Suthep Udomsawaengsup

Endoscopic ultrasound forum summary from the asian pacific digestive week 2012

Pradermchai Kongkam, Benedict M. Devereaux, Ryan Ponnudurai, Thawee Ratanachu-ek, Anand V. Sahai, Takuji Gotoda, Suthep Udomsawaengsup, Jacques Van Dam, Nonthalee Pausawasdi, Somchai Limsrichemrern, Dong-Wan Seo, Shomei Ryozawa, Yoshiki Hirooka, Yongyut Sirivatanauksorn, Siyu Sun, Sundeep Punamiya, Takao Itoi, Bancha Ovartlanporn, Ichiro Yasuda, Tiing Leong Ang, Hsiu-Po Wang, Khek Yu Ho, Heng Boon Yim, Kenjiro Yasuda, Christopher J.L. Khor

Modular design of a real-time passive magnetic localization system for enhanced safety in nasogastric intubation

Nasogastric (NG) intubation is a commonly performed clinical procedure to gain direct access to the stomach. This procedure is usually done blind without visual feedback; and final confirmation of correct placement is usually achieved using radiography. Hence lacking of real-time localization, the current clinical practice poses high risks of erroneous placement which could potentially cause morbidity and mortality. In this paper, we present a modular design of a passive magnetic field-based, real-time localization system to detect possible erroneous placements at key locations along the upper gastrointestinal tract. Three high risk areas during the intubation process were identified and three independent modules were developed to target these three regions of interest namely: laryngopharynx, carina of the lungs and stomach respectively. A modular approach and design allows the system to be easily adapted to different patients by positioning the modules with reference to the corresponding anatomical landmarks. Verification tests were performed on a manikin model and a soft cadaver. In both environments, the proposed modular system is efficacious in detecting different types of misplacements, such as incorrect insertion to the respiratory system and tube coiling. With the proposed modular system, the clinician can determine and prevent any erroneous placement in real-time. It is expected that this approach could eventually replace the radiography confirmation, which is both expensive and time-consuming, in the current clinical routine.

Outcome of endoscopic small-bore naso-jejunal tube stenting in early postoperative jejunal limb obstruction after gastrectomy

BackgroundEarly postoperative jejunal limb obstruction is a rare complication following gastric surgery with jejunal reconstruction. The condition is mainly attributed to kinking of the jejunal limbs, gastrojejunal or jejunojejunal anastomosis. There has been currently limited information regarding the safety and efficacy of endoscopic treatment in patients with early postoperative jejunal obstruction. We aimed to investigate outcome of endoscopic small-bore naso-jejunal (N-J) tube stenting across the obstructed segment in patients with uncomplicated early postoperative partial jejunal limb obstruction.MethodsAll patients diagnosed of jejunal limb obstruction within 8 weeks after gastric-related surgery were reviewed. Patients with malignant obstruction, complete closed loop obstruction, sepsis, instability, intestinal strangulation, or perforation were excluded. All patients underwent endoscopic dekinking and stenting for 2 weeks with an N-J tube using 16-French single lumen plastic nasogastric tube across the obstruction segment after failed conservative therapy. Successful N-J tube placement across the obstruction point was confirmed by contrast study. Complications, technical, and clinical success were evaluated.ResultsTwenty-one patients met the criteria. The primary operations were 7 partial gastrectomies with Billroth-II reconstruction, 7 total or partial gastrectomies with Roux-en-Y reconstruction and 4 Whipple’s operations, 2 bypass procedures, and 1 proximal gastrectomy. Most common site of obstruction was jejunojejunal anastomosis and gastrojejunal anastomosis following Roux-en-Y and Billroth-II reconstruction, respectively. Endoscopic N-J tube placement was technically successful in 20 out of 21 patients (95%). One patient had aspirated pneumonia. There was no procedure-related mortality. After N-J tube removal, clinical success was demonstrated in 19 out of 20 patients (95%) at the median duration of 6 months. One patient underwent reoperation due to repeated tube dislodgement.ConclusionsEndoscopic stenting with a 16-F naso-jejunal tube across the angulated segment is safe and effective for treatment of patients with uncomplicated early postoperative partial jejunal limb obstruction following gastric surgery with jejunal reconstruction.

Selection Guidelines for Bariatric Surgery

Morbid obesity is becoming a serious public health problem worldwide. In Asian countries, the prevalence has increased many times over in the past few decades. Bariatric surgery has been shown to be the most effective treatment for these patients. The primary goal of bariatric surgery is to reduce the body weight or the body mass index (BMI). However, it is increasingly recognized that this surgery can also help several medical comorbidities associated with obesity such as type 2 diabetes mellitus, dyslipidemia, obstructive sleep apnea etc.

Prevention and Management of Gastro-Jejunostomy Anastomotic Strictures

A stricture of the gastrojejunal(GJ) anastomosis is one the most common complication after laparoscopic roux-en-Y gastric bypass(LRYGB), ranging from 2.9 to 23 % across numerous studies [1, 2]. An anastomotic stricture has to be suspected if the patient has frequent nausea, emesis and/or dysphagia with liquids or meal. A stricture can be confirmed by the inability to pass the gastroscope (10-mm) through the gastrojejunal anastomosis. It usually occurs 1 month after the surgery and can be classified as early or late (within or longer than 30 days after operation, respectively [3].