IJGII Inernational Journal of Gastrointestinal Intervention

pISSN 2636-0004 eISSN 2636-0012
ESCI

January 31, 2022Current Issue Vol. 11 No. 1

    January, 2022 | Volume 11, No. 1
  • Review Article 2022-01-31

    Single-use endoscopes: A narrative review

    Maged Tharwat Elghannam *, Moataz Hassan Hassanien , Yosry Abdelrahman Ameen et al.

    Abstract : The transmission of infections through gastrointestinal endoscopy is a vital issue. The main problem lies in the use of duodenoscopes due to mechanical aspects of the scope design. Even with high-level disinfection, sterilization of the scope can fail. Hence, the Food and Drug Administration has encouraged a shift to single-use endoscopes. Available options include endoscopes with single-use components (mainly single-use endcaps), fully single-use duodenoscopes (SUDs), and even those with a disposable elevator mechanism. Clinical trials revealed that both reusable and single-use scopes have the same efficacy, while single-use scopes have benefits in terms of infection control, economic considerations, and ease of reprocessing. A few drawbacks are left to be dealt with. Reusable duodenoscopes with removable/disposable endcaps are satisfactory except in specific situations where SUDs are better to use.

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  • Review Article 2022-01-31

    Balloon enteroscope-assisted endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy

    Yuki Tanisaka *, Masafumi Mizuide , Akashi Fujita et al.

    Abstract : Endoscopic retrograde cholangiopancreatography (ERCP) is the gold standard for diagnosis and intervention in patients with biliopancreatic disorders. However, ERCP in patients with surgically altered anatomy (SAA) is considered more difficult than in patients with normal anatomy. Since the introduction of balloon enteroscopes for patients with small intestine disorders, single-balloon enteroscopes (SBEs) and double-balloon enteroscopes (DBEs) have also been used for biliopancreatic diseases in patients with SAA. Nevertheless, the use of conventional SBEs and DBEs is limited, as a balloon enteroscope has a working length of 200 cm and a narrow working channel with a diameter of 2.8 mm; therefore, few ERCP accessories are available for use. A short-type SBE with a working length of 152 cm and a working channel of 3.2 mm in diameter, and a short-type DBE with a working length of 155 cm and a working channel of 3.2 mm were introduced to solve these difficulties. Favorable outcomes of these devices have recently been reported. Moreover, studies have reported several tips to achieve procedural success and factors affecting procedure failure. Difficult cases necessitate alternative techniques, such as percutaneous transhepatic biliary drainage and endoscopic ultrasound-guided biliary drainage.

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  • Original Article 2022-01-31

    Balloon-occluded retrograde transvenous obliteration for six consecutive patients with duodenal varices

    Shiro Miyayama , Masashi Yamashiro , Rie Ikeda et al.

    Abstract : Background: Bleeding from duodenal varices is a rare but life-threatening complication of portal hypertension. The treatment of duodenal varices remains difficult and a definitive treatment strategy has not been established. The aim of this study was to report the technical aspects and outcomes of balloon-occluded retrograde transvenous obliteration (BRTO) using 5% ethanolamine oleate with iopamidol (EOI) for duodenal varices. Methods: Six consecutive patients with duodenal varices treated using BRTO were eligible. Endoscopic treatment was performed first in three patients with active bleeding. After coil embolization of collateral veins, stepwise EOI infusion was performed at intervals of 10–30 minutes under balloon occlusion until the main efferent vein, varices, and the main afferent vein were filled with EOI and clots. The techniques and outcomes of BRTO were retrospectively evaluated. Results: The main efferent vein of duodenal varices was the right (n = 4) or left (n = 2) gonadal vein. In three patients with ruptured varices, BRTO was performed after achieving hemostasis by endoscopic treatment. In five patients, 1–4 (mean, 2.4 ± 1.1) collateral veins were embolized with coils before EOI infusion. Furthermore, 11–21 mL (mean, 15.3 ± 4.2 mL) of EOI was infused by 3–5 (mean, 3.5 ± 1.0) stepwise infusions via the efferent vein under balloon occlusion. The duration of EOI infusion under balloon occlusion ranged from 82 to 118 minutes (mean, 87.8 ± 13.6 minutes). The varices were thrombosed in all but one patient. In the remaining patient, the varices were thrombosed by additional BRTO under overnight balloon occlusion performed 19 days later. The only complications were a transient fever and hematuria. All duodenal varices disappeared during a followup of 4–32 months (mean, 16.2 ± 11.1 months) after BRTO. Conclusion: BRTO using EOI is an effective treatment for duodenal varices.

