RESUMO
BACKGROUND AND AIMS: Direct endoscopic necrosectomy (DEN) is a recommended strategy for treatment of walled-off-necrosis (WON). DEN uses a variety of devices including the EndoRotor (Interscope, Inc.) debridement catheter. Recently, a 5.1 mm EndoRotor with increased chamber size and rate of tissue removal was introduced. The aim of this study was to assess the efficacy and safety of this device. METHODS: A multi-center cohort study was conducted at eight institutions including patients who underwent DEN with the 5.1 mm EndoRotor. The primary outcome was the number of DEN sessions needed for WON resolution. Secondary outcomes included the average percent reduction in solid WON debris and decrease in WON area per session, total time spent performing EndoRotor therapy for WON resolution, and adverse events. RESULTS: 64 procedures in 41 patients were included. For patients in which the 5.1 mm EndoRotor catheter was the sole therapeutic modality, an average of 1.6 DEN sessions resulted in WON resolution with an average cumulative time of 85.5 minutes. Of the 21 procedures with data regarding percent of solid debris, the average reduction was 85% +/- 23% per session. Of the 19 procedures with data regarding WON area, the mean area significantly decreased from 97.6 +/- 72.0 cm2 to 27.1 +/- 35.5 cm2 (p<0.001) per session. Adverse events included two intra-procedural LAMS dislodgements managed endoscopically and three perforations none of which were related to EndoRotor. Bleeding was reported in seven cases, none required embolic or surgical therapy and two required blood transfusions. CONCLUSIONS: This is the first multi-center retrospective study to investigate the efficacy and safety of the 5.1 mm EndoRotor catheter for WON. Results from this study showed an average of 1.6 DEN sessions were needed to achieve WON resolution with an 85% single session reduction in solid debris and a 70% single session decrease in WON area with minimal adverse events.
RESUMO
While there is scientific consensus that global and local mean sea level (GMSL and LMSL) has risen since the late nineteenth century, the relative contribution of natural and anthropogenic forcing remains unclear. Here we provide a probabilistic upper range of long-term persistent natural GMSL/LMSL variability (P=0.99), which in turn, determines the minimum/maximum anthropogenic contribution since 1900. To account for different spectral characteristics of various contributing processes, we separate LMSL into two components: a slowly varying volumetric component and a more rapidly changing atmospheric component. We find that the persistence of slow natural volumetric changes is underestimated in records where transient atmospheric processes dominate the spectrum. This leads to a local underestimation of possible natural trends of up to â¼1 mm per year erroneously enhancing the significance of anthropogenic footprints. The GMSL, however, remains unaffected by such biases. On the basis of a model assessment of the separate components, we conclude that it is virtually certain (P=0.99) that at least 45% of the observed increase in GMSL is of anthropogenic origin.
