ASGE Postgraduate Course at ACG: Innovative Practices for the Endoscopist of Today, Tomorrow and Beyond | October 2023-2_Pawa

2_Pawa_Reducing Adverse Events

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The document is a comprehensive presentation by Dr. Swati Pawa on reducing adverse events in Endoscopic Ultrasound (EUS)-related luminal interventions, delivered at the ASGE Postgraduate Course at ACG 2023. It covers various EUS-guided procedures such as pancreatic fluid collection, gallbladder drainage, and gastroenterostomy, and highlights strategies for improving outcomes and minimizing complications.<br /><br />### Key Objectives and Content<br /><br />1. **Transluminal Drainage**:<br />   - Various types: pancreatic fluid collections (cyst-enterostomy), gallbladder (cholecystostomy), bile duct (choledocho-enterostomy), and stomach (gastrojejunostomy).<br /><br />2. **Pancreatic Fluid Collection**:<br />   - Mostly asymptomatic but can be complicated by necrosis and infection.<br />   - Imaging for detecting solid debris and decision-making between open necrosectomy and step-up approach.<br /><br />3. **Acute Pancreatitis**:<br />   - Categorized into interstitial and necrotizing pancreatitis.<br />   - Intervention criteria and timing for infected necrosis.<br /><br />4. **LAMS vs. Plastic Stents**:<br />   - Except for procedure duration, both have similar outcomes.<br />   - To reduce adverse events, follow-up imaging and stent removal at 3 weeks if resolved.<br /><br />5. **Technical Details for EUS Procedures**:<br />   - Importance of using cutting current cautiously (Cautery/GW).<br />   - Timing and positioning in EUS cystgastrostomy drainage.<br />   - Post-procedure planning like deploying pigtail stents and imaging.<br /><br />6. **Complications and Prevention**:<br />   - Early detection and addressing complications like bleeding, stent migration, and perforation.<br />   - Use of "Perforation tool kit" for quick response.<br /><br />7. **Gallbladder Drainage**:<br />   - An emerging alternative for surgically unfit patients.<br />   - Using LAMS for better outcomes and the importance of technical accuracy in stent placement.<br /><br />8. **EUS-Guided Gastroenterostomy**:<br />   - Suitable for inoperable malignant obstructions.<br />   - Comparable to surgical bypass with fewer adverse events and quicker patient recovery.<br /><br />### Take-Home Points<br /><br />- Master technical skills and know one’s limits.<br />- Select patients based on expertise and overall clinical understanding.<br />- Be prepared to handle complications and stent misdeployments.<br />- Contingency planning is critical for successful outcomes.

Keywords

Endoscopic Ultrasound

EUS-guided procedures

Pancreatic fluid collection

Gallbladder drainage

Gastroenterostomy

Adverse events

LAMS vs. Plastic Stents

Technical details

Complications prevention

ASGE Postgraduate Course