Complete esophageal strictures are rare complications in patients who have received head and neck radiation therapy. Although mild strictures are generally amenable to dilation or stenting, management of these debilitating strictures is not well established. Treatment of long-segment obstructions is particularly complicated because documented techniques generally apply for strictures up to 3 cm in length. This report describes a successful recanalization of a long-segment complete esophageal stricture using combined antegrade-retrograde endoscopic therapy with adjunctive fluoroscopic techniques.
Introduction: There is scarce evidence on the impact of biliary stents on endoscopic ultrasound (EUS) fine-needle biopsy (FNB) or fine-needle aspiration (FNA) of pancreatic head masses. Aim of this metaanalysis was to compare the diagnostic performance of EUS-guided tissue sampling in patients with or without biliary stents. Methods: We searched PubMed/Medline and Embase databases through March 2022 and identified 7 studies (2458 patients). Primary outcome was diagnostic accuracy. Secondary outcomes were sample adequacy, diagnostic sensitivity, specificity, and number of needle passes. We performed pairwise meta-analysis through a random effects model and expressed results as odds ratio (OR) or mean difference along with 95% confidence interval (CI). Results: Pooled accuracy was 85.4% (95% CI 78.8%-91.9%) and 88.1% (83.3%-92.9%) in patients with and without stent, respectively with no significant difference between the two approaches (OR 0.74, 95% CI 0.53-1.02; p50.07). No difference in patients with plastic stent was observed (OR 0.89, 0.51-1.54; p50.67) whereas a significant difference was observed in patients with metal stent (OR 0.54, 0.17-0.97; p50.05). Diagnostic accuracy with EUS-FNB was significantly lower in patients with biliary stents (OR 0.64, 0.43-0.95; p50.03) whereas no difference was observed with FNA. No difference in terms of sample adequacy was observed between the two groups (OR 1.06, 0.67-1.67; p50.81). Diagnostic sensitivity was significantly lower in patients with biliary stent (OR 0.59, 0.44-0.80; p, 0.001) and the number of needle passes was not significantly different between the two groups (mean difference -0.09, -0.30 to 0.11; p50.38).
Conclusion:The presence of a metal stent negatively impacts on diagnostic yield of EUS tissue sampling for pancreatic head lesions, whereas no difference seems to be observed with plastic stents. Therefore, in jaundiced patients, EUS tissue sampling should precede ERCP, especially when metal stents are used.
Introduction: Liver is the most common site for intra-abdominal abscess. Pyogenic liver abscess is more common in men compared to women. Risk factors include diabetes mellitus and chronic hepatobiliary disease. Alcohol abuse is known to cause bone marrow suppression and compromised immune system. Limited data are available regarding clinical outcomes in patients with history of alcohol use disorder who are admitted with pyogenic liver abscess. Methods: Using National Inpatient Sample databases from 2016 to 2019. We identified patients presenting with pyogenic liver abscess, the population were then divided based on the presence and absence of alcohol use disorder using appropriate ICD-10-CM/PCS codes. STATA 16.0 software was used for the analysis. Pearson's Chi-Square test was used to analyze categorical variable, whereas the student t-test was used to analyze continuous variables. Univariate and multivariate logistic regression was used to adjust for potential confounders. Primary outcome was in hospital mortality due to Pyogenic liver abscess in patients with alcohol use disorder. Results: Amongst total of 19,830 patients admitted with pyogenic liver abscess, 1,090 patients had history of alcohol use disorder and 18,740 patients did not. Both groups consisted predominantly of white male patients. Mean LOS was higher in alcohol use disorder group (866.08 days) than in non-alcohol use disorder group (7.3566.34 days ) (P5, 0.001 ). Mean total hospitalization charges were higher in AUD group ($ 20,968) than in the non-AUD group ($ 18,994) (P5 , 0.001) Conclusion: Patient with Pyogenic liver abscess with alcohol use disorder history had higher resource utilization, but less odds of mortality. (Table )
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