Endoscopic transgastric fenestration versus percutaneous drainage for management of(peri)pancreatic fluid collections adjacent to gastric wall(with video)

BACKGROUND Percutaneous drainage(PCD)and endoscopic approaches have largely replaced surgical drainage as the initial approach for(peri)pancreatic fluid collections(PFC)s,while complications associated with endoscopic stent implantation are common.AIM To introduce a novel endoscopic therapy named endoscopic transgastric fenestration(ETGF),which involves resection of tissue by endoscopic accessory between gastric and PFCs without stent implantation,and to evaluate its efficacy and safety compared with PCD for the management of PFCs adjacent to the gastric wall.METHODS Patients diagnosed with PFCs adjacent to the gastric wall and who subsequently received ETGF or PCD were restrospectively enrolled.Indications for intervention were consistent with related guidelines.We analyzed patients baseline characteristics,technical and clinical success rate,recurrence and reintervention rate,procedure-related complications and adverse events.RESULTS Seventy-two eligible patients were retrospectively identified(ETGF=34,PCD=38)from October 2017 to May 2021.Patients in the ETGF group had a significantly higher clinical success rate than those in the PCD group(97.1 vs 76.3%,P=0.01).There were no statistically significant differences regarding recurrence,reintervention and incidence of complication between the two groups.While long-term catheter drainage was very common in the PCD group.CONCLUSION Compared with PCD,ETGF has a higher clinical success rate in the management of PFCs adjacent to the gastric wall.ETGF is an alternative effective strategy for the treatment of PFCs adjacent to the gastric wall.

Percutaneous drainage in the treatment of intrahepatic pancreatic pseudocyst with Budd-Chiari syndrome:A case report

BACKGROUND Intrahepatic pancreatic pseudocyst(IHPP)is an extremely rare complication of acute pancreatitis,with only a few cases previously described in the literature.To the best of our knowledge,IHPP with Budd-Chiari syndrome(BCS)has not yet been described.CASE SUMMARY A 35-year-old male presented with abdominal pain,vomiting and anorexia,followed by severe swelling of the lower body after 4 d.The morphological assessment(using computed tomography revealed the presence of a huge cyst of 18.28 cm×10.34 cm under the liver capsule accompanied by a large amount of ascites.Percutaneous puncture allowed us to detect a high level of amylase in the collection,confirming the diagnosis of IHPP.The cyst was treated by percu-taneous drainage,producing complete resolution of the cyst.CONCLUSION IHPP can be treated with percutaneous drainage,endoscopic drainage,surgery or even conservative treatment,depending on the specific condition.We recommend percutaneous drainage as the first choice of treatment when IHPP with secondary BCS.

Ultrasound-guided percutaneous drainage of a traumatic abdominal wall hematoma in the emergency department

BACKGROUND:Abdominal wall hematoma is due to trauma,coagulation disorders or anticoagulation therapy complications.METHODS:in this report we present a case of a 44-year-old female who suffered from blunt abdominal trauma and presented to the emergency department with sharp abdominal pain and ecchymosis.FAST and abdominal computerized tomography(CT) revealed an abdominal wall hematoma.Treatment with an ultrasound-guided percutaneous drainage was performed successfully.RESULTS:The patient remained under observation for six hours with serial ultrasound scans,and no signs of hematoma recurrence were present.She was discharged the same day with clinical improvement.CONCLUSION:Complete history investigation and clinical examination help to make a correct diagnosis of abdominal wall hematoma,select a prompt treatment,and reduce complications.

