Stent choice for preoperative biliary drainage in pancreatic cancer does not affect long-term survival. Among 6,429 patients, overall and recurrence-free survival were similar for plastic (PS) and metal stents (MS) after pancreaticoduodenectomy, even in those receiving neoadjuvant therapy. No significant difference in postoperative complications between PS and MS. Choose stents based on drainage duration and […]
Category: Surgical Endoscopy
New Peptide Strategy Outperforms Balloon for Post-ERCP Bleeding
A self-assembling peptide-first approach significantly enhances hemostasis for immediate post-sphincterotomy bleeding during ERCP. Successful initial hemostasis was achieved in 92.3% of the peptide group versus 76.9% in the balloon group (15.4% risk difference, p=0.027). The mean procedure time was shorter for the peptide strategy, and rescue devices were needed less often (7.7% vs 23.1%, p=0.033). […]
EUS-guided RFA shows promise for managing IPMNs
Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) offers a safe, minimally invasive option for patients with branch-duct IPMNs who cannot undergo surgery. Technical success reached 100% across 62 procedures, with local control in 98% of lesions. Adverse events occurred in 27% of cases, mainly mild abdominal pain; no procedure-related deaths were reported. This approach maintains pancreas-wide disease […]
Negligible benefit of terminal ileal intubation in asymptomatic colonoscopy
Routine terminal ileal intubation in asymptomatic patients undergoing colon cancer screening shows minimal diagnostic value. Overall diagnostic yield for any ileal finding is just 1.74%. Yield for clinically significant pathology is only 0.28%, with Crohn’s disease detection at 0.1%. Surgeons should reconsider routine TII during screening and surveillance colonoscopies due to negligible benefit. Review by […]
New risk scoring for achalasia post-POEM reveals critical patterns.
The JAMS POEM score effectively predicts short-term clinical failure (AUROC 0.71) but loses accuracy long-term (AUROC 0.54). A three-tiered risk stratification identifies an intermediate-risk group with a 10-year failure rate of 35.8%, suggesting different follow-up strategies. Surgeons should consider long-term outcomes when applying the JAMS POEM score for better patient surveillance. In the low-risk group, […]
Effective outcomes for laparoscopic hiatal hernia repair with cTIF
Laparoscopic hiatal hernia repair combined with consecutive transoral incisionless fundoplication (cTIF) achieves high success rates in GERD patients. 92% of patients achieved complete clinical success within 12 months. Symptom improvement was reported by 90% and 84% normalized esophageal acid exposure. Most patients (84%) stopped daily proton pump inhibitors, enhancing long-term management potential for surgeons. Serious […]
Colonic obstruction management redefined: SEMS trumps surgery.
Using self-expanding metal stents (SEMS) as bridge-to-surgery improved outcomes for obstructive left colon cancer. One-year stoma rates were lower with SEMS (44.4%) compared to emergency surgery (73.4%). Fewer readmissions (4.2% vs 15.9%) and faster chemotherapy initiation (76.1% vs 55.8%) were noted with SEMS. Consider SEMS for selected patients to reduce stoma rates and enhance quality […]
Endoscopic ultrasound-drained gallbladders safe in perforation
Surgeons can safely use endoscopic ultrasound-guided gallbladder drainage in patients with inoperable acute cholecystitis and Niemeier type II perforation. Technical success was 100% in 14 patients treated with electrocautery-enhanced stents. Clinical success reached 92.9% with only mild adverse events, and no severe complications after a median follow-up of 315 days. Consider this approach in high-risk […]
POEM and LHD show similar long-term outcomes for achalasia.
At 5 years, 87.3% of POEM and 90.1% of LHD patients had an Eckardt score ≤3. POEM patients had a higher need for PPIs (45.6% vs 24.6%) and increased rates of esophagitis (34% vs 10.4%). Surgeons should consider the higher GERD incidence with POEM when selecting treatment. Symptomatic recurrence at 5 years was low in […]
Standardized Endoscopy Could Improve Gastric Cancer Outcomes
Diagnostic endoscopy for gastric cancer is underused, leading to late-stage diagnoses and worse survival rates. 73% of stage I gastric cancer patients are symptomatic, yet many are diagnosed late. Median overall survival varies drastically: 47 months for stage II versus 11 months for stage IV. Surgeons should advocate for standardized endoscopy protocols to improve early […]