Buried bumper syndrome:A critical analysis of endoscopic release techniques

Buried bumper syndrome(BBS)is the situation in which the internal bumper of the gastrostomy tube,due to prolonged compression of the tissues between the external and the internal bumper,migrates from the gastric lumen into the gastric wall or further,into the tract outside the gastric lumen,ending up anywhere between the stomach mucosa and the surface of the skin.This restricts liquid food from entering the stomach,since the internal opening is obstructed by gastric mucosal overgrowth.We performed a comprehensive search of the PubMed literature to retrieve all the case-reports and case-series referring to BBS and its management,after which we focused on the endoscopic techniques for releasing the internal bumper to re-establish the functionality of the tube.From the“push”and the“push and pull T”techniques to the most sophisticated-using high tech instruments,all 10 published techniques have been critically analysed and the pros and cons presented,in an effort to optimize the criteria of choice based on maximum efficacy and safety.

Gastric fundoplication with endoscopic technique:A novel approach for gastroesophageal reflux disease treatment

BACKGROUND Gastric fundoplication with endoscopic technique(GFET)is an innovative approach to managing gastroesophageal reflux disease(GERD).This minimally invasive procedure utilizes the GEN-2 Apollo endosuture device and Olympus H2T180 gastroscope to perform partial fundoplication by strategically placing Prolene 2-0 sutures at the 11,7,5,1,and 3 o’clock positions around the gastroesophageal junction.AIM To evaluate whether GFET enhances the lower esophageal sphincter function by creating comprehensive plication to improve the barrier against reflux.METHODS This single-center prospective study included patients undergoing GFET.Before beginning GFET,pH metrics and subsequent manometric measurements were obtained.An analysis of variance was performed to determine statistically significant differences between quality of life(QOL)and DeMeester scores at the time of the procedure and 6 and 12 months postoperatively.Pearson’sχ2 test was performed to identify statistically significant differences between categorical variables at the time of the procedure and 6 and 12 months postoperatively.RESULTS Eighteen participants were enrolled(11 males and 7 females;mean age,35 years).More than 70%had an initial Hill grade of IIb.One adverse event was recorded after the procedure.One patient underwent valve reinforcement at 12 months.The mean QOL score was markedly higher at the time of the procedure(39.9±4.0)compared to those at 6 and 12 months postoperatively(P<0.001).Scores at 12 months were slightly higher than those at 6 months.The highest mean QOL score was observed at the time of the procedure,followed by those at 6 and 12 months postoperatively(P<0.001).A similar trend was noted for the mean DeMeester scores(P<0.001).CONCLUSION GFET is a minimally invasive alternative to traditional surgical interventions and endoscopic techniques for managing GERD.Further research is warranted to validate its long-term efficacy and effectiveness over existing treatments.

Management of chronic dacryocystitis cases after failed external dacryocystorhinostomy using endoscopic technique with a novel lacrimal ostium stent

AIM: To demonstrate the outcomes of endoscopic endonasal dacryocystorhinostomy(En-DCR) with an novel lacrimal ostium stent(LOS) which was performed in patients with recurrent epiphora after failed external dacryocystorhinostomy(Ex-DCR) and analyze the causes of failed Ex-DCR.METHODS: From September 2015 and December 2017, the clinic data of 29 cases suffered from recurrent epiphora after failed Ex-DCR was reviewed.The LOS were implanted into the ostium at the end of the revisional surgery.The causes of failed Ex-DCR were analyzed before revisional surgeries.Outcome of revisional surgeries with the new device were evaluated as well.RESULTS: The major causes of failure of the external approach were synechiae formation in the nasal ostium(29/29), followed by inadequate removal of the bony wall(21/29), nasal synechiae formation between lateral wall of nose and middle turbinate(11/29), and the bone opening was not in good location(7/29).The rate of success after revisional surgery was 82.76%.Re-obstruction of the ostiums were found in 5 failed cases.CONCLUSION: Endoscopic approach with a novel LOS may be an effective procedure to manage recurrent epiphora after previous failed Ex-DCR surgery.Synechiae formation in the nasal ostium and inadequate removal of the bony wall were the major causes of failure of Ex-DCR.

Endoscopic shielding technique, a new method in therapeutic endoscopy

Prevention of late complications after large endoscopic resection is inefficient with current methods.Endoscopic shielding,as a simple and safe technique,has been proposed to improve the incidence of these events.Different methods,sheets or hydrogels,have showed proven efficacy in the prevention of late bleeding and perforation,as well as the improvement of tissue repair,in experimental models and in clinical practice.

