SummaryThe Billroth III guidelines were developed during a consensus meeting of the Austrian Society of Gastroenterology and Hepatology (ÖGGH) and the Austrian Society of Interventional Radiology (ÖGIR) held on 18 February 2017 in Vienna. Based on international guidelines and considering recent landmark studies, the Billroth III recommendations aim to help physicians in guiding diagnostic and therapeutic strategies in patients with portal hypertension.

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Percutaneous drainage of 101 pancreatic pseudocysts (51 infected, 50 noninfected) in 77 patients is described. In this group of patients, 91 of 101 pseudocysts were cured by means of catheter drainage (90.1%) (noninfected, 43 of 50 [86%]; infected, 48 of 51 [94.1%]). Six patients underwent operation after percutaneous treatment due to persistent drainage. In patients with infected pseudocysts, the infection was eradicated by percutaneous drainage before operation. Four pseudocysts recurred and were redrained percutaneously. The mean duration of drainage was 19.6 days (infected pseudocysts, 16.7 days; noninfected, 21.2 days). Various access routes were used for catheter drainage: transperitoneal, retroperitoneal, transhepatic, transgastric, transduodenal, and transsplenic (inadvertent). Four major (superinfections) and six minor complications occurred. An unexpected finding in seven patients was spontaneous fistulization of the pseudocyst into the gastrointestinal tract. Percutaneous drainage is an effective front-line treatment for most pancreatic pseudocysts; cure is likely if fluid collections are drained adequately and if sufficient time is allowed for closure of fistulas from the pancreatic duct.

Background and Purpose-Carotid stent cell design has recently been suggested to be a determinant of periprocedural and early postprocedural neurologic complications. We investigated the impact of closed-versus open-cell stent design on neurologic adverse events and mortality after carotid artery stenting. Methods-We studied 1684 consecutive patients (1010 asymptomatic, 674 symptomatic) from 10 European centers who underwent carotid artery stenting with either closed-cell (nϭ859, 51%) or open-cell (nϭ825, 49%) design stents. Rates of transient ischemic attack, stroke, and death on the day of the procedure (acute events) and from day 1 to day 30 after the procedure (subacute events) were analyzed (95% CIs). Results-Combined transient ischemic attack, stroke, or death rates, and stroke or death rates within 30 days of treatment were 6.1% (95% CI, 5.0 to 7.2) and 3.1% (95% CI, 2.3 to 3.9) for the closed-cell design versus 4.1% (95% CI, 3.2 to 5.0) and 2.4% (95% CI, 1.7 to 3.1) for the open-cell design stents (Pϭ0.077, Pϭ0.38), respectively, without significant differences in asymptomatic and symptomatic patients. By propensity-score-adjusted multivariable analysis, the open-cell carotid stent design was not associated with a differential risk for combined acute and subacute neurologic complications compared with closed-cell stents (adjusted odds ratioϭ0.84, Pϭ0.53). When analyzed separately, the risk for acute events on the day of the procedure (adjusted odds ratioϭ0.83, Pϭ0.57) and the risk for subacute events at days 1 to 30 (adjusted odds ratioϭ1.61, Pϭ0.51) also were not significantly different between the groups. Conclusions-Current data do not support the superiority of a specific carotid stent cell design with respect to neurologic complications, stroke, and mortality risk.

' for the Vienna TIPS Study GroupIn patients with liver cirrhosis, implantation of a transjugular intrahepatic shunt (TIPS) leads to reduction of portal pressure, but not of mortality compared with other therapies. The high stenosis rates of conventional bare stents causes high reintervention rates and costs and may be correlated with poor survival. ePTFE-covered stentgrafts provide much improved patency rates, but their impact on survival is unclear. All suitable patients receiving either bare TIPS (419/466) or undergoing implantation of ePTFE endoprostheses (89/ 100) in several centers in Austria up to 2002 were included in this retrospective analysis. Both patient groups were compared regarding survival with Kaplan-Meier and Cox regression analysis. Unmatched and 1: 1-matched survival analyses were performed. Patients undergoing ePTFE stentgraft implantation had significantly higher survival rates in all analyses. The 3-month, 1-year, and 2-year survival rates were 93%, 88%, and 76% for the ePTFE-group and 83%, 73%, and 62% for conventional TIPS patients, respectively. The matched survival analyses validated these findings. The model of the stent, patient age, and Child-Pugh Class (CPC) were independent predictors of survival. In conclusion, patients undergoing ePTFEendoprosthesis implantation had higher survival rates within 2 years after TIPS-implantation. This may be the result of improved patency rates after correct placement (up to the inferior caval vein [Icv]) of the ePTFE stentgraft. These data should be validated in a prospective series. (