Poster General HPB |
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PG01 General HPB: Endoscopy (ePoster) |
Selection of ePoster Presentations from Abstract Submissions |
PG01-01 | Double-Endoscope Necrosectomy via Enlarged Transgastric Access Site, a Novel Modified NOTES-Associated Technique for Walled-Off Necrosis in Acutenecrotizing Pancreatitis Qida Hu, China
Q. Hu1, F. Meyer2, U. Will3 1Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, China, 2Department of General, Abdominal, Vascular, and Transplant Surgery, University Hospital of Magdeburg, Germany, 3Department of Gastroenterology, Municipal Hospital (SRH Wald-Klinikum), Germany
Introduction: Endoscopic modalities, in particularly the natural orifice
transluminal endoscopic surgery (NOTES), have minimized the invasiveness for
pancreatic necrosis, therefore becoming increasingly important. However, the
transmural access to the pancreatic necrosis was limited by the size of the
available transendosccopic balloon catheters, with the maximum diameter of 20
mm. We herein reported a novel modified NOTES-associated technique using
double-endoscopes to create an enlarged transgastric access site and a more
efficient necrosectomy for WON in acute necrotizing pancreatitis.
Methods: After confirmation of successful puncture by aspiring the
fluid collection content under EUS guidance, a 0.035-inch Jagwire guidewire was
then advanced through the puncture needle, and a 6-F-outer plastic sheath was
then advanced into the gastric wall to create cystogastrostomy. We then
exchanged the EUS needle was exchanged for a balloon catheter, followed by
dilatation with an over-the-wire balloon to extent the access diameter to at
least 10 mm. The second therapeutic endoscope was then placed to the access
site with another balloon catheter to achieve double-balloon dilation to
increase the access diameter up to 40 mm. Necrosectomy was therefore performed
using the two forward-viewing endoscopes.
Results: All 4 cases undergoing the modified endoscopic
necrosectomies were performed successfully, making the technical success rate
100%. No severe postoperative complication was observed. Within a 9-month
follow-up period, all the pancreatic necrosis was resolved, which indicated a
clinical success rate of 100%.
Conclusions: A complete necrosectomy has become possible because of maximal
enlargement of the transgastric access site with double endoscopes. |
PG01-02 | Resection of the Spleen Using Radiofrequency Ablation Dmitry Ionkin, Russian Federation
D. Ionkin1, R. Ikramov1,1, Y. Stepanova2, M. Alimurzaeva2 1Oncology, A.V. Vishnevsky National Medical Research Center of Surgery, Russian Federation, 2Radiology, A.V. Vishnevsky National Medical Research Center of Surgery, Russian Federation
Objective: to expand the
possibilities of performing organ-saving interventions in patients with focal
spleen formations.
Materials and methods: Since 1976, we have gained experience in treating> 450 patients with
local formations of the spleen. In
recent years, with benign lesions, we give preference to organ-preserving
interventions. We performed 86
laparoscopic and robot-assisted surgeries with spleen preservation.
We have experience in performing >
60 liver resections using RFA. In recent
years, we began to perform similar operations on the spleen. Using the Cool-Tipe Radionics® device, 12
patients were operated on. The following
morphological forms of focal formations were noted: echinococcal cyst - 3,
abscesses - 2, hamartoma - 1, hemangioma - 2, lymphangioma -3, hemlimphangioma
-1.Twice such operations were performed by laparoscopic access using 3 trocars.
Results: The RFA intervention time has not increased compared to standard
operations. In one observation, a small
hematoma was noted along the edge of the spleen resection, which did not
require repeated intervention. In the
remaining patients, the postoperative period was uneventful. According to instrumental research methods,
in the long term there was a zone of moderate decrease in blood flow along the
edge of the resection with a thickness of up to 5-7 mm. There were no signs of relapse.
Conclusion: With benign local
formation of the spleen, if technical difficulties arise during organ-saving
operations, it is possible to use radiofrequency ablation. The use of this technique allows resection of
the spleen with good near and long-term results to be performed almost
bloodlessly. |
PG01-03 | Endoscopic Management of Surgical Jaundice in Nigeria Olusegun Alatise, Nigeria
O. Alatise1, M. Owojuyigbe2, A. Omisore3, D. Ndububa4, A. Asombang5 1Surgery, Obafemi Awolowo University, Nigeria, 2Anaesthesia, Obafemi Awolowo University, Nigeria, 3Radiology, Obafemi Awolowo University, Nigeria, 4Medicine, Obafemi Awolowo University, Nigeria, 5Medicine, Warren Alpert Medical School of Brown University, United States
Introduction: Endoscopy management of obstructive jaundice has
been limited in Nigeria because of unavailability of ERCP,
despite growing demand. This study
presents our experience establishing an ERCP program at Obafemi Awolowo
University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Nigeria.
Methods: ERCP was introduced into a well-established
advanced endoscopy unit at OAUTHC. We employed an apprenticeship-style model of
training with graded responsibility, multidisciplinary group feedback and
short-interval repetition. We collate the sociodemographic and
clinicopathologic information on consecutive patients who underwent ERCP from
March 2018- December 2019.
Result: From 155 referrals, 130 patients underwent ERCP,
with a median age of 55 (range 8-83). 50.8% (66/130) were male. In total, 143
procedures were performed on this cohort. Sixteen percent of referrals were
inappropriate, secondary to misdiagnosis or poor functional status. Ten
patients required a repeat procedure due to technical failure, while three
patients had a planned second-stage procedure. The most common indications were
cancer of the head of pancreas (52/130), choledocholithiasis (33/130),
cholangiocarcinoma (18/130) and gallbladder cancer (9/130). Almost all patients
(99%) had sphincterotomies and (57/130) had a stent inserted. Twenty-four of
these individuals (42%) had self-expanding metallic stents inserted. In total, seven
patients had post ERCP pancreatitis and five periprocedural mortalities were
recorded.
Conclusion: Using an apprenticeship-style educational model
- an experienced endoscopist with a well-established endoscopy unit, it is
possible to develop an ERCP program in Nigeria without travelling abroad. The
multidisciplinary nature of ERCP service delivery places an incentive on
training within the home institution environment. |
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