Endoscopic management of common patologies with a new suturing system

Background: Overstitch endoscopic suturing system (Apollo Endosurgery. Austin, Texas) was created for NOTES procedures. As it demonstrated to be feasible, secure and effective in this field, further studies have evaluated its use in common gastrointestinal disorders in which current therapeutic tools, endoscopic or not, are not efficient or safe enough. Published results are promising. We present our initial experience with this system in the management of pathologies we usually face in our clinical practice. Method: Suturing system was evaluated for: 1. Endoscopic fixation of metallic stent to prevent migration in patients with gastrointestinal non-neoformative pathology. 2. Outlet reduction in patients with weight regain following Roux-en-Y gastric bypass. Results: During a period of 6 months Overstitch endoscopic suturing system was used in 5 patients: For stent fixation in 3 and for outlet reduction in 2. Technical success: Suture was performed in all the patients. Only 1 stitch was lost. Effectiveness: Stent fixation and outlet reduction were achieved in all the patients. However, in 1 patient the final anastomotic size was not close enough. Clinical success: Clinical recovery was achieved in all the patients in whom endoscopic stent fixation was performed. The patient which appropriated outlet closure developed a significant weight loss. The patient in which final size was not close enough did not lose weight. Conclusions: We found Overstitch endoscopic suturing system feasible, safe and effective, as it has been previously described. We encourage the publication of further studies evaluating the real utility of this tool, mostly taking into account that it allows a successful management of usual disorders for which there are not current effective therapies

Diagnostic Yield and Safety of Endoscopic Ultrasound Guided Fine Needle Aspiration of Central Mediastinal Lung Masses

Background and Aims. EUS-FNA is an accurate and safe technique to biopsy mediastinal lymph nodes. However, there are few data pertaining to the role of EUS-FNA to biopsy central lung masses. The aim of the study was to assess the diagnostic yield and safety of EUS-FNA of indeterminate central mediastinal lung masses. Methods. Design: Retrospective review of a prospectively maintained database; noncomparative. Setting: Tertiary referral center. From 10/2004 to 12/2010, all patients with a lung mass located within proximity to the esophagus were referred for EUS-FNA. Main Outcome Measurement: EUS-FNA diagnostic accuracy and safety. Results. 73 consecutive patients were included. EUS allowed detection in 62 (85%) patients with lack of visualization prohibiting FNA in 11 patients. Among sampled lesions, one patient (1/62 = 1.6%) had a benign lung mass (hamartoma), while the remaining 61 patients (61/62 = 98.4%) had a malignant mass (primary lung cancer: 55/61 = 90%; lung metastasis: 6/61 = 10%). The sensitivity, specificity, and accuracy of EUS-FNA were 96.7%, 100%, and 96.7%, respectively. The sensitivity was 80.8% when considering nonvisualized masses. One patient developed a pneumothorax (1/62 = 1.6%). Conclusions. EUS-FNA appears to be an accurate and safe technique for tissue diagnosis of central mediastinal lung masses

Evaluación prospectiva y controlada de las características técnicas de un nuevo ecoendoscopio de punción frontal

RESUMEN Introducción: la ultrasonografía endoscópica (USE) es una técnica de gran utilidad en el diagnóstico y tratamiento de distintas patologías del tracto digestivo. Objetivo: evaluar de forma prospectiva la utilidad clínica de un nuevo ecoendoscopio de visión frontal (FV-CLA). Métodos: estudio observacional transversal. Todos los pacientes sometidos a una USE durante un periodo de dos meses fueron evaluados para su inclusión en el estudio. Se analizaron de forma sistemática todas las estaciones mediastínicas, perigástricas y periduodenales (evaluando la facilidad de obtener los cortes ultrasonográficos y la calidad de los mismos) y se realizó punción de las lesiones indicadas clínicamente. Resultados: se incluyeron un total de 45 pacientes. La exploración ecoendoscópica pudo ser completada en el 100% de los pacientes, registrándose dos complicaciones menores. La manejabilidad del ecoendoscopio fue catalogada como sobresaliente; la visibilidad global del plano USE, como notable; y tan solo la visualización USE de las estaciones 4L y 5 fue puntuada como insuficiente. La visualización del páncreas y del resto de las estaciones USE fue puntuada como sobresaliente o notable. La facilidad de realizar punción, incluso desde la segunda porción duodenal, fue puntuada como notable o sobresaliente. Conclusión: el FV-CLA permite realizar una exploración completa y de calidad en el tracto digestivo superior, incluyendo punciones. Existen algunas estaciones mediastínicas que parecen poco accesibles para este nuevo aparato. Sería interesante validar la utilidad del FV-CLA en la terapéutica guiada por USE