Recent Endoscopic Ultrasound-Related Publications With Potential to Influence Clinical Practice

The field of endoscopic ultrasound (EUS) has evolved significantly over the last two decades from being a tool of only diagnostic purpose to tissue acquisition and now therapeutic potential. There have been several important publications in the field of EUS in the last few years, which had a major impact in the clinical management of various gastrointestinal disorders. In this review, we discuss four such articles that in our opinion will significantly impact the role of EUS in treating various conditions. The first article is a randomized controlled trial comparing EUS-guided gall bladder drainage with percutaneous gall bladder drainage for high-risk acute cholecystitis. The second article is a randomized controlled trial comparing EUS versus minimally invasive surgery for necrotizing pancreatitis. The third article is a novel human study of EUS-guided portal pressure measurement in patients with portal hypertension. The last article is also a randomized controlled trial evaluating the role of rapid on-site evaluation for EUS-guided fine needle biopsy in solid pancreatic lesions.

A case report of percutaneous direct injection of N-butyl-2-cyanoacrylate (NBCA) to treat a pancreatic duodenal stump leak after a simultaneous pancreas and kidney transplantation

Background Simultaneous pancreas and kidney transplantation (SPK) is a treatment option for patients with end-stage renal disease due to type 1 diabetes mellitus. We report a patient with a refractory fistula due to leakage from the duodenal stump of the pancreas graft after an SPK with bladder drainage who was successfully treated with a percutaneous direct injection of N-butyl-2-cyanoacrylate (NBCA). Case presentation A 60-year-old female with a 33-year history of type 1 diabetes mellitus and a 10-year history of renal replacement therapy underwent an SPK in 2015. At the time of transplantation, an abdominal aortic aneurysm with a high risk of rupture was treated by a Y-graft replacement prior to the SPK. Bladder drainage of the pancreas graft was chosen to avoid a vessel graft infection. The patient’s postoperative course was uneventful. The patient was discharged on postoperative day 93 with good-functioning pancreas and kidney grafts. One and a half years after the operation, the patient was found to have acute graft pancreatitis and a leak from the duodenal stump of the pancreas graft due to a paralytic neurogenic bladder. The insertion of an indwelling catheter into the bladder and the endoscopic-guided insertion of a catheter into the graft pancreatic duct through the duodenum/bladder anastomosis did not result in the closure of the fistula. Therefore, NBCA was injected at the site of the leak point using CT-guided technique. The fistula was completely closed immediately after the injection, with no recurrences of leaks. Conclusions A percutaneous direct injection of NBCA is one of the treatment options to treat intractable fistulas.

An elderly male with lower urinary tract symptoms during COVID-19 pandemic: Extraperitoneal perforation of bladder diverticulum

Case: We present a case of spontaneous extra-peritoneal rupture of an acquired diverticulum an elderly male with symptoms of bladder outlet obstruction who presented in emergency with acute abdomen. Outcome: The acute phase was managed conservatively with bladder drainage and intravenous antibiotics. He recently underwent Transurethral Resection of Prostate. He is asymptomatic on follow-up. Conclusions: Acquired bladder diverticulum are rare in adults and are mostly seen in patients with high pressure bladder due to bladder outlet obstruction. Atraumatic extraperitoneal ruptures of diverticulum are uncommonly reported.

Bouveret syndrome: a rare cause of gastric outlet obstruction

Bouveret syndrome is a rare cause of gastric outlet obstruction. It is characterised by the presence of an obstructing gallstone in the pylorus or proximal duodenum, which has travelled to its obstructing position via an acquired fistula. Our case involves a 73-year-old man presenting to the acute surgical take with a 2-day history of right-sided abdominal pain and vomiting. His medical history included perforated cholecystitis treated with antibiotics and percutaneous gall bladder drainage, 1 year earlier. Examination and blood tests were suggestive of gastric outlet obstruction. CT abdomen and pelvis demonstrated a large gallstone obstructing the duodenum, confirming a diagnosis of Bouveret syndrome. The patient improved following gastrolithotomy, and was discharged 2 weeks postoperatively. Fistula formation is a complication of chronic cholecystitis and therefore Bouveret syndrome should be considered in patients with a background of gallstone disease presenting with gastric outlet obstruction.

