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Safety and efficacy of Kaffes intraductal self-expanding metal stents in the management of post-liver transplant anastomotic strictures

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World Journal of Transplantation 2024年第2期14卷 88-98页

作者： Chee Lim Jonathan Ng Babak Sarraf Rhys Vaughan Marios Efthymiou Leonardo Zorron Cheng Tao Pu sujievvan chandran Department of Gastroenterology and Hepatology Austin HealthMelbourne HeidelbergVIC 3084Australia Melbourne Medical School The University of MelbourneMelbourne ParkvilleVIC 3052Australia

BACKGROUND Endoscopic management is the first-line therapy for post-liver-transplant anas-tomotic *** the optimal duration of treatment with plastic stents has been reported to be 8-12 months,data on safety and duration for metal stents in this setting is *** to limited access to endoscopic retrograde cholan-giopancreatography(ERCP)during the coronavirus disease 2019 pandemic in our centre,there was a change in practice towards increased usage and length-of-stay of the Kaffes biliary intraductal self-expanding stent in patients with suitable *** was mainly due to the theoretical benefit of Kaffes stents allowing for longer indwelling periods compared to the traditional plastic *** Adult liver transplant recipients aged 18 years and above who underwent ERCP were retrospectively identified during a 10-year period through a database *** admissions post-Kaffes stent insertion were identified manually through electronic and scanned medical *** main outcome was the incidence of complications when stents were left indwelling for 3 months vs 6 *** efficacy was calculated via rates of stricture recurrence between patients that had stenting courses for≤120 d or>120 *** During the study period,a total of 66 ERCPs with Kaffes insertion were performed in 54 patients throughout their stenting *** 33 ERCPs,the stent was removed or exchanged on a 3-month *** pancreatitis,perfor-ations or deaths *** post-ERCP complications were similar between the 3-month(abdominal pain and intraductal migration)and 6-month(abdominal pain,septic shower and embedded stent)groups-6.1%vs 9.1%respectively,P=*** strictures resolved at the end of the stenting course,but the stenting course was variable from 3 to 22 *** recurrence rate for stenting courses lasting for up to 120 d was 71.4%and 21.4%for stenting courses of 121 d or over(P=0.03).There were 28 patients that were treated with a sin

关键词： Liver transplantation Cholangiopancreatography Endoscopic retrograde Constriction Pathologic Self expandable metallic stents Bile duct diseases Cholestasis

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Unpacking the challenge of gastric varices: A review on indication, timing and modality of therapy

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World Journal of Hepatology 2021年第8期13卷 868-878页

作者： Karl Vaz Marios Efthymiou Rhys Vaughan Adam G Testro Hin-Boon Lew Leonardo Zorron Cheng Tao Pu sujievvan chandran Department of Gastroenterology and Hepatology Austin HealthHeidelberg 3084VictoriaAustralia University of Melbourne Parkville 3052VictoriaAustralia Department of Radiology Austin HealthHeidelberg 3084VictoriaAustralia

Upper gastrointestinal bleeding from oesophageal or gastric varices is an important medical condition in patients with portal *** the emergence of a number of novel endoscopic and radiologic therapies for oesophagogastric varices,controversy exists regarding the indication,timing and modality of *** aim of this review is to provide a concise and practical evidence-based overview of these issues.

关键词： Upper gastrointestinal bleeding Portal hypertension Gastric varices Variceal band ligation Variceal obliteration Sclerotherapy Transjugular intrahepatic portosystemic shunt Balloon-occlusion retrograde transvenous obliteration

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Long-term clinical outcomes of lipiodol marking using standard gastroscopy for image-guided radiotherapy of upper gastrointestinal cancers

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World Journal of Gastroenterology 2021年第42期27卷 7387-7401页

作者： Kim Hay Be Richard Khor Daryl Lim Joon Ben Starvaggi Michael Chao Sweet Ping Ng Michael Ng Leonardo Zorron Cheng Tao Pu Marios Efthymiou Rhys Vaughan sujievvan chandran Department of Gastroenterology and Hepatology Austin HealthHeidelberg 3084VictoriaAustralia Department of Radiation Oncology Austin HealthHeidelberg 3084VictoriaAustralia School of Cancer Medicine La Trobe UniversityMelbourne 3086VictoriaAustralia Medicine Dentistry and Health SciencesUniversity of MelbourneParkville 3010VictoriaAustralia Genesis Care East Melbourne 3002VictoriaAustralia