Evaluating effectiveness and safety of combined percutaneous transhepatic gallbladder drainage and laparoscopic cholecystectomy in acute cholecystitis patients:Meta-analysis

BACKGROUND Acute cholecystitis(AC)is a common disease in general surgery.Laparoscopic cholecystectomy(LC)is widely recognized as the"gold standard"surgical procedure for treating AC.For low-risk patients without complications,LC is the recommended treatment plan,but there is still controversy regarding the treatment strategy for moderate AC patients,which relies more on the surgeon's experience and the medical platform of the visiting unit.Percutaneous transhepatic gallbladder puncture drainage(PTGBD)can effectively alleviate gallbladder inflammation,reduce gallbladder wall edema and adhesion around the gallbladder,and create a"time window"for elective surgery.AIM To compare the clinical efficacy and safety of LC or PTGBD combined with LC for treating AC patients,providing a theoretical basis for choosing reasonable surgical methods for AC patients.METHODS In this study,we conducted a clinical investigation regarding the combined use of PTGBD tubes for the treatment of gastric cancer patients with AC.We performed searches in the following databases:PubMed,Web of Science,EMBASE,Cochrane Library,China National Knowledge Infrastructure,and Wanfang Database.The search encompassed literature published from the inception of these databases to the present.Subsequently,relevant data were extracted,and a meta-analysis was conducted using RevMan 5.3 software.RESULTS A comprehensive analysis was conducted,encompassing 24 studies involving a total of 2564 patients.These patients were categorized into two groups:1371 in the LC group and 1193 in the PTGBD+LC group.The outcomes of the meta-analysis revealed noteworthy disparities between the PTGBD+LC group and the LC group in multiple dimensions:(1)Operative time:Mean difference(MD)=17.51,95%CI:9.53-25.49,P<0.01;(2)Conversion to open surgery rate:Odds ratio(OR)=2.95,95%CI:1.90-4.58,P<0.01;(3)Intraoperative bleeding loss:MD=32.27,95%CI:23.03-41.50,P<0.01;(4)Postoperative hospital stay:MD=1.44,95%CI:0.14-2.73,P=0.03;(5)Overall postoperative compli-cation rate:OR=1.88,95%CI:1.45-2.43,P<0.01;(6)Bile duct injury:OR=2.17,95%CI:1.30-3.64,P=0.003;(7)Intra-abdominal hemorrhage:OR=2.45,95%CI:1.06-5.64,P=0.004;and(8)Wound infection:OR=0.These find-ings consistently favored the PTGBD+LC group over the LC group.There were no significant differences in the total duration of hospitalization[MD=-1.85,95%CI:-4.86-1.16,P=0.23]or bile leakage[OR=1.33,95%CI:0.81-2.18,P=0.26]between the two groups.CONCLUSION The combination of PTGBD tubes with LC for AC treatment demonstrated superior clinical efficacy and enhanced safety,suggesting its broader application value in clinical practice.

Computerized tomography-guided therapeutic percutaneous puncture catheter drainage-combined with somatostatin for severe acute pancreatitis: An analysis of efficacy and safety

