Multiple Ulcers Closed by Multiple Flaps as a Single Procedure

2015 ◽  
pp. 175-189
Author(s):  
Salah Rubayi
Keyword(s):  
Single Procedure ◽  
Multiple Ulcers

scholarly journals Magnets and self-retractable wire for endoscopic septotomies: From concept to first-in-human use.

Endoscopy ◽  
2021 ◽  
Author(s):  
François Huberland ◽  
Ricardo Rio Tinto ◽  
Sonia Dugardeyn ◽  
Nicolas Cauche ◽  
Cécilia Delattre ◽  
...  
Keyword(s):  
Animal Studies ◽  
Unmet Needs ◽  
Previous Knowledge ◽  
Esophageal Diverticulum ◽  
Gi Tract ◽  
Single Procedure ◽  
Compression Anastomosis ◽  
Human Use ◽  
Epiphrenic Esophageal Diverticulum ◽  
Safe Performance

Background and study aims: A medical device that allows simple and safe performance of an endoscopic septotomy could have several applications in the gastrointestinal (GI) tract. We developed such a device by combining two magnets and a self-retractable wire to perform a progressive septotomy by compression of the tissues. We describe here the concept, preclinical studies, and first clinical use of the device in symptomatic epiphrenic esophageal diverticulum (EED). Materials and methods: The MAGUS was designed based on previous knowledge of compression anastomosis and current unmet needs. After initial design, the feasibility of the technique was tested on artificial septa in pigs. A clinical trial was then initiated to assess the feasibility and safety of the technique. Results: Animal studies showed that the MAGUS can perform a complete septotomy at various levels of the GI tract. In two patients with symptomatic EED, uneventful complete septotomy was observed within 28 and 39 days after the endoscopic procedure. Conclusions: This new system provides a way to perform endoluminal septotomy in a single procedure. It appears to be effective and safe for managing symptomatic EED. Further clinical applications where this type of remodeling of the GI tract could be beneficial are under investigation.

scholarly journals Multiple Small Intestine Ulcers with Desquamation of the Fingers

2017 ◽  
Vol 11 (2) ◽  
pp. 452-461
Author(s):  
Azusa Kawasaki ◽  
Kunihiro Tsuji ◽  
Hisashi Doyama
Keyword(s):  
Computed Tomography ◽  
Small Intestine ◽  
Abdominal Pain ◽  
Small Bowel ◽  
Yersinia Pseudotuberculosis ◽  
Oral Ulcers ◽  
Palmar Erythema ◽  
Antibody Titers ◽  
Endoscopic Characteristics ◽  
Multiple Ulcers

A 73-year-old female was admitted to our hospital with abdominal pain and diarrhea. Computed tomography detected distension of the small intestine. A palmar erythema, multiple oral ulcers, and desquamation of the fingers appeared after hospitalization. Small-bowel endoscopic images showed multiple ulcers. We attributed this case to infection with Yersinia pseudotuberculosis based on the changes in Y. pseudotuberculosis antibody titers throughout the course of the illness. This report is valuable, as it illustrates the endoscopic characteristics of a Y. pseudotuberculosis infection with skin lesion and ileus, which may enable us to deepen the pathologic understanding of this disease.

Long-Term Outcome of Children with Short Bowel Syndrome Treated with a Modification of the STEP Technique Avoiding Mesenteric Defect

2021 ◽  
Author(s):  
Javier Bueno ◽  
Laura García-Martínez ◽  
Susana Redecillas ◽  
Oscar Segarra ◽  
Manuel López
Keyword(s):  
Short Bowel Syndrome ◽  
Bacterial Overgrowth ◽  
Central Line ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Short Bowel ◽  
Mesenteric Defects ◽  
Multiple Ulcers

Abstract Background The Serial Transverse Enteroplasty Procedure (STEP) Registry has reported a 47% success to achieve enteral autonomy in pediatric short bowel syndrome (SBS). We have performed the STEP with a technical modification (MSTEP) consisting in stapler application without mesenteric defects that can also be applied to the duodenum. Our experience with this technique is described. Materials and Methods In this study, 16 children with SBS underwent MSTEP (2005–2019). Indications were nutritional autonomy achievement (n = 11, with duodenal lengthening in 5/11) and bacterial overgrowth treatment (n = 5). Results With a median follow-up of 5.8 years (0.7–13.7 years), 5 of 11 (45%) patients achieved enteral autonomy, 4 of them with duodenal lengthening. Four of four who preserved > 50% colon, while only one of seven with < 50% of colon achieved enteral autonomy (p < 0.05). After redo procedures, three of four attained enteral autonomy. Thus, 8 of 11 (73%) progressed to enteral autonomy, including all with duodenal lengthening. One child, already parenteral nutrition free, died due to central line sepsis. All the patients from the bacterial translocation group improved their metabolic/nutritional status, but one required subsequent enterectomy of the lengthened intestine due to multiple ulcers in the staple lines. Conclusion The effectiveness of MSTEP to achieve enteral autonomy seems similar to the classical STEP. It can be applied to the duodenum. The retained colon length may influence the post-STEP enteral autonomy achievement.