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  • Original Article 2022-01-31

    Portal and hepatic vein thrombosis after transjugular intrahepatic portosystemic shunt: Incidence in follow-up imaging and clinical implications

    Partha Mandal , Barrett P. O’Donnell, Eric Reuben Smith et al.

    Abstract : Background: This study investigated the incidence and clinical outcomes of portal and hepatic vein thrombosis (VT) on imaging after transjugular intrahepatic portosystemic shunt (TIPS). Methods: A retrospective review of records at a single liver transplant center between 2010 and 2018 revealed 423 patients who underwent TIPS. Contrast-enhanced computed tomography and magnetic resonance images within 1 year post-TIPS were available for 138 patients and compared to assess the imaging findings of VT and liver infarction. The associations of VT with overall survival, patient characteristics, stent size, pre- and post- TIPS Model for End-Stage Liver Disease (MELD) scores, and post-TIPS hepatic encephalopathy at 90 days were analyzed. Results: The prevalence of VT on imaging within 1 year was 63.0% (n = 87). VT within the right portal vein was more common: 41 cases were in the right portal vein, 25 in the posterior portal vein, and two in the anterior right portal vein. Ten patients had VT in the left portal vein. Four had VT in the main portal vein (MPV), and one had shunt thrombosis extending into the superior mesenteric vein. Hepatic VT was seen in the right hepatic vein in 17 patients and in the middle hepatic vein in six patients. VT was associated with liver infarction (n = 9, P = 0.018). There was no relationship between VT and sex, age, cirrhosis etiology, indication for TIPS, stent size, or hepatic encephalopathy at 90 days. VT in the MPV had poorer survival (P < 0.001). Older age (P = 0.028) and higher pre-TIPS MELD score (P = 0.049) were poor prognostic factors. VT was not treated. Conclusion: Portal and hepatic VTs were common imaging findings after TIPS without worsened clinical outcomes unless VT involved the MPV. VT may cause liver infarction, but infarcts were not independently associated with poorer survival.

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  • Original Article 2022-01-31

    Mirizzi syndrome: A retrospective analysis of 84 patients from a single center

    Syed Shafiq , Mallikarjun Patil , and Mathew Philip

    Abstract : Background: There is a paucity of literature regarding the prevalence of Mirizzi syndrome (MS) in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) for obstructive jaundice. We aimed to describe the clinical presentation; laboratory, imaging, and ERCP findings; and surgical management of patients with MS at our center. Methods: A retrospective review was performed of the medical records of 3,852 consecutive patients who underwent ERCP between January 2010 to December 2019 at our center. Results: MS was diagnosed in 84 (2.2%) of the patients who underwent ERCP, with 45 male and 39 female patients. Jaundice was the most common symptom (100%) followed by abdominal pain (91.6%). Leukocytosis and altered liver function tests were noted in all our patients. Although most of our patients had one or more pre-procedure imaging studies, MS was confirmed and subclassified based on cholangiographic and intraoperative findings. There were 11 post-cholecystectomy MS patients who opted for endoscopic therapy with repeated biliary stenting. Among the remaining 73 patients, 48 with type I and 21 with type II MS underwent open cholecystectomy, 4 with type III MS received cholecystectomy and choledochoduodenostomy, and another 4 patients with type II MS underwent subtotal cholecystectomy and choledochoplasty. Associated cystic duct abnormalities were noted in 20.2% of patients. Bile duct injuries occurred in 3 patients during an attempted laparoscopic procedure; however, no mortality was reported. Conclusion: Although it is preferable to diagnose MS preoperatively, a preoperative diagnosis is seldom possible. ERCP is both a diagnostic and therapeutic procedure of choice before definitive surgery and helps to identify any associated cystic duct anomalies in these patients.

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  • Original Article 2022-01-31

    Long-term outcomes of surgery for oesophageal achalasia

    Zi Qin Ng , Brendan Murphy, Simon Edmunds et al.