BACKGROUND Severe acute pancreatitis(SAP),a condition with rapid onset,critical condition and unsatisfactory prognosis,poses a certain threat to human health,warranting optimization of relevant treatment plans to improve treatment efficacy.AIM To evaluate the efficacy and safety of computerized tomography-guided the-rapeutic percutaneous puncture catheter drainage(CT-TPPCD)combined with somatostatin(SS)in the treatment of SAP.METHODS Forty-two SAP patients admitted to The Second Affiliated Hospital of Fujian Medical University from June 2020 to June 2023 were selected.On the basis of routine treatment,20 patients received SS therapy(control group)and 22 patients were given CT-TPPCD plus SS intervention(research group).The efficacy,safety(pancreatic fistula,intra-abdominal hemorrhage,sepsis,and organ dysfunction syndrome),abdominal bloating and pain relief time,bowel recovery time,hospital stay,inflammatory indicators(C-reactive protein,interleukin-6,and pro-calcitonin),and Acute Physiology and Chronic Health Evaluation(APACHE)II score of both groups were evaluated for comparison.RESULTS Compared with the control group,the research group had a markedly higher total effective rate,faster abdominal bloating and pain relief and bowel recovery,INTRODUCTION Pancreatitis,an inflammatory disease occurring in the pancreatic tissue,is classified as either acute or chronic and is associated with high morbidity and mortality,imposing a socioeconomic burden[1,2].The pathogenesis of this disease involves early protease activation,activation of nuclear factor kappa-B-related inflammatory reactions,and infiltration of immune cells[3].Severe acute pancreatitis(SAP)is a serious condition involving systemic injury and subsequent possible organ failure,accounting for 20%of all acute pancreatitis cases[4].SAP is also characterized by rapid onset,critical illness and unsatisfactory prognosis and is correlated with serious adverse events such as systemic inflammatory response syn-drome and acute lung injury,threatening the health of patients[5,6].Therefore,timely and effective therapeutic inter-ventions are of great significance for improving patient prognosis and ensuring therapeutic effects.Somatostatin(SS),a peptide hormone that can be secreted by endocrine cells and the central nervous system,is in-volved in the regulatory mechanism of glucagon and insulin synthesis in the pancreas[7].It has complex and pleiotropic effects on the gastrointestinal tract,which can inhibit the release of gastrointestinal hormones and negatively modulate the exocrine function of the stomach,pancreas and bile,while exerting a certain influence on the absorption of the di-gestive system[8,9].SS has shown certain clinical effectiveness when applied to SAP patients and can regulate the severity of SAP and immune inflammatory responses,and this regulation is related to its influence on leukocyte apoptosis and adhesion[10,11].Computerized tomography-guided therapeutic percutaneous puncture catheter drainage(CT-TPPCD)is a surgical procedure to collect lesion fluid and pus samples from necrotic lesions and perform puncture and drainage by means of CT image examination and precise positioning[12].In the research of Liu et al[13],CT-TPPCD applied to pa-tients undergoing pancreatic surgery contributes to not only good curative effects but also a low surgical risk.Baudin et al[14]also reported that CT-TPPCD has a clinical success rate of 64.6%in patients with acute infectious necrotizing pan-creatitis,with nonfatal surgery-related complications found in only two cases,suggesting that this procedure is clinically effective and safe in the treatment of the disease.In light of the limited studies on the efficacy and safety of SS plus CT-TPPCD in SAP treatment,this study performed a relevant analysis to improve clinical outcomes in SAP patients.

Percutaneous transhepatic cholangial drainage-guided methylene blue for fistulotomy using dual-knife for bile duct intubation: A case report

BACKGROUND Difficult bile duct intubation is a big challenge for endoscopists during endoscopic retrograde cholangiopancreatography(ERCP)procedure.We report a case of percutaneous transhepatic cholangial drainage(PTCD)-guided methylene blue for fistulotomy using dual-knife for bile duct intubation.CASE SUMMARY A 50-year-old male patient had developed obstructive jaundice,and ERCP procedure need to be performed to treat the obstructive jaundice.But intubation cannot be performed if the duodenal papilla cannot be identified because of previous surgery for a perforated descending duodenal diverticulum.We used PTCD-guided methylene blue to identify the intramural common bile duct before dual-knife fistulotomy,and bile duct intubation was successfully completed.CONCLUSION The method that combing methylene blue and dual-knife fistulotomy to achieve bile duct intubation during difficult ERCP is safe and effective.

Percutaneous endoscopic necrosectomy for walled-off necrosis in the retroperitoneal space of the elderly:A case report

BACKGROUND Walled-off necrosis(WON)is a late complication of acute pancreatitis possibly with a fatal outcome.Even for WON spreading to the retroperitoneal space,percutaneous endoscopic necrosectomy(PEN)can be an alternate approach to surgical necrosectomy,particularly for the older individuals or patients with poor condition because of WON.CASE SUMMARY An 88-year-old man was admitted to our hospital with a jaundice.Endoscopic retrograde cholangiopancreatography(ERCP)was performed to improve jaundice;however,post-ERCP pancreatitis developed.The inflammation of pancreatitis spread widely from the right retroperitoneal cavity to the pelvis,and WON was formed 4 wk later.A percutaneous drainage tube was placed into the WON under computed tomography guidance.However,the drainage did not ameliorate clinical symptoms including fever,which assured less invasive necrosectomy.A metallic stent for the upper gastrointestinal(GI)tract was placed from the percutaneous drainage route.An upper GI endoscope was inserted into the inside of the WON through the metallic stent,and the necrotic tissues were bluntly removed with a snare forceps.Ten times of these necrosectomies resulted in the near-complete removal of necrotic tissues.These procedures consequently abated his fever and remarkable improvement in blood tests.CONCLUSION PEN for WON occurring in the retroperitoneal space was safe and effective for very old individuals.

