RESULTS: Forty-three patients underwent PGBD and 30 underwent EGBD (24 transpapillary, 6 transmural). Technical (97.6% vs 100%) and clinical (97.6% vs 86.7%) success rates of PGBD and EGBD were similar. However, postprocedure hospital length of stay (16.3 vs 7.6 days), time to clinical resolution (4.6 vs 3.0 days), adverse event rate (39.5% vs 13.3%), number of sessions (2.0 vs 1.0), number of repeat interventions (53.4% vs 13.3%), and postprocedure pain scores (3.8 vs 2.1) were significantly higher for PGBD than EGBD. LIMITATIONS: Retrospective analysis. CONCLUSION: Although EGBD has similar technical and clinical success compared with PGBD, it uses fewer hospital resources and results in fewer adverse events, improved pain scores, and decreased need for repeat gallbladder drainage. EGBD may provide a less-invasive, safer, cost-effective option for gallbladder drainage than PGBD with improved clinical outcomes.

Entre affirmation et contestation, la citoyenneté des sourds en question / Entre afirmação e contestação, a cidadania de surdos em questão / Between affirmation and contestation, deaf people's citizenship in question / Entre afirmación y contestación, la ciudadanía de los sordos en debate

Depuis le mouvement de reconnaissance de la langue des signes française des années 1980 et la législation promouvant l'égalité des chances des personnes handicapées (loi du 11 février 2005), les sourds locuteurs d'une langue visuo-gestuelle se sont mobilisés pour réclamer la présence de la langue des signes française comme condition d’accès au plein exercice de leur citoyenneté. Cette revendication, liant langue et instruction à l'accès à la citoyenneté, remonte à deux siècles. Afin d’explorer l'idée de citoyenneté, la place des sourds en tant qu’êtres parlants et "capables de" s'exprimer comme n’importe qui, servira d'analyseur. Nous nous efforcerons de déplacer la perspective : pour nous dégager de la conception statique du citoyen sourd comme sujet de droit ressortissant des lois et des institutions, nous tenterons de l’inscrire dans un processus de subjectivation politique toujours soumis à l'épreuve de l'égalité. (AU)

Desde o movimento de reconhecimento da língua francesa de sinais nos anos 1980 e a legislação promovendo oportunidades igualitárias para pessoas com deficiência (lei de 11 de fevereiro de 2005), pessoas surdas que utilizam língua gestual-visual têm se mobilizado para solicitar a presença da língua de sinais como uma condição para o acesso ao pleno exercício de sua cidadania. Esta questão, relacionando língua e instrução com o acesso de pessoas surdas à cidadania, surgiu há dois séculos. Com a finalidade de explorar a ideia de cidadania, o papel de pessoas surdas como seres falantes e “aptos a” expressarem-se como qualquer outro, servirá aqui como analisador. Tentaremos mover de uma perspectiva a outra. Com a finalidade de nos distanciarmos de uma concepção estática do cidadão surdo como sujeito jurídico emergindo de leis e instituições, nós o consideramos como inscrito em um processo de subjetivação política submetido sempre à prova da igualdade. (AU)

Since the French sign language recognition's movement in the 80's and the legislation promoting equal opportunities for disabled persons (law of February 11th, 2005), Deaf people using a visual-gestural language have mobilized to claim French sign language's presence as a condition of access to the full exercise of their citizenship. This question, linking language and instruction with Deaf people's access to citizenship, dates back to two centuries ago. In order to explore the idea of citizenship, Deaf people's role as talking beings and "able to" express themselves like anyone else, will serve here as analyzer. We will try to move from one perspective to another: in order to move forward from the static conception of the Deaf citizen as a legal subject emerging from laws and institutions, we will rather consider him as part of a process of political subjectivation always depending on the test of equality. (AU)

