Amol Agarwal

Outcomes of Single‐Stage Compared to Two‐Stage Basilic Vein Transposition Fistulae

Basilic vein transposition (BVT) fistulae are increasing in prevalence in the United States. We examined outcomes of BVT fistulae created in a single stage compared to those created in two stages. Prospective QA databases identified a consecutive cohort of 144 patients with BVT fistulae. Of these, 42% were created in one stage and 58% in two stages. Fistula maturation rates, mean time to fistula use and intensity of percutaneous interventions were compared; patency rates were compared from time of first intervention. Maturation rates (including assisted maturation) were 90% among 1‐stage and 75% among 2‐stage BVT (p = 0.02). Mean time to initiation of fistula use was 142 days (1‐stage) and 146 days (2‐stage) (p = 0.92). Intensity of percutaneous interventions was 1.84/patient‐year of dialysis (PYD) (1‐stage) and 2.15/PYD (2‐stage) (p = 0.57). Secondary patency at 1, 2, 3, and 4 years for 1‐stage BVT was 86%, 75%, 69%, and 57%; secondary patency at 1, 2, 3, and 4 years for 2‐stage BVT was 76%, 71%, 49%, and 25%, respectively (p = 0.12). BVT creation in two stages confers only a modest reduction in maturation rates and secondary patency and therefore should be considered over a synthetic graft in patients with basilic veins deemed inadequate for 1‐stage BVT.

Sa1934 ENDOSCOPIC FULL THICKNESS RESECTION USING A CLIP NON-EXPOSED METHOD FOR GASTROINTESTINAL TRACT LESIONS: A META-ANALYSIS

Background and study aims Endoscopic full-thickness resection (EFTR) allows for treatment of epithelial and subepithelial lesions (SELs) unsuitable to conventional resection techniques. This meta-analysis aimed to assess the efficacy and safety of clip-assisted method for non-exposed EFTR using FTRD or over-the-scope clip of gastrointestinal tumors. Methods A comprehensive literature search was performed. The primary outcome of interest was the rate of histologic complete resection (R0). Secondary outcomes of interest were the rate of enbloc resection, FTR, adverse events, and post-EFTR surgery. Random-effects model was used to calculate pooled estimates and generate forest plots. Results Eighteen studies with 730 patients and 733 lesions were included in the analyses. Indications for EFTR were difficult/residual colorectal adenoma, adenoma at a diverticulum or appendiceal orifice and early cancer (n=634), colorectal SELs (n =42), and upper gastrointestinal lesions (n = 51), other colonic lesions (n =6). Median size of lesions was 13.5mm. There were 22 failed EFTR attempts. Pooled overall R0 resection rate was 82% (95% CI: 75, 89). The pooled overall FTR rate was 83% (95% CI: 77, 89). The pooled overall enbloc resection rate was 95 (95% CI: 92, 96). The pooled estimates for perforation and bleeding were <0.1% and 2%, respectively. Following EFTR, a total of 110 patients underwent surgery for any reason [pooled rate 7% (95% 2, 14). The pooled rates for post-EFTR surgery due to invasive cancer, for non-curative endoscopic resection and for adverse events were 4%, <0.1% and <0.1%, respectively. No mortality related to EFTR was noted. Conclusions EFTR appears to be safe and effective for gastrointestinal lesions that are not amenable to conventional endoscopic resection. This technique should be considered as an alternative to surgery in selected cases. Original article Supplementary material Online content viewable at: https://doi.org/10.1055/a-1073-7593 Brewer Gutierrez Olaya I et al. Endoscopic full-thickness resection... Endoscopy International Open 2020; 08: E313–E325 E313 Published online: 2020-02-21

Endoscopic Therapy is Effective for Recurrent Anastomotic Biliary Strictures after Orthotopic Liver Transplantation

INTRODUCTION Orthotopic liver transplantation anastomotic biliary strictures (OLT ABS) are managed with endoscopic biliary stent therapy but the recurrence rate is substantial. Our aims were to retrospectively determine the recurrence rates of OLT ABS after initial successful stent therapy, characterize the management of recurrences and identify associated variables. MATERIALS AND METHODS Clinical data from 943 patients receiving non-living donor OLT at our institution from 2005-2012 were reviewed, and 123 OLT ABS patients receiving stent therapy were identified. Features of their endoscopic stent therapy and other pertinent clinical information were evaluated. RESULTS ABS recurred in 25.5% of patients (24/94) after an initial successful course of stent therapy. Recurrences were received a second course of endoscopic stent therapy and 67% of patients (16/24) achieved long-term remediation of ABS. Six patients underwent a third course of endoscopic stent therapy with 4 patients achieving remediation. Overall remediation rate among ABS recurrences was 83.3% (20/24). A bivariate comparison demonstrated HCV infection, age, median months of maximal stenting and a lower maximum cumulative stent diameter were risk factors for ABS recurrence. Using a Cox regression model, only HCV status proved to be a risk factor for recurrence. DISCUSSION In conclusion repeat stent therapy achieved high stricture remediation rates. Recurrence after the first or even second course of stenting should not imply failure of endoscopic therapy. A positive HCV status may be associated with higher stricture recurrence rates and this association should be further investigated.INTRODUCTION Orthotopic liver transplantation anastomotic biliary strictures (OLT ABS) are managed with endoscopic biliary stent therapy but the recurrence rate is substantial. Our aims were to retrospectively determine the recurrence rates of OLT ABS after initial successful stent therapy, characterize the management of recurrences and identify associated variables. MATERIALS AND METHODS Clinical data from 943 patients receiving non-living donor OLT at our institution from 2005-2012 were reviewed, and 123 OLT ABS patients receiving stent therapy were identified. Features of their endoscopic stent therapy and other pertinent clinical information were evaluated. RESULTS ABS recurred in 25.5% of patients (24/94) after an initial successful course of stent therapy. Recurrences were received a second course of endoscopic stent therapy and 67% of patients (16/24) achieved long-term remediation of ABS. Six patients underwent a third course of endoscopic stent therapy with 4 patients achieving remediation. Overall remediation rate among ABS recurrences was 83.3% (20/24). A bivariate comparison demonstrated HCV infection, age, median months of maximal stenting and a lower maximum cumulative stent diameter were risk factors for ABS recurrence. Using a Cox regression model, only HCV status proved to be a risk factor for recurrence. DISCUSSION In conclusion repeat stent therapy achieved high stricture remediation rates. Recurrence after the first or even second course of stenting should not imply failure of endoscopic therapy. A positive HCV status may be associated with higher stricture recurrence rates and this association should be further investigated.