IJGII Inernational Journal of Gastrointestinal Intervention

pISSN 2636-0004 eISSN 2636-0012
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January 31, 2024Current Issue Vol. 13 No. 1

    January, 2024 | Volume 13, No. 1
  • Review Article 2024-01-31

    Later lines in pMMR/MSS metastatic colorectal cancer: News opportunities with immunotherapy and local treatments

    Alfredo Colombo and Concetta Maria Porretto

    Abstract : Colorectal cancer (CRC) is one of the most prevalent malignancies, and most patients are diagnosed with metastatic disease at first presentation. However, immunotherapy is particularly useful only in a limited number of patients with mismatch repair-deficient/high microsatellite instability metastatic CRC (mCRC), while most patients have proficient mismatch repair (pMMR)/microsatellite stability (MSS). Currently, many clinical research on immunotherapy in association with tyrosine kinase inhibitors are aiming to modulate the immune microenvironment of pMMR/MSS mCRC and turn “cold tumors” into “hot tumors,” which has not only unanticipated implications, but also good results. Some consequences include that the response may not be selective for metastases. This review summarizes recent studies on potential mechanisms of immunotherapy combined with local therapy (including radiotherapy, ablation, and transcatheter arterial chemoembolization) in the treatment of metastases.

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  • Original Article 2024-01-31

    Safety of EEG BIS-guided nurse-administered procedural sedation during gastro-intestinal intervention

    Alexander Oh , Sviatlana Vasileuskaya , Nabil Kibriya et al.

    Abstract : Background: Sedation remains a subject of contention and anxiety for many interventional teams. We reviewed our outcomes of electroencephalographic (EEG) bi-spectral index sensor (BIS) guidance, which allowed us to transfer the role of the sedation practitioner to the interventional radiology nurses. Methods: In total, 150 consecutive cancer-related interventional procedures were collected prospectively at a tertiary center. All patients were given 4 L oxygen via a nasal cannula and had conscious sedation administered by two trained interventional nurses. In addition to standard monitoring, frontal lobe EEG BIS monitoring was used. The initial amount of midazolam or fentanyl administered were dependant on the patient’s age and American Society of Anesthesiologists classification score. Thereafter, conscious sedation was maintained by titrating small incremental doses to maintain BIS between 80 and 85. The patients’ vitals were monitored at 5-minute intervals and recorded along with the Ramsay sedation scale and tolerance score. Results: The three most common procedures were: radiologically inserted gastrostomy (48%), percutaneous transhepatic cholangiography (35%), and esophageal stenting (11%). All procedures were completed without disruption or unexpected patient movements. No reversal agents or airway management were required and no incidences of hypoxia occurred. Conclusion: BIS monitoring is an invaluable tool that has successfully allowed the role of the sedation practitioner to be transferred to the interventional nurses. It allows sedation to be personalized to each patient and their individual susceptibility to combination sedation and represents a vast improvement over interval clinical assessment of patients’ responsiveness to stimuli.

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  • Original Article 2024-01-31

    Use of cryopreserved, ultra-thick amniotic membrane allograft for colorectal and intestinal anastomoses

    John Charles Blaney

    Abstract : Background: Anastomotic leak (AL) is one of the most feared complications following intestinal surgery and is associated with increased complications, costs, length of hospital stay, and mortality. While many pre-clinical animal model studies have successfully demonstrated the efficacy of amniotic membrane (AM) in preventing AL, its clinical utility is less reported. Methods: A single-center, retrospective study was performed on patients who underwent intestinal surgery followed by end-to-end or side-by-side single layer anastomosis and placement of cryopreserved, ultra-thick AM. Post-operative outcomes were assessed including time to first defecation, length of hospital stay, and complications, including incidence of AL. Results: Eleven consecutive patients (7 male, 4 female) underwent open (n = 2) or laparoscopic (n = 9) resection of the sigmoid (n = 6), cecum (n = 2), ascending colon (n = 1), rectum (n = 1), and small bowel (n = 1). Surgery was uneventful in all cases. The time to first defecation was 3.5 ± 2.1 days. After an average follow up of 65.3 ± 42.0 days, none of the patients suffered an AL nor required another colorectal procedure. Conclusion: These preliminary findings suggest the use of cryopreserved, ultra-thick AM following intestinal surgery is safe and may be beneficial in reducing the incidence of AL and post-operative complications. Larger prospective, randomized trials are warranted.

