Obesity is a growing pandemic across the world. Dietary restrictions and behavior modifications alone have a limited benefit. Bariatric surgery, despite being the current gold standard, has limited acceptance by patients due to cost and associated morbidity. In our review, we have discussed nine original studies describing endoscopic sleeve gastroplasty (ESG). A total of 172 subjects successfully underwent ESG. Of 65 subjects with follow up data, 95.4% (62/65) had intact gastric sleeve confirmed via esophagogastroduodenoscopy or oral contrast study at the end of study specific follow up interval (the longest being 6 months). Individual studies reported a technical success rate for intact gastric sleeve from as low as 50% to as high as 100%. A statistically significant p<0.05) weight loss was reported in seven of the eight studies with available data. None of the patients experienced any intra-procedure complications, and approximately 2.3% (4/172) of patients experienced major post-procedure complications; however, no mortality was reported. Majority of the studies reported relatively high incidence of minor post-procedure complications, which improved with symptomatic treatment alone. Good patient tolerance with comparable clinical efficacy in achieving and sustaining desired weight loss makes ESG an attractive option to consider among other bariatric therapies.
This article is a systematic review of relevant literature on endoscopic suturing as a primary closure technique for large submucosal and full-thickness defects after endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), and endoscopic full-thickness resection (EFTR). A comprehensive literature search was conducted through 2016 by using PubMed, to find peer-reviewed original articles. The specific factors considered were the procedural indications and details, success rates, clinical outcomes including complications, and study limitations. Six original articles were included in the final review: two with non-human subjects and four with human subjects. The mean success rate of endoscopic suturing was 97.4% (100% for human subjects and 95.4% for non-human subjects). The procedural time ranged from 7 to 89 min. The average size and depth of lesions were 2.71 cm (3.74 cm [human] and 1.96 cm [non-human]) and 1.52 cm, respectively. The technique itself had no reported impact on mortality. In conclusion, endoscopic suturing is a minimally invasive technique for the primary closure of defects caused by EMR, ESD, and EFTR, with a high success and low complication rate.
Ankylosing spondylitis (AS) is a chronic inflammatory disease of the spine which leads to ossification and formation of a classical bamboo spine. This poses a challenge to the anesthetist both in terms of administering general and regional anesthesia due to the limited mobility of the spine. With the advent of ultrasound as an aid in regional anesthesia, it has been relatively easy to perform a central neuraxial blockade in such patients though the skill requires some degree of expertise. Here, we have described the use of ultrasound as a guide for administering regional anesthesia to a patient with AS after initially attempting a blind approach which had failed due to difficult anatomy.
e22052 Title: A pilot study to compare the 18 - FDG and F18 PET/CT study in delineating metastases in suspected skeletal disease. Background: Flourodeoxy glucose (FDG), positron emission tomography/computed tomography (PET/CT) scans have been used to identify metastatic disease including skeletal lesions. But the advent of Flourine -18 (F - 18), has necessitated a need to identify its accuracy over FDG scans. Aim: To evaluate and compare FDG PET/CT and F18 PET/CT studies in locating skeletal metastases in patients with suspected disease. Methods: A pilot study was carried out on 27 patients who were referred for a FDG PET/CT study for suspected skeletal disease. A whole body (skull to ankle) FDG PET/CT study followed by a F18 PET/CT bone scan within a period of 1 week was performed. A total of 150 lesions with increased tracer concentration on FDG and F18 scan were analyzed and the characteristics of the lesion on corresponding CT images were noted. Results: Of the 150 lesions noted, 49 were seen in both FDG and F18 scans. 11 were sclerotic,16 lytic, 17 mixed while CT was normal in 5 lesion. 95 of the 101 mismatched lesions were seen on F18 scan alone & were not appreciated on the FDG scan. 40% were sclerotic, 12% mixed and 11.5% were lytic. Degenerative changes comprised 12% lesions. Only 6 mismatched lesions were seen on FDG and not appreciated on F18 study.They showed no morphological abnormality on CT. 9 patients with a negative FDG scan showed lesions ranging from solitary to 16 on F18 scan, while 5 patients who had a single metastasis on FDG showed more than 6 lesions on a F18 scan. Conclusions: A F18 PET/CT study detects more skeletal lesions than FDG PET and can thus has a potential to impact patient management . Sclerotic lesions missed on FDG scans seem to be better picked on F18 scans. This pilot study provides the feasibility of a prospective study in a larger patient population to validate the impact of F18 scan in identifying skeletal metastases in various malignancies with a predisposition to bone spread. No significant financial relationships to disclose.
Objective Symptomatic developmental venous anomalies (DVAs) are rare. Here, we illustrate the varied clinicoradiologic profiles of symptomatic DVAs and contemplate the mechanisms that render these (allegedly) benign entities symptomatic supported by a review of literature. Methods Institutional databases were searched to identify cases of symptomatic DVAs. Clinical and imaging (angiographic and cross-sectional) data of 9 cases with 11 neurovascular symptoms consequent to inflow/outflow perturbations and mechanical obstruction that manifested because of the strategic topography of underlying DVAs were analyzed. A review of the existing literature on DVAs in agreement with our case series was performed on publications retrieved from the PubMed database. Results Symptoms secondary to venous hypertension arising from flow-related perturbations were broadly divided into those arising from restricted outflow and increased inflow. Restricted outflow occurred because of collector vein stenosis (n = 2) and collector vein/DVA thrombosis (n = 3), whereas the latter pathomechanism was initiated by arterialized/transitional DVAs (n = 2). A mechanical/obstructive pathomechanism culminating in moderate supratentorial ventriculomegaly was noted in 1 case. One patient was given a diagnosis of hemorrhage associated with a cavernoma. Conclusions Awareness and contextualization of potential flow-related perturbations and mechanical insults that render DVAs symptomatic aid in accurate diagnosis, management, and prognostication.
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