Percutaneous catheter drainage in combination with choledochoscope-guided debridement in treatment of peripancreatic infection

AIM:To introduce and evaluate the new method used in treatment of pancreatic and peripancreatic infections secondary to severe acute pancreatitis(SAP).METHODS:A total of 42 SAP patients initially underwent ultrasound-guided percutaneous puncture and catheterization.An 8-Fr drainage catheter was used to drain the infected peripancreatic necrotic foci for 3-5 d.The sinus tract of the drainage catheter was expanded gradually with a skin expander,and the 8-Fr drainage catheter was replaced with a 22-Fr drainage tube after 7-10 d.Choledochoscope-guided debridement was performed repeatedly until the infected peripancreatic tissue was effectively removed through the drainage sinus tract.RESULTS:Among the 42 patients,the infected peripancreatic tissue or abscess was completely removed from 38 patients and elective cyst-jejunum anastomosis was performed in 4 patients due to formation of pancreatic pseudocysts.No death and complication occurred during the procedure.CONCLUSION:Percutaneous catheter drainage in combination with choledochoscope-guided debridement is a simple,safe and reliable treatment procedure for peripancreatic infections secondary to SAP.

Biliary drainage for obstructive jaundice caused by unresectable hepatocellular carcinoma: the endoscopic versus percutaneous approach

BACKGROUND: For palliative treatment of the obstructive jaundice associated with unresectable hepatocellular carcinoma (HCC), percutaneous transhepatic biliary drainage (PTBD) or endoscopic retrograde biliary drainage (ERBD) has been performed. PTBD is preferred as an initial procedure. Little is known about the better option for patients with obstructive jaundice caused by unresectable HCC. METHODS: Sixty patients who had received ERBD or PTBD for the palliative treatment of obstructive jaundice caused by unresectable HCC between January 2006 and May 2010 were included in this retrospective study. Successful drainage, drainage patency, and the overall survival of patients were evaluated. RESULTS: Univariate analysis revealed that the overall frequency of successful drainage was higher in the ERBD group (22/29, 75.9%) than in the PTBD group (15/31, 48.4%) (P=0.029); but multivariate analysis showed marginal significance (P=0.057). The duration of drainage patency was longer in the ERBD group than in the PTBD group (82 vs 37 days, respectively, P=0.020). Regardless of what procedure was performed, the median survival time of patients who had a successful drainage was much longer than that of the patients who did not have a successful drainage (143 vs 38 days, respectively, P<0.001).CONCLUSION: Besides PTBD, ERBD may be used as the initial treatment option to improve obstructive jaundice in patients with unresectable HCC if there is a longer duration of drainage patency after a successful drainage.

Impact of Percutaneous Transhepatic Biliary Drainage on Clinical Outcomes of Patients with Malignant Obstructive Jaundice Undergoing Laparoscopic Pancreaticoduodenectomy

