Efficacy and safety of endoscopic ultrasound-guided drainage of pancreatic pseudocysts using double-pigtail plastic stents: A single tertiary center experience

OBJECTIVES: Pancreatic pseudocysts (PPC) are fluid collections with a well-defined wall that persist for more than 4 weeks inside or around the pancreas as a result of pancreatic inflammation and/or a ductal lesion. PPC have been successfully treated with endoscopic ultrasound (EUS)-guided drainage using different stents. This study aimed to evaluate the safety and efficacy of EUS-guided drainage of PPC using double-pigtail plastic stents in a tertiary hospital. METHODS: Patients with PPC referred for EUS-guided drainage between May 2015 and December 2019 were included in this case series. The primary endpoint was to evaluate the efficacy (clinical success) and safety (adverse events and mortality) of EUS-guided drainage of PPC. Secondary endpoints included technical success and pseudocyst recurrence. RESULTS: Eleven patients (mean age, 44.5±18.98 years) were included in this study. The etiologies for PPC were acute biliary pancreatitis, chronic alcoholic pancreatitis, and blunt abdominal trauma. The mean pseudocyst size was 9.4±2.69 cm. The clinical success rate was 91% (10/11). Adverse events occurred in three of 11 patients (27%). There were no cases of mortality. The technical success rate was 100%. Pseudocyst recurrence was identified in one of 11 patients (9%) at 12 weeks after successful clinical drainage and complete pseudocyst resolution. CONCLUSION: EUS-guided transmural drainage of PPC using double-pigtail plastic stents is safe and effective with high technical and clinical success rates

Acute inflammatory response to transgastric natural orifice transluminal endoscopic surgery peritoneoscopy: An experimental study in swine

OBJECTIVE: To investigate the impact of transgastric peritoneal access on plasma biomarkers of acute inflammatory response in comparison to laparoscopy. METHODS: This was a prospective and comparative study in a porcine model. Transgastric peritoneal access performed by natural orifice transluminal endoscopic surgery was compared with laparoscopy. Laparotomy and sham groups were used as positive and negative controls, respectively. Thirty-four pigs were assigned to receive transgastric natural orifice transluminal endoscopic surgery (n = 12), laparoscopy (n = 8), laparotomy (n = 8) or a sham procedure involving only anesthesia (n = 6). In the natural orifice transluminal endoscopic surgery group, peritoneoscopy was performed with a gastroscope via transgastric access. Blood samples were collected at baseline and 1, 3, 6, 9 and 24 h after the surgical procedure for measurement of interleukins 1β, 6 and 10 and tumor necrosis factor-α. A complete blood count was performed, and C-reactive protein levels were measured at baseline and at 24 h. RESULTS: All surgical and endoscopic procedures were performed without major complications. Peritoneal cavity inventory showed no signs of peritonitis in any animal. Interleukin 1β, interleukin 10 and tumor necrosis factor-α levels were below the threshold of detection. The mean level of interleukin 6 was statistically significantly higher in the laparotomy group than in the other groups (p;0.05). C-reactive protein analysis indicated significant increases in all groups, with no differences among the groups. Complete blood count analysis showed no differences among the groups. CONCLUSIONS: Based on the observed interleukin 6 patterns, the systemic inflammatory response resulting from transgastric peritoneal access by natural orifice transluminal endoscopic surgery is similar in intensity to the response that occurs after laparoscopy

Acute inflammatory response to transgastric natural orifice transluminal endoscopic surgery peritoneoscopy: An experimental study in swine

