Endoscopic ultrasound (EUS) significantly enhances diagnosis for pancreatic cystic neoplasms when MRI results are inconclusive. EUS detected morphologic high-risk features in 24% of cases, while MRI detected 28%, with 26% discordance between the two. In surgical patients, using EUS after normal MRI increased specificity by 14%, reaching 38% when combined with fine needle aspiration (FNA). […]
Category: Surgical Endoscopy
Endoscopic Drainage Comparison: Primary vs. Conversion Methods
Conversion endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is as effective and safe as primary EUS-GBD in acute cholecystitis, crucial for high-risk surgical patients. Technical success rates were similar: 98.3% for primary EUS-GBD vs. 95.8% for conversion EUS-GBD. Despite longer initial procedure times for conversion (adjusted later), overall safety metrics were comparable. Consider conversion EUS-GBD in cases […]
Sphincter-Sparing Closure Cuts Bleeding in Endoscopic Papillectomy
A new pre-closure technique for endoscopic papillectomy significantly lowers delayed bleeding risk in duodenal papilla adenoma patients. Delayed bleeding rate was 0% with pre-closure vs. 17.95% without (p = 0.017). Immediate bleeding rate decreased from 66.67% to 37.93% (p = 0.027). This approach also shortens hospital stays: 6 days vs. 7 days (p = 0.048). […]
EUS-Guided Drainage for Symptomatic Gallstones Works
EUS-Guided Gallbladder Drainage shows strong promise for non-surgical patients with symptomatic cholelithiasis without cholecystitis. 100% technical success, with complete stone clearance achieved in all 23 patients. 87% achieved clearance in just one treatment; no procedure-related complications reported. Improving patient selection and outcomes may lead to broader acceptance of this technique in practice. Journal Article by […]
Cholecystectomy Beats ERCP for Gallstone-Related Pancreatitis
Same-admission cholecystectomy lowers recurrence of acute pancreatitis compared to ERCP or no intervention. Recurrence rates post-discharge: 3.4% (cholecystectomy), 4.9% (ERCP), and 17.5% (no intervention). Other gallstone complications: 1.6% in the cholecystectomy group versus 19.9% (ERCP) and 16.3% (no intervention). Prioritizing immediate cholecystectomy can improve long-term outcomes in suitable patients. Risk of recurrence surged 8 to […]
Real-world outcomes of duodenal endoscopic techniques
Endoscopic submucosal dissection and full-thickness resection are effective for select duodenal lesions but carry significant risks. Technical success rate was 98.2%, with R0 resection rates at 93.3% for epithelial and 90.4% for subepithelial lesions. Intraprocedural bleeding occurred in 16.5%; perforation rate was 5.5%, all manageable endoscopically. Consider severe fibrosis a key predictor for adverse events, […]
Upfront Endoscopic Necrosectomy Shows No Advantage Over Step-Up Approach
A systematic review finds no significant difference in outcomes between upfront endoscopic necrosectomy (UEN) and step-up endoscopic necrosectomy (SUEN) for walled-off pancreatic necrosis, influencing surgical decision-making. Clinical success rates were similar: RR 1.04 (95% CI, 0.98-1.11). Safety outcomes, including postprocedural bleeding and infection, also showed no significant differences. Surgeons should consider individual patient factors when […]
Laparoscopic Bile Duct Exploration Matches ERCP for Stones
Two leading treatments for choledocholithiasis—laparoscopic bile duct exploration (lbeps) and ERCP with laparoscopic cholecystectomy—show similar effectiveness, but surgeons can leverage their distinct recovery profiles. Both methods achieved 100% stone clearance with no conversions to open surgery, but lbeps showed quicker postoperative recovery of liver function tests. Patients receiving lbeps faced less acute cholangitis and had […]
New Endoscope Enhances Efficiency in Minimally Invasive Surgery
A novel distal-flexible endoscope offers improved maneuverability, benefiting surgeons performing complex procedures. The prototype reduced operative time by 18% in simulated tasks (5.8 vs. 4.6 min, p=0.042) and by 21% in vivo (40.2 vs. 51.0 min, p=0.046). Fewer endoscope repositionings were needed—4.8 vs. 12.8 (p=0.004). This system’s intuitive design reduces surgeon workload while ensuring patient […]
Ultra-early endoscopy cuts anastomotic leak risk post-MIE
Ultra-early postoperative endoscopy within 24 hours significantly reduces anastomotic leaks after minimally invasive esophagectomy (MIE). Anastomotic leak rates dropped from 20.07% to 11.31% with ultra-early endoscopy (p=0.007). Hypoproteinemia rates fell from 21.90% to 9.49% (p<0.001), and median hospital stay decreased (p=0.01). This approach safely enables earlier risk detection and promotes faster enteral nutrition, improving patient […]