The OTSC device has successfully secured FCSEMS in place in all 3 patients for a median dwell time of 6 weeks. There click here have been no adverse events at placement (3/3) or removal (1/1) of the OTSC device. The OTSC device is pending removal in 2 patients. We therefore conclude that the OTSC device can be used to secure FCSEMS and prevent migration. Using APC to cut the joint of the OTSC device, removal is feasible. However, larger case series are needed to confirm the efficacy and safety of this technique to preclude prosthesis migration. “
“Bleeding is a potentially
life-threatening AE that can occur at/after drainage of a pancreatic fluid collection (PFC). Traditionally, after failed endoscopic attempt at hemostasis (balloon-tamponade and cautery), angiographic embolization, and finally surgery have been the next and last resort, respectively, for treatment. We describe our outcomes at endoscopic management of 12 patients from 6/2010 to 6/2012 with severe bleeding at/after drainage of PFC. Twelve patients (8 males, median age 55) underwent endoscopic treatment of severe bleeding encountered at/after (11/1) drainage of symptomatic PFC (7 WON, 5 pseudocysts). Route of puncture was
transgastric in 9 and transduodenal in 3 patients.Suspected source of bleeding was arterial in 8 patients and variceal in 4 patients occuring at needle-knife puncture in 7, balloon dilation in 4, and at a tube check in 1 patient. Balloon tamponade and cautery were attempted in 11/12 patients and SB431542 manufacturer successful in 5/11 (45%) patients.
Self-expandable covered metal stents were used successfully in 2/2 (100%) patients. EUS guided or direct endoscopic cyanoacrylate was used successfully in 4/5 (80%) patients [total endoscopic success 11/12 (92%), median follow up 12 months]. One patient had an associated perforation, managed conservatively, Arachidonate 15-lipoxygenase and another patient had partial splenic embolization, without any AE. Median decline in hemoglobin 3gm/dL.One patient had recurrent bleding from pseudoaneurysm. Severe bleeding can be a dangerous problem that can occur at/after drainage of pancreatic fluid collections. After failed balloon tamponade, epinephrine and cautery, self-expandable metal stents, and direct or EUS-guided cyanoacrylate are options available to the endoscopist prior to proceeding to angiography or surgery. Larger prospective series are needed to confer benefit. “
“Conventional treatments for achalasia include endoscopic balloon dilation and Heller cardiomyotomy. The initial clinical cases utilizing the POEM technique were published in 2010. We hereby report a POEM procedure on a porcine model using a novel Submucosal Lifting Gel or SLG (Cook Medical), which facilitated a rapid submucosal dissection with minimal bleeding and excellent visibility. After marking the entrance point, pre-injection was performed using normal saline. Submucosal Lifting Gel was injected into the sub-mucosal layer.