Endoscopic ultrasound-guided biliary drainage-current status and future perspectives

Endoscopic retrograde cholangiopancreatography(ERCP)with stenting is the treatment modality of choice for patients with benign and malignant bile duct obstruction.ERCP could fail in cases of duodenal obstruction,duodenal diverticulum,ampullary neoplastic infiltration or surgically altered anatomy.In these cases percutaneous biliary drainage(PTBD)is traditionally used as a rescue procedure but is related to high morbidity and mortality and lower quality of life.Endoscopic ultrasound-guided biliary drainage(EUS-BD)is a relatively new interventional procedure that arose due to the development of curvilinear echoendoscope and the various endoscopic devices.A large amount of data is already collected that proves its efficacy,safety and ability to replace PTBD in cases of ERCP failure.It is also possible that EUS-BD could be chosen as a first-line treatment option in some clinical scenarios in the near future.Several EUS-BD techniques are developed EUS-guided transmural stenting,antegrade stenting and rendezvous technique and can be personalized depending on the individual anatomy.EUS-BD is normally performed in the same session from the same endoscopist in case of ERCP failure.The lack of training,absence of enough dedicated devices and lack of standardization still makes EUS-BD a difficult and not very popular procedure,which is related to life-threatening adverse events.Developing training models,dedicated devices and guidelines hopefully will make EUS-BD easier,safer and well accepted in the future.This paper focuses on the technical aspects of the different EUS-BD procedures,available literature data,advantages,negative aspects and the future perspectives of these modalities.

Transcanal endoscopic assisted skull base endolymphatic sac tumor resection: A rare disease with advanced technology

Endolymphatic sac tumors(ELSTs) are rare, papillary adenomatous tumors that arise from the endothelium of the endolymphatic sac. We demonstrate a difficult case of endolymphatic sac tumor and how it is managed via transcanal endoscopic assisted technique, with discussion of feasibility of transcanal approach to lateral skull base tumor.

Endoscopic ultrasound guided fine needle tissue acquisition:Where we stand in 2013?

Since its introduction,endoscopic ultrasound(EUS)guided fine needle aspiration and fine needle biopsy have become an indispensable tool for the diagnosis of lesions within the gastrointestinal tract and surrounding organs.It has proved to be an effective diagnostic method with high accuracy and low complication rates.Several factors can influence the accuracy and the diagnostic yield of this procedure including experience of the endosonographer,availability of onsite cytopathology services,the method of cytopathology preparation,the location and physical characteristics of the lesion,sampling techniques and the type and size of the needle used.In this review we will outline the recent studies evaluating EUS-guided tissue acquisition and will provide practical recommendations to maximize tissue yield.

Endoscopic ear surgery in middle ear cholesteatoma

Objective:Endoscope has been used as diagnostic tool for recidivism and as an adjunct to microscopic technique in the management of cholesteatoma.At present transcanal endoscopic ear surgery(TEES)is being used as a minimally invasive alternative for microscopic approach.We aim to evaluate the feasibility,structural,functional and quality of life outcomes of endoscopic technique in middle ear cholesteatoma.Method:This prospective study was conducted at a tertiary care hospital from January 2017 to January 2018 including 32 adult patients who were treated by TEES for middle ear cholesteatoma.Feasibility of endoscopic technique was assessed by the conversion rates,visualization of middle ear structures and complications.Structural outcomes were evaluated in terms of graft uptake at the third month follow-up and presence of residual or recurrent disease.Functional outcomes were evaluated in terms of postoperative air-bone gap closure at third month follow-up.Patient outcomes in terms of post-operative pain,cosmetic score,day of return to daily activities and patient comfort scores were evaluated.The quality of life outcomes were evaluated using chronic ear survey(CES)and short form questionnaire12 version 2(SF-12V2)which are disease specific and general quality of life assessment tools respectively.Result:Out of 32 patients,endoscopic intact canal wall mastoidectomy was done for 28 and endoscopic canal wall down mastoidectomy in 4 patients.One(3.1%)patient had to be converted to microscopic technique.Median follow-up period was 32.8 months(9e46 months).There were no post-operative complications in any of our patients.The mean middle ear structural visibility index score was 8.4±1.4 with the use of zero-degree endoscope.Graft uptake rate at third month follow-up was 100%.Two(6.3%)patients had recurrent disease at 6 months follow-up and were treated by revision endoscopic surgery.The air conduction(51.3±20.2 dB vs.34.5±20.4 dB,p<0.001),and air-bone gap(33.5±11.1 dB vs.16.9±11.8 dB,p<0.001)has been significantly improved.The mean pain score at 0 hours,6 hours and 24 hours after surgery were 2.5/10,1.6/10 and 0.75/10 respectively.At the discharge,the mean patient comfort score was 9.3±0.6 out of 10.Mean cosmetic score was 9.3±0.5 at the third month follow-up.There was significant post-operative improvement in the sub-scale and total scores of CES and SF-12V2.Conclusion:Endoscopic approach to middle ear cholesteatoma is feasible and confers excellent structural,functional as well as patient related quality of life outcomes.

