EUS-guided radiofrequency ablation is a safe alternative for patients with branch-duct IPMNs showing worrisome features who cannot undergo surgery. Technical success was 100% in 62 procedures, with 98% achieving local control. Adverse events occurred in 27%, primarily mild abdominal pain; no deaths reported. This procedure effectively prevents cancer progression in patients unsuitable for traditional surgery. […]
Category: Surgical Endoscopy
Long-term Insights on ESD for T1 Colorectal Cancer
Endoscopic submucosal dissection offers effective long-term outcomes for T1 colorectal cancer, but high-risk patients may benefit from additional surgery. In a study of 383 T1 CRC patients, the 5-year local recurrence rate was 6.8% in high-risk follow-up patients vs. 0% in those who had surgery (p<0.001). Overall survival at 5 years was significantly lower for […]
Timing of Necrosectomy in Infected Pancreatic Necrosis Matters
Immediate necrosectomy for infected walled-off pancreatic necrosis offers no advantages over an on-demand approach. Clinical success rates were similar: 92% (immediate) vs. 88% (on-demand), p = .5. On-demand patients required fewer necrosectomy sessions (1 vs. 2, p ≤ .01) and had fewer adverse events (24% vs. 40%, p = .2). This suggests that a selective […]
Endoscopic Closure vs. Surgery for Colonic Perforations
Endoscopic closure may be a viable first-line approach for select iatrogenic colonic perforations. No difference in treatment success between endoscopic closure and surgery (RR 1.00, 95% CI 0.94-1.06). Endoscopy was generally used for smaller, immediately recognized injuries, while surgery was preferred for larger, delayed presentations. In ideal candidates (perforations <2 cm with no peritonitis), endoscopy […]
New Robotic Procedure Shows Promise for Colorectal Lesions
Endorobotic submucosal dissection (ERSD) using the da Vinci SP system is a safe and effective option for resecting distal colorectal lesions. En-bloc resection rate was 96%, with a median procedure time of 73 minutes. Patients had a median hospital stay of 0 days and minimal long-term complications. This indicates ERSD could expand surgical options for […]
Endoscopic Necrosectomy: No Major Differences Found
Upfront endoscopic necrosectomy (UEN) and step-up endoscopic necrosectomy (SUEN) show similar outcomes for walled-off pancreatic necrosis, impacting how you approach patient management. No significant difference in clinical success (RR: 1.04) or technical success (RR: 1.27) between UEN and SUEN. Patient safety outcomes, including post-procedural bleeding (RR: 0.66) and recurrence (RR: 0.71), were comparable. Individualized treatment […]
Biliary Stents for Bile Leaks After Fenestrated Cholecystectomy Show No Difference
This study examines the effectiveness of different biliary stents for treating bile leaks post-fenestrated cholecystectomy, revealing significant implications for patient management. PCBL resolution rates were similar across stent types: 93.8% for 10 fr stents, 92.3% for 7 fr stents, and 88.9% for fully covered self-expanding metal stents. Plastic stents, including single and double pigtail options, […]
Effective Strategies for Malignant Gastric Outlet Obstruction
Endoscopic ultrasound-guided gastrojejunostomy (eus-gj) outperforms surgical methods for malignant gastric outlet obstruction, impacting patient outcomes. EUS-gj shows a clinical success rate significantly higher than surgical gastrojejunostomy (rr 0.82) and enteral stents (rr 0.91). Surgical options are linked to longer hospital stays and increased reintervention rates compared to EUS-gj. Consider recommending EUS-gj as the primary treatment […]
Guidelines for EUS-Guided Gastroenterostomy Standardized
A consensus among experts highlights vital technical practices for EUS-guided gastroenterostomy (EUS-GE) that can improve patient outcomes in gastric outlet obstruction. 31 key statements were approved, showing strong agreement on essentials like fluoroscopy and managing complications. Over 90% consensus on sedation, patient positioning, and saline use as a distension solution. Surgeons should adopt these recommendations […]
Immediate Endoscopic Necrosectomy Cuts Recovery Time in Pancreatitis
Immediate endoscopic necrosectomy (den) after drainage significantly speeds recovery in patients with necrotizing pancreatitis. Time to clinical success was 29 days with immediate den, compared to 44 days with the step-up approach (p = .009). Adverse events were similar between groups: 24% for immediate den vs. 22% for step-up (p = .79). Consider immediate den […]