Advanced Endoscopy Fellows Program | September 2024-Tyberg

Tyberg_Interventional EUS Troubleshooting

Pdf Summary

"Interventional EUS Troubleshooting" by Dr. Amy Tyberg provides an in-depth exploration of adverse events (AEs) associated with Interventional Endoscopic Ultrasound (EUS) and offers strategies to mitigate and manage these complications.<br /><br />The document first highlights the most common AEs, which include bleeding, stent migration, occlusion, and maldeployment. It details practical tips to anticipate and avoid these events as well as rescue techniques when they occur.<br /><br />For bleeding, Dr. Tyberg advises assessing vascular anatomy and using Doppler to ensure a clear needle path. If bleeding occurs, techniques include waiting for stent expansion, epinephrine injections, balloon dilation, and thermocoagulation.<br /><br />Stent migration is tackled by suggesting the avoidance of tension on the flanges and choosing the appropriate stent. Rescue techniques include observation, antibiotics, and sometimes surgical intervention.<br /><br />Occlusion is addressed by recommending timely LAMS removal and avoiding passages through inflamed or neoplastic tissues. Endoscopy for debris removal and balloon dilation are primary rescue methods.<br /><br />Maldeployment classifications were introduced by Dr. Tyberg, identifying types based on the location of the improperly deployed flange. Tips for preventing maldeployment include thorough planning and cautious deployment. Rescue involves stabilizing the patient, potentially removing and replacing the LAMS, and employing stent-in-stent techniques.<br /><br />This comprehensive guide is enriched with video case examples for practical understanding and ends with references and a note of gratitude for the audience's attention.

Keywords

Interventional EUS

adverse events

bleeding

stent migration

occlusion

maldeployment

rescue techniques

LAMS removal

endoscopic ultrasound

Dr. Amy Tyberg