BACKGROUND Image-guided radiotherapy(IGRT)has significantly improved the precision in which radiotherapy is delivered in cancer ***,IGRT uses bony landmarks and key anatomical structures to locate the *** studies have demonstrated the feasibility of peri-tumor fiducials in enabling even more accurate delineation of target and normal *** use of gold coils as fiducials in gastrointestinal tumors has been extensively ***,placement requires expertise and specialized endoscopic ultrasound *** article reports the long-term outcomes of using a standard gastroscopy to inject liquid fiducials for the treatment of oesophageal and gastric tumors with *** To assess the long-term outcomes of liquid fiducial-guided IGRT in a cohort of oesophageal and gastric cancer *** A retrospective cohort study of consecutive adults with Oesophagogastric cancers referred for liquid fiducial placement before definitive/neo-adjuvant or palliative IGRT between 2013 and 2021 at a tertiary hospital in Melbourne,Australia was *** to four liquid fiducials were inserted per patient,each injection consisting of 0.2-0.5mL of a 1:1 mixture of iodized oil(Lipiodol;Aspen Pharmacare)and n-butyl 2-cyanoacrylate(Histoacryl®;***).A 23-gauge injector(Cook Medical)was used for the *** procedures were performed by or under the supervision of a *** fiducial-based IGRT(LF-IGRT)consisted of computer-assisted direct matching of the fiducial region on cone-beam computerised tomography at the time of *** received standard-IGRT(S-IGRT)if fiducial visibility was insufficient,consisting of bone match as a surrogate for tumor *** was delivered to 54Gy in 30 fractions for curative patients and up to 45Gy in 15 fractions for palliative *** 52 patients were referred for liquid fiducial placement within the study period.A total of 51 patients underwent liquid f

关键词： Image-guided radiotherapy Lipiodol Gastroscopy Gastric cancer Oesophageal cancer Fiducial

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High-flow oxygen via oxygenating mouthguard in short upper gastrointestinal endoscopy:A randomised controlled trial

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World Journal of Gastrointestinal Endoscopy 2022年第12期14卷 777-788页

作者： Kim Hay Be Leonardo Zorron Cheng Tao Pu Brett Pearce Matthew Lee Luke Fletcher Rebecca Cogan Philip Peyton Rhys Vaughan Marios Efthymiou sujievvan chandran Department of Gastroenterology and Hepatology Austin HealthHeidelberg 3084VictoriaAustralia Department of Anaesthesia and Pain Medicine Austin HealthHeidelberg 3084VictoriaAustralia Faculty of Medicine Dentistry and Health SciencesUniversity of MelbourneParkville 3010VictoriaAustralia

BACKGROUND Anaesthetic care during upper gastrointestinal(GI)endoscopy has the unique challenge of maintaining ventilation and oxygenation via a shared upper *** oxygen is recommended by international society guidelines,however,the optimal route or rate of oxygen delivery is not *** oxygen delivery devices have been investigated to improve oxygenation during upper GI endoscopy,however,these are limited by commercial availability,costs and in some cases,the expertise required for *** at our centre,higher flows of supplemental oxygen can safely be delivered via an oxygenating mouthguard routinely used during upper GI endoscopic *** To assess the incidence of hypoxaemia(SpO2<90%)in patients undergoing upper GI endoscopy receiving supplemental oxygen using an oxygenating mouthguard at 20 L/min flow compared to standard nasal cannula(SNC)at 2 L/min *** A single centre,prospective,randomised clinical trial at two sites of an Australian tertiary hospital between October 2020 and September 2021 was *** undergoing elective upper gastrointestinal endoscopy under deep sedation were randomised to receive supplemental oxygen via high-flow via oxygenating mouthguard(HFMG)at 20 L/min flow or SNC at 2 L/min *** primary outcome was the incidence of hypoxaemia of any duration measured by pulse ***-related,procedural-related,and sedation-related adverse events and patient-reported outcomes were also *** Three hundred patients were *** patients were excluded after randomisation.292 patients were included in the intention-to-treat *** incidence of hypoxaemia was significantly reduced in those allocated *** patients(4.4%)allocated to HFMG experienced an episode of hypoxaemia,compared to thirty-four(22.1%)patients allocated to SNC(P value<0.001).No significant difference was observed in the rates of adverse events or patient-reported outcome meas

关键词： Upper gastrointestinal endoscopy Supplementary oxygen Hypoxaemia Oxygenating mouthguard

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