Techniques and Innovations in Gastrointestinal Endoscopy最新文献

{"title":"Endoscopic Tissues Sampling of Solid Pancreatic Lesions for Molecular Analysis","authors":"Divya M. Chalikonda,&nbsp;Uzma D. Siddiqui","doi":"10.1016/j.tige.2024.09.001","DOIUrl":"10.1016/j.tige.2024.09.001","url":null,"abstract":"<div><div>Endoscopic ultrasound (EUS)–guided tissue acquisition of solid pancreatic lesions is the diagnostic gold standard for most pancreas lesions. Since this technique was initially developed, there have been several iterations of the device technology and advancements in understanding technique to maximize diagnostic yield while minimizing adverse events. We describe the current literature on techniques for EUS-guided tissue acquisition, including fine-needle biopsy vs fine-needle aspiration, suction vs slow pull, fanning vs torque technique, and the use of rapid onsite cytopathology in obtaining a diagnosis. Additionally, modern medicine has allowed for use of these specimens to guide personalized cancer treatment for patients. Unique to this review, we have included a discussion on next-generation sequencing, organoids, and single-cell analysis and how EUS specimens perform in these novel downstream analyses.</div></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"26 4","pages":"Pages 347-358"},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142533696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utilization of Through-the-scope Sutures for Complex Tissue Apposition: A Series of Novel Cases","authors":"Calvin X. Geng ,&nbsp;Jagannath Kadiyala ,&nbsp;Ross C.D. Buerlein ,&nbsp;Vanessa M. Shami ,&nbsp;Andrew Y. Wang ,&nbsp;Alexander Podboy","doi":"10.1016/j.tige.2023.09.003","DOIUrl":"10.1016/j.tige.2023.09.003","url":null,"abstract":"","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"26 1","pages":"Pages 42-45"},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135408192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low Body Mass Index and Risk of Endoscopy-Related Adverse Events: A United States Cohort Propensity Score—Matched Study","authors":"Saurabh Chandan ,&nbsp;Rahul Karna ,&nbsp;Aakash Desai ,&nbsp;Babu P. Mohan ,&nbsp;Dushyant Singh Dahiya ,&nbsp;Daryl Ramai ,&nbsp;Antonio Facciorusso ,&nbsp;Mohammad Bilal ,&nbsp;Douglas G. Adler ,&nbsp;Gursimran S. Kochhar","doi":"10.1016/j.tige.2023.12.001","DOIUrl":"10.1016/j.tige.2023.12.001","url":null,"abstract":"<div><h3>Background and Aims</h3><p>Patients with a low body mass index (LBMI) are often encountered in routine outpatient gastrointestinal (GI) endoscopy practice, and the assessment of procedure-related risks in this subset of individuals remains paramount. Although the risk of endoscopy-related adverse events (AEs) has been reported in patients with obesity, the association between LBMI and AEs has not been established.</p></div><div><h3>Methods</h3><p>We conducted a retrospective cohort study using TriNetX, a multi-institutional database, to assess the risk of endoscopy-related AEs in patients with LBMI (&lt;18.4 kg/m²) compared with patients with a nonobese body mass index (18.5-29.9 kg/m²) (control cohort) after low-risk outpatient diagnostic esophagogastroduodenoscopy (EGD), colonoscopy, or percutaneous endoscopic gastrostomy (PEG) tube placement. One-to-one (1:1) propensity score matching was performed. The primary endpoints were to assess the risk of GI bleeding, perforation, or aspiration pneumonia within 30 days. Risk was expressed as adjusted odds ratios (aORs) with 95% confidence intervals.</p></div><div><h3>Results</h3><p>A total of 28,677, 18,449, and 3076 patients with LBMI underwent EGD, colonoscopy, and PEG tube placement, respectively. After propensity score matching, compared with the control cohort, patients with LBMI undergoing EGD and colonoscopy with or without biopsies were at an increased risk for GI bleeding (aOR 1.36 and 2.21), perforation (aOR 1.96 and 2.65), and aspiration pneumonia (aOR 3.13 and 2.71), respectively. Additionally, patients in the LBMI PEG cohort were found to be at an increased risk for aspiration pneumonia (aOR 1.33).