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Ductal stenting

Abhishek Raval, Bhavesh Thakkar, Tarun Madan, Nilesh Oswal, Rajiv Garg, Rhshikesh Umalkar, Komal Shah, Bhumika Maheriya
OBJECTIVES: We aimed to study the feasibility and outcomes of ductal stenting in patients with duct-dependent pulmonary blood flow (PBF). METHODS: Duct-dependent hypoxic patients with confluent pulmonary artery (PA) branches were enrolled for ductal stenting and followed regularly. RESULTS: Sixty patients, with a median age of 12 (1-1095) days and weight of 2.8 (2.2-8.9) kg, were enrolled. Median right PA (RPA) and left PA (LPA) Z-scores were -1...
October 13, 2016: Portuguese Journal of Cardiology: An Official Journal of the Portuguese Society of Cardiology
Sushil Kumar Mishra, Pawan Kumar Jain, Sukhdev Gupta
Pseudocyst is a common complication of Acute and chronic pancreatitis. However, its extension into the mediastinum is a rare entity. We present a case of 52 years male with acute on chronic pancreatitis (alcohol related) who presented with dysphagia and dyspnoea and was found to have a pancreatic pseudocyst extending upto the neck. Ultrasound fails to pick up mediastinal pseudocysts and requires additional imaging modalities - CT and MRI. Management of Mediastinal pseudocyst depends upon underlying etiology, ductal anatomy, size of the pseudocyst, and availability of expertise...
March 2016: Journal of the Association of Physicians of India
María-Victoria Alvarez-Sánchez, Bertrand Napoléon
Most pancreatic cancers and extrahepatic cholangiocarcinomas are unresectable at the time of diagnosis, and even in case of a resectable cancer, for elderly or patients with coexistent comorbidities, surgery is not an option. Current treatment alternatives in these scenarios are very limited. Biliary stenting with self-expanding metal stents (SEMS) is the mainstay palliative treatment of biliary obstruction due to unresectable pancreatic cancer or cholangiocarcinoma. Nevertheless, more than 50% of SEMS become occluded after 6 mo due to tumour over- and ingrowth, leading to hospital readmissions and reinterventions that significantly impair quality of life...
October 7, 2016: World Journal of Gastroenterology: WJG
Igor V Polivenok, John P Breinholt, Sri O Rao, Olga V Buchneva
Management of pulmonary atresia with ventricular septal defect (PA-VSD) in the neonatal period presents numerous challenges. Endovascular stenting of the ductus arteriosus or of a collateral vessel in ductal-dependent pulmonary circulation as an alternative to the Blalock-Taussig (BT) shunt has become increasingly popular in the last decades. The utilization of the reverse Szabo (anchor-wire) technique for single collateral vessel stenting in a case of PA-VSD is described.
July 2016: Translational pediatrics
Ji Woong Jang, Myung-Hwan Kim, Dongwook Oh, Dong Hui Cho, Tae Jun Song, Do Hyun Park, Sang Soo Lee, Dong-Wan Seo, Sung Koo Lee, Sung-Hoon Moon
BACKGROUND AND AIMS: Acute necrotizing pancreatitis (ANP) can affect main pancreatic duct (MPD) as well as parenchyma. However, the incidence and outcomes of MPD disruption has not been well studied in the setting of ANP. METHODS: This retrospective study investigated 84 of 465 patients with ANP who underwent magnetic resonance cholangiopancreatography and/or endoscopic retrograde cholangiopancreatography. The MPD disruption group was subclassified into complete and partial disruption...
September 20, 2016: Pancreatology: Official Journal of the International Association of Pancreatology (IAP) ... [et Al.]
Ferdinando De Vita, Jole Ventriglia, Antonio Febbraro, Maria Maddalena Laterza, Alessio Fabozzi, Beatrice Savastano, Angelica Petrillo, Anna Diana, Guido Giordano, Teresa Troiani, Giovanni Conzo, Gennaro Galizia, Fortunato Ciardiello, Michele Orditura
BACKGROUND: Pancreatic adenocarcinoma is an aggressive disease with poor prognosis. In a randomized phase III trial, combination of Nab-paclitaxel (Nab-P) plus gemcitabine showed superior activity and efficacy in first-line treatment compared with gemcitabine alone. METHODS: Nab-P is not dispensed in Italy; however, we obtained this drug from our Ethics Committee for compassionate use. The aim of this study was to evaluate the efficacy and safety profile of this Nab-P and gemcitabine combination in a cohort of patients treated outside clinical trials...
2016: BMC Cancer
Takeshi Ogura, Saori Onda, Wataru Takagi, Masayuki Kitano, Tastsushi Sano, Atsushi Okuda, Akira Miyano, Daisuke Masuda, Toshihisa Takeuchi, Shinya Fukunishi, Kazuhide Higuchi
BACKGROUND: Temporary stent placement is widely performed for pancreatic duct stenosis due to chronic pancreatitis. A fully covered self-expandable metal stent (FCSEMS) has a larger diameter, and therefore longer stent patency, and the effect of expansion of the main pancreatic duct stricture may be obtained. However, if stent migration upstream occurs, stent removal is extremely difficult. In addition, because of the diameter gap between the FCSEMS and the main pancreatic duct, stent-induced ductal change may occur...