OBJECTIVE: To investigate the impact of transgastric peritoneal access on plasma biomarkers of acute inflammatory response in comparison to laparoscopy.METHODS: This was a prospective and comparative study in a porcine model. Transgastric peritoneal access performed by natural orifice transluminal endoscopic surgery was compared with laparoscopy. Laparotomy and sham groups were used as positive and negative controls, respectively. Thirty-four pigs were assigned to receive transgastric natural orifice transluminal endoscopic surgery (n = 12), laparoscopy (n = 8), laparotomy (n = 8) or a sham procedure involving only anesthesia (n = 6). in the natural orifice transluminal endoscopic surgery group, peritoneoscopy was performed with a gastroscope via transgastric access. Blood samples were collected at baseline and 1, 3, 6, 9 and 24 h after the surgical procedure for measurement of interleukins 1 beta, 6 and 10 and tumor necrosis factor-alpha. A complete blood count was performed, and C-reactive protein levels were measured at baseline and at 24 h.RESULTS: All surgical and endoscopic procedures were performed without major complications. Peritoneal cavity inventory showed no signs of peritonitis in any animal. Interleukin 1 beta, interleukin 10 and tumor necrosis factor-alpha levels were below the threshold of detection. the mean level of interleukin 6 was statistically significantly higher in the laparotomy group than in the other groups (p 0.05). C-reactive protein analysis indicated significant increases in all groups, with no differences among the groups. Complete blood count analysis showed no differences among the groups.CONCLUSIONS: Based on the observed interleukin 6 patterns, the systemic inflammatory response resulting from transgastric peritoneal access by natural orifice transluminal endoscopic surgery is similar in intensity to the response that occurs after laparoscopy.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade Federal de São Paulo, Div Gastroenterol, São Paulo, SP, BrazilUniversidade Federal de São Paulo, Expt Surg Div, São Paulo, SP, BrazilUniversidade Federal de São Paulo, Infect & Parasit Dis Div, São Paulo, SP, BrazilUniv São Paulo, Coll Vet Med & Anim Sci, Dept Internal Med, São Paulo, SP, BrazilUniversidade Federal de São Paulo, Div Gastroenterol, São Paulo, SP, BrazilUniversidade Federal de São Paulo, Expt Surg Div, São Paulo, SP, BrazilUniversidade Federal de São Paulo, Infect & Parasit Dis Div, São Paulo, SP, BrazilWeb of Scienc

Prospective comparative study of ERCP brush cytology and EUS-FNA for the diferential diagnosis of biliary strictures

OBJECTIVE: To evaluate and to compare the diagnostic yield of ERCP brush cytology (ERCP) and EUS-FNA in patients with biliary strictures and evaluates the agreement between general pathologists (GP) and expert GI pathologists (GIP) in the final diagnosis of biliary strictures. METHODS: Patients with biliary strictures documented by ERCP were included. Brush cytology was performed and during EUS, only visible mass lesions or localized bile duct wall thickening were aspirated. The gold standard method for diagnosis was surgical histology and/or follow-up. Tissue sampling results were: malignant, suspicious, atypical, insufficiently or benign. Specimens were interpreted by GP and GIP, blinded for prior tests results. RESULTS: 46 patients were included. Final diagnosis was malignancy in 37 (26 pancreatic - 11 biliary) and benign in 9 (8 chronic pancreatitis - 1 common bile duct inflammatory stricture). Sensitivity and accuracy for ERCP brush cytology were 43.2% and 52.2% for GP and 51.4% and 58.7% for GIP. Sensitivity and accuracy for EUS-FNA were 52.8% and 58.5%, respectively for GP and 69.4% e 73.2% for GIP. In comparison, the combination of brush cytology and EUS-FNA demonstrated higher sensitivity and accuracy for both GP (64.9% and 69.6%, respectively) and GIP (83.8% and 84.8%, respectively) and improved agreement with final diagnosis for both (mostly for GIP). CONCLUSION: Both, ERCP brush cytology and EUS-FNA has a similar yield for the diagnosis of biliary strictures. However, the combination of these methods results in an improved diagnostic accuracy. In addition, GIP might be expected to interpret specimens with greater accuracy than GP.OBJETIVO: Avaliar o desempenho diagnóstico da citologia obtida pela CPER, aquele obtido pela EE-PAAF e a concordância entre patologistas gerais (PG) e especialistas (PE) em pacientes com estenose biliar. MÉTODOS: Incluímos pacientes com estenose biliar identificados pela CPER. A EE-PAAF foi realizada apenas em áreas com efeito de massa ou da parede espessada do ducto biliar. O padrão-ouro foi a cirurgia, histologia e/ou o seguimento. As amostras teciduais foram consideradas: malignas, suspeitas, atípicas, insuficientes ou benignas. Os espécimes obtidos por cada método foi interpretado (cego) por um PG e outro PE. RESULTADO: 46 pacientes foram incluídos (37 malignos e 9 benignos). O diagnóstico final foi de tumor pancreático (26), biliar (11), pancreatite crônica (8) e estenose inflamatória do ducto biliar (1). Sensibilidade e acurácia da CPER foram 43,2% e 52,2% para o PG e 51,4% e 58,7% para o PE. Sensibilidade e acurácia da EE-PAAF foi 52,8% e 58,5% para o PG e 69,4% e 73,2% para o PE. A combinação entre a CPER e EE-PAAF demonstrou maior sensibilidade e acurácia para ambos PG (64,9% e 69,6%) e PE (83,8% e 84,8%), respectivamente. CONCLUSÃO: A citologia obtida pelo escovado da via biliar durante a CPER e as amostras teciduais colhidas pela EE-PAAF tem rendimento semelhante para o diagnóstico das estenoses biliares. No entanto, a combinação dos métodos resulta em uma maior acurácia. Além disso, espera-se que a interpretação das amostras ocorra com maior precisão pelo PE se comparado ao PG.Universidade de São Paulo Faculdade de Medicina de Ribeirão Preto Departamento de Cirurgia e AnatomiaUniversidade Federal de São Paulo (UNIFESP) Unidade de Diagnóstico AnatomopatológicoUNIFESP, Unidade de Diagnóstico AnatomopatológicoSciEL