</p></div><div><h3>Conclusion</h3><p>Our study shows that, when compared with nonobese controls, patients with LBMI are at an increased risk of endoscopy-related AEs. Appropriate precautions must be considered while performing routine endoscopic procedures to offset these risks in such patients.</p></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"26 2","pages":"Pages 99-108"},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138617468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Predictors of Success of Esophageal Hydraulic Balloon Dilation in Patients With and Without Previous Foregut Surgery","authors":"Anh D. Nguyen ,&nbsp;Austin Dickerson ,&nbsp;Jesse Zhang ,&nbsp;Ashton Ellison ,&nbsp;Chanakyaram A. Reddy ,&nbsp;Daisha J. Cipher ,&nbsp;Rhonda F. Souza ,&nbsp;Stuart J. Spechler ,&nbsp;Vani JA Konda","doi":"10.1016/j.tige.2023.12.002","DOIUrl":"10.1016/j.tige.2023.12.002","url":null,"abstract":"<div><h3>Background and Aims</h3><p>The advantages of esophageal hydraulic balloon dilation<span><span> include the ability to dilate up to 30 mm without fluoroscopic guidance and real-time display of the esophagogastric junction diameter during dilation. We aimed to explore the safety and efficacy of esophageal hydraulic balloon dilation in patients with and without previous </span>foregut surgery, as well as to evaluate for predictors of clinical success.</span></p></div><div><h3>Methods</h3><p>We reviewed our database for patients who had esophageal hydraulic balloon dilation, and patients were divided into those with and without previous foregut surgery. Clinical success was determined by improvement in Eckardt/Brief Esophageal Dysphagia<span> Questionnaire scores or, if not available, by physician assessment documented in the medical records<span><span>. Technical success was defined as the ability to successfully perform esophageal hydraulic balloon dilation with visualization of the waist and stabilization of the balloon. Univariate analysis and </span>logistic regression were used to evaluate predictors of clinical success after dilation.</span></span></p></div><div><h3>Results</h3><p>Among 80 patients who had esophageal hydraulic balloon dilation (36 without and 44 with previous foregut surgery), clinical success was achieved in 48% of patients without previous foregut surgery (43% in achalasia<span> and 73% in esophagogastric junction outflow obstruction) and 83% of patients with previous foregut surgery (87% in surgically treated achalasia and 80% in patients without achalasia with previous fundoplication). Technical success was achieved in 86% of patients without previous foregut surgery and 98% in patients with previous foregut surgery. There was 1 esophageal perforation (1.3%). Opiate use was a negative predictor of clinical success.</span></p></div><div><h3>Conclusion</h3><p>Clinical success rates after esophageal hydraulic balloon dilation differ depending on the patient's foregut surgery history. Opiate users appear to have a lower clinical success rate compared with nonusers.</p></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"26 2","pages":"Pages 109-120"},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139013664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic Ultrasound Can Measure Esophageal Remodeling in Eosinophilic Esophagitis","authors":"Simon S. Rabinowitz ,&nbsp;Jeremy Weedon ,&nbsp;Evan Grossman ,&nbsp;Steven M. Schwarz ,&nbsp;Sairaman Nagarajan ,&nbsp;Frank Gress","doi":"10.1016/j.tige.2023.12.005","DOIUrl":"10.1016/j.tige.2023.12.005","url":null,"abstract":"<div><h3>Background and Aims</h3><p><span>Although esophageal widening is a normal consequence of growth in pediatric individuals, esophageal remodeling plays a major role in the morbidity of pediatric and adult </span>eosinophilic esophagitis<span> (EoE). However, the disease is defined by esophageal dysfunction and mucosal eosinophilia. One potential explanation is the difficulty in quantitating remodeling.