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The Role of Therapeutic Endoscopic Ultrasound in Management of Malignant Double Obstruction (Biliary and Gastric Outlet): A Comprehensive Review with Clinical Scenarios.
J Clin Med
December 2024
Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy.
Endoscopic ultrasound (EUS)-guided interventions have revolutionized the management of malignant biliary obstruction (MBO) and gastric outlet obstruction (GOO), providing minimally invasive alternatives with improved outcomes. These procedures have significantly reduced the need for high-risk surgical interventions or percutaneous alternatives and have provided effective palliative care for patients with advanced gastrointestinal and bilio-pancreatic malignancies. EUS-guided biliary drainage (EUS-BD) techniques, including hepaticogastrostomy (EUS-HGS), choledochoduodenostomy (EUS-CDS), and antegrade stenting (EUS-AS), offer high technical and clinical success rates, with a good safety profile particularly when Endoscopic Retrograde Cholangiopancreatography (ERCP) is not feasible.
View Article and Find Full Text PDFPancreaticoduodenectomy after Roux-en-Y gastric bypass and novel endoscopic ultrasound-directed transgastric ERCP procedure.
J Surg Case Rep
December 2024
Department of Surgery, The University of Texas Health Science Center at Tyler, 11937 US HWY 271, Tyler, TX 75708, United States.
Performing a pancreaticoduodenectomy (PD) in patients having undergone a Roux-en-Y gastric bypass (RNYGB) poses a significant surgical challenge. We present a patient with a history of RNYGB and endoscopic ultrasound-directed transgastric ERCP (EDGE) procedure who underwent a successful PD. This 77-year-old female with history of open RNYBG presented with resectable pancreatic adenocarcinoma.
View Article and Find Full Text PDFDirect Initiation of Levodopa-Carbidopa Intestinal Gel Infusion After a Positive Levodopa Challenge Test in Advanced Parkinson's Disease.
Brain Behav
December 2024
Department of Neurology, Helsinki University Hospital, Helsinki, Finland.
Article Synopsis
- LCIG is a treatment for advanced Parkinson's disease, often starting with a nasojejunal tube (NJT) test phase, but some centers have initiated treatment directly with a PEG-J tube.
- A study compared these two methods in 33 advanced PD patients, evaluating treatment discontinuations, adverse events, and hospital stay length.
- Results showed no significant differences in complications or discontinuations between the two methods, but direct initiation with PEG-J reduced hospital stays significantly.
Endoscopic ultrasonography-guided drainage of the pancreatic duct (EUS-PD) in postoperative anastomotic stenosis after previous pancreatic resection.
Z Gastroenterol
December 2024
Dept. of General, Abdominal, Vascular and Transplant Surgery, Otto-von-Guericke University with University Hospital, Magdeburg, Germany.
As an alternative instead of a repeat surgical intervention, results (feasibility, safety, and technical and clinical success rate) of EUS-guided pancreatic duct drainage (EUS-PD) in a consecutive patient cohort because of symptomatic postoperative anastomotic stenosis as part of a unicenter observational study in daily clinical practice are presented.EUS-guided puncture (19-G needle) of the pancreatic duct, pancreaticography, and advancement of a guide wire (0.035 inches) via the anastomosis into the small intestine after previous dilatation of the transgastric access site (using ring knife): 1.
View Article and Find Full Text PDFClinical course for pancreatic necrosis and pancreatic pseudocysts due to severe acute or chronic pancreatitis.
Therap Adv Gastroenterol
November 2024
Section of Gastroenterology, Gastrointestinal Oncology, Hepatology, Infectiology and Geriatrics, Department of Internal Medicine I, University Hospital of Tübingen, Tübingen, Germany.
Background: The acute and chronic pancreatitis (CP) can lead to severe complications like walled-off necrosis, large symptomatic pseudocyst or multiorgan failure. The treatment of these complications is multivariate and can differ from conservative, symptomatic treatment or minimal-invasive, endoscopic transgastral stenting to transgastral necrosectomy.
Objectives: This study aims to analyse the clinical course for patients that develop local complications of severe pancreatitis.
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