Journal of Digestive Endoscopy最新文献

{"title":"Percutaneous Endoscopic Gastrostomy Tube Gone Wrong: Endoscopic Closure to the Rescue","authors":"J. Dhar, N. Kumar, P. Gupta, R. Kochhar, J. Samanta","doi":"10.1055/s-0041-1739563","DOIUrl":"https://doi.org/10.1055/s-0041-1739563","url":null,"abstract":"Abstract Percutaneous endoscopic gastrostomy (PEG) is one of the most commonly performed endoscopic procedures and a first-line treatment for the establishment of enteral access in those with intolerance or contraindication to oral feedings. A small amount of pneumoperitoneum in the immediate postprocedure period is well reported after PEG tube placement. However, pneumoperitoneum resulting from displaced gastric bumper within 24 hours postprocedure is uncommon and rarely reported in the literature. Timely diagnosis and early endoscopic management can help tackle such an unusual complication.","PeriodicalId":43098,"journal":{"name":"Journal of Digestive Endoscopy","volume":"12 1","pages":"169 - 171"},"PeriodicalIF":0.7,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46826587","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":"Outcomes of Palliative Colonic Stent Placement in Malignant Colonic Obstruction: Experience from a Tertiary Care Oncology Center in India","authors":"S. Sundaram, Raosaheb Rathod, P. Patil, K. Mane, Vishal Seth, A. Saklani, A. Desouza, S. Mehta","doi":"10.1055/s-0042-1749073","DOIUrl":"https://doi.org/10.1055/s-0042-1749073","url":null,"abstract":"Abstract Introduction  Colonic self-expanding metal stent (SEMS) placement is the preferred method for palliation of malignant colonic obstruction. We analyzed outcomes of patients who underwent colonic SEMS placement for palliation at a tertiary care oncology center in Western India. Methods  Retrospective review of the endoscopy database was done for patients who underwent colonic SEMS placement at our center between January 2013 and September 2021. Demographic details, intent of stent placement, site of obstruction, length of stricture, technical success of stenting, clinical success, and complications (both immediate and long term) were noted. Results  Sixty-one patients underwent colonic SEMS placement during the study period (mean age 53.6 years, 50.7% men). Obstruction was due to primary colonic malignancy in 43 (70.5%) patients and extracolonic malignancies in 18 (29.5%) patients. Most common extracolonic malignancy was gallbladder cancer in 8 (44.4%) patients. Most common site of obstruction was sigmoid colon in 18 (29.5%) patients. Proximal colonic obstruction was seen in 17 (27.9%) patients. Peritoneal metastases were seen in 26 (42.6%) patients. Colonoscopy revealed an impassable stenosis in 58 (95.1%) patients. Median length of stricture was 5 cm (range 2–9 cm). Technical success was achieved in 98.3% (60/61). Clinical success was achieved in 51 (86.4%) patients. Perforation during colonic SEMS placement was seen in 2 (3.4%) patients. Stent migration was seen in 3 (5.9%) patients, needing surgery for retrieval in all 3 patients. Over a median follow-up of 9 months (0–21 months), stent block was seen in 7 (13.7%) patients. Stent block developed after a median period of 6 months. Of these patients, three patients underwent SEMS placement within the SEMS and the other four patients underwent surgery. Conclusion  Colonic SEMS placement achieves good palliation of malignant colonic obstruction in approximately 87% patients. Long-term complications like obstruction occur in a few patients after a median duration of 6 months.","PeriodicalId":43098,"journal":{"name":"Journal of Digestive Endoscopy","volume":"14 1","pages":"008 - 013"},"PeriodicalIF":0.7,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47950042","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":"Tuberculosis is still the most Common Cause of Mediastinal and Intra-abdominal Lymphadenopathy by EUS-FNA in India","authors":"M. Behera, Jimmy Narayan, Shobhit Agarwal, Debakanta Mishra, P. Reddy, Ayaskanta Singh, G. Pati, M. Sahu","doi":"10.1055/s-0041-1739965","DOIUrl":"https://doi.org/10.1055/s-0041-1739965","url":null,"abstract":"\u0000 Background Lymph nodal tuberculosis is reported to occur in 4% to 7% of all tuberculosis, and mediastinal lymphadenopathy accounts for 10% of lymph nodal tuberculosis but the diagnosis still remains a challenge due to inaccessibility to these sites. There is a scarcity of recent data from India about the etiology of intra-abdominal and mediastinal lymphadenopathy despite being frequently detected in cross-sectional imaging.