11 research outputs found
Thalidomide for refractory gastrointestinal bleeding from vascular malformations in patients with significant comorbidities
No full textThalidomide for refractory gastrointestinal bleeding from vascular malformations in patients with significant comorbidities
No full textBACKGROUND: Refractory gastrointestinal bleeding (GIB) secondary to gastrointestinal vascular malformations (GIVM) such as gastrointestinal angiodysplasia (GIAD) and gastric antral vascular ectasia (GAVE) remains challenging to treat when endoscopic therapy fails. Recently thalidomide has been suggested as a treatment option for refractory GIB.
AIM: To determine the outcome of patients treated with thalidomide for refractory GIB due to GIVM.
METHODS: IRB approved, single center, retrospective review of electronic medical records from January 2012 to November 2018. Patients age \u3e 18 years old, who had \u3e 3 episodes of GIB refractory to medical or endoscopic therapy, and who had been treated with thalidomide for at least 3 mo were included. The primary endpoint was recurrence of GIB 6 mo after initiation of thalidomide.
RESULTS: Fifteen patients were included in the study, all with significant cardiac, hepatic, or renal comorbidities. The cause of GIB was GIAD in 10 patients and GAVE in 5 patients. Two patients were lost to follow up. Of the 13 patients followed, 38.5% (
CONCLUSION: Thalidomide appears to be an effective treatment for refractory GIB due to GIAD or GAVE in a Western population with significant comorbidities
Afferent Loop Syndrome as Second Presentation of Gastric Outlet Obstruction in Patient With Billroth II Anatomy
No full textAfferent loop syndrome can result from both benign and malignant strictures of the biliary limbs of patients with surgically altered anatomy. Afflicted patients accumulate intestinal and pancreaticobiliary secretions, which leads to bowel distention and pain. We describe the endoscopic management of a 52-year-old woman with a history of Billroth II gastrojejunostomy due to gastric cancer who developed malignant gastric outlet obstruction and subsequently malignant afferent loop syndrome, using lumen-apposing metal stents
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EUS-guided bilateral biliary access and metal stent placement post-Whipple resection
No full textVideo 1Narration of case and demonstration of EUS-guided bilateral stent placement for malignant hilar obstruction post-Whipple resection using integrate and rendezvous approach
Wages, housework and attitudes in the Philippines
No full textThis paper is one of the few studies that systematically analyzes housework in the Philippines. It seeks to understand how wages and attitudes to work and family life affect the time devoted to housework. Based on different specifications and estimators, our findings indicate that respondents’ own wages are not a significant predictor of the hours they spend on housework but that they are a significant predictor of the time spouses devote to non-market production. We find that husbands’ housework hours are positively affected by female respondents’ wages, while wives’ housework hours are negatively affected by male respondents’ wages. We turn to the Philippine context to explain these results and find the combination of egalitarian society and gender inequality in the labor market to be plausible explanations. Results also show that both wages and attitudes have direct effects on wives’ housework time but that some of the effects of wages are mediated by respondents’ attitudes toward gender roles. JEL code: D13, J22. © 2017, © The Author(s) 2017
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Utilization of an overtube for placement of a lumen-apposing metal stent for removal of a capsule endoscope retained proximal to an ileal stricture
No full textVideo 1Narration of case and demonstration of overture-mediated lumen-apposing metal stent placement for removal of retained capsule endoscopy
Utilization of an overtube for placement of a lumen-apposing metal stent for removal of a capsule endoscope retained proximal to an ileal stricture
No full textCurrent state of biliary cannulation techniques during endoscopic retrograde cholangiopancreatography (ERCP): International survey study.
No full textCurrent state of biliary cannulation techniques during endoscopic retrograde cholangiopancreatography (ERCP): International survey study
No full textBackground and study aims Endoscopist techniques affect biliary
cannulation success and the risk of adverse events during endoscopic retrograde
cholangiopancreatography (ERCP). This survey study aims to understand the current practice of
biliary cannulation techniques among endoscopists.
Methods Practicing endoscopists were sent an anonymous
28-question electronic survey on biliary cannulation techniques and intraprocedural
pancreatitis prophylactic strategies.
Results The survey was completed by 692 endoscopists (6.2%
females). A wire-guided cannulation technique (WGT) was the preferred initial biliary
cannulation approach (95%). The preferred secondary approaches were a double-wire (DWT)
(65.8%), precut needle-knife technique (NKT) (25.7%), transpancreatic sphincterotomy (5.9%) or
other (2.6%). Overall, 18.1% of respondents were not comfortable with NKTs. In the setting of
pancreatic duct (PD) access, 81.9% and 97% reported a threshold of three or more wire passes
or contrast injections into the PD, respectively, before changing strategy, 34% reported
placement of a prophylactic PD stent <50% of the time and 12.1% reported removal of the PD
stent at the end of the procedure. Advanced endoscopy fellowship (AEF) training and high
volume (>200 ERCPs per year) were associated with comfort with precut NKTs and likelihood
of prophylactic PD stent (P<0.001 for both).
Conclusions A WGT technique followed by the DWT and NKT were the
preferred biliary cannulation techniques; however, almost one-fifth of respondents were not
comfortable with the NKT. There was considerable variability in secondary cannulation
approaches, time spent attempting biliary cannulation and prophylactic PD stent placement,
factors known to be associated with cannulation success and adverse outcomes
