Abstract : Background: To investigate the expansion force of current colonic stents and to match these to industry standards. Methods: Samples of all colonic stents were requested from manufactures world-wide. Expansion forces were tested with an RX650 compression tool (MSI, Flagstaff, AZ, USA). Measurements were averaged over three cycles of compression and expansion, independently performed at 37°C by specialist engineers of MSI. In parallel, a survey was undertaken on standards, and tests used by manufacturers in their production process. As a labbased study, Institutional Review Board approval was not required. Results: A literature search did not identify any industry standards for testing expansion force or a suggested range for this primary stent function. Median expansion force of all stents was 24.4 N, (35.1 N for braided, 20.7 N for knitted stents) with a vast range from 5.6–130.8 N. Covering braided stents in liquid silicone increased their median force 5.5-fold, separate membranes attached to knitted stents only had a minor effect on expansion force. Five of eight manufacturers replied, describing three different test methods with three different units for expansion force. Conclusion: There are no standards on assessing expansion force, or what the ideal range should be. Consequently, the variation is remarkable, but values are not published, and even if they were, they could not be compared. Consequently, interventionists are unable to discriminate between different stents and to select the most suitable device for their patients, and no recommendation can be made on the ‘best stent’. The industry needs an agreed test standard and an acceptable range of stent forces.
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Abstract : Background: Recent developments in the design of needle tips used for fine needle biopsy via endoscopic ultrasound (EUS) allows for the procurement of core tissue for histological assessment in addition to cytology. Core tissue provides tissue architecture as well as the ability to perform molecular profiling investigations. We present a single centre study of experience with a new EUS needle with a Franseen tip (AcquireTM; Boston Scientific, Natick, MA, USA). The aim of the study was to assess the diagnostic yield of biopsies from solid lesions throughout the gastrointestinal tract. Methods: We performed a retrospective study of consecutive patients undergoing EUS biopsy between January 2017 and November 2018. Cystic lesions with no solid component were excluded or if samples were not sent for both cytology and histology. Rapid onsite evaluation (ROSE) was performed and the core tissue obtained was sent for histology. Results: Forty-six patients underwent EUS biopsy of solid lesions with specimens sent for both cytology and histology. Lesions included solid pancreatic masses (n = 31), lymph node (n = 3), gastric subepithelial lesion (n = 3), other (n = 9). The mean number of passes per lesion was 1.9 (range 1–4). In 43/46 (93%) of cases, a core specimen was obtained. Tissue obtained by EUS biopsy was adequate for evaluation by ROSE in 39/46 cases (85%). Histological diagnosis was confirmed in 41/46 (89%) cases compared to 31/46 (67%) cases with cytology (P = 0.011). Subgroup analysis of pancreatic lesions showed histological diagnosis was superior to cytology (90% vs 61%, P = 0.007). There were no adverse events. Conclusion: Histological analysis of specimens obtained via EUS biopsy was superior to cytology, particularly in assessment of solid pancreatic lesions
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Abstract : The coexistence of an esophageal leiomyoma with an achalasia cardia is extremely rare and poses a diagnostic dilemma as the clinical presentation of an esophageal leiomyoma strongly resembles to an achalasia cardia. Moreover, at most of the time, an esophageal leiomyoma exist with absence of leiomyoma specific symptoms or findings. It could be the reason why the diagnosis of esophageal leiomyoma is missed while the patient has the coexistence of the both. Here, we present a case series of an unusual coexistence of an esophageal leiomyoma with achalasia in three patients who were presented with dysphagia and had an initial diagnosis of achalasia. Even endoscopic evaluation couldn’t reveal esophageal leiomyoma; it became apparent during the peroral endoscopic myotomy.
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Abstract : Plummer–Vinson syndrome is known as the association of dysphagia, upper esophageal web, weight loss, and iron-deficiency anemia. Esophageal dilation therapy is usually necessary to remove webs and to relieve dysphagia in order to encourage oral intake. We report two cases of Plummer–Vinson syndrome. Both patients presented with significant and longstanding dysphagia, sideropenia, and painful swallowing. Patients’ esophagograms revealed the presence of tight stenosis in the high cervical esophagus. Both patients were treated with fluoroscopically guided balloon dilation and iron supplementation. These patients were followed up after the initial treatment and showed improvement of dysphagia and iron-deficiency anemia.
