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pISSN 2636-0004
eISSN 2636-0012
pISSN 2636-0004
eISSN 2636-0012
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Articles
Abstract : Ectopic varices are large portosystemic collaterals in locations other than the gastroesophageal region. They account for up to 5% of all variceal bleeding; however, hemorrhage can be massive with mortality reaching up to 40%. Given their sporadic nature, literature is limited to case reports, small case series and reviews, without guidelines on management. As the source of bleeding can be obscure, the physician managing such a patient needs to establish diagnosis early. Multislice computed tomography with contrast and reformatted images is a rapid and validated modality in establishing diagnosis. Further management is dictated by location, underlying cause of ectopic varices and available expertise. Therapeutic options may include double balloon enteroscopy, transcatheter embolization or sclerotherapy, with or without portosystemic decompression, i.e., transjugular intrahepatic portosystemic shunts. In this article we review the prevalence, etiopathogenesis, anatomy, presentation, and diagnosis of ectopic varices with emphasis on recent advances in management.
Abstract : Endoscopic retrograde cholangiopancreatography (ERCP) may fail in 10–15% of cases. These patients are usually referred for percutaneous transhepatic biliary drainage (PTBD) or surgical interventions. Endoscopic ultrasound (EUS) offers an alternative route of access to the biliary tree. Using the curved linear array echoendoscope, access to the bile duct is possible under real-time EUS guidance. The route of access is anterograde, in contrast to the retrograde approach of ERCP. We have coined the term EUS-guided anterograde cholangiopancreatography (EACP) to cover the spectrum of EUS-guided techniques for accessing and draining the bile and pancreatic ducts. The possible approaches and techniques are reviewed in this paper. The literature supports the feasibility of EACP for malignant and benign biliary obstruction, with high success rates and improving safety profile with regard to significant complications. Tools are being designed for EUS-guided applications to enable safer transenteric access and drainage.
Abstract : Endoscopic drainage of malignant biliary obstruction can be challenging. For patients in whom conventional wire-guided cannulation or precut attempts are unsuccessful, an endoscopic ultrasound-guided approach may be helpful. Concomitant duodenal strictures occur in 10–20% of patients with malignant biliary obstruction from pancreatic cancer. Gastric outlet obstruction due to a duodenal stricture can be relieved either by endoscopic gastroduodenal stent placement or gastrojejunostomy. In this setting, simultaneous stenting of the bile duct and duodenal strictures should be considered. In this review article, we highlight the issues involved in performing endoscopic retrograde cholangiopancreatography in patients with malignancy and present a review of literature describing techniques to overcome the challenges.
Abstract : The field of surgery has undergone a revolution in the past 25 years, progressing toward a less invasive approach to address surgical pathology. With the introduction of laparoscopy, operations classically associated with significant morbidities could now be accomplished on an almost outpatient basis. More recently, single-site laparoscopic surgery and natural orifice translumenal endoscopic surgery (NOTES) have been introduced for use in humans. These new techniques promise new approaches to minimize the potential morbidities and maximize the cosmetic outcome for patients. Herein is a discussion on surgical innovation detailing the progression from laparoscopic approaches to NOTES within the United States, including the limitations prohibiting the widespread adoption of these new techniques.
Abstract : Endoscopic resection of early gastric cancer is a well-established standard therapy in Japan, and is increasingly used in other countries. The development of endoscopic submucosal dissection (ESD) for early gastric cancer provides en bloc R0 specimen, regardless of size and/or location. On the other hand, for many years, conventional endoscopic mucosal resection and surgery were the only available treatments for large colorectal tumors, including laterally spreading tumors. Recently, ESD has also been increasingly applied to the colon and rectum. However, ESD has not yet been fully established as a standard therapeutic method for colorectal lesions because of its technical difficulty and complications, such as perforation and longer procedure time than the conventional endoscopic mucosal resection. In this report, we provide an overview of the indications for colorectal ESD and presented clinical outcome, regarding the safety and efficacy in our hospital with a review of the published works.
