Use of a colonoscope for distal duodenal stent placement in patients with malignant obstruction

Background: Stent placement in the distal duodenum or proximal jejunum with a therapeutic gastroscope can be difficult, because of the reach of the endoscope, loop formation in the stomach, and flexibility of the gastroscope. The use of a colonoscope may overcome these problems. Objective: To report our experience with distal duodenal stent placement in 16 patients using a colonoscope. Methods: Multicenter, retrospective series of patients with a malignant obstruction at the level of the distal duodenum and proximal jejunum and treated by stent placement using a colonoscope. Main outcome measurements are technical success, ability to eat, complications, and survival. Results: Stent placement was technically feasible in 93% (15/16) of patients. Food intake improved from a median gastric outlet obstruction scoring system (GOOSS) score of 1 (no oral intake) to 3 (soft solids) (p = 0.001). Severe complications were not observed. One patient had persistent obstructive symptoms presumably due to motility problems. Recurrent obstructive symptoms were caused by tissue/tumor ingrowth through the stent mesh [n = 6 (38%)] and stent occlusion by debris [n = 1 (6%)]. Reinterventions included additional stent placement [n = 5 (31%)], gastrojejunostomy [n = 2 (12%)], and endoscopic stent cleansing [n = 1 (6%)]. Median survival was 153 days. Conclusion: Duodenal stent placement can effectively and safely be performed using a colonoscope in patients with an obstruction at the level of the distal duodenum or proximal jejunum. A colonoscope has the advantage that it is long enough and offers good endoscopic stiffness, which avoids looping in the stomach

Mathematical methodology to obtain and compare different embryo scores

In Vitro Fertilization (IVF) units need to decrease multiple pregnancies without affecting their overall success rate. In this study we propose a mathematical model to evaluate an embryo’s potential ability to implant in the uterus. Embryos are graded by the embryologist based on the number of blastomeres, evenness of growth and degree of fragmentation. Therefore, the following variables were considered: number of blastomeres produced by division of the egg after fertilisation (blastomeres), symmetry and fragmentation of the embryo (grade). This model evaluates the embryos assigning them a score which represents their quality. The main result derived from this model is the estimation of the significant improvement in the implantation rate due to the increase in blastomere values and the decrease in grade factor values. But the increase from two–three to four produces more improvement in the implantation rate than two–three to five–six blastomeres. First, statistical models were used to study embryo traceability from transfer to implantation and to evaluate the effect of the quality of the embryos (embryo score) and women’s age on implantation potential. This score was obtained by making predictions from the fitted model which was used to rank embryos in terms of implantation potential. Then we totalled the scores of embryos that had been transferred to each woman for obtaining the Embryo Quality Index (EQI). In addition, we studied the effects of EQI and women’s age on pregnancy. Finally, statistical techniques such as Receiver Operating Characteristics (ROC) and bootstrap procedures were used to assess the accuracy of this model. This embryo score is a quick, efficient and accurate tool to optimise embryo selection for transfers on the second day after fertilisation. This tool is especially useful for transfers involving non-top embryos.This work was partially supported by a grant from the Generalitat Valenciana (grant no. GVPRE/2008/103). The research of AD and SC was partially supported by a grant from Ministerio de Asuntos Exteriores (grant no. A/023444/09) too. The authors are indebted to the anonymous referee whose comments and suggestions improved the paper considerably.Debón Aucejo, AM.; Molina Botella, MI.; Cabrera García, S.; Pellicer, A. (2013). Mathematical methodology to obtain and compare different embryo scores. Mathematical and Computer Modelling. 57(5-6):1380-1394. https://doi.org/10.1016/j.mcm.2012.11.027S13801394575-

Gastrostomy and Gastrojejunostomy

Percutaneous radiological gastrostomy is a minimally invasive means of accessing the stomach for the purposes of enteral feeding or decompression. In this chapter, we discuss the various methods of percutaneous access of the gastrointestinal tract, including gastrostomy, gastrojejunostomy (transgastric jejunostomy), and direct jejunostomy. The indications, contraindications, technical characteristics, patient preparation prior to the procedure, and possible adverse events associated with these procedures are discussed. The relevant background literature and the advantages of radiologic gastrostomy are also detailed in the chapter