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

2_Pawa_Reducing Adverse Events

Pdf Summary

The document outlines strategies to minimize adverse events related to Endoscopic Ultrasound (EUS)-guided luminal interventions. These procedures include drainage of pancreatic fluid collections, gallbladder, bile duct, and gastric bypass operations.<br /><br />For pancreatic fluid collections, topics include the management of asymptomatic collections, necrotizing pancreatitis, and when and how to intervene in infected necrosis. The document emphasizes the necessity to answer key questions about intervention methods, such as the efficacy of open necrosectomy versus a step-up approach and conservative management strategies.<br /><br />It discusses the significance of understanding LAMS (Lumen-Apposing Metal Stents) and their deployment to improve outcomes in procedures such as cystgastrostomy drainage. Recommendations include thorough pre-procedure imaging, careful cystic neoplasm identification, and adherence to the timing of follow-up imaging and endoscopy.<br /><br />Emphasis is placed on tools and techniques for necrosectomy, outlining the use of devices like the Endoroter and hydrogen peroxide for lavage. The document also highlights the challenges and complications such as bleeding, migration, and perforation that practitioners may encounter, and recommends preventive measures, like using plastic double pigtail stents.<br /><br />In EUS-guided gallbladder drainage, the document advocates for its application in surgically unfit patients with acute cholecystitis, underscoring the need to understand stent deployment and complications management.<br /><br />The document explores technically challenging scenarios, including strategies for dealing with gallbladder conditions, preloading the guidewire, and managing adverse effects of procedures like stent migration and occlusion.<br /><br />Tips for success include understanding anatomy, ensuring good coordination during procedures, and being prepared with proper tools. Recommendations are made for planning and executing interventions, emphasizing multidisciplinary input and personalized patient care.<br /><br />Overall, the document suggests that EUS-guided procedures offer a less invasive, highly effective alternative to surgery, with the caveat that they require substantial technical expertise and careful patient selection.

Keywords

Endoscopic Ultrasound

EUS-guided interventions

pancreatic fluid collections

Lumen-Apposing Metal Stents

necrosectomy

gallbladder drainage

acute cholecystitis

stent deployment

complications management

multidisciplinary care