Preoperative biliary drainage may increase the morbidity and mortality of pancreatico-duodenectomy.Studies on percutaneous transhepatic biliary drainage(PTBD)before laparoscopic pancreaticoduodenectomy(LPD),however,are scarce.The aim of this study was to examine the impact of PTBD on clinical outcomes of patients with malignant obstructive jaundice undergoing LPD.Clinical data of 172 patients who had malignant obstructive jaundice and underwent LPD from 2014 to 2017 in our hospital were retrospectively analyzed.Demographics,catheterrelated complications,postoperative complications,and oncological outcormes were collected and analyzed.Propensity score matching was performed to minimize selection bias associated with the comparison of data between patients who underwent PTBD and then LPD(PTBD group),and those given LPD alone(LPD group).The results showed that,in the PTBD group relative to the LPD group,the operating time was significantly shortened(250.28±69.95 vs.278.58±86.51 min,P=0.0196),the intraopcrative blood loss was markedly reduced(271.96±403.47 vs.429.72±482.47 mL,P=0.022),and overall rates of complications(16.33%vs.36.49%,P=0.0025)including postoperative haemorrhage(2.04%vs.12.16%,P=0.0072)and delayed gastric emptying(4.08% vs.13.51%,P=0.0251)were greatly decreased.The propensity score-matched analysis,with 48 patients enrolled in each group,revealed no statistically significant differences in operating duration(262.71±68.64 vs.280.25±83.52 min,P=0.264),intraoperative blood loss(290.21±407.71 vs.373.75±422.33 mL,P=0.327)and delayed gastric emptying(4.17% vs.12.50%,P=0.1396).PTBD group had lower incidences in overall complications(22.92% vs.39.58%,P=0.0481)and postoperative haemorrhage(2.08% vs.12.50%,P=0.0497)than LPD group.In conclusion,patients with malignant obstructive jaundice may benefit from PTBD procedure before LPD in terms of perioperative outcomes.

Endoscopic or percutaneous biliary drainage in hilar cholangiocarcinoma:When and how?

Hilar cholangiocarcinoma (hCCA) is a primary liver tumor associated with a dimprognosis. The role of preoperative and palliative biliary drainage has long beendebated. The most common techniques are endoscopic retrograde cholangiopancreatography(ERCP) and percutaneous transhepatic biliary drainage (PTBD);however, recently developed endoscopic ultrasound-assisted methods are gainingmore atention. Selecting the best available method in any specific scenario iscrucial, yet sometimes challenging. Thus, this review aimed to discuss theavailable techniques, indications, perks, pitfalls, and timing-related issues in themanagement of hCCA. In a preoperative setting, PTBD appears to have someadvantages: low risk of postprocedural complications (namely cholangitis) andbetter priming for surgery. For palliative purposes, we propose ERCP/PTBDdepending on the experience of the operators, but also on other factors: the levelof bilirubin (if very high, rather PTBD), length of the stenosis and the presence ofcholangitis (PTBD), ERCP failure, or altered biliary anatomy.

Improving rehabilitation and quality of life after percutaneous transhepatic cholangiography drainage with a rapid rehabilitation model

BACKGROUND Percutaneous transhepatic cholangiography drainage(PTCD)effectively treats biliary obstruction.However,patients must maintain the drainage tube after hospital discharge,which may interfere with daily life and work,potentially causing psychological distress.Postoperative rehabilitation is crucial,and strengthened nursing interventions can shorten recovery time.AIM The aim was to evaluate an inpatient model to shorten rehabilitation duration and improve quality of life after PTCD.METHODS A total of 118 patients with malignant obstructive jaundice who were admitted to our hospital between May 2018 and January 2021 were included and divided into observational(with therapy)and control(no therapy)groups of 59 each.RESULTS The observational group had fewer hospitalization days than the control group.The complication,the PTCD fixed-tube prolapse,and tube-related admission rates within 3 mo after PTCD were significantly lower in the observation group than in the control group(P<0.05).The fatigue,pain,nausea,vomiting,pruritus,emaciation,and fever scores after PTCD decreased in both groups compared with the scores before PTCD(P<0.05).The quality of life scores after the intervention were higher in the observation than in the control group(P<0.05).CONCLUSION The model promoted rehabilitation after PTCD,reduced post-PTCD complications,and the tube-related admissions in the 3 mo after the procedure,and improved the quality of life.