Abstract 18601: Impact of Right and Left Atrial Remodeling on Outcomes From Atrial Fibrillation Rotor Ablation

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Amir Schricker ◽  
Tina Baykaner ◽  
Junaid Zaman ◽  
Gautam Lalani ◽  
Kenneth Hopper ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Structural Changes ◽  
Unknown Etiology ◽  
Atrial Remodeling ◽  
Left Atrial Remodeling ◽  
Single Procedure ◽  
Clinical Indices ◽  
The Right

Introduction: Targets for the ablation of atrial fibrillation (AF) are debated. In particular, recent studies questioning fractionated electrograms and lines has increased focus on AF substrates of rotors and focal impulses. These AF sources are seen in both atria, but have unknown etiology. We hypothesized that differential remodeling between the right atrium (RA), whose structural changes are largely undefined, and left atrium (LA) influence the distribution of AF sources and the outcomes from AF source ablation. Methods: In 60 patients at AF ablation (62±10 years, 60% persistent, 5% long-standing persistent), we compared size differences between RA and LA to the number of sources in each chamber and outcomes from AF source-guide ablation. We studied if a 64-pole basket differentially fit the LA or RA, judged by deformation of its splines by the atria (fig. A, B) over multiple cardiac cycles on fluoroscopy. Ablation targeted sources in both atria and was followed by PVI, with follow-up per guidelines. Results: Using baskets in both atria, 205 sources (LA 138; RA 67) were identified and ablated. Notably, the same basket in each patient was dynamically deformed by RA in 51 (85%) of cases but in the LA in only 39 (65%), indicating greater LA remodeling. The number of AF sources was higher in the presence of basket deformation of RA (n=174) than LA (n=130). LA deformation correlated with LVEF (p=0.05). Freedom from AF at 1 year was reduced in patients with no basket deformation (i.e. dilation) in LA (p=0.07) or RA (p=0.06). Notably, single procedure AF freedom was substantially lower in patients with differential remodeling (deformation in only 1 chamber) of 84% vs. 60% (fig C). Conclusions: Structural atrial remodeling influences the number of electrical rotors and focal sources in each chamber. A mismatch between right and left atrial remodeling predicts lower success from rotor ablation. These data also provide novel clinical indices of effective basket positioning.

scholarly journals The outcome of ablation for non-paroxysmal atrial fibrillation targeting spatiotemporal electrogram dispersion compared with ganglionated plexi ablation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Sakata ◽  
T Tanaka ◽  
S Yamashita ◽  
K Yamashiro
Keyword(s):  
Atrial Fibrillation ◽  
Study Groups ◽  
Atrial Arrhythmia ◽  
Single Procedure ◽  
Ganglionated Plexi ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Left And Right ◽  
Fibrillatory Conduction ◽  
And Control

Abstract Background Although catheter ablation targeting ganglionated plexi (GP) playing an important role in formation of triggers and substrates of atrial fibrillation (AF) has been reported as one of the effective ablation strategies in non-paroxysmal AF (non-PAF) patients, its effectiveness varies among the study groups. More recently, ablation targeting spatiotemporal electrogram dispersion (STED) areas, assumed to contain AF drivers in forms of rotational activation is proposed. However, the optimal ablation strategy for non-PAF is still controversial since the exact mechanisms of non-PAF are not well understood. Purpose To investigate the effectiveness of GP ablation for autonomic modification and STED ablation for modulation of AF drivers. Methods Consecutive 149 non-PAF patients who underwent STED ablation in our center were enrolled. We detected STED areas within the whole left and right atrium during AF using PentaRay®, and ablated them. If AF was terminated during STED ablation, we finished the procedure without burning the remaining STED areas. If not, electrical cardioversion was applied. The outcome was compared with that in consecutive 156 non-PAF patients undergoing GP ablation previously in our center. Results (1) The clinical characteristics were comparable between two groups (see Table). (2) A Kaplan-Meier curve showed that there was no significant difference between the freedom rates from non-PAF/non-paroxysmal atrial tachycardia (non-PAT) after single procedure in STED group and GP group (Figure, left). (3) However, the freedom rates from non-PAT in STED group was significantly lower than that GP group (Figure, right). Conclusions The recurrence type of atrial arrhythmia after ablation was remarkably different between ablation of STED and GP. STED ablation might eliminate fibrillatory conduction and control AF driver in patients with non-PAF. Freedom from atrial arrhythmia Funding Acknowledgement Type of funding source: None

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