Progress in the Study of Esophageal Heterotopic Gastric Mucosa

Esophageal Heterotopic Gastric Mucosa (EHGM) refers to the abnormal growth of gastric mucosal tissue in the esophagus, which often appears endoscopically as a localized red-orange, island-like mucosa that is clearly demarcated from the surrounding esophageal mucosa. It is primarily detected during esophagogastroduodenoscopy (EGD), and although rare, cases of Barrett’s esophagus and malignant tumors associated with EHGM have been reported. In this article, we review various studies on the relevance of different aspects of EHGM, including etiology and pathogenesis, epidemiology, symptoms and staging, diagnosis, acid secretion studies, tumor transformation, and treatment options.

Surgery for Acute Complicated Tracheal Stenosis

Tracheal stenosis is a serious, life-threatening disease with increasing incidence. Among these stenoses, the number of complicated tracheal lesions, where a resection and anastomosis is not successful or not applicable, is also increasing significantly. These acute situations often need to be managed by a combined surgical technique. The present paper is dedicated to this topic;the management of combined surgical and endoscopic technique in case of complicated long tracheal stenosis.

Enhancing diagnostic strategies for biliary strictures:an evolving landscape

The diagnosis of patients with biliary strictures of undetermined etiology remains a significant challenge.Biliary strictures,whether benign or malignant,often present with similar clinical features and imaging findings.For patients,this uncertainty can lead to repeated laboratory and radiological tests,invasive procedures,as well as delayed treatment and considerable anxiety.The complexity of these cases necessitates the integration of multiple diagnostic modalities to enhance accuracy while balancing patient safety and resource utilization.

From surgery to endoscopy:the evolution of the bariatric discipline

Obesity,with its increasing morbidity and prevalence,is now a worldwide public health problem.Obesity and its related comorbidities impose a heavy burden on societal health and the economy.The practice of bariatric surgery has evolved from its early surgical procedures,many of which are no longer routine operations.With clinical practice,research,and experience,bariatric surgery has gradually become an important last resort for the control of weight and obesity-related metabolic diseases in moderately and severely obese patients.However,there is still room for further improvements in bariatric surgical procedures,especially with regard to long-term issues and complications.Endoscopic weight loss technology has developed rapidly in recent years.The advantages of this technology include minimal invasiveness,an obvious weight loss effect,and few complications,thus filling the gap between medications and lifestyle adjustments and surgical treatment of obesity.Endoscopic weight loss technology may even replace surgical bariatric procedures.This review summarized the current status of bariatric metabolic surgery and newly developed bariatric endoscopic procedures.

Clinical application of trans-sinus gastric stent placement and drainage in the management of persistent external pancreatic fistula after minimal access retroperitoneal pancreatic necrosectomy in severe acute pancreatitis patients

Background:Persistent external pancreatic fistula(EPF)in patients with pancreatic duct disruption or disconnection can result from minimal access to retroperitoneal pancreatic necrosectomy(MARPN)in severe acute pancreatitis patients,which is a difficult problem for clinicians and requires a long treatment duration.This study aimed to investigate the effectiveness and safety of trans-sinus gastric stent placement and drainage using interventional technology in the management of persistent EPF after MARPN in severe acute pancreatitis.Methods:From August 2018 to December 2020,the data of 9 patients with persistent EPF treated with trans-sinus gastric stent placement and drainage in our hospital were retrospectively collected.The main outcome measures were technical success rate,recurrence rate,new pancreatic fluid collection,morbidity,and mortality.All patients were followed up after the procedure through clinic visits and imaging modalities.Results:The median age of the patients was 46 years(30-61 years).The median persistent EPF duration was 5 months(2-12 months).The median follow-up time was 41 months(range,20-47 months).The median operation time was 48 minutes(range,40-54 minutes),and the technical success rate was 100%.Seven days after treatment,the percutaneous drainage tubes of all patients were removed.Six months after the procedure,2 patients lost the stents,and one of those patients suffered from a pseudocyst,which gradually increased to a maximum diameter of 7 cm over 9 months.Therefore,a double pigtail drainage tube was placed under the guidance of an endoscope.The second of these 2 patients had no recurrence or pseudocyst.Twelve months after the procedure,another 3 patients lost the stents;18 months after the procedure,another 2 patients lost the stents.These patients had no recurrence as well.No other adverse events or deaths occurred during the study period.Conclusion:Trans-sinus tract gastric stent placement and drainage are safe and effective in the treatment of persistent EPF after MARPN in severe acute pancreatitis patients.However,this study had a small sample size and did not include a comparative group.