September 2016: Therapeutic Advances in Gastroenterology
Patrick Aepli, Andrew St John, Saurabh Gupta, Luke F Hourigan, Rhys Vaughan, Marios Efthymiou, Arthur Kaffes
BACKGROUND: Anastomotic biliary strictures (AS) after orthotopic liver transplantation (OLT) belong to the most common biliary complications and cause the biggest morbidity burden after OLT. Metal stents for benign biliary strictures are gaining acceptance with many published series. Traditional metal stent designs seem to have poor durability in AS after OLT. Novel intra-ductal stents are showing promise in these strictures. As a result, we designed a special stent with an antimigration waist and a short stent length with a long removal string that rests in the duodenum for easy removal...
August 29, 2016: Surgical Endoscopy
Stephan Schubert, Björn Peters, Felix Berger
We report interventional re-opening of a PDA for reverse Potts shunt circulation 12 months after closure in a 3.8 year old child, suffering from right ventricular (RV) failure due to suprasystemic pulmonary artery hypertension (PAH) after ADO I implantation. After ex vivo simulation, perforation through the mesh of the ADO I with the use of transseptal needle, wire looping (AO-PA), balloon dilatation, stent implantation (Palmaz 6 mm) and post dilatation, a reverse Pott-shunt circulation was established. A follow-up period of 11 months was achieved with preserved RV function and reverse Pott shunt circulation maintained a post ductal saturation of 94-88%...
August 12, 2016: Catheterization and Cardiovascular Interventions
Tom K Lin, David M Troendle, Daniel B Wallihan, Bradley Barth, Victor L Fox, Douglas S Fishman, Veronique D Morinville
OBJECTIVES: An increasing number of children are being diagnosed with pancreatitis and other pancreatic abnormalities. Dissemination of the information regarding existing imaging techniques and endoscopic modalities to diagnose and manage pancreatic disorders in children is sorely needed. METHODS: We conducted a review of the medical literature on the use of the following imaging and procedural modalities in pediatric pancreatology: transabdominal ultrasonography (TUS), computed tomography (CT), magnetic resonance imaging (MRI)- magnetic resonance cholangiopancreatography (MRCP), endoscopic ultrasonography (EUS), endoscopic retrograde cholangiopancreatography (ERCP)...
August 6, 2016: Journal of Pediatric Gastroenterology and Nutrition
E Girard, J Abba, N Cristiano, M Siebert, S Barbois, C Létoublon, C Arvieux
The spleen and pancreas are at risk for injury during abdominal trauma. The spleen is more commonly injured because of its fragile structure and its position immediately beneath the ribs. Injury to the more deeply placed pancreas is classically characterized by discordance between the severity of pancreatic injury and its initial clinical expression. For the patient who presents with hemorrhagic shock and ultrasound evidence of major hemoperitoneum, urgent "damage control" laparotomy is essential; if splenic injury is the cause, prompt "hemostatic" splenectomy should be performed...
August 2016: Journal of Visceral Surgery
Jared J Rejeski, Sarba Kundu, Matthew Hauser, Jason D Conway, John A Evans, Rishi Pawa, Girish Mishra
BACKGROUND AND OBJECTIVES: The management of ampullary lesions has evolved to include endoscopic ampullectomy (EA) as a curative approach to cancers of the ampulla of Vater. With this change comes a need to risk-stratify patients at initial diagnosis. MATERIALS AND METHODS: Patients with verified ampullary lesions (N = 50) were analyzed in a case-control design. We evaluated endoscopic ultrasound (EUS) data to define characteristics that yield a high sensitivity in selecting candidates for EA...
May 2016: Endoscopic Ultrasound
Surinder Singh Rana, Ravi Sharma, Puneet Chhabra, Vishal Sharma, Rajesh Gupta, Deepak Kumar Bhasin
BACKGROUND: Splenic pseudocysts (SP) are a rare consequence of both acute and chronic pancreatitis. Surgery has been conventional treatment for SP and literature on role of endoscopic treatment is scant. In this study, we retrospectively evaluated SP clinical and radiological characteristics as well as the outcome following endoscopic drainage. METHODS: Retrospective analysis of SP patients seen at our unit from January 2002 to June 2015. All patients were treated with attempted endoscopic transpapillary drainage with a nasopancreatic drain or stent...
July 2016: Annals of Gastroenterology: Quarterly Publication of the Hellenic Society of Gastroenterology
MinJie Yang, ZhiPing Yan, JianJun Luo, QingXin Liu, Wen Zhang, JinQing Ma, ZiHan Zhang, TianZhu Yu, Qian Zhao, LingXiao Liu
PURPOSE: To investigate the safety and feasibility of intraluminal brachytherapy using (125)I seed strand for locally advanced pancreatic ductal adenocarcinoma with obstructive jaundice. METHODS AND MATERIALS: From January 2010 to February 2015, 18 consecutive patients diagnosed with locally advanced, nonmetastatic, inoperable pancreatic ductal adenocarcinoma with obstructive jaundice were enrolled and underwent intraluminal brachytherapy using (125)I seed strand...
