Efficacy of Trans-nasal Endoscopic Sphenopalatine Artery Ligation in the Management of Recurrent Posterior Epistaxis

Background: Recurrent posterior epistaxis is a challenging problem for most otolaryngologists. Of the several proposed treatment modalities, endoscopic ligation of SPA (Sphenopalatine artery) provides a simple and effective solution with relatively minor complications. Objectives: Aim of this study was to find out the success rate and complications of endoscopic ligation of SPA in the management of recurrent posterior epistaxis. Materials and Methods: This was an observational study conducted from Jan 2019 to Jan 2021. Total 60 patients were included in this study. Inclusion criteria were - recurrent epistaxis (at least 4 episodes in last 2 months) with bleeding point not seen in anterior rhinoscopy, Failure of previous conservative management with medications and nasal packing, age between 18–60 years of both sexes. All the patients underwent trans-nasal endoscopic Sphenopalatine artery ligation, and patients were followed up for 12 weeks to identify repeated bleeding and to evaluate complications. Results: In this study male to female ratio was 1.5:1. Mean age of study group was 44.66 (±8.62) years. No recurrent bleeding occurred in 51 (85%) and in 9 (15%) nasal bleeding occurred in the 2 months postoperative period. Anesthesia of incisor teeth occurred in 18 patients (30%), 22 patients (37%) complained about increased nasal crusting. Conclusion: Endoscopic ligation of Sphenopalatine artery shows good outcome in prevention of further episodes of epistaxis in most patients. Although some minor complications can occur, these are manageable. KYAMC Journal. 2021;12(3): 133-137

THE USE OF ENDOSCOPIC LIGATION AND PORTO-SYSTEMIC SHUNTING IN THE TREATMENT STAGE OF CHILDREN WITH PORTAL HYPERTENSION

The bleeding from esophageal and gastric varices is one of the most dangerous complications in children with prehepatic portal hypertension (PH). The literature sources systematization shows that the question of choosing the variceal bleeding prevention optimal method and timing remains debatable in children. The main purpose of our study was to determine the optimal management for the variceal bleeding preventive treatment in children with prehepatic PH. The obtained results indicate that the optimal option of the variceal bleeding prophylactic treatment may be a combination of endoscopic and surgical treatment methods in children with prehepatic PH.

OPEN ESOPHAGOGASTRIC DEVASCULARIZATION IN ITS OWN MODIFICATION. CASE SERIES PRELIMINARY REPORT

Introduction. Progress in surgical technologies and the presence of a category of patients with alcoholic cirrhosis of the liver and bleeding from esophageal varices who can not take nonselective beta-blockers and undergo repeated sessions of endoscopic ligation, allow to perform open esophagogastric devascularization as a reserve technique in surgical practice. Aim. Preliminary analysis of the results of performing open esophagogastric devascularization in its own modification. Material and methods. Open esophagogastric devascularization in its own modification was performed in five patients with Child-Pugh class B cirrhosis (3 men and 2 women) aged 44 to 59 years for delayed and planned indications after a repeated episode of bleeding from esophageal varices (from 2 up to 4 relapses). The technique included open esophagogastric devascularization with esophageal transection in combination with truncal vagotomy and pyloroplasty without splenectomy. Results. All patients underwent successful surgery. The duration of the operation (Me [min; max]) was 245 [230; 310] min. The time spent in the department of anesthesiology, resuscitation and intensive care was 2 [1; 5] days. During the postoperative follow-up of these patients for the period from 31 to 92 months, there were no recurrences of bleeding from esophageal varices. In all patients, endoscopic examination after a year showed regression of the degree of expansion of esophageal varices. Сonclusions. The use of the described methodology of multilevel stitching of submucosal esophageal varices in addition to hardware transection during open esophagogastric devascularization in its own modification enable to detect early all remaining significant varicose veins after hardware transsection of the esophagus and carry out their additional stitching without the need to open the esophagus and stomach potentially reduced the incidence of recurrent bleeding.

Traction-assisted endoscopic full-thickness resection followed by O-ring and over-the-scope clip closure in the stomach: an animal experimental study

Background and study aims Exposed endoscopic full-thickness resection (EFTR) enables the operator to obtain a sufficient surgical margin. However, insufflation leakage and secure endoscopic full-thickness closure (EFTC) remain problematic. This study aimed to evaluate the safety and feasibility of a new exposed EFTR. Patients and methods Exposed EFTR was performed for 2-cm virtual lesions in different locations of the upper stomach in four dogs. EFTR mainly involved half-circumferential EFTR of the endpoint and clip-line traction. Pulley traction was applied with the forward approach for the greater curvature. EFTC involved endoscopic ligation with O-ring closure to diminish insufflation leakage, followed by over-the-scope clip closure. Results Complete resection and technical success were achieved in all four cases. One case of intraoperative bleeding was endoscopically managed. No postoperative complications occurred in any cases. The median maximum resected size was 27.5 mm. The median procedure time of the total operation, EFTR, and EFTC was 76, 37, and 35.5 minutes, respectively. The 1-month survival rate was 100 %. Conclusions This therapeutic strategy may lead to the establishment of exposed EFTR.

Frecuencia y factores de riesgo asociados a re-sangrado posterior a ligadura de várices esofágicas en pacientes con cirrosis hepática

BACKGROUND: Re-bleeding of esophageal varices after endoscopic ligation is a frequent complication, that significantly increases morbidity and mortality in this patients. This study aims to describe the frequen-cy of rebleeding due to esophageal varices after endoscopic ligation, as well as the frequency of certain factors and their association with rebleeding. METHODS: Cross-sectional, descriptive and correlational, observational study. A total of 179 patients who underwent endoscopic ligation of esophageal varices participated. For the association analysis Chi2 test was applied, prevalence ratio was obtained, with 95% IC. Data was presented with charts, with frequencies and percentages. RESULTS: Alcoholism was the main cause of cirrhosis in patients that underwent ligation of esophageal varices (44.1%). Most of the cases were classified as Child Pugh Sore B functional class, with a frequency of 36.3%. The prevalence of rebleeding was 49.2% (95% CI 41.55%- 56.76%), it was more frequent in patients 65 years old and older (58%), and male patients (64.8%). Death rate due to rebleeding after ligation was 43%. We found significant statistical association of rebleeding with factors such as: TPT >33.3 (PR: 1.91, 95% CI 1.07-3.39, p value =0.00); moderate and severe anemia (PR: 1.43, 95% CI 1.05-1.96, p value =0.02), and blood transfusion (PR: 2.23. 95% CI 1.37-3.65, p value=0.00). CONCLUSION: Rebleeding frequency was 49.2% (early and late rebleeding), it was more common in male patients, and patients aged 65 or more. This study found statistical association between rebleeding and: elevated values of partial thromboplastin time, moderate and severe anemia, and blood transfusion. Mor-tality due to rebleeding was 43%. KEYWORDS: ESOPHAGEAL AND GASTRIC VARICES, LIVER CIRRHOSIS, PORTAL HYPERTENSION