1
|
Carbajo AY, Brunie Vegas FJ, García-Alonso FJ, Cimavilla M, Torres Yuste R, Gil-Simón P, de la Serna-Higuera C, Fernández Pérez GC, Pérez-Miranda M. Retrospective cohort study comparing endoscopic ultrasound-guided and percutaneous drainage of upper abdominal abscesses. Dig Endosc 2019; 31:431-438. [PMID: 30629764 DOI: 10.1111/den.13342] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 01/07/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM Endoscopic ultrasonography (EUS)-guided drainage (EUS-D) has become the standard treatment for peripancreatic fluid collections. Its use in other intra-abdominal abscesses has been reported, although there is limited evidence. METHODS We carried out a single-center retrospective cohort study comparing percutaneous drainage (PCD) and EUS-D of upper abdominal abscesses between January 2012 and June 2017. Pancreatic fluid collections and liver transplant recipients were excluded. Primary endpoints were technical and clinical success rates. RESULTS We included 18 EUS-D (nine hepatic and nine intraperitoneal abscesses) and 62 PCD. There were no differences regarding age, gender and etiology. Size was larger in the PCD group (80 vs 65.5 mm, P = 0.04) and perivesicular location was more frequent in the PCD group (24.2% vs 11.1%, P = 0.003). In the EUS-D group, metal stents were deployed in 16 (88.9%) subjects (eight lumen-apposing metal stents and eight self-expandable metal stents), coaxial double-pigtail plastic stents in six (33.3%) and lavage/debridement was carried out in five (27.8%). There were no significant differences in technical success (EUS-D: 88.9%, PCD: 96.8%, P = 0.22) or clinical success (EUS-D: 88.9%, PCD: 82.3%, P = 0.50), with no relapses in the EUS-D group and 10 (16.1%) in the PCD group (P = 0.11). There were four (22.2%) adverse events in the EUS-D group, none of them severe, and 13 (21%) in the PCD group (P = 0.91). CONCLUSIONS EUS-D is an alternative to PCD in the treatment of upper abdominal abscesses, reaching similar success, relapse and adverse events rates.
Collapse
Affiliation(s)
- Ana Yaiza Carbajo
- Department of Gastroenterology, Hospital Universitario Río Hortega, Valladolid, Spain
| | | | | | - Marta Cimavilla
- Department of Gastroenterology, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Raúl Torres Yuste
- Department of Gastroenterology, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Paula Gil-Simón
- Department of Gastroenterology, Hospital Universitario Río Hortega, Valladolid, Spain
| | | | | | - Manuel Pérez-Miranda
- Department of Gastroenterology, Hospital Universitario Río Hortega, Valladolid, Spain
| |
Collapse
|
2
|
Yuste RT, García-Alonso FJ, Sánchez-Ocana R, Cimavilla M, Herrero IP, Carbajo AY, Sanz MDB, Higuera CDLS, Pérez-Miranda M. Safety and clinical outcomes of endoscopic ultrasound-guided gallbladder drainage with lumen-apposing metal stents in patients with dwell time over one year. Ann Gastroenterol 2019; 32:514-521. [PMID: 31474799 PMCID: PMC6686095 DOI: 10.20524/aog.2019.0395] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 05/27/2019] [Indexed: 12/17/2022] Open
Abstract
Background: Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) has proved effective in patients with cholecystitis at high surgical risk. The long-term risks of gallstone-related disease and stent-related adverse events are unknown. Methods: We performed a retrospective evaluation of a case series including subjects who underwent EUS-GBD using lumen-apposing metal stents (LAMS). Patients were identified from a prospective LAMS registry at a single tertiary center. Patients with a stent indwell time <1 year were excluded. Data regarding stent deployment and adverse events were retrieved from the prospective LAMS registry, while emergency room visits, admissions and causes of death were retrieved from electronic medical records. Results: We included 22 patients with a median age of 88.3 years (interquartile range [IQR]: 82.6-92.7), 14 (63.6%) were male. Median follow up was 24.4 months (IQR: 18.2-42.4) and median time to the last available imaging procedure was 607 days (IQR: 463-938). No LAMS-related adverse events were identified beyond the first year of follow up. During follow up, 12 patients (54.5%) visited the emergency room 34 times (1 visit/patient, IQR: 0-3) and a total of 36 hospital admissions were required, with a median of 1 admission/patient (IQR: 0-3). Fourteen (63.6%) patients died during follow up. Only 1 patient (4.5%) required new hospital admissions for gallstone-related disease. Conclusions: There were no adverse events beyond the first year after stent deployment, with only 4.5% of subjects requiring gallstone-related admissions. Permanent EUS-GBD with LAMS may be a definitive treatment for acute cholecystitis in patients ineligible for cholecystectomy.