\u0000 Methods A retrospective study was conducted after reviewing hospital records over a period of 3 years from December 2017 to December 2020 who underwent endoscopic ultrasonography (EUS). A total of 126 patients with mediastinal and/or intra-abdominal lymphadenopathy detected by cross-sectional imaging were examined for clinical features, EUS, and histopathology records.\u0000 Results The mean age of patients was 53.12 ± 14.15 years. Seventy-one patients (56%) had intra-abdominal lymph nodes and 55 (44%) had mediastinal lymph nodes. The average number of needle passes was 2.35 ± 0.58 (range: 2–4). The majority of patients had tubercular etiology (53.2%) followed by metastatic (26.2%). Other etiologies were reactive (4.8%), lymphoma (4.8%), sarcoidosis (3.2%), and GIST (1.6%). No diagnosis could be ascertained in 6.3% of patients. The EUS features that favored tubercular etiology over metastatic were heterogeneous echotexture (72% vs. 30%), irregular shape (78% vs. 12%), indistinct borders (81% vs. 30%) and calcification (43% vs. 15%). Partial anechoic area and hyperechoic area were seen in 21% and 64% of tubercular patients, respectively. EUS only had sensitivity and specificity of 63% and 84%, respectively, and EUS FNA had a very high sensitivity and specificity of 93% and 100%, respectively.\u0000 Conclusion Tuberculosis is still the most common cause of lymph nodes. EUS FNA had a very high sensitivity and specificity of 93% and 100%, respectively, for the diagnosis of mediastinal and intra-abdominal lymphadenopathy.","PeriodicalId":43098,"journal":{"name":"Journal of Digestive Endoscopy","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49162956","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":"Duodenoscope-Acquired Infections: Risk Factors to Consider","authors":"G. Thornhill, B. Dunkin","doi":"10.1055/s-0041-1739562","DOIUrl":"https://doi.org/10.1055/s-0041-1739562","url":null,"abstract":"In the wake of highly publicized duodenoscope-associated outbreaks caused by multidrug-resistant organisms (MDRO), a herculean effort was made to understand the conditions that led to these transmission events. Although there is now a clearer picture on how these outbreaks happened, there are still significant data gaps when it comes to understanding the rate of duodenoscope-acquired infections (DAIs), especially in nonoutbreak situations. Recent publications indicate that DAIs are still occurring and suggest that infection rates are higher than currently believed. Given this data gap, it is important to identify those patient populations that are most at risk of postprocedure infection, so that appropriate infection control measures may be implemented. Although those patients receiving antibiotic prophylaxis are most at risk for infection, there are additional risk factors that should be considered. For the purposes of this review, risk factors for infection were divided into three broad categories as follows: (1) those that increase patient susceptibility to infection, (2) those related to the endoscopic procedure, and (3) those factors that put reusable duodenoscope inventories at risk of contamination. Infection risk is a complex interaction between the immune status of the patient, the characteristics of the infectious agent (antibiotic sensitivity, virulence factors, and epidemiology), and the environment of care. Because of this complexity, any assessment of the risk of infection should be performed on a case-by-case basis. There is a dearth of information on infection risk for those patients undergoing endoscopic retrograde cholangiopancreatograpy (ERCP), especially in the context of the development and implementation of new device technology, and new endoscopic procedures that are increasing in complexity. This narrative review was developed using the Medical Subject Heading (MeSH) terms to perform an electronic search in PubMed with the goal of generating a summary of the patient, procedural, and duodenoscope-associated factors that increase the risk of infection in patients undergoing ERCP. This review provides practical information regarding the segmentation of ERCP patients by infection risk, so that endoscopists can make informed decisions about the risk benefits of using enhanced duodenoscope technologies in the care of their patients.","PeriodicalId":43098,"journal":{"name":"Journal of Digestive