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  • Original Article 2024-01-31

    Functional bowel disorders among bariatric surgery candidates before and after surgery: A prospective cohort study

    Sharif Yassin, Noa Sori, Ophir Gilad et al.

    Abstract : Background: Functional bowel disorders (FBDs), including irritable bowel syndrome (IBS), are common worldwide. Recently, increasingly many bariatric surgical procedures have been performed in response to rising obesity rates. However, data on the association between FBDs and bariatric surgery are scarce. We examined the prevalence of FBDs among candidates for bariatric surgery and prospectively investigated the association between FBDs and bariatric surgery. Methods: This prospective cohort study included 112 bariatric surgery candidates at the Tel Aviv Medical Center from 2019 to 2020. Before and after surgery, patients completed the Rome III questionnaire. Data regarding demographics, socioeconomic status, and gastrointestinal symptoms were recorded. The rates of FBDs—IBS, functional constipation (FC), functional diarrhea (FDi), and unspecified functional bowel disorder (UFBD)—were then compared from before surgery to 6 months after the procedure. Results: Of 112 candidates with obesity at baseline, 68 underwent surgery and completed the postoperative questionnaire. Overall, the respective prevalence rates of FBDs, IBS, FC, FDi, and UFBD were 37.5%, 2.7%, 17.9%, 5.4%, and 11.6%. Female sex and single status were particularly common among patients with FBDs, whereas divorced status was more frequent in the group without FBDs. However, these factors were not independently associated with FBD presence upon multivariable analysis. IBS was more prevalent after surgery than before (8.8% vs. 1.5%, P = 0.06), but FBDs in general did not share this trend (44.1% vs. 36.8%, P = 0.44). Conclusion: Bariatric surgery appears to increase the risk of developing IBS, while not impacting the overall risk of FBDs.

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  • Case Report 2024-01-31

    Percutaneous transhepatic obliteration with N-butyl-2-cyanoacrylate in a patient with a superior mesenteric vein intraluminal distal small bowel variceal bleed

    William Henry Eskew , Jesus Beltran-Perez , and Bruce Bordlee

    Abstract : Gastrointestinal (GI) bleeding is a serious complication with a high mortality rate (45%–55%) that can result from a variety of conditions, including portal hypertension, diverticulosis, or splenic vein thrombosis. There are a variety of established treatment strategies for GI bleeds, and there are different indications and contraindications for each. In this case, colonoscopy did not identify any active source of bleeding. Furthermore, because this GI hemorrhage did not involve any shunts, balloon-occluded retrograde transvenous obliteration was not performed. Additionally, a transjugular intrahepatic portosystemic shunt was ruled out due to the poor primary shunt patency rate. Here, we report the treatment of a GI bleed with N-butyl-2-cyanoacrylate (n-BCA) liquid embolization with no complications. This case demonstrates the potential of using n-BCA to treat small bowel varices.

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  • Case Report 2024-01-31

    Delayed presentation of an entrapped small bowel loop stricture in a case of seat belt injury with the seat belt sign: laparoscopic resection and anastomosis

    Raju Badipati , Lakshmi Durga Kasinikota , Kushal Gunturu et al.

    Abstract : Seat belt-related injuries are frequent and are often associated with a specific injury pattern known as “seat belt syndrome.” The presence of the seat belt sign can facilitate the early identification of seat belt injuries, which can help prevent the delayed or missed diagnosis of certain intestinal injuries, such as obstructions. We report the case of a 39-year-old man who sustained a bone fracture and a seat belt injury that led to an intestinal stricture. This condition manifested as delayed acute small bowel obstruction, necessitating laparoscopic intestinal resection and side-to-side anastomosis with a linear stapler. In polytrauma patients with seat belt syndrome, abdominal pain may be overshadowed by the pain from extra-abdominal injuries. Nevertheless, this pain should not be overlooked and must be thoroughly evaluated during regular follow-up visits to prevent complications.

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