    Abstract : Background: Long-term patient-reported outcomes following surgery for achalasia are lacking in the literature. The aim of this study was to evaluate both short- and long-term outcomes of the surgical management of achalasia. Methods: A retrospective analysis was performed of all surgically managed achalasia cases from January 2004 to December 2017. Data collection included demographics, previous interventions, type of surgery performed, and postoperative outcomes. Long-term data collected by questionnaire included residual regurgitation, dysphagia, chest pain, heartburn, need for subsequent intervention, and overall satisfaction. Patients were divided into primary group (group P) and secondary group (group S) based on whether they had undergone a previous intervention. Results: Ninety-one patients (male : female = 43 : 49; group P : S = 66 : 25) underwent surgery for achalasia. The median follow-up was 107 months (32–172 months). Twenty-five patients (27.5%) had previous interventions. Eighty-nine (97.8%) underwent Heller cardiomyotomy; the procedure was laparoscopic in 86 cases (97%) and open in three patients (3.3%). Two patients underwent stapled cardiomyotomy. The postoperative complication rate was 4.4%, and no complications were serious. There was no significant difference in length of stay between the groups. Short-term followup showed that most residual symptoms were mild. During long-term follow-up, the residual symptoms were mainly mild and did not differ between the groups. Furthermore, 72.9% of patients were satisfied or very satisfied with their symptoms post-surgery. Conclusion: The peri-operative morbidity for the surgical management of achalasia is low and re-intervention is uncommon. Heartburn was not a major long-term sequela of myotomy. Though patients still experienced mild symptoms in the longer term, most were satisfied with their outcome.

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  • Case Report 2022-01-31

    Transhepatic glue injection for hepatic pseudoaneurysm and arteriohepatic venous fistula after the failure of transarterial embolization

    Thanh Dung Le , Minh Duc Nguyen , and Van Sy Than

    Abstract : The liver is the most frequently injured organ during abdominal trauma. Vascular injuries account for approximately 3% to 25% of all cases of liver trauma and are typically treated by transarterial embolization (TAE). We describe a case of American Association for the Surgery of Trauma grade V liver injury with a very large pseudoaneurysm and an arteriohepatic venous fistula (AHVF), which failed to respond to TAE. This case was successfully treated using a direct transhepatic glue injection without complications. AHVF is an exceedingly rare type of vascular injury in blunt trauma. Direct transhepatic glue injections could represent a reliable alternative to TAE for the treatment of visceral pseudoaneurysms, especially if TAE fails to eliminate the lesion.

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  • Case Report 2022-01-31

    Endoscopic closure of duodenal perforation using an endoloop anchored by hemoclips

    Jong Min Yun , Kyunghyun Kim , and Tae-Geun Gweon

    Abstract : Perforation is one of the most serious adverse events related to endoscopic gastrointestinal (GI) procedures. Through-the-scope endoscopic clipping is the first-line therapy for GI perforation. However, conventional hemoclipping is inappropriate for large or anatomically complex perforations. Endoloop closure assisted by hemoclips has shown favorable efficacy for GI perforation. Here, we report a case of duodenal perforation treated using an endoloop anchored by hemoclips.

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  • Case Report 2022-01-31

    Necrotizing pancreatitis in a COVID-19 patient managed with endoscopic AXIOS stent placement

    Suryansh Bajaj , Unnati Bhatia , Stevi Barrett et al.

    Abstract : As coronavirus disease 2019 (COVID-19) is a relatively novel infectious process, atypical presentations like acute pancreatitis (AP) are still being studied and a clear association between pancreatic injury and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has yet to be established. This makes the diagnosis and management of such conditions exceedingly difficult. Although several cases of severe AP with concurrent SARS-CoV-2 infection have been reported, to the best of our knowledge, ours is the first COVID-19 case to present with necrotizing pancreatitis and the first reported case requiring intervention for associated local complications.

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  • Complication Forum 2022-01-31

    An unusual stent migration after endoscopic ultrasound-guided choledochoduodenostomy

    Aditya Kale *, Sridhar Sundaram , and Manish Dodmani

    Abstract : Summary of event: Endoscopic ultrasound-guided choledochoduodenostomy (EUS-CD) with the placement of a fully covered self-expandable metal stent (SEMS) is an alternative method to percutaneous transhepatic biliary drainage in cases of failed endoscopic retrograde cholangiopancreatography (ERCP) for malignant distal biliary obstruction. We report the case of a 64-year-old female who underwent EUS-CD with placement of a fully covered SEMS for obstructive jaundice due to distal bile duct obstruction by a pancreatic head mass and failed ERCP. Five months after the procedure, she presented with spontaneous expulsion of the stent in vomitus. She did not have bile leak and jaundice due to the formation of an epithelialized fistulous tract between the bile duct and duodenum (choledocho-duodenal fistula). Teaching point: Delayed distal migration of a fully covered SEMS after EUS-CD can occur. The formation of an epithelialized choledochoduodenal fistula prevented the occurrence of bile leak, pneumoperitoneum and perforation. Re-stenting through the same tract is possible. Stents with antimigration flanges or lumen-apposing metal stents may prevent migration.

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pISSN 2636-0004 eISSN 2636-0012