Value of neutrophil-lymphocyte ratio in evaluating response to percutaneous catheter drainage in patients with acute pancreatitis

BACKGROUND Early prediction of response to percutaneous catheter drainage(PCD)of necrotic collections in acute pancreatitis(AP)using simple and objective tests is critical as it may determine patient prognosis.The role of white blood cell(WBC)count and neutrophil-lymphocyte ratio(NLR)has not been assessed as a tool of early prediction of PCD success and is the focus of this study.AIM To assess the value of WBC and NLR in predicting response to PCD in AP.METHODS This retrospective study comprised consecutive patients with AP who underwent PCD between June 2018 and December 2019.Severity and fluid collections were classified according to the revised Atlanta classification and organ failure was defined according to the modified Marshall Score.WBC and NLR were monitored 24 h prior PCD(WBC-0/NLR-0)and 24 h(WBC-1/NLR-1),48 h(WBC-2/NLR-2)and 72 h(WBC-3/NLR-3)after PCD.NLR was calculated by dividing the number of neutrophils by the number of lymphocytes.The association of success of PCD(defined as survival without the need for surgery)with WBC and NLR was assessed.The trend of WBC and NLR was also assessed post PCD.RESULTS One hundred fifty-five patients[median age 40±13.6(SD),64.5%males,53.5%severe AP]were included in the final analysis.PCD was done for acute necrotic collection in 99(63.8%)patients and walled-off necrosis in 56(36.1%)patients.Median pain to PCD interval was 24±69.89 d.PCD was successful in 109 patients(group 1)and 46 patients(group 2)who failed to respond.There was no significant difference in the baseline characteristics between the two groups except the severity of AP and frequency of organ failure.Both WBC and NLR showed an overall decreasing trend.There was a significant difference between WBC-0 and WBC-1(P=0.0001).WBC-1 and NLR-1 were significantly different between the two groups(P=0.048 and 0.003,respectively).The area under the curve of WBC-1 and NLR-1 for predicting the success of PCD was 0.602 and 0.682,respectively.At a cut-off value of 9.87 for NLR-1,the sensitivity and specificity for predicting the success of PCD were calculated to be 75%and 65.4%respectively.CONCLUSION WBC and NLR can be used as simple tests for predicting response to PCD in patients with acute necrotizing pancreatitis.

Portal vein embolization in the treatment of portal vein bleeding after percutaneous transhepatic biliary drainage: A case report and literature review

Percutaneous transhepatic biliary drainage(PTBD)is an effective treatment for benign and malignant obstructive jaundice.Major bleeding complications occur in approximately 2–3%of patients after PTBD,which can result in death.A case involving a 63-year-old male with malignant obstructive jaundice,who experienced severe bleeding after PTBD,is reported.Emergency digital subtraction angiography,celiac trunk artery and superior mesenteric artery angiography were performed;however,no signs of arterial bleeding were found.To identify etiology,portal venography was performed under ultrasound guidance and portal vein bleeding was diagnosed.Ultimately,selective portal vein embolization successfully stopped the bleeding.

Amebic liver abscess: An update

Amebic liver abscess(ALA)is still a common problem in the tropical world,where it affects over three-quarters of patients with liver abscess.It is caused by an anaerobic protozoan Entamoeba hystolytica,which primarily colonises the cecum.It is a non-suppurative infection of the liver consisting primarily of dead hepatocytes and cellular debris.People of the male gender,during their reproductive years,are most prone to ALA,and this appears to be due to a poorly mounted immune response linked to serum testosterone levels.ALA is more common in the right lobe of the liver,is strongly associated with alcohol consumption,and can heal without the need for drainage.While majority of ALA patients have an uncomplicated course,a number of complications have been described,including rupture into abdomino-thoracic structures,biliary fistula,vascular thrombosis,bilio-vascular compression,and secondary bacterial infection.Based on clinico-radiological findings,a classification system for ALA has emerged recently,which can assist clinicians in making treatment decisions.Recent research has revealed the role of venous thrombosis-related ischemia in the severity of ALA.Recent years have seen the development and refinement of newer molecular diagnostic techniques that can greatly aid in overcoming the diagnostic challenge in endemic area where serology-based tests have limited accuracy.Metronidazole has been the drug of choice for ALA patients for many years.However,concerns over the resistance and adverse effects necessitate the creation of new,safe,and potent antiamebic medications.Although the indication of the drainage of uncomplicated ALA has become more clear,high-quality randomised trials are still necessary for robust conclusions.Percutaneous drainage appears to be a viable option for patients with ruptured ALA and diffuse peritonitis,for whom surgery represents a significant risk of mortality.With regard to all of the aforementioned issues,this article intends to present an updated review of ALA.