Innovative option for removal of encrusted, incarcerated longstanding indwelling Foleys catheter

Encrustation of indwelling Foley’s catheter is one of the common complication associated with long term indwelling catheter, encrusted catheter are often incarcerated and difficult to remove. Many methods have been evolved to remove stuck urethral catheter but each has its own complications. Here we have described a case of 90 year old male patient with chronic indwelling (7 months) Foley urethral catheter, who presented with chronic urinary retention. After initial bladder drainage with 8 Fr feeding tube by the side of catheter. Massive encrustation was fragmented by performing laser cyst lithotripsy with 6/7.5 Fr semi rigid ureter scope and 30 Watt Holmium laser. Catheter was removed intact and stone fragments evacuated. Post-operative recovery was uneventful. Surgical removal with minimally invasive technique should be treatment of choice for encrusted and stucked urethral catheter. Traditional technique of performing suprapubic cystostomy for removal of Foleys catheter are associated with various complications and should be reserved for hospital with limited facilities.

Selection of the urine derivation method in patients with acute urinary retention before surgical treatment of benign prostatic hyperplasia

Actuality. Nowadays it is necessary to recognize that the problem of acute urinary retention associated with benign prostatic hyperplasia is one of the most frequent causes of hospitalization into the urology hospital. A number of standard urine derivation techniques are used as a part of preoperative treatment. The aim of the study is to optimize the choice of the preoperative bladder drainage. Material and methods. The data of 280 patients hospitalized in the Urology Department of Samara City Clinical Hospital No. 8 over the period of 20122015 were studied to evaluate the results of acute urinary retention. Results and conclusions. Retrospective pseudo-factor analysis allows to evaluate the effect of the bladder drainage method on the results of treatment of acute urinary retention in benign prostatic hyperplasia. The results can be used as the basis for a mathematical model which allows to predict the outcome of the treatment of acute urinary retention during surgical treatment of benign prostatic hyperplasia. Obtained data were used to develop recommendations on the methods of bladder drainage as a part of preoperative treatment in patients with benign prostatic hyperplasia.

Risk factors of complications after plastics of vesico-vaginal fistulas with a preoperative application of autoplasma, enriched with platelets

Introduction. Vesicovaginal fistula, or VVF, is one of the most urgent and sociomedically significant problems in modern urology. As of today, more than three million women suffer from VVF worldwide. Purpose of the study. To evaluate the risk factors for complications in a group of patients with VVF operated with the preliminary use of platelet-rich plasm, or PRP. Materials and methods. Study included 22 patients who underwent surgical closure of VVF in period from 2011 to 2018 with the preliminary preparation of PRP tissues. A total of 22 patients were divided into two groups: the 1st group included 14 patients who had no complications, while the 2nd group included eight women with developed complications. Results. Statistically significant differences in the assessment of clinical characteristics of patients in the two groups were observed for the following indicators: duration of hospitalization (p<0.01), duration of bladder drainage (p<0.01). Urinary tract infection, or UTI, was identified more often in the group with complications (p<0.05). Presence of hypertension (p<0.05), pain syndrome (p<0.05), macrohematuria (p<0.05). Statistically significant differences in the assessment of characteristics of vesicovaginal fistula of patients in the two groups were observed for four indicators: distance between the fistula and the internal urethral orifice (p<0.05), the largest diameter of the fistula (p<0.05), the stage of сicatrization (p<0.05), the diameter of the fistula before surgical treatment (p<0.01). Conclusion. Results of the study dictate the need for an operating surgeon to carefully select the timing and volume of surgical treatment, taking into account many factors mentioned above. Patients should be made aware in detail of possible complications that might arise following VVF fistuloplasty and the reasons for their development in order to adequately prepare for surgical treatment, compensate for concomitant diseases, optimize tissues and blood vessels for better healing of the postoperative wound.