Abstract : Endoscopic ultrasound-guided fine-needle aspiration is currently the gold standard in the diagnosis of solid pancreatic lesions, with high diagnostic accuracy. However, this technique is demanding, as its diagnostic yield and efficacy are affected by several factors, including the rapid on-site cytologic evaluation, sampling techniques, needle size and type, use of a stylet, suction techniques, number of needle passes, and novel techniques. This article provides information on up-to-date advances and considerations for maximizing the diagnostic yield of endoscopic ultrasound-guided fine-needle sampling in solid pancreatic lesions, especially from a technical perspective.
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Abstract : Despite various advanced medical treatments for chronic metabolic diseases, such as type 2 diabetes and obesity, many fall short of their treatment goals. Bariatric surgery is one of the potential treatment options. However, with its invasiveness and association with some morbidity, minimally invasive endoscopic duodenal mucosal resurfacing has emerged in recent years. The procedure is performed based on an outpatient setting, and it enhances the duodenal capability to maintain metabolic homeostasis for treating insulin-resistance–related metabolic diseases, including type 2 diabetes mellitus. This article will provide a better insight into the novel therapeutic opportunity for treating metabolic disorders.
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Abstract : Background: Tumor budding is a negative prognostic factor for many solid malignancies. We investigated the relationship between patients’ clinicopathological characteristics and tumor budding, as well as the effect of budding level on prognosis. Methods: In this retrospective, cross-sectional, and descriptive study at a tertiary university hospital, 104 patients with gastric adenocarcinoma were divided into two groups according to whether they had a high (≥ 10 buds) or low (< 10 buds) level of budding. The patients were retrospectively evaluated. Results: Sixty-two patients had a low level of budding and 42 had a high level of budding. The mean time from the first diagnosis to the last followup was significantly longer (P < 0.05) in the low-budding group (27 months) than in the high-budding group (17 months). As the T stage, N stage, grade, and size of the tumor increased, the proportion of patients with high budding was found to be significantly higher (P < 0.05). High tumor budding, an age of 60 or over at diagnosis, a low body mass index, high N stage, presence of lymphovascular invasion, and recurrence were associated with overall survival. Conclusion: Our study supports that budding is a negative prognostic factor in gastric cancer.
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Abstract : Background: To evaluate the outcomes of conventional transarterial chemoembolization (TACE) using guidance software for hepatocellular carcinoma (HCC) in the caudate lobe. Methods: Seventy-two patients with 79 treatment-naïve caudate lobe HCCs were eligible. TACE was performed through feeders not only identified by automated tumor-feeder detection (AFD) functionality but also detected manually. Technical success of TACE was classified into three grades according to 1-week computed tomography findings: entire tumor embolized with a safety margin (5 mm for tumors < 25 mm and 10 mm for tumors ≥ 25 mm) (grade A); tumor embolized without a margin in parts (grade B); and entire tumor not embolized (grade C). Tumor response was evaluated using the modified Response Evaluation Criteria in Solid Tumors. Tumor-feeder detectability by AFD, technical success of TACE, complete response (CR) at 2–4 months, durable CR, and local tumor progression (LTP) rates calculated by the Kaplan-Meier method were compared in each tumor among three subsegments: the Spiegel lobe (SP); paracaval portion (PC); and caudate process (CP). LTP rates between the grade A and B tumors were also compared. Results: The mean tumor diameter was 18.6 ± 9.9 mm (range, 6–53 mm), and 111 of 129 (86.0%) tumor feeders were detected by AFD. The rates of feeder detectability by AFD, grade A technical success of TACE, CR at 2–4 months, and durable CR in 30 SP, 38 PC, and 11 CP tumors were 71.4%, 93.3%, 93.1%, and 79.3%; 94.8%, 65.8%, 59.4%, and 34.4%; and 76.5%, 63.6%, 80.0%, and 30.0%, respectively. LTP rates of SP tumors were significantly lower than those of PC tumors (P = 0.0044), and the grade B tumors progressed more frequently (P = 0.0012). Conclusion: AFD could detect 86.0% of tumor feeders in the caudate lobe; however, the feeder detectability, technical success of TACE, and outcomes differed among the three subsegments.
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Abstract : Background: Left-sided portal hypertension (LPH) is an uncommon clinical condition resulting from splenic vein stenosis/occlusion, which may cause bleeding from gastric varices. This study reviewed the long-term safety and efficacy of splenic artery embolization for the treatment of gastric varix bleeding secondary to splenic vein thrombosis. Methods: From April 2008 to March 2020, all consecutive patients diagnosed with LPH-associated variceal bleeding who had undergone percutaneous splenic artery embolization were reviewed retrospectively. Patients’ demographics, etiology of splenic vein thrombosis, embolization level and techniques, adverse events after embolization, and rebleeding rate were reviewed. Results: Twenty-two patients received splenic artery embolization for bleeding gastric varices in the setting of LPH. Three patients who underwent subsequent splenectomy were excluded. Median age was 44.5 years (range: 27–83 years) and 13 were male. Etiologies of splenic vein thrombosis were pancreatitis (n = 9), chronic liver disease (n = 6), and hematologic abnormalities (n = 4). Technical success was achieved in all 19 patients. Embolization level and material were as follows: proximal splenic artery coil embolization (n = 9), partial splenic parenchymal embolization with coils or particles (n = 7), and total parenchymal embolization with particles (n = 3). Procedure-related adverse events developed in 2 patients (one pleural effusion and one ileus with leukocytosis). During the median follow-up of 55 months (range, 7–165 months), two rebleeding events occurred 29 and 111 months after initial embolization, and both were successfully treated with repeat splenic artery embolization (n = 1) and transhepatic variceal embolization (n = 1). Conclusion: Splenic artery embolization for variceal bleeding secondary to LPH is safe and feasible. A total of 10.5% patients had delayed rebleeding more than 2 years after the index procedure, and both were successfully managed by repeat splenic artery embolization or transhepatic variceal embolization.