Efficacy and safety analysis of continued nursing of complications in discharged patients after percutaneous transhepatic biliary drainage

BACKGROUND Percutaneous hepatobiliary drainage(PTCD)is an effective method for the treatment of biliary obstruction and other diseases,but postoperative complications are still one of the important problems faced by patients.Continuous nursing is a comprehensive nursing model that plays an important role in postoperative recovery.The purpose of this study was to investigate the effect of continuous nursing on the incidence of complications in patients after PTCD surgery through meta-analysis and to evaluate its efficacy and safety.AIM To evaluate the effect of extended nursing on the incidence of complications in discharged patients after percutaneous transhepatic biliary drainage(PTBD).METHODS Randomized controlled studies on PTBD postdischarge extended care were identified in the CNKI,Wanfang,VIP,CBM,PubMed,Cochrane Library,Embase,Web of Science,and other databases.The quality of the included studies was evaluated using the Joanna Briggs Institute of Australia literature quality evaluation tool,and a meta-analysis of the included studies was performed with RevMan 5.4 software.RESULTS Finally,9 studies were included,with a total sample size of 854 patients(425 patients in the control group and 429 patients in the intervention group).Meta-analysis revealed that extended care effectively reduced biliary tract infection(RR:0.42,95%CI:0.30-0.57),puncture wound infection(RR:0.19,95%CI:0.06-0.65),catheter protrusion or displacement in discharged patients after PTBD(RR:0.31,95%CI:0.18-0.54),catheter blockage(RR:0.23,95%CI:0.13-0.42),skin infection around the drainage tube(RR:0.30,95%CI:0.12-0.77),and catheter-related readmissions(RR:0.34,95%CI:0.18-0.65)(P<0.05).CONCLUSION Compared with conventional discharge care,extended care can effectively reduce the occurrence of complications such as biliary tract infection,puncture wound infection,catheter prolapse or displacement,catheter blockage,skin infection around the drainage tube,and catheter-related readmission in discharged patients after PTBD.

Endoscopic ultrasound-guided biliary drainage vs percutaneous transhepatic bile duct drainage in the management of malignant obstructive jaundice

BACKGROUND Malignant obstructive jaundice(MOJ)is a condition characterized by varying degrees of bile duct stenosis and obstruction,accompanied by the progressive development of malignant tumors,leading to high morbidity and mortality rates.Currently,the two most commonly employed methods for its management are percutaneous transhepatic bile duct drainage(PTBD)and endoscopic ultrasound-guided biliary drainage(EUS-BD).While both methods have demonstrated favorable outcomes,additional research needs to be performed to determine their relative efficacy.To compare the therapeutic effectiveness of EUS-BD and PTBD in treating MOJ.METHODS This retrospective analysis,conducted between September 2015 and April 2023 at The Third Affiliated Hospital of Soochow University(The First People’s Hospital of Changzhou),involved 68 patients with MOJ.The patients were divided into two groups on the basis of surgical procedure received:EUS-BD subgroup(n=33)and PTBD subgroup(n=35).Variables such as general data,preoperative and postoperative indices,blood routine,liver function indices,myocardial function indices,operative success rate,clinical effectiveness,and complication rate were analyzed and compared between the subgroups.RESULTS In the EUS-BD subgroup,hospital stay duration,bile drainage volume,effective catheter time,and clinical effect-iveness rate were superior to those in the PTBD subgroup,although the differences were not statistically significant(P>0.05).The puncture time for the EUS-BD subgroup was shorter than that for the PTBD subgroup(P<0.05).Postoperative blood routine,liver function index,and myocardial function index in the EUS-BD subgroup were significantly lower than those in the PTBD subgroup(P<0.05).Additionally,the complication rate in the EUS-BD subgroup was lower than in the PTBD subgroup(P<0.05).CONCLUSION EUS-BD may reduce the number of punctures,improve liver and myocardial functions,alleviate traumatic stress,and decrease complication rates in MOJ treatment.