Collapse
Affiliation(s)
- Raúl Torres Yuste
- Gastroenterology Department, Hospital Universitario Río Hortega, Valladolid (Raúl Torres Yuste, Francisco Javier García-Alonso, Ramón Sánchez-Ocana, Ana Yaiza Carbajo, Marina De Benito Sanz, Carlos De la Serna Higuera, Manuel Pérez-Miranda).,Hospital General de Segovia, Segovia (Raúl Torres Yuste)
| | - Francisco Javier García-Alonso
- Gastroenterology Department, Hospital Universitario Río Hortega, Valladolid (Raúl Torres Yuste, Francisco Javier García-Alonso, Ramón Sánchez-Ocana, Ana Yaiza Carbajo, Marina De Benito Sanz, Carlos De la Serna Higuera, Manuel Pérez-Miranda)
| | - Ramón Sánchez-Ocana
- Gastroenterology Department, Hospital Universitario Río Hortega, Valladolid (Raúl Torres Yuste, Francisco Javier García-Alonso, Ramón Sánchez-Ocana, Ana Yaiza Carbajo, Marina De Benito Sanz, Carlos De la Serna Higuera, Manuel Pérez-Miranda)
| | - Marta Cimavilla
- Hospital Río Carrión, Palencia (Marta Cimavilla, Irene Peñas Herrero), Spain
| | - Irene Peñas Herrero
- Hospital Río Carrión, Palencia (Marta Cimavilla, Irene Peñas Herrero), Spain
| | - Ana Yaiza Carbajo
- Gastroenterology Department, Hospital Universitario Río Hortega, Valladolid (Raúl Torres Yuste, Francisco Javier García-Alonso, Ramón Sánchez-Ocana, Ana Yaiza Carbajo, Marina De Benito Sanz, Carlos De la Serna Higuera, Manuel Pérez-Miranda)
| | - Marina De Benito Sanz
- Gastroenterology Department, Hospital Universitario Río Hortega, Valladolid (Raúl Torres Yuste, Francisco Javier García-Alonso, Ramón Sánchez-Ocana, Ana Yaiza Carbajo, Marina De Benito Sanz, Carlos De la Serna Higuera, Manuel Pérez-Miranda)
| | - Carlos De la Serna Higuera
- Gastroenterology Department, Hospital Universitario Río Hortega, Valladolid (Raúl Torres Yuste, Francisco Javier García-Alonso, Ramón Sánchez-Ocana, Ana Yaiza Carbajo, Marina De Benito Sanz, Carlos De la Serna Higuera, Manuel Pérez-Miranda)
| | - Manuel Pérez-Miranda
- Gastroenterology Department, Hospital Universitario Río Hortega, Valladolid (Raúl Torres Yuste, Francisco Javier García-Alonso, Ramón Sánchez-Ocana, Ana Yaiza Carbajo, Marina De Benito Sanz, Carlos De la Serna Higuera, Manuel Pérez-Miranda)
| |
Collapse
|
4
|
Diez Redondo P, Núñez Rodríguez H, de Benito Sanz M, Torres Yuste R, Pérez-Miranda M. Endoscopic treatment of Zenker's diverticulum with Ligasure: simple, safe and effective. Endosc Int Open 2019; 7:E203-E208. [PMID: 30705954 PMCID: PMC6338546 DOI: 10.1055/a-0809-4875] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 10/15/2018] [Indexed: 01/22/2023] Open
Abstract
Background and study aims Zenker's diverticulum may cause disabling symptoms, especially in the elderly. Treatment has changed in recent decades from open surgery to management with flexible endoscopy, resulting in lower morbidity and mortality. The goal of this study was to present the largest series, with the longest follow-up, of patients with Zenker's diverticulum receiving outpatient treatment with flexible endoscopy using a diverticuloscope and Ligasure (Covidien, Minneapolis, Minnesota, United