Christiano Sakai

Endoscopic biliary recanalization by using a needle catheter in patients with complete ligation or stricture of the bile duct: safety and feasibility of a novel technique (with videos)

we did not encounter any procedural complications, the study cohort was made up of only 20 patients. Several larger series on EUS-guided PFC drainage have reported bleeding, perforation, infection, and stent migration as potential complications associated with the procedure. This study demonstrates that EUS-guided drainage is a minimally invasive, safe, and highly effective technique for the management of symptomatic PFCs after distal pancreatectomy. When the technology and technical expertise are available, EUS should be considered the first-line treatment modality for the management of these patients.

Flexible Endoscopic Zenker's Diverticulotomy Using Endoscopic Hood, Overtube, and Hook Knife

Abstract Zenkers diverticulum affects the elderly and is often without clinical conditions ideal for surgical treatment. In this scenario, endoscopic treatment is an appropriate indication, being a minimally invasive procedure. In this article, three videos demonstrate the techniques and details for a complete and safe treatment with low risk of complications and recurrence of the diverticulum. This article is part of an expert video encyclopedia.

Computed tomography colonography versus colonoscopy for the diagnosis of colorectal cancer: a systematic review and meta-analysis

Colorectal cancer (CRC) is a significant cause of morbidity and mortality. Optical colonoscopy (OC) is the first choice of investigation for assessing the state of the colon and it is excellent for CRC screening. Newer technologies such as computed tomography colonography (CTC) may also be useful in CRC screening. This systematic review compares the benefits of CTC and OC for CRC screening. This review includes all the available randomized clinical trials comparing CTC and OC for CRC screening in asymptomatic patients. Three studies were included in the systematic review and were submitted for meta-analysis. In the analysis of participation rates, only 2,333 of 8,104 (29%) patients who were invited for screening underwent the CTC, and only 1,486 of the 7,310 (20%) patients who were invited for screening underwent OC. The absolute risk difference in participation rate in the two procedures was 0.1 (95% CI, 0.05–0.14) in favor of CTC. In the analysis of advanced colorectal neoplasia (ACN) detection rates, 2,357 patients undergoing CTC and 1,524 patients undergoing OC were included. Of these, 135 patients (5.7%) who underwent a CTC and 130 patients (8.5%) who underwent an OC were diagnosed with ACN. The absolute risk difference in ACN detection rate in the two procedure types was −0.02 (with a 95% CI between −0.04 and −0.00) in favor of OC. CTC is an option for CRC screening in asymptomatic patients. However, as CTC was inferior in detecting ACN, it should not replace OC, which remains the gold standard.

Endoscopic treatment of upper-GI ulcer bleeding with hemostatic powder spray

Peptic ulcer is the most common cause of upper-GI bleeding (UGIB). Despite the advances in the management of this condition, mortality remains significant, at 10%. Hemospray (TC-325, Cook Medical, Bloomington, Ind) is a new hemostatic modality that has shown interesting results in a variety of causes, either as monotherapy or as rescue therapy, apparently with the advantage of its easy applicability, especially in difficult situations. Hemospray consists of a mineral powder that absorbs water when applied into the actively bleeding lesion, forming a mechanical barrier over the bleeding site. A 58-year-old man experienced major in-hospital UGIB. The patient did not describe previous diseases and presented to the emergency department with progressive dyspnea. A CT scan showed small nodules uniformly distributed throughout both lungs, suggestingmiliary tuberculosis asso-

Endoscopic colostomy with percutaneous colopexy: an animal feasibility study

BACKGROUND Indications for colostomy in colorectal diseases are obstruction of the large bowel, such as in cancer, diverticular disease in the acute phase, post-radiotherapy enteritis, complex perirectal fistulas, anorectal trauma and severe anal incontinence. Some critically ill patients cannot tolerate an exploratory laparotomy, and laparoscopic assisted colostomy also requires general anesthesia. OBJECTIVE To evaluate the feasibility, safety and efficacy of performing colostomy assisted by colonoscopy and percutaneous colopexy. MATERIALS AND METHODS Five pigs underwent endoscopic assisted colostomy with percutaneous colopexy. Animals were evaluated in post-operative days 1, 2, 5 and 7 for feeding acceptance and colostomy characteristics. On day 7 full colonoscopy was performed on animals followed by exploratory laparotomy. RESULTS Average procedure time was 27 minutes (21-54 min). Postoperative mobility and feeding of animals were immediate after anesthesia recovery. Position of the colostomy, edges color, appearance of periostomal area, as well as its function was satisfactory in four animals. Retraction of colostomy was present in one pig. The colonoscopy and laparotomy control on the seventh day were considered as normal. A bladder perforation that was successfully repaired through the colostomy incision occurred in one pig. The main limitation of this study is its experimental nature. CONCLUSION Endoscopic assisted colostomy with percutaneous colopexy proves to be a safe and effective method with low morbidity for performing colostomy in experimental animals, with possible clinical application in humans.