Current status of treatments of pancreatic and peripancreatic collections of acute pancreatitis

Pancreatic and peripancreatic collections are the main local complications of acute pancreatitis with a high incidence.In the early phase,most acute pancreatic and peripancreatic collections can resolve spontaneously with supportive treatment.However,in some cases,they will develop into pancreatic pseudocyst(PPC)or walled-off necrosis(WON).When causing symptoms or coinfection,both PPC and WON may require invasive intervention.Compared to PPC,which can be effectively treated by endoscopic ultrasound-guided transmural drainage with plastic stents,the treatment of WON is more complicated and challenging,particularly in the presence of infected necrosis.In the past few decades,with the development of minimally invasive interventional technology especially the progression of endoscopic techniques,the standard treatments of those severe complications have undergone tremendous changes.Currently,based on the robust evidence from randomized controlled trials,the step-up minimally invasive approaches have become the standard treatments for WON.However,the pancreatic fistulae during the surgical step-up treatment and the stent-related complications during the endoscopic step-up treatment should not be neglected.In this review article,we will mainly discuss the indications of PPC and WON,the timing for intervention,and minimally invasive treatment,especially endoscopic treatment.We also introduced our preliminary experience in endoscopic gastric fenestration,which may be a promising innovative method for the treatment of WON.

Abscess of the caudate lobe of the liver, a rare disease with a challenging management: a case report

We reported a rare case of abscess of the caudate lobe of the liver in a 60-year old man. We first tried computed tomography （CT） guided percutaneous drainage of the abscess but failed to eradicate the infection. Deterioration of the general condition of the patient necessitated open surgical drainage, which resulted in cure of the abscess. The peculiar anatomical location of caudate lobe abscess introduces a great challenge for the surgeon in plan- ning the appropriate management and paucity of patients with caudate lobe abscess has led to lack of guidelines for management. The non-operative interventional radiology approach has become the therapeutic choice for pyo- genic liver abscess, but is it applicable also for caudate lobe abscess？

Endoscopic ultrasound-guided biliary drainage using electrocauteryenhanced lumen-apposing metal stent for malignant biliary obstruction:A promising procedure

In this editorial,we comment on the article by Peng et al.Palliative drainage for biliary obstruction resulting from unresectable malignant lesions includes internal and external drainage.The procedures of biliary drainage are usually guided by fluoroscopy or transcutaneous ultrasound,endoscopic ultrasound(EUS),or both.Endoscopic retrograde cholangiopancreatography(ERCP)has been primarily recommended for the management of biliary obstruction,while EUS-guided biliary drainage and percutaneous transhepatic biliary drainage(PTBD)are alternative choices for cases where ERCP has failed or is impossible.PTBD is limited by shortcomings of a higher rate of adverse events,more reinterventions,and severe complications.EUS-guided biliary drainage has a lower rate of adverse events than PTBD.EUS-guided biliary drainage with electrocautery-enhanced lumen-apposing metal stent(ECE-LAMS)enables EUS-guided biliaryenteric anastomosis to be performed in a single step and does not require prior bile duct puncture or a guidewire.The present meta-analysis showed that ECELAMS has a high efficacy and safety in relieving biliary obstruction in general,although the results of LAMS depending on the site of biliary obstruction.This study has highlighted the latest advances with a larger sample-based comprehensive analysis.