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Abstract : Background: Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is a common complication of therapeutic endoscopy. The aim of this trial was to determine whether a combination of rectal diclofenac and vigorous hydration with Ringer’s lactate is superior to the corresponding individual treatments for preventing PEP in high-risk patients. Methods: This randomized, open-label, controlled trial was conducted from August 2020 to January 2022. We included patients who were at high risk of developing PEP. Three intervention groups were made: group A, diclofenac sodium suppository (100 mg); group B, aggressive hydration with Ringer’s lactate; group C, a combination of diclofenac and aggressive hydration. PEP was defined as a serum amylase level > 3 times the upper limit of normal with epigastric pain within 24 hours after endoscopic retrograde cholangiopancreatography. Results: A total of 144 patients were included and 48 cases were randomized to each intervention group. The incidence of PEP was 8.3%, 10.4%, and 8.3% in groups A, B, and C, respectively. A personal history of alcohol consumption and more than one pancreatic duct guidewire cannulation were significantly associated with the development of PEP. Conclusion: No difference in the incidence of PEP was observed with or without the use of aggressive hydration. Combining aggressive hydration with a rectal nonsteroidal anti-inflammatory drug for preventing PEP cannot be recommended.
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Abstract : Background: Endoscopic hemostasis is the primary therapeutic method for gastrointestinal bleeding. Hemoclips and thermocoagulation are the most commonly used methods of endoscopic hemostasis to control non-variceal upper gastrointestinal bleeding (NVUGIB). Recent findings have proven that hypertonic saline has the ability to act as a topical hemostatic agent in gastrointestinal bleeding and has the advantages of being inexpensive and readily available. This study aimed to compare the efficacy of hypertonic dextrose solution spray as an endoscopic hemostasis method for NVUGIB to that of standard therapy (hemoclips and thermocoagulation). Methods: This experimental prospective study included patients with NVUGIB in Cipto Mangunkusumo National Central General Hospital between February 2020 and December 2021. There were 32 patients each in the control and intervention groups. Patients in the control group were treated with epinephrine only or with hemoclips/thermocoagulation, while the intervention group received hypertonic dextrose solution (40%) spray with or without epinephrine as an endoscopic hemostatic method. Results: In the 64 patients with NVUGIB, peptic ulcers were the most common cause of bleeding (39.2%). The Rockall scores varied greatly from 0–6, with the most frequent Rockall score being 2 (31.3%). Nearly half of patients (43.8%) had Forrest IB bleeding. Initial hemostasis was successful in 100% of the control group and 96.9% of the intervention group. There were no complications after endoscopic hemostasis in both groups. The occurrence of re-bleeding was the same in both groups (25.0%). Eleven patients (17.2%) died during the study period. No significant differences were found in the success rate of initial hemostasis and the re-bleeding rate of NVUGIB between the control and intervention groups. Conclusion: This study showed that hypertonic dextrose solution (40%) spray had a hemostatic effect. Hence, we recommend hypertonic dextrose solution spray as an alternative to endoscopic hemostasis for NVUGIB.
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Abstract : Immunoglobulin G4-related disease (IgG4-RD) is an immune-mediated fibroinflammatory condition involving the development of mass lesions of the affected organ, which can mimic many malignant disorders. IgG4-related autoimmune pancreatitis (AIP) is a common presentation form of IgG4-RD. Patients presenting with multiple mass lesions in the pancreas undergo aggressive surgeries with the misdiagnosis of pancreatic adenocarcinoma. A patient applied to the health center with back and stomach pain. She had two mass lesions involving the pancreatic head and tail; tumor markers were not significantly elevated. The patient underwent total pancreatoduodenectomy, total gastrectomy, and total splenectomy due to misdiagnosed pancreatic adenocarcinoma and developed severe morbidities afterward. She was diagnosed with IgG4-related AIP after surgery. On performing clinical suspicion the necessary diagnostic procedures for exclusion will protect patients from unnecessary surgeries that may lead to severe morbidities.
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Abstract : We retrospectively report a case of rapid exchange of a percutaneous radiologic gastrostomy tube (balloon-occluded type catheter) via off-label use of a pigtail catheter for nutrition supply during a very early episode of coronavirus disease 2019 (COVID-19) in an outpatient clinic. This case demonstrates that minimally invasive percutaneous procedures might be provided safely and effectively under appropriate precautions for preventing COVID-19 transmission during the pandemic.
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Maged Tharwat Elghannam *, Moataz Hassan Hassanien , Yosry Abdelrahman Ameen , Gamal Mohammed Elattar , Ahmed Ali El Ray , Emad Abdel Wahab Turky , and Mohammed Darwish El Talkawy
Int J Gastrointest Interv 2022; 11(1): 1-4
Mahmoud Ali , Ahmed Aly , Ayahallah Ahmed *, and Joseph Stavas
Int J Gastrointest Interv 2021; 10(3): 137-141
Int J Gastrointest Interv 2021; 10(3): 114-119
Int J Gastrointest Interv 2021; 10(3): 96-100
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
Thomas G. Morgan , Tarryn Carlsson , Eric Loveday , Neil Collin , Graham Collin , Peter Mezes , and Anne M. Pullyblank
Int J Gastrointest Interv 2021; 10(1): 17-22
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