</span></p></div><div><h3>Methods</h3><p><span><span>This prospective, IRB-approved longitudinal study evaluated endoscopic ultrasound (EUS) in 78 children, adolescents, and young adults referred to a single academic medical center for esophageal indications. Patients with proven EoE had serial EUS exams that measured total wall thickness (TWT) and esophageal wall sublayers during routine </span>endoscopies to manage their disease. Student </span><em>t</em> tests and mixed linear models were employed to compare groups.</p></div><div><h3>Results</h3><p>TWTs from the distal (2.3 ± 0.5 vs 1.7 ± 0.3, <em>P</em> &lt; 0.01) and mid esophagus (2.1 ± 0.5 vs 1.6 ± 0.3, <em>P</em> &lt; 0.05) were increased in active EoE patients &gt; 10 years of age compared with similarly aged controls. After achieving clinical and histologic remission, their TWTs were significantly decreased (distal: 1.9 ± 0.4 vs 2.3 ± 0.5, <em>P</em> &lt; 0.05; mid: 1.7 ± 0.4 vs 2.1 ± 0.5, <em>P</em><span> &lt; 0.05). Mixed linear models further demonstrated that during active EoE, TWTs, esophageal muscle<span><span> layers, and the mucosa and </span>submucosa were thickened in older adolescents at both sites (</span></span><em>P</em> &lt; 0.05 for each). In remission, TWTs returned to control values.</p></div><div><h3>Conclusion</h3><p>This pilot study demonstrates that EUS, a unique application of point-of-care ultrasound, can identify the esophageal remodeling that occurs in older adolescents with active EoE. Furthermore, EUS has defined this remodeling as a transmural phenomenon that occurs in the mid and distal esophagus and can completely reverse with adequate treatment.</p></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"26 2","pages":"Pages 121-129"},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138993266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Electronic Medical Record Prediction Model to Identify Inadequate Bowel Preparation in Patients at Outpatient Colonoscopy","authors":"Jared A. Sninsky ,&nbsp;J. Vincent Toups ,&nbsp;Cary C. Cotton ,&nbsp;Anne F. Peery ,&nbsp;Shifali Arora","doi":"10.1016/j.tige.2023.12.008","DOIUrl":"10.1016/j.tige.2023.12.008","url":null,"abstract":"<div><h3>Background and Aims</h3><p><span><span><span>Inadequate bowel preparation during </span>colonoscopy is associated with decreased </span>adenoma detection, increased costs, and patient procedural risks. The aim of this study was to develop a prediction model for identifying patients at high risk of inadequate bowel preparation for potential clinical integration into the </span>electronic medical record (EMR).</p></div><div><h3>Methods</h3><p>A retrospective study was conducted using outpatient screening/surveillance colonoscopies at the University of North Carolina from 2017 to 2022. Data were extracted from the EMRs of <em>Epic</em> and <em>ProVation</em><span>, including demographic, socioeconomic, and clinical variables. Logistic regression, LASSO regression, and gradient boosting machine models were evaluated and validated in a held-out testing set.</span></p></div><div><h3>Results</h3><p>The dataset included 23,456 colonoscopies, of which 6.25% had inadequate bowel preparation. The reduced LASSO regression model demonstrated an area under the curve of 0.65 (95% CI 0.63-0.67) in the held-out testing set. The relative risk of inadequate bowel prep in the high-risk group determined by the model was 2.42 (95% CI 2.07-2.82) compared with patients identified as low risk. The model calibration in the testing set revealed that among patients categorized as having 0%-11%, 11%-22%, and 22%-33% predicted risk of inadequate prep, the respective proportions of patients with inadequate prep were 5.5%, 19.3%, and 33.3%. Using the reduced LASSO model, a rudimentary code for a potential Epic FHIR application called <em>PrepPredict</em> was developed.</p></div><div><h3>Conclusion</h3><p>This study developed a prediction model for inadequate bowel preparation with the potential to integrate into the EMR for clinical use and optimize bowel preparation to improve patient care.