Desde el movimiento de reconocimiento de la lengua de señas francesa en los años 1980 y la legislación que promueve igualdad de oportunidades para las personas discapacitadas (ley de 11 de febrero de 2005), las personas sordas locutores de una lengua visual-gestual han reclamado la lengua de señas como condición del pleno ejercicio de su ciudadanía. Esta reivindicación, que condiciona lengua e instrucción al acceso a la ciudadanía, surgió hace dos siglos. Con la finalidad de explorar la idea de ciudadanía, el papel de las personas sordas como seres hablantes y "capaces de" expresarse como cualquier otro, servirá como analizador. Intentaremos desplazar la perspectiva : para liberarnos de una concepción estática del ciudadano sordo como sujeto de derechos emergente de leyes e de instituciones, lo inscribiremos en un proceso de subjetivación política sometido incesantemente a la prueba de la igualdad. (AU)

Entre affirmation et contestation, la citoyenneté des sourds en question / Entre afirmação e contestação, a cidadania de surdos em questão / Between affirmation and contestation, deaf people's citizenship in question / Entre afirmación y contestación, la ciudadanía de los sordos en debate

Depuis le mouvement de reconnaissance de la langue des signes française des années 1980 et la législation promouvant l'égalité des chances des personnes handicapées (loi du 11 février 2005), les sourds locuteurs d'une langue visuo-gestuelle se sont mobilisés pour réclamer la présence de la langue des signes française comme condition d’accès au plein exercice de leur citoyenneté. Cette revendication, liant langue et instruction à l'accès à la citoyenneté, remonte à deux siècles. Afin d’explorer l'idée de citoyenneté, la place des sourds en tant qu’êtres parlants et "capables de" s'exprimer comme n’importe qui, servira d'analyseur. Nous nous efforcerons de déplacer la perspective : pour nous dégager de la conception statique du citoyen sourd comme sujet de droit ressortissant des lois et des institutions, nous tenterons de l’inscrire dans un processus de subjectivation politique toujours soumis à l'épreuve de l'égalité.

Desde o movimento de reconhecimento da língua francesa de sinais nos anos 1980 e a legislação promovendo oportunidades igualitárias para pessoas com deficiência (lei de 11 de fevereiro de 2005), pessoas surdas que utilizam língua gestual-visual têm se mobilizado para solicitar a presença da língua de sinais como uma condição para o acesso ao pleno exercício de sua cidadania. Esta questão, relacionando língua e instrução com o acesso de pessoas surdas à cidadania, surgiu há dois séculos. Com a finalidade de explorar a ideia de cidadania, o papel de pessoas surdas como seres falantes e “aptos a” expressarem-se como qualquer outro, servirá aqui como analisador. Tentaremos mover de uma perspectiva a outra. Com a finalidade de nos distanciarmos de uma concepção estática do cidadão surdo como sujeito jurídico emergindo de leis e instituições, nós o consideramos como inscrito em um processo de subjetivação política submetido sempre à prova da igualdade.

Since the French sign language recognition's movement in the 80's and the legislation promoting equal opportunities for disabled persons (law of February 11th, 2005), Deaf people using a visual-gestural language have mobilized to claim French sign language's presence as a condition of access to the full exercise of their citizenship. This question, linking language and instruction with Deaf people's access to citizenship, dates back to two centuries ago. In order to explore the idea of citizenship, Deaf people's role as talking beings and "able to" express themselves like anyone else, will serve here as analyzer. We will try to move from one perspective to another: in order to move forward from the static conception of the Deaf citizen as a legal subject emerging from laws and institutions, we will rather consider him as part of a process of political subjectivation always depending on the test of equality.

Desde el movimiento de reconocimiento de la lengua de señas francesa en los años 1980 y la legislación que promueve igualdad de oportunidades para las personas discapacitadas (ley de 11 de febrero de 2005), las personas sordas locutores de una lengua visual-gestual han reclamado la lengua de señas como condición del pleno ejercicio de su ciudadanía. Esta reivindicación, que condiciona lengua e instrucción al acceso a la ciudadanía, surgió hace dos siglos. Con la finalidad de explorar la idea de ciudadanía, el papel de las personas sordas como seres hablantes y "capaces de" expresarse como cualquier otro, servirá como analizador. Intentaremos desplazar la perspectiva : para liberarnos de una concepción estática del ciudadano sordo como sujeto de derechos emergente de leyes e de instituciones, lo inscribiremos en un proceso de subjetivación política sometido incesantemente a la prueba de la igualdad.