BackgroundPCI has been done traditionally through transfemoral route. But now transradial and transbrachial routes are also coming up in practice. We compared transradial versus transfemoral routes for ease of operability, time for procedure, complications, and failure rates through a prospective study.MethodsFour hundred Patients admitted in department of cardiology for percutaneous interventions were enrolled in the study. 200 patients were assigned to each group randomly. A single team did all the procedures. Pre procedure, intra procedure and post procedure data of all the patients was collected, tabulated and analysed properly.ResultsAccess time (6.0 ± 1vs 4.2 ± 0.7; P =0.001); Fluoroscopy time and overall procedure time (29 ± 11.3 Vs. 27.3 ± 12.4 min) were more with trans radial than transfemoral route, respectively. The most common post procedure complication, ecchymosis was seen in 20.5% in transfemoral group compared to 12.5% in transradial group (P 0.031). Thrombophelibites (17.5 VS 8%, P0.004); Hematoma (14.5 Vs 0%, P 0.005); post procedure access bleed (7 VS 3%, P 0.039) were seen in transfemoral than transradial group, respectively. Failure rates were almost similar. None of our patients had post procedure myocardial infarction, stroke, acute renal failure and infections.ConclusionTransradial approach of PCI is better than transfemoral route with respect to complications like bleeding, haematoma formation, thrombophelebites and ecchymosis is concerned. However access and fluoroscopic time is more with the former. We recommend the transradial route for PCI.Trial registrationTrial is retrospectively registered in ClinicalTrials.gov with the Identifier: NCT02983721, Date of registration is December 2, 2016.

Bleomycin

Introduction Endoscopist-directed, nurse-administered sedation using propofol, midazolam, and fentanyl for endoscopic retrograde cholangiopancreatography (ERCP) is being utilized worldwide. However, this is not usually employed in India by endoscopists. Aim To assess the efficacy, acceptability, and safety of this sedation in low to moderate risk patients undergoing ERCP. Material and methods This was a prospective study involving 500 patients with any indication for ERCP. The sedation was given by trained nurses. Results The sedative dosages per patient were as follows: propofol = 90 ±20 mg, fentanyl 0.75 ±0.25 mg (range: 0.25–1.00 mg), and midazolam 2 ±0.5 mg (range: 1–3 mg). Ninety-seven percent of patients achieved Richmond agitation sedation score of ≥ –3, and 96.8% achieved Gloucester comfort score of ≤ 2. 4.22% of the patients had mild adverse events (AE), and 2.11% had moderate AE. Two (0.4%) patients required intubation and intensive care unit admission. Mean recovery time was 15.3 min. 98.3% of the endoscopists were satisfied with the sedation achieved. 31.2% of the patients remembered the procedure. 93% of the patients were satisfied with the type of sedation. 92.75% of ERCPs were successful. 7.59% had procedure-related complications: in the form PEP – 5.290%, significant bleeding – 1.08%, and perforation – 0.43%. Conclusions Endoscopist-directed, nurse-administered sedation for ERCP with balanced propofol solution is practical, efficient, time saving, safe, and acceptable to patients.

Introduction Gastric outlet obstruction (GOO) is one of the common symptoms/complications of many cancers. Endoscopic placement of a self-expandable metal stent has emerged as one of the best alternative treatment options for surgical gastrojejunostomy. Aim We took up this study to find the technical and clinical success, and complication rates of duodenal stenting in such patients presented at India’s largest tertiary care cancer hospital. Material and methods This retrospective observational study included all patients who underwent endoscopic placement of an enteral WallFlex stent for malignant GOO between April 2013 and February 2019 at Tata Memorial Cancer Hospital, Mumbai, India. For estimation and improvement of symptoms, a GOO scoring system (GOOS) was used. The endpoints were defined as technical success, improvement of the GOO scoring system, and safety. Results Technical and clinical success rates were 98.13% (210/214) and 91.42% (192/210), respectively. Complications included bleeding in 12 (5.60%), pancreatitis in 4 (1.86%), and sedation-related complications in 25 (11.68%) of the patients. In the mean follow-up period of 120 days (range: 90 to 270 days), recurrence of obstructive symptoms was observed in 66 (31.42%) of the patients. Tumour ingrowth in 59.09% (39/66), food impaction in 31.81% (21/66), and migration of the stent in 15.15% (10/66) of patients were reasons for recurrence. The median time between clinical success and recurrence of obstructive symptoms was 148 days (95% confidence interval (CI): 0–328). Conclusions Placement of an enteral WallFlex stent in patients with malignant GOO is a practical, easy, and safe alternative to surgical gastrojejunostomy in malignant GOO.

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