June 27, 2016: Brachytherapy
Juan-Miguel Gil-Jaurena, María-Teresa González-López, Ana Pita-Fernández, Ramón Pérez-Caballero
We describe a neonate with aortic atresia and hypoplastic aorta, listed for heart transplant after extracorporeal membrane oxygenation resuscitation and ductal stenting. The donor aorta was detached from the graft, after an isolated arch reconstruction prior to the transplant itself in a routine fashion. To the best of our knowledge, this is the first reported case of neonatal arch reconstruction before transplantation performed with grafts from the same donor in a split-way strategy.
October 2016: Interactive Cardiovascular and Thoracic Surgery
Sushrut Trakroo, Kamran Qureshi
Hepatic arterial flow is paramount in preserving biliary integrity. We present an interesting clinical scenario of a liver transplant recipient with biliary anastomotic stricture who developed biliary abscess and sepsis after Endoscopic Retrograde Cholangiopancreatography. The abscess did not respond to maximal medical management, percutaneous drainage, and adequate endoscopic biliary drainage. Clinically, patient continued to deteriorate and imaging identified hepatic artery stenosis which was treated with percutaneous intra-arterial stenting...
2016: Case Reports in Transplantation
Gábor Lakatos, Anita Balázs, Balázs Kui, Szilárd Gódi, Ákos Szücs, Andrea Szentesi, Zsolt Szentkereszty, Richárd Szmola, Dezső Kelemen, Róbert Papp, Áron Vincze, József Czimmer, Gabriella Pár, Judit Bajor, Imre Szabó, Ferenc Izbéki, Adrienn Halász, László Leindler, Gyula Farkas, Tamás Takács, László Czakó, Zoltán Szepes, Péter Hegyi, Zsuzsanna Kahán
BACKGROUND AND AIMS: Pancreatic cancer is a devastating disease with poor prognosis. There is very limited information available regarding the epidemiology and treatment strategies of pancreatic cancer in Central Europe. The purpose of the study was to prospectively collect and analyze data of pancreatic cancer in the Hungarian population. METHODS: The Hungarian Pancreatic Study Group (HPSG) organized prospective, uniform data collection. Altogether 354 patients were enrolled from 14 Hungarian centers...
June 2016: Journal of Gastrointestinal and Liver Diseases: JGLD
Sala Abdalla, Ioannis Nikolopoulos, Rajab Kerwat
Extra-abdominal complications of pancreatitis such as pancreaticopleural fistulae are rare. A pancreaticopleural fistula occurs when inflammation of the pancreas and pancreatic ductal disruption lead to leakage of secretions through a fistulous tract into the thorax. The underlying aetiology in the majority of cases is alcohol-induced chronic pancreatitis. The diagnosis is often delayed given that the majority of patients present with pulmonary symptoms and frequently have large, persistent pleural effusions...
2016: Case Reports in Emergency Medicine
Hyun Jong Choi, Jong Ho Moon, Yun Nah Lee, Hyun Su Kim, Moon Han Choi, Tae Hoon Lee, Sang-Woo Cha, Young Deok Cho, Sang-Heum Park, Sun-Joo Kim
BACKGROUND AND STUDY AIM: The nonflared ends of fully covered, self-expandable, metal stents (FCSEMSs) may minimize stent-induced ductal injury. Suprapapillary intraductal placement of nonflared FCSEMSs for malignant biliary stricture might reduce duodenobiliary reflux and pancreatitis. The aim of this study was to evaluate the efficacy of a newly modified, nonflared FCSEMS for intraductal placement in patients with malignant biliary stricture. PATIENTS AND METHODS: A total of 51 patients with nonhilar, extrahepatic, malignant biliary stricture were enrolled prospectively...
July 2016: Endoscopy
Laura Indolfi, Matteo Ligorio, David T Ting, Kristina Xega, Abraham R Tzafriri, Francesca Bersani, Nicola Aceto, Vishal Thapar, Bryan C Fuchs, Vikram Deshpande, Aaron B Baker, Cristina R Ferrone, Daniel A Haber, Robert Langer, Jeffrey W Clark, Elazer R Edelman
Pancreatic ductal adenocarcinoma (PDAC) is one of the most devastating and painful cancers. It is often highly resistant to therapy owing to inherent chemoresistance and the desmoplastic response that creates a barrier of fibrous tissue preventing transport of chemotherapeutics into the tumor. The growth of the tumor in pancreatic cancer often leads to invasion of other organs and partial or complete biliary obstruction, inducing intense pain for patients and necessitating tumor resection or repeated stenting...
July 2016: Biomaterials
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