Background: Select patients with acute cholecystitis (AC) are not candidates for index cholecystectomy. We compared the influence of ERCP-guided transpapillary gallbladder drainage (ERGD) versus percutaneous cholecystostomy (PC) on delayed cholecystectomy outcomes. Methods: Consecutive patients undergoing ERGD or PC for AC from January 2007 to October 2018 were included. Primary outcome was the rate of conversion to open cholecystectomy and perioperative complications in groups.Results: The study included 52 patients with ERGD and 140 with PC prior to cholecystectomy (median 68 days [IQR: 47-105.5]). Technical success was higher in the PC group (100% vs 91%; P = 0.0004).There was a nonsignificant trend to lower postoperative complications with ERGD (30.7% vs 43.5%; P = 0.07). No difference in conversion to open cholecystectomy OR: 1.5 (95% CI: 0.68-3.65; P = 0.28) or severity of complications (Clavien-Dindo grade >2) OR: 0.60, (95% CI: 0.19-1.87; P = 0.38) was noted between the ERGD and PC groups. PC was associated with higher rates of unplanned repeat intervention (16.4% vs 7.7%; P = 0.02).
Conclusion:ERGD is suitable for patients with AC who is candidates for delayed cholecystectomy and should be considered for gallbladder drainage in patients with concomitant choledocholithiasis or cholangitis who require ERCP.
Introduction: Large walled-off necrosis (WON) are challenging to manage endoscopically even with the use of large caliber lumen-apposing metal stents (LAMS). Therefore, some experts suggest percutaneous drainage (PCD) to facilitate endoscopic management with LAMS. The aim of this study is to determine the impact of PCD on WON resolution in patients undergoing LAMS drainage. Methods: A retrospective cohort study was performed for patients who underwent Endoscopic Ultrasound (EUS)-guided LAMS drainage of WON from 4/2014 to 10/2019. Demographic and procedural information and patient clinical outcomes were recorded. Cross-sectional imaging was reviewed by two abdominal radiologists blinded to patient outcome to independently determine size and percentage of solid necrosis within the WON. Wilcoxon rank sum test and Fisher's exact tests were used to compare continuous and categorical variables, respectively. A 2-sided p-value <0.05 was regarded as statistically significant. Results: A total of 62 patients underwent LAMS drainage for WON >10cm during the study period, of whom 54 (87%) did not undergo PCD. Baseline characteristics were similar between both groups including size, rate of paracolic gutter extension, percentage of solid necrosis, and presence of disconnected pancreatic duct (Table 1). Both groups were noted to contain a median of 60% solid necrosis (pZ0.66). Although no statistical procedural differences were noted between the groups (Table 2), use of a multigateway technique was more common in those without PCD (30% vs 0%; pZ0.21). Patients with PCD had no observed improvement in time to WON resolution (103 vs 78 days; pZ0.63) and did not reduce the number of endoscopic necrosectomy procedures (3.5 vs 1.0; pZ0.12) compared to those without PCD. Conclusions: In this cohort study, the majority of patients with large WON were successfully managed endoscopically with LAMS drainage and necrosectomy without the need for additional percutaneous drainage. Further studies are needed to clarify the role of percutaneous drainage in the setting of LAMS placement for WON.
Context:Fatigue is one of the most frequent nonmotor manifestations in Parkinson's disease (PD), having a major effect on quality of life but is not reported in Indian patients.Aims:To evaluate the frequency of fatigue in a cohort of PD population and its correlation with disease.Settings and Design:Fatigue Severity Scale (FSS) was translated and validated in local vernacular language. All patients of PD visiting neurology outpatient department of a tertiary care hospital.Subjects and Methods:A total of 150 patients were screened, and 104 were included in this study. They were divided into – Group I with fatigue (score of >4 in each item) and Group II without fatigue.Statistical Analysis:Data were analyzed by SPSS software version 20.0. Spearman correlation was used to evaluate the convergent validity of the FSS-Ind score with PD-related variables. The principal components analysis was applied to detect the domain structure of the FSS.Results:Of the total 104 patients, 68 (65.3%) patients experienced fatigue. The duration of disease was significantly more (P = 0.021) in Group I (4.39 ± 3.8 years) than in the Group II (3.13 ± 1.6 years). The severity of disease also showed a positive correlation with fatigue with 50.9% patients in H and Y stage >3 experiencing fatigue. 69.1% patients of tremor phenotype experienced fatigue as compared to 32.3% of rigid phenotype. There was no relation of fatigue with age, gender, H and Y stage, levodopa equivalent dose and mean Unified PD Rating Scale motor III score.Conclusions:Translated version of the FSS, FSS-Ind has high internal consistency and validity which supports its application as an effective tool in detecting fatigue in patients with PD. Fatigue in PD was related to duration and phenotype of the disease.
index FNA. In the first case, a lumen-apposing metal stent (LAMS) with a coaxial pigtail stent was placed and in the second case, two pigtail stents were placed without a LAMS. Technical and clinical success was achieved in both cases. Both cases experienced complete resolution of their collections, without need for concomitant ERCP and pancreatic duct stenting. Neither patient required subsequent endoscopic, percutaneous or surgical interventions after the initial stent placement on long-term follow up. Conclusion: Pancreatic duct leak and subsequent symptomatic fluid collection after EUS-FNA is extremely uncommon especially in the absence of an inciting post-FNA pancreatitis. In our experience, EUS-guided transmural drainage of post-FNA fluid collections appears to be safe, feasible and effective in the long term, furthermore avoiding the morbidity of percutaneous or surgical management.
Introduction: Large walled-off necrosis (WON) are challenging to manage endoscopically even with the use of large caliber lumen-apposing metal stents (LAMS). Therefore, some experts suggest percutaneous drainage (PCD) to facilitate endoscopic management with LAMS. The aim of this study is to determine the impact of PCD on WON resolution in patients undergoing LAMS drainage. Methods: A retrospective cohort study was performed for patients who underwent Endoscopic Ultrasound (EUS)-guided LAMS drainage of WON from 4/2014 to 10/2019. Demographic and procedural information and patient clinical outcomes were recorded. Cross-sectional imaging was reviewed by two abdominal radiologists blinded to patient outcome to independently determine size and percentage of solid necrosis within the WON. Wilcoxon rank sum test and Fisher's exact tests were used to compare continuous and categorical variables, respectively. A 2-sided p-value <0.05 was regarded as statistically significant. Results: A total of 62 patients underwent LAMS drainage for WON >10cm during the study period, of whom 54 (87%) did not undergo PCD. Baseline characteristics were similar between both groups including size, rate of paracolic gutter extension, percentage of solid necrosis, and presence of disconnected pancreatic duct (Table 1). Both groups were noted to contain a median of 60% solid necrosis (pZ0.66). Although no statistical procedural differences were noted between the groups (Table 2), use of a multigateway technique was more common in those without PCD (30% vs 0%; pZ0.21). Patients with PCD had no observed improvement in time to WON resolution (103 vs 78 days; pZ0.63) and did not reduce the number of endoscopic necrosectomy procedures (3.5 vs 1.0; pZ0.12) compared to those without PCD. Conclusions: In this cohort study, the majority of patients with large WON were successfully managed endoscopically with LAMS drainage and necrosectomy without the need for additional percutaneous drainage. Further studies are needed to clarify the role of percutaneous drainage in the setting of LAMS placement for WON.
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