Abstract : This review details the indications, technique, and outcomes of endoscopic necrosectomy for the treatment of pancreatic necrosis. Data from 14 previous reports revealed that the rate of complete resolution of pancreatic necrosis with endoscopic necrosectomy ranged from 53% to 100%. The procedure-related morbidity was 0–46% and the overall mortality was 0–13%. In particular, two recent multicenter studies with large cohort numbers reported that successful resolution was achieved in 80–91% of cases, morbidity was 14–26% and mortality was 5.8–7.5%. Interestingly, delayed intervention is currently preferred to early intervention, since maturation of the necrotic bed develops encapsulation and demarcation of peripancreatic collections, namely walled-off pancreatic necrosis. Such structural changes facilitate necrosectomy and improve conditions for intervention, thereby decreasing the risk of complications such as bleeding and perforation. It is now believed that intervention should be delayed to approximately 3–4 weeks after the onset of pancreatitis if the patient’s condition is kept stable by conservative treatment.
Abstract : Natural orifice transluminal endoscopic surgery (NOTES) is a novel surgical technique that is widely anticipated to define the next paradigm shift in surgery. Besides leaving no external scar on the patient, the natural orifice approach is envisaged to reduce postoperation morbidity and improve surgical outcomes. However, performing NOTES is technically more demanding than conventional surgery, as the surgical procedure is performed entirely within the small confines of the peritoneal cavity. Current endoscopic systems are not equipped with sufficient dexterity for the intricate maneuvers required in the performance of NOTES. Hence, advanced innovations in endoscopy are called for to circumvent the technical issues commonly encountered in endoscopic surgery. Herein, we describe the development of a robotic NOTES platform that could potentially make the performance of complex endoscopic surgical procedures such as NOTES safer and easier. By applying robotic technology and separating control of instrumental motion from that of endoscopic movement, the robotic system increases dexterity of surgical maneuvers, such as triangulation of instruments, retraction, grasping, approximation, and cutting of tissue, and allows these tasks to be performed with relative ease and precision. The novel robotic NOTES platform discussed herein is nonoperator dependent, is intuitively operated, and comes with force and tactile feedback capability to provide surgeons not just the ease of use, but also a sense of touch while manipulating the tissues. Preliminary evaluations of the platform in animal survival studies and human trials have demonstrated that the system is easy and safe to use. With further development, it may be adapted for highly intricate NOTES, which may otherwise be very difficult to perform using currently available endoscopic tools.
Abstract : Bleeding is a common adverse event following invasive endoscopic procedures within the gastrointestinal tract. In a recent lexicon of adverse events following endoscopic procedures, severity of bleeding was defined as mild, moderate, and severe. These definitions are based on need for hospitalization, transfusion, and subsequent interventions. Therapy for procedure-related bleeding includes hemodynamic stabilization, transfusion of blood products, reversal of coagulopathy (if present), and endoscopic, radiologic, and/or surgical interventions. In this article, the approach to procedurally induced bleeding will be reviewed, with an emphasis on endoscopic intervention.