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Abstract : Benign afferent loop obstruction (ALO) is a complication that occurs after general surgery making Roux-en-Y or Billroth-II reconstruction and has typically been treated surgically. However, the surgery is difficult to conduct in about 25% of cases due to comorbidity and nonoperative management has been attempted. Here, we report two cases of benign ALO that were treated with percutaneous transhepatic afferent loop balloon dilatation and indwelling catheter, including one case with no improvement after surgery.
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Abstract : Delayed massive hemorrhage after pancreaticoduodenectomy is known as a fatal complication, frequently caused by gastroduodenal artery stump bleeding or hepatic artery pseudoaneurysm. Transarterial hepatic artery embolization is one of the treatment options in such cases. However, hepatic artery embolization can also result in ischemic complications of the liver, even fatal sometimes. We report a case of a 70-year-old male patient with distal common bile duct cancer who underwent pancreaticoduodenectomy. After three weeks, there was a bloody drain component accompanied with a decreased hemoglobin level. The immediate computed tomography scan and subsequent angiography demonstrated a hepatic artery pseudoaneurysm (1.8 cm in size) with segmental narrowing of the portal vein and superior mesenteric vein. The pseudoaneurysm and common hepatic artery were embolized using microcoils, following percutaneous portomesenteric stenting. There was no such ischemic complication as hepatic infarction after the procedure, and the patient was well tolerable. We suggest that the simultaneous portomesenteric stenting prior to hepatic artery embolization may be helpful to reduce the risk of hepatic infarction/failure in a patient with hepatic artery pseudoaneurysm accompanying portomesenteric vein stenosis after pancreaticoduodenectomy.
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Abstract : We present a case of a 53-year-old male with alcoholic cirrhosis who presented with acute hematemesis and hematochezia. The patient was initially treated with esophagogastroduodenoscopy guided band ligation of a large duodenal varix. Our interventional radiology department planned to treat this varix with balloon-occluded antegrade transvenous obliteration via a transhepatic approach. However, his hospital course was further complicated by decreasing hemoglobin and new hematochezia necessitated emergency transjugular intrahepatic portosystemic shunt (TIPS) placement. The patient underwent transcatheter embolization of the duodenal varices one day after the TIPS procedure due to recurrent bleeding. This case highlights the various decision points in the treatment algorithm for duodenal varices in the context of portal hypertension.
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Abstract : Walled-off pancreatic necrosis (WOPN) is defined as encapsulated necrotic tissue after severe acute pancreatitis. Treatment strategies for WOPN can be challenging. Although open surgical necrosectomy is the standard treatment for WOPN, it is associated with high rates of morbidity and mortality. Endoscopic necrosectomy, introduced recently, is a treatment option that produces lower rates of morbidity than does open surgery. We report a case of severe WOPN that could not be treated with the usual procedures. Although endoscopic necrosectomy of the left subphrenic and prepancreatic spaces was technically impossible, these spaces could be percutaneously drained. Finally, sufficient drainage of these spaces was achieved with endoscopic necrosectomy through the internal lumen of the self-expandable metallic stent placed percutaneously. This procedure was performed by an endoscopist and an interventional radiologist, and the multidisciplinary approach was useful.
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Gastrointestinal Intervention 2018; 7(3): 100-105
Gastrointestinal Intervention 2018; 7(3): 136-141
Gastrointestinal Intervention 2018; 7(3): 155-157
Paul R. Tarnasky, and Prashant Kedia
Gastrointestinal Intervention 2017; 6(1): 37-53
Karel Volenec, and Ivan Pohl
Gastrointestinal Intervention 2016; 5(2): 98-104
Adarsh M. Thaker, and V. Raman Muthusamy
Gastrointestinal Intervention 2017; 6(1): 2-8
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