Endoscopic ultrasound-guided gallbladder drainage is now more effective than traditional methods for patients unfit for surgery. EUS-guided drainage shows higher technical success rates and better patient outcomes compared to percutaneous methods. Fewer complications and reinterventions are reported with EUS compared to previous techniques. Surgeons should consider EUS for optimal patient selection in non-surgical candidates, balancing […]
Category: Surgical Endoscopy
Preoperative Biliary Drainage with Metal Stents Safe in Pancreatic Cancer
Preoperative biliary drainage (PBD) using self-expanding metal stents (SEMS) is noninferior to early surgery for pancreatic cancer patients, impacting surgical timing decisions. Serious adverse events were similar: 29.0% in PBD vs. 26.5% in early surgery (p = 0.011 for noninferiority). 82.6% of PBD patients had curative surgery versus 88.5% in the early surgery group. Surgeons […]
New Biliary Drainage Technique for Altered Anatomy Shows Promise
A novel endoscopic approach improves biliary drainage outcomes for patients with altered anatomy. Technical success rate: 87.3%, clinical success: 93.8%. Adverse event rate: 20%, with 30.6% persistent fistula rate within 3 months. Consider this technique for patients with complex anatomy, especially when multiple biliary interventions are needed. Most common indication: benign strictures (58.2%). Multicenter Study […]
EUS-RFA Offers Safe Option for Intraductal Neoplasms
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. […]
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, […]