</p></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"26 2","pages":"Pages 130-137"},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139189412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preface: Peroral Endoscopic Myotomy for Benign Gastrointestinal Disorders—Best Clinical Practices and Recent Updates","authors":"Ryan Law","doi":"10.1016/j.tige.2023.12.006","DOIUrl":"10.1016/j.tige.2023.12.006","url":null,"abstract":"","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"26 1","pages":"Page 1"},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139191931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing Endoscopic Suture vs Clip vs No Intervention in Esophageal Stent Migration: A Network Meta-Analysis","authors":"Manesh Kumar Gangwani ,&nbsp;Zohaib Ahmed ,&nbsp;Muhammad Aziz ,&nbsp;Dushyant Singh Dahiya ,&nbsp;Abeer Aziz ,&nbsp;Hassam Ali ,&nbsp;Umar Hayat ,&nbsp;Amir Humza Sohail ,&nbsp;Wade Lee-Smith ,&nbsp;Mohammad Aadil Qamar ,&nbsp;Faisal Kamal ,&nbsp;Sumant Inamdar ,&nbsp;Yaseen Alastal ,&nbsp;Douglas Adler","doi":"10.1016/j.tige.2023.10.004","DOIUrl":"10.1016/j.tige.2023.10.004","url":null,"abstract":"<div><h3>Background and Aims</h3><p><span>Stent migration is a consequential complication associated with </span>esophageal stent placement. We aimed to compare endoscopic suturing vs clips vs no intervention to determine the optimal strategy.</p></div><div><h3>Methods</h3><p><span>A literature search was performed using the MEDLINE, Embase, Cochrane, Web of Science, and Global Index Medicus databases. Direct head-to-head comparator analysis and network meta-analysis of all available groups were performed using the random-effects model. A </span><em>P</em> value less than 0.05 was considered statistically significant.</p></div><div><h3>Results</h3><p>Ten studies with 1019 participants were included in the final analysis. The direct meta-analysis revealed comparable stent migration rates between endoscopic suturing and clips, with an odds ratio (OR) of 1.07 (95% CI 0.07-14.8, <em>P</em> = 0.96), signifying no significant difference in their efficacy. When compared with the no intervention group, endoscopic suturing demonstrated a lower stent migration rate, with an OR of 0.33 (95% CI 0.17-0.62, <em>P</em> &lt; 0.001). Conversely, endoscopic clips did not exhibit a statistically significant advantage over the no intervention group, displaying an OR of 0.29 (95% CI 0.06-1.48, <em>P</em> = 0.14). The results were consistent in the network meta-analysis. The rankings of interventions, as reflected by the <em>P</em> scores, underscored the superior effectiveness of endoscopic suturing with a score of 0.78, followed closely by endoscopic clips at 0.70, whereas the no intervention approach lagged behind with a score of only 0.03.</p></div><div><h3>Conclusion</h3><p>Our findings indicate that stent fixation with sutures significantly prevents stent migration, with no clear advantage of one modality over another. However, it is essential to acknowledge that the feasibility of implementing endoscopic suture fixation in every case is constrained by cost, time, and technical expertise.</p></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"26 2","pages":"Pages 145-152"},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139299911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Randomized Double-blind Sham-controlled Trial of a Novel Silicone-filled Endoscopically Placed Device for Weight Loss","authors":"Richard I. Rothstein ,&nbsp;Branko Kopjar ,&nbsp;George E. Woodman ,&nbsp;James M. Swain ,&nbsp;Nestor de la Cruz-Muñoz ,&nbsp;Vladimir M. Kushnir ,&nbsp;Auora D. Pryor ,&nbsp;Wayne J. English ,&nbsp;Elizabeth A. Odstrcil ,&nbsp;Shelby Sullivan","doi":"10.1016/j.tige.2023.10.002","DOIUrl":"10.1016/j.tige.2023.10.002","url":null,"abstract":"<div><h3>Background and Aims</h3><p>Although obesity affects over 40% of adults in the United States and is a driver of preventable chronic diseases and health care costs, most patients are left untreated.</p></div><div><h3>Methods</h3><p>This was a randomized, double-blind, sham-controlled trial to investigate the safety and efficacy of a novel, endoscopically placed intragastric device for weight reduction<span>, the TransPyloric Shuttle, implanted for 1 year in 270 patients with Class I and II obesity. An additional 32 treatment patients were enrolled in an Open-Label group. The co-primary efficacy endpoints were percent total body weight loss (%TBWL) in the Treatment group compared with the Sham group and a proportion of treatment patients achieving ≥5% TBWL at 12 months.