States), a device that allows tissue sealing and coagulation of vessels before cutting the septum between the diverticulum and esophagus. Patients and methods We performed 79 diverticulotomies in 69 patients (65.2 % male, mean age 73.4 years). The mean diverticulum size was 2.8 cm. In three cases with a diverticulum ≤ 1.5 cm, the diverticuloscope could not be placed. Results The technical success was 95.83 % and the clinical success 96.7 %: 84 % of the 56 patients followed for a mean of 34.6 months (24 - 64 months) had no dysphagia. The recurrence rate was 10.4 %, with a good response to a second diverticulotomy at 12 months (IQR: 11.5 - 17) in most cases. The most severe complications were two microperforations, resolved with conservative treatment, and one case of delayed bleeding endoscopically-controlled with a clip. Conclusions Diverticulotomy of the esophageal-diverticular septum with Ligasure is an outpatient endoscopic technique that is simple, effective in the long term and very safe for the treatment of patients with Zenker's diverticulum. In symptomatic recurrences, a second procedure was equally safe and effective in most patients.
Collapse
Affiliation(s)
- Pilar Diez Redondo
- Servicio de Gastroenterología. Hospital Universitario del Río Hortega, Valladolid, España,Corresponding author Pilar Diez Redondo Hospital Universitario Rio Hortega – Digestive DiseasesCalle Dulzaina 2Valladolid 47012Spain+983420400
| | - Henar Núñez Rodríguez
- Servicio de Gastroenterología. Hospital Universitario del Río Hortega, Valladolid, España
| | - Marina de Benito Sanz
- Servicio de Gastroenterología. Hospital Universitario del Río Hortega, Valladolid, España
| | - Raúl Torres Yuste
- Servicio de Gastroenterología. Hospital Universitario del Río Hortega, Valladolid, España
| | - Manuel Pérez-Miranda
- Servicio de Gastroenterología. Hospital Universitario del Río Hortega, Valladolid, España
| |
Collapse
|
5
|
de Benito Sanz M, Cimavilla Román M, Torres Yuste R. A Dieulafoy's lesion in a duodenal diverticulum. An infrequent cause of UGIB. Rev Esp Enferm Dig 2018; 110:266-267. [PMID: 29421917 DOI: 10.17235/reed.2018.5396/2017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
We present the case of an 82-year-old man with a history of heart failure, mitral regurgitation, type 2 DM, hypertension, dilated cardiomyopathy and a paroxysmal atrial flutter. The patient was under treatment with Sintrom. The patient presented to the emergency department due to melenic depositions of a one day evolution and dietary vomiting. There was no rectal bleeding and the patient was admitted three months previously due to self-limited melena with a normal gastroscopy. Anemia of 8 g and an overdose of Sintrom was diagnosed. A gastroscopy was performed and a large duodenal diverticulum with a fresh clot was found that was washed. A Dieulafoy lesion was subsequently found underneath with jet bleeding, which was sclerotic with adrenaline and a hemoclip. There was a favorable evolution after correcting the coagulopathy.
Collapse
|