Abstract : The management of patients with acute upper gastrointestinal bleeding should consist of early assessment and volume resuscitation. Endoscopy should be performed in all patients within 24 hours of their presentation. The Glasgow Blatchford score requires validation in different centers. It is accurate in identifying those at low risk of requiring intervention. The risk score is less specific in identifying those who require urgent endoscopic intervention. During endoscopy, the presence of active bleeding and a non-bleeding visible vessel mandate endoscopic hemostatic treatment. There is also evidence that clots overlying ulcers should be unveiled and hemostatic treatment offered to underlying stigmata. Injection therapy using diluted epinephrine alone is considered inadequate. A second treatment should be added to induce thrombosis of the bleeding artery. The use of thermo-coagulation with a thermal device or hemo-clips alone or after pre-injection with epinephrine is equally efficacious. Second look endoscopy should be performed in selected high risk or re-bleeding patients. Proton pump inhibitor (PPI) should administer as an adjunctive therapy. The dose of PPI use continues to be controversial. Angiographic embolization compares favorably to surgery as a rescue therapy where endoscopic therapy fails. Helicobacter pylori should be tested and treated in the presence of infection. In those who require aspirin for cardiovascular prophylaxis, aspirin should be resumed early. A low dose PPI should be added for secondary prophylaxis. In those who continue to require an analgesic, co-therapy of PPI with traditional non-steroidal anti-inflammatory agent and the use of COX-II inhibitor alone are associated with a small risk of recurrent bleeding. A combination of COX-II inhibitor and PPI is preferred in those with very high risk of gastrointestinal events. In patients on dual antiplatelet agents, PPI appears to reduce gastrointestinal events without increasing cardiovascular events.
Abstract : Antiplatelet agents and anticoagulants make up the larger group of antithrombotic medications, which have seen increasing use worldwide as populations in developed countries age, and ischemic heart disease prevalence rises. Antithrombotic medications reduce the risk of thromboembolic events in susceptible individuals, but increase the risk of gastrointestinal bleeding. Cessation of antithrombotic drugs prior to endoscopic therapy has been proposed, aimed at reducing the risk of immediate and early bleeding. However, interruption of antithrombotic therapy is associated with cardiovascular risk. The peri-endoscopic management of patients at high thromboembolic risk therefore requires knowledge of both the bleeding risk associated with endoscopic procedures, and the potential risks of stopping antithrombotic therapy. Three major endoscopy organizations (British Society of Gastroenterology, American Society of Gastrointestinal Endoscopy & European Society of Gastrointestinal Endoscopy) have published guidelines aimed at providing a rational strategy for the endoscopist in managing the individual patient on antithrombotic medication. This article compares and contrasts the approach of each guideline, in an attempt at consensus. The British Society of Gastroenterology and American Society of Gastrointestinal Endoscopy guidelines address the use of both antiplatelet agents and anticoagulants during the peri-endoscopic period, while the European Society of Gastrointestinal Endoscopy guideline is focused solely on antiplatelet medication. The guidelines were formulated with reference mainly to observational studies and expert opinion, and therefore have a limited basis in evidence. A rational strategy is proposed for common scenarios encountered in gastrointestinal endoscopy, based on the published guidelines. Despite the existence of these guidelines, they serve at best as a framework for individualized management tailored to the patient’s particular clinical scenario.
Hyung Ku Chon 
and Seong-Hun Kim
Int J Gastrointest Interv 2023; 12(1): 7-15
https://doi.org/10.18528/ijgii220037
Se Hwan Kwon , Seung Yeon Noh , and Joo Hyeong Oh
Int J Gastrointest Interv 2023; 12(1): 37-42
https://doi.org/10.18528/ijgii220005
Nam Hee Kim and Hong Joo Kim
Int J Gastrointest Interv 2023; 12(2): 57-63
https://doi.org/10.18528/ijgii220004
Partha Mandal , Barrett P. O'Donnell , Eric Reuben Smith , Osamah Al-Bayati , Adam Khalil , Serena Jen , Mario Vela , and Jorge Lopera
Int J Gastrointest Interv 2022; 11(1): 18-23
https://doi.org/10.18528/ijgii210028
Young Koog Cheon
Int J Gastrointest Interv 2021; 10(3): 96-100
https://doi.org/10.18528/ijgii210032
Dominic Andre Staudenmann , Ellie Patricia Skacel , Tatiana Tsoutsman , Arthur John Kaffes , and Payal Saxena
Int J Gastrointest Interv 2021; 10(3): 128-132
https://doi.org/10.18528/ijgii200050
pISSN 2636-0004
eISSN 2636-0012
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| TOTAL | 226,925 |
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