Endoscopy","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46520953","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":"Antiphospholipid Antibody Syndrome Presenting as Subacute Abdominal Pain Due to Portomesenteric Thrombosis","authors":"T. S. Chandrasekar, B. J. Gokul, T. C. Viveksandeep, K. R. Yogesh, S. Sathiamoorthy, M. S. Prasad","doi":"10.1055/s-0040-1701397","DOIUrl":"https://doi.org/10.1055/s-0040-1701397","url":null,"abstract":"Abstract Antiphospholipid antibody syndrome (APS), a hypercoagulable state, affects organ by causing venous or arterial thrombosis. We present an unusual case of a 58-year-old male who presented with diffuse abdominal pain and on evaluation diagnosed as having portomesenteric venous thrombosis due to primary APS. Upon successful treatment with enoxaparin followed by anticoagulants for 6 months, recanalization of the portal vein was documented by endoscopic ultrasonography. Early identification and treatment of portomesenteric thrombosis is crucial to prevent bowel ischemia. Lifelong anticoagulation with vitamin K antagonists should be considered in those patients with major thrombosis and established APS.","PeriodicalId":43098,"journal":{"name":"Journal of Digestive Endoscopy","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2021-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48301866","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":"Mediastinal Lymphadenopathy in Visceral Leishmaniasis","authors":"S. Rana, N. Gupta, R. Sharma, Pankaj Kumar","doi":"10.1055/s-0040-1715983","DOIUrl":"https://doi.org/10.1055/s-0040-1715983","url":null,"abstract":"Abstract Visceral leishmaniasis (VL) usually presents with malaise, fever, weight loss, and hepatosplenomegaly. Lymphadenopathy is rarely reported in patients with VL from India. We report an interesting case of VL, presenting with malaise, fever and weight loss along with isolated mediastinal lymphadenopathy and mimicked tuberculosis. Absence of spleen because of previous splenectomy for symptomatic portal hypertension led to difficulty in establishing the correct diagnosis that was eventually established by endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA).","PeriodicalId":43098,"journal":{"name":"Journal of Digestive Endoscopy","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2021-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43231603","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 for Detection of Liver Metastasis: Hope or Hype?","authors":"A. Singh, S. Rana","doi":"10.1055/s-0041-1728234","DOIUrl":"https://doi.org/10.1055/s-0041-1728234","url":null,"abstract":"Abstract Transabdominal ultrasonography, contrast-enhanced computed tomography, and magnetic resonance imaging (MRI) are the common diagnostic tests for the detection of hepatic lesions. Use of enhanced and advanced MRI technique, that is, diffusion weighted MRI and hepatocyte-specific contrast agents, has further improved the accuracy of detection of metastatic liver lesions ≤10 mm in diameter. However, even with these advanced imaging modalities sensitivity is low for lesions smaller than 10 mm when compared with standard intraoperative ultrasound. Endoscopic ultrasound (EUS) is an emerging imaging modality with resolution sufficient to detect and sample lesions as small as 5 mm in diameter. In this news and views, we have discussed the role of standard and enhanced EUS for the detection of metastatic liver lesions.","PeriodicalId":43098,"journal":{"name":"Journal of Digestive Endoscopy","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2021-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0041-1728234","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49060344","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":"A Giant Lymph Node—Liver Imposter","authors":"Sagar Dembla, S. Asif, A. Singh, A. Sekaran, S. Lakhtakia, D. Reddy","doi":"10.1055/s-0041-1731585","DOIUrl":"https://doi.org/10.1055/s-0041-1731585","url":null,"abstract":"Abstract Abdominal tuberculosis has insidious course and is a diagnostic challenge. Tubercular lymphadenitis is associated with constitutional symptoms and multiple enlarged lymph nodes. Isolated giant lymph nodes are rare in tuberculosis and are common in lymphoma or malignancy. Peripancreatic mass on endosonography are commonly lymph node less than 4 cm. Isolated giant nonnecrotizing lymph node can mimic liver architecture on endoscopic ultrasound but lack a biliary connection.","PeriodicalId":43098,"journal":{"name":"Journal