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Sharma Vivek Mohan,Mathur Amit,Goyal Mohan Babu,Jat Shankar Lal 소화기인터벤션의학회 2023 International journal of gastrointestinal interven Vol.12 No.2
Background: Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is a common complication of therapeutic endoscopy. The aim of this trial was to determine whether a combination of rectal diclofenac and vigorous hydration with Ringer’s lactate is superior to the correspond-ing individual treatments for preventing PEP in high-risk patients. Methods: This randomized, open-label, controlled trial was conducted from August 2020 to January 2022. We included patients who were at high risk of developing PEP. Three intervention groups were made: group A, diclofenac sodium suppository (100 mg); group B, aggressive hydration with Ringer’s lactate; group C, a combination of diclofenac and aggressive hydration. PEP was defined as a serum amylase level > 3 times the upper limit of normal with epigastric pain within 24 hours after endoscopic retrograde cholangiopancreatography.Results: A total of 144 patients were included and 48 cases were randomized to each intervention group. The incidence of PEP was 8.3%, 10.4%, and 8.3% in groups A, B, and C, respectively. A personal history of alcohol consumption and more than one pancreatic duct guidewire cannulation were significantly associated with the development of PEP.Conclusion: No difference in the incidence of PEP was observed with or without the use of aggressive hydration. Combining aggressive hydration with a rectal nonsteroidal anti-inflammatory drug for preventing PEP cannot be recommended.
Emmanouil Giorgakis,Brian Chong,Rahmi Oklu,Dawn E. Jaroszewski,Grace Knuttinen,Amit K. Mathur 한국간담췌외과학회 2020 Annals of hepato-biliary-pancreatic surgery Vol.24 No.1
Aim of the study is the description of the successful management of gastroepiploic artery pseudoaneurysm with preservation of parent vessels using flow-diversion technology. The present report describes the application of a flow-diversion Pipeline<SUP>TM</SUP> Flex device for occlusion of a sidewall bleeding pseudoaneurysm on a patient who was status-post sub-total pancreatectomy and remote esophagectomy with a gastric conduit. The pseudoaneurysm was on the solitary vessel supplying the patient’s conduit. Use of flow diversion technology excluded the sidewall pseudoaneurysm while maintaining gastric conduit perfusion. In our case, the application of flow diversion technology allowed the preservation of patency of the main arterial supply to the gastric conduit on a post-esophagectomy patient; loss of the right gastroepiploic artery in that case would had been otherwise catastrophic. Flow-diversion technology can be considered for the treatment of pseudoaneurysms post-pancreatic resections, especially when there is no other surgical or endovascular treatment option.
Divyanshoo Rai Kohli,Bashar A. Aqel,Nicole L. Segaran,M. Edwyn Harrison,Norio Fukami,Douglas O. Faigel,Adyr Moss,Amit Mathur,Winston Hewitt,Nitin Katariya,Rahul Pannala 한국간담췌외과학회 2023 Annals of hepato-biliary-pancreatic surgery Vol.27 No.1
Backgrounds/Aims: Data regarding outcomes of endoscopic retrograde cholangiography (ERC) in liver transplant (LT) recipients with biliary-enteric (BE) anastomosis are limited. We report outcomes of ERC and percutaneous transhepatic biliary drainage (PTBD) as first-line therapies in LT recipients with BE anastomosis. Methods: All LT recipients with Roux-BE anastomosis from 2001 to 2020 were divided into ERC and PTBD subgroups. Technical success was defined as the ability to cannulate the bile duct. Clinical success was defined as the ability to perform cholangiography and therapeutic interventions. Results: A total of 36 LT recipients (25 males, age 53.5 ± 13 years) with Roux-BE anastomosis who underwent biliary intervention were identified. The most common indications for a BE anastomosis were primary sclerosing cholangitis (n = 14) and duct size mismatch (n = 10). Among the 29 patients who initially underwent ERC, technical success and clinical success were achieved in 24 (82.8%) and 22 (75.9%) patients, respectively. The initial endoscope used for the ERC was a single balloon enteroscope in 16 patients, a double balloon enteroscope in 7 patients, a pediatric colonoscope in 5 patients, and a conventional reusable duodenoscope in 1 patient. Among the 7 patients who underwent PTBD as the initial therapy, six (85.7%) achieved technical and clinical success (p = 0.57). Conclusions: In LT patients with Roux-BE anastomosis requiring biliary intervention, ERC with a balloon-assisted enteroscope is safe with a success rate comparable to PTBD. Both ERC and PTBD can be considered as first-line therapies for LT recipients with a BE anastomosis.