</span></p></div><div><h3>Results</h3><p>The mean %TBWL at 12 months was 9.5% (95% CI, 8.2-10.8) in the Treatment group (<em>n</em> = 181) compared with 2.8% (95% CI, 1.1-4.5) in the Sham group (<em>n</em> = 89). In the Treatment group, 67.0% (95% CI, 59.3-74.4) of patients achieved ≥5% TBWL compared with 29.3% (95% CI, 19.3-39.4) in the Sham group. Patients in the Treatment group achieved lower blood pressure, total cholesterol, and low-density lipoprotein cholesterol compared with the Sham group. Early withdrawals occurred in 22% and 11% patients in the Treatment and Sham groups, respectively. Device- or procedure-related serious adverse events occurred in 6 patients (2.8%), and no deaths occurred.</p></div><div><h3>Conclusion</h3><p>Treatment with a novel endoscopically placed intragastric device resulted in meaningful weight loss and improvement in cardiometabolic outcomes in patients with Class I and II obesity (ClinicalTrials.gov number NCT02518685).</p></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"26 1","pages":"Pages 21-29"},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136093698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Efficacy and Safety of a Novel Stent for Fistula Management Following Sleeve Gastrectomy","authors":"Carlos Noronha Ferreira ,&nbsp;Daniela Reis ,&nbsp;Patrícia Santos ,&nbsp;Carolina Simões ,&nbsp;Miguel Moura ,&nbsp;Filipe Damião ,&nbsp;Nuno Ladeira ,&nbsp;Luís Jasmins ,&nbsp;Nicodemos Fernandes ,&nbsp;Vítor Magno Pereira ,&nbsp;Olavo Costa Gomes ,&nbsp;Helena Nogueira ,&nbsp;António Chiado ,&nbsp;João Raposo ,&nbsp;João Lopes ,&nbsp;Amelia Almeida ,&nbsp;Luís Carrilho-Ribeiro ,&nbsp;João Coutinho ,&nbsp;Rui Tato Marinho","doi":"10.1016/j.tige.2023.07.005","DOIUrl":"10.1016/j.tige.2023.07.005","url":null,"abstract":"<div><h3>Background and Aims</h3><p>Management of fistulas<span> after bariatric surgery<span><span> has shifted from a surgical to a primarily endoscopic approach. We aimed to determine the efficacy of a novel stent for the closure of fistulas and stent-related adverse events in patients with fistulas after </span>sleeve gastrectomy (SG).</span></span></p></div><div><h3>Methods</h3><p>Fifteen patients who developed fistulas following SG between July 2016 and December 2020 and managed at a tertiary care hospital by a primarily endoscopic approach were retrospectively evaluated. The technical and clinical success of a novel stent for the exclusion and definitive closure of fistulas and the need for endoscopic and surgical reinterventions and adverse events were analyzed.</p></div><div><h3>Results</h3><p><span>Fifteen patients with median age of 47 (20-61) years, 11 (73%) females, were included. Fistulas were located at the cardia in 12 (80%) patients, with a median diameter of 4 (2-15) mm. Concomitant stricture of the gastric tube was detected in 8 (53%) patients. A single stent was placed in 13 (87%) patients. Endoscopic reinterventions were required in 5 (33%), and a surgical toilette was needed for 3 (20%) patients. After a median stent implantation duration of 6 (3-21) weeks, fistula closure was documented in all 15 (100%) patients. The concomitant stricture of the gastric tube that occurred in 8 (53%) patients was also successfully managed. Adverse events related to </span>stent placement<span> or removal occurred in 5 (33%) patients and were managed endoscopically. Stent dysfunction occurred in 1 (7%) patient. One patient died due to bleeding from an aortoesophageal fistula 3 cm above the proximal edge of the stent.</span></p></div><div><h3>Conclusion</h3><p>The novel stent is effective in closing fistulas after SG. The unique stent design is associated with a low risk of migration, allows for the management of concomitant strictures in the gastric tube, and facilitates stent removal.</p></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"26 1","pages":"Pages 12-20"},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128604647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}