of Digestive Endoscopy","volume":"12 1","pages":"112 - 113"},"PeriodicalIF":0.7,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47742399","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":"Isolated Ascending Colon Varix: An Unusual Cause of Lower Gastrointestinal Bleed","authors":"J. Dhar, J. Samanta, G. Muktesh, R. Kochhar","doi":"10.1055/s-0041-1733346","DOIUrl":"https://doi.org/10.1055/s-0041-1733346","url":null,"abstract":"Abstract Ectopic varices, defined as dilated portosystemic veins located at unusual sites other than the gastroesophageal junction and fundus, have been reported in cases of cirrhosis with underlying portal hypertension. The common sites usually are the rectum and duodenum. Isolated colon varix is therefore a rare phenomenon and such varix presenting with lower gastrointestinal bleed as the first manifestation is still uncommon. A high index of clinical suspicion, timely imaging with full-length colonoscopy, and subsequent endoscopic therapy can effectively manage this rare entity.","PeriodicalId":43098,"journal":{"name":"Journal of Digestive Endoscopy","volume":"12 1","pages":"116 - 117"},"PeriodicalIF":0.7,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47868980","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":"A Descriptive Analysis of Capsule Endoscopy Events in the FDA Manufacturer and User Facility Device Experience (MAUDE) Database.","authors":"Hangyu Ji, Shaoli Wang, Yang Gong","doi":"10.1055/s-0041-1731960","DOIUrl":"10.1055/s-0041-1731960","url":null,"abstract":"<p><strong>Introduction: </strong>The malfunction of capsule endoscopy (CE) devices is a significant reason for the failure of CE procedures, which could hinder and prevent diagnosis. Unfortunately, malfunction-related adverse events (AEs) caused by CE devices are rarely reported in publications. Although most malfunction-related AEs could not lead to physical harm, they could reduce the efficiency of medical care and increase medical costs. The manufacturer and user facility device experience (MAUDE) database, a publicly accessible resource for patient safety, contains not only the common complications of CE but also valuable malfunction-related AEs, which have been underutilized. Therefore, the study aims to discover and analyze the possible AEs associated with CE and demonstrate the utility of the MAUDE reports to promote patient safety.</p><p><strong>Materials and methods: </strong>We acquired MAUDE reports of CE systems from January 01, 2008, to July 31, 2020, through a systematic search strategy. We utilized the manufacturers, brand names, and product codes as search terms from which medical device reports including structured data and narrative texts were extracted, followed by a manual review of the narrative texts, reporter occupation, device involved, event type and the phase of the event; finally, patient outcomes were recorded and analyzed as per CE categories and characteristics.</p><p><strong>Results: </strong>A total of 377 CEs medical device reports were retrieved, and 342 reports were included after reviewing. There were 327 mandatory reports (96%) and 15 voluntary reports (4%). These reports referred to capsule endoscope (<i>n</i> = 213), sensing system (<i>n</i> = 66), patency capsule (<i>n</i> = 38), and capsule delivery device (<i>n</i> = 26). A total of 349 CE-related AEs were identified, including complications (<i>n</i> = 228), malfunction-related AEs (<i>n</i> = 109), and other events (<i>n</i> = 12). The composition of AEs was not the same for the CE devices. Complications were major AEs of capsule endoscope and patency capsule, but malfunction-related AEs were the most common in AEs of sensing systems and capsule delivery devices.</p><p><strong>Conclusion: </strong>MAUDE serves as an invaluable data source for investigating malfunction-related AEs. In addition to common complications, malfunction of CE devices could threaten patient safety in CE procedures. Improving awareness of the malfunction of CE devices and raising adequate training for staff working in gastrointestinal (GI) endoscopic units could be critical and beneficial in preventing malfunction-related AEs.</p>","PeriodicalId":43098,"journal":{"name":"Journal of Digestive Endoscopy","volume":"12 1","pages":"71-77"},"PeriodicalIF":0.7,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11104222/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47674614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}