Pyloric Brunner’s gland hamartoma with atypical hyperplasia

Brunner’s gland hamartoma (BGH) is an extremely rare benign digestive tumor, \ud generally located in the duodenal bulb. We report the case of a 51-year-old \ud asymptomatic man with a large pedunculated BGH arising from the pylorus. It \ud was successfully removed en bloc by endoscopic resection

Eficacia e complicacoes da drenagem endoscopica do pseudocisto de pancreas

Pseudocistos de pancreas sao causados principalmente pela pancreatite cronica alcoolica, podendo ser diagnosticados em cerca de 20% a 40% dos portadores de pancreatite cronica e em ate 50% dos pacientes apos pancreatite aguda. O principal sintoma e a dor abdominal e suas complicacoes podem ser fatais. O seguimento dos pacientes com pseudocistos, por exames de imagem, demonstram regressao espontanea da lesao em cerca de 50% dos casos, principalmente aquelas que se desenvolvem apos pancreatites agudas. As lesoes com mais de seis semanas de evolucao em portadores de pancreatite cronica apresentam menores taxas de resolucao espontanea e maior taxa de morbidade e mortalidade. Pacientes com lesoes maiores que 4 cm, sintomaticos, com mais de 6 semanas de evolucao ou com complicacoes, podem ser tratados atraves da drenagem cirurgica, percutanea guiada por exames de imagem, e mais recentemente, pela drenagem endoscopica. O presente estudo avaliou a eficacia e complicacoes da drenagem endoscopica dos pseudocistos de pancreas, alem da recorrencia dos sintomas e da lesao. Trinta pacientes portadores de pseudocisto de pancreas foram incluidos no estudo, sendo realizada drenagem em 25 que apresentavam condicoes favoraveis, por via transmural ou transpapilar. Os procedimentos de drenagem foram: cistogastrostomia, cistoduodenostomia e/ou drenagem transpapilar. Os resultados deste estudo mostraram resolucao em 70% dos pseudocistos tratados, se avaliados pelo criterio ointencao de tratamentoo e 84% ao serem analisados pelo criterio do presente protocolo. A taxa geral de morbidade foi de 16,2%, sendo a maioria delas tratadas clinica e/ou endoscopicamente. Houve melhora significativa da dor abdominal apos a drenagem e regressao do pseudocisto, e a recorrencia da lesao foi observada em 4,8% dos pacientes apos seguimento medio de 39 semanas. Concluimos que a drenagem endoscopica do pseudocisto de pancreas e eficaz, suas complicacoes sao incomuns e, na maioria dos casos, passiveis de tratamento conservador. O alivio dos sintomas e obtido na maioria dos pacientes tratados com sucesso e a recorrencia da lesao nao e comum apos seguimento medio de cerca de 10 mesesBV UNIFESP: Teses e dissertaçõe

Propofol in upper GI endoscopy in patients with cirrhosis Response

Universidade Federal de São Paulo, Dept Gastroenterol, São Paulo, BrazilUniversidade Federal de São Paulo, Endocopy Unit, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Gastroenterol, São Paulo, BrazilUniversidade Federal de São Paulo, Endocopy Unit, São Paulo, BrazilWeb of Scienc