Volume 86 - 2023 - Fasc.1 - Original articles
Endoscopic management of buried bumper syndrome using the Balloon Dilation Pull (BDP) technique: a multicenter analysis
Background and study aims: Buried bumper syndrome (BBS)
may complicate percutaneous endoscopic gastrostomy placement.
In these patients, endoscopic treatment ought to be considered.
Various approaches have been published, ranging from dissectionbased
techniques to novel dedicated devices, although the evidence
supporting the use of the Balloon Dilation Pull (BDP) technique has
been limited to single case reports. The aim of this paper is to assess
the feasibility, efficacy and safety of the systematic use of the BDPtechnique
for the endoscopic treatment of BBS.
Patients and methods: We performed a retrospective multicenter
analysis of prospectively collected data from all patients treated
with the BDP-technique between January 2011 and November
Results: In total, 26 patients were identified (median age 72 (SD
± 13) years, 74% male, 84.6% underlying neurological disease).
Technical success was achieved in 92.3%, with a median procedure
time of 17.5 minutes (range 5-27). Adverse events were identified
in 3.8% of patients (N=1, aspiration, ASGE lexicon severity grade:
Conclusions: Our experience suggests that the BDP-technique
is highly efficacious and safe, using accessories readily available
in every endoscopic unit. Given the limited procedure time and
tools required, this procedure has the potential to further optimize
patient care in the context of BBS.
Driving performance of outpatients achieving discharge criteria after deep sedation is worse than these of their escort-driver: a prospective observational study on simulator
Background: Achieving post-anesthesia discharge criteria after
surgery or outpatient procedures does not mean that the patient
has regained all his or her faculties, such as driving. Although
mandated by many clinical guidelines, there is no evidence that
escort-drivers reduce the risk of traffic accidents after deep
sedation. The purpose of this study was to evaluate that hypothesis
that driving performance as measured using a driving simulation
would not differ between patients who had undergone deep
sedation for gastrointestinal endoscopy meeting discharge criteria
and their escorts.
Methods: This prospective study included patients scheduled
for ambulatory gastrointestinal endoscopy under deep propofol
sedation (patient group) and their escorts (escort group). Driving
performance of escorts and patients (when discharge criteria were
met) was assessed using a driving simulator.
Results: 30 patients and their escorts were included. Patients
crossed the midline significantly more frequently than escorts (3
[2-4] (median [IQR]) and 2 [1-3] crossings, respectively, p=0.015].
Patients were speeding for a higher proportion of the distance
traveled compared with escorts (37 (20)% (mean (SD)) and 24
(17)% in patients and escorts, respectively, p = 0.029). There were
no significant differences between groups in other simulation
Conclusions: The ability to stay within the traffic lanes, as
measured by the number of midline crossing during a simulated
driving performance, is impaired in patients who meet discharge
criteria after gastrointestinal endoscopy under deep sedation
compared with their escorts. This finding does not support a
practice of allowing patients to drive themselves home after these
Epidemiological characteristics of a population visiting a patient-centered informative website about irritable bowel syndrome
Background and aims: Irritable bowel syndrome (IBS) is a
chronic disorder characterized by abdominal pain and an altered
bowel habit. The aim of this study was to evaluate the characteristics
of a population visiting a patient-centered informative website
Methods: Five digital surveys were used to assess the Rome
IV criteria, red flag symptoms, healthcare use, psychological
comorbidities, quality of life, symptom severity, diet, physical
activity. Patients were divided into a Rome positive and negative
population with the Rome positive population being further
subtyped based on dominant stool pattern.
Results: Red flag symptoms (42%) and comorbid psychological
disorders (65% anxiety and 39% depression) were common.
Despite consulting health care professionals and therapy, most
patients (96%) still experienced moderate to severe symptoms
with an average impact on quality of life. 73% performed regular
physical exercise and 25% of the Rome positive population
followed the FODMAP diet. Almost all participants consulted a
health care professional at one point in time and used some form
of therapy. 54% of the patients believed there is generally sufficient
information available and 57% thinks that their physician takes
IBS seriously. However, only 41% thinks that their physician has
sufficient knowledge about IBS.
Conclusions: This study underlines the importance of a thorough
characterization of IBS patients. Furthermore, patients expressed
an urgent need for high quality information and education for both
health care professionals and patients.
Endoscopic ultrasound-guided biliary drainage for distal malignant biliary obstruction: a prospective 3-year multicenter Egyptian study
Background/Aim: Malignant biliary obstruction (MBO) is often diagnosed at late stages with mostly unresectable lesions. Recently, EUS-guided biliary drainage (EUS-BD) has gained wide acceptance and appears to be a feasible and safe backup option after ERCP failure in such patients. Herein, we aimed to represent a 3-year multi-center Egyptian experience in the application of this challenging procedure for distal MBO as a salvage technique after failed ERCP.
Patients and methods: This was a prospective multi-center study of patients underwent EUS-BD for distal MBO in the duration between December 2018 and December 2021, after ERCP failure.
Results: Ninety-one patients (59 males, median age: 61 years) were included in the study. EUS-guided extrahepatic approach including choledocho-duodenostomy (CDS) was done for 48 patients (52.8%), followed by choledecho-antrostomy (CAS) in 4 patients (4.4%). The intrahepatic approach included hepaticogastrostomy (HGS) for 35 patients (38.5%) and antegrade stenting (AG) stenting in 2 patients (2.2%), while Rendezvous (RV) approach was performed in 2 patients (2.2%). Technical and Clinical success were achieved in the majority of cases; 93.4% and 94.1% respectively. Adverse events occurred in 13.2% of patients which were mostly mild (8.2%) to moderate (2.4%). Only one patient died within 48h after the procedure with progression of preceding sepsis and organ failure.
Conclusion: EUS-BD is a feasible option, even in developing countries, after a failed ERCP, and it is a relatively safe option in patients with MBO once experienced team and resources were present. Majority of cases in our study have achieved technical and clinical success with relatively low incidence of adverse events