Endoscopic internal drainage for the management of leak,fistula, and collection after sleeve gastrectomy: our experience in 617 consecutive patients

BackgroundEndoscopy plays a pivotal role in the management of adverse events (AE) following bariatric surgery. Leaks, fistulae, and post-operative collection after sleeve gastrectomy (SG) may occur in up to 10% of cases.ObjectivesTo evaluate the efficacy and safety of endoscopic internal drainage (EID) for the management of leak, fistula, and collection following SG.SettingRetrospective, observational, single center study on patients referred from several bariatric surgery departments to an endoscopic referral center.MethodsEID was used as first-line treatment for the management of leaks, fistulae, and collections. Leaks and fistulae were treated with double pigtail stent (DPS) deployment in order to guarantee internal drainage and second intention cavity obliteration. Collections were treated with endoscropic ultrasound (EUS)–guided deployment of DPS or lumen apposing metal stents.ResultsA total of 617 patients (83.3% female; mean age, 43.1 yr) were enrolled in the study for leak (n = 300, 48.6%), fistula (n = 285, 46.2%), and collection (n = 32, 5.2%). Median follow-up was 19.5 months. Overall clinical success was 84.7% whereas 15.3% of cases required revisional surgery after EID failure. Clinical success according to type of AE was 89.5%, 78.5%, and 90% for leak, fistula, and collection, respectively. A total of 10 of 547 (1.8%) presented a recurrence during follow-up. A total of 28 (4.5%) AE related to the endoscopic treatment occurred. At univariate logistic regression predictors of failure were: fistula (OR 2.012), combined endoscopic approach (OR 2.319), need for emergency surgery (OR 1.755), and previous endoscopic treatment (OR 4.818).ConclusionEarly EID for the management of leak, fistula, and post-operative collection after SG seems a safe and effective first-line approach with good long-term results.     

Recent innovations in therapeutic endoscopy for pancreatobiliary diseases

The development of endoscopic treatment for pancreatobiliary diseases in recent years is remarkable. In addition to conventional transpapillary treatments under endoscopic retrograde cholangiopancreatography (ERCP), new endoscopic ultrasound-guided therapy is being developed and implemented. On the other hand, due to the development/improvement of various devices such as new metal stents, a new therapeutic strategy under ERCP is also advocated. The present review focuses on recent advances in the endoscopic treatment of pancreatic pseudocysts, walled-off necrosis, malignant biliary strictures, and benign biliary/pancreatic duct strictures.     

昆布多糖硫酸酯对荷瘤小鼠前列腺癌的抑瘤作用

目的:研究昆布多糖硫酸酯(LAMS)对移植前列腺癌细胞RM-1荷瘤小鼠的抑瘤作用。方法:C57小鼠接种前列腺癌RM-1细胞7 d后,按瘤体大小将40只小鼠均分为4组,分别为模型组(NS),环磷酰胺(CY)组(20 mg.kg-1),LAMS低、高剂量组(50,100 mg.kg-1)i,g,1次/d,连续14 d,停药次日称体质量并处死动物,剥取瘤块,摘取脾脏和胸腺,称质量,计算抑瘤率、脾指数和胸腺指数。结果:CY 20 mg.kg-1抑瘤率为40.3%,LAMS低、高剂量组抑瘤率分别为25.0%和33.8%,与模型组比较均有显著差异;CY在抑瘤的同时能显著抑制荷瘤小鼠的胸腺指数和脾指数,与模型组比较有显著性差异,LAMS对荷瘤小鼠的胸腺指数和脾指数无明显影响。结论:LAMS对移植前列腺癌RM-1的荷瘤小鼠有一定的抑瘤作用,LAMS在抑制肿瘤的同时不影响荷瘤鼠的免疫功能,无CY等化疗药物的常见副作用。     

An Endoscopic Transluminal Approach,Compared With Minimally Invasive Surgery,Reduces Complications and Costs for Patients With Necrotizing Pancreatitis

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Clinical outcomes of lumen-apposing metal stent in the management of benign gastrointestinal strictures: a systematic review and meta-analysis

Background and aims: Lumen-apposing metal stent (LAMS) have been considered as a viable alternative to treat benign gastrointestinal (GI) strictures. We aimed to determine the efficacy and safety of LAMS for benign GI strictures.

Methods: Medline, Embase, Cochrane, and PubMed databases were searched using the keywords ‘benign stricture’, ‘gastrointestinal stricture’, ‘lumen-apposing metal stent’ and related terms on December 2018. Articles were selected for review by two authors independently according to predefined inclusion criteria and exclusion criteria. A meta-analysis using a random effects model was performed.

Results: Six studies with a total of 144 patients were included in the final analysis (60 males, 41.7%). Overall, the pooled technical success rate was 98.3% [95% confidence interval (CI): 0.962–1.004], clinical success rate was 73.8% (95% CI: 0.563–0.912) and adverse events rate was 30.6% (95% CI: 0.187–0.425). The most common complication associated with LAMS for benign GI strictures was migration, and the pooled events rate was 10.9% (95% CI: 0.058–0.160). According to locations of stricture, subgroup analysis was performed in terms of clinical success [Esophagogastric: 63.9% (95% CI: 0.365–0.914); Gastroduodenal: 67.4% (95% CI: 0.421–0.927); Gastrojejunal: 78% (95% CI: 0.638–0.922); Pylorus: 77.6% (95% CI: 0.551–1.002); Colonic: 85.3% (95% CI: 0.515–1.191)].

Conclusions: Although the safety of LAMS placement in benign GI strictures is not very satisfactory, it is associated with a low migration rate. LAMS can achieve clinical symptom improvement or resolution in most patients with benign GI strictures, and it might be an alluring prospect for treating patients with this difficult condition.