Browsing by Author "Peetermans, Joyce"

Now showing 1 - 2 of 2
  • Thumbnail Image
    Item
    A new through-the-scope clip with anchor prongs is safe and successful for a variety of endoscopic uses
    (Thieme, 2024-06-21) Guardiola, John J.; Rex, Douglas K.; Thompson, Christopher C.; Mosko, Jeffrey; Ryou, Marvin; Peetermans, Joyce; Rousseau, Matthew J.; von Renteln, Daniel; Medicine, School of Medicine
    Background and study aims Endoscopic through-the-scope clips (TTSC) are used for hemostasis and closure. We documented the performance of a new TTSC with anchor prongs. Patients and methods We conducted a prospective case series of the new TTSC in 50 patients with an indication for endoscopic clipping at three hospitals in the United States and Canada. Patients were followed for 30 days after the index procedure. Outcomes included defect closure and rate of serious adverse events (SAEs) related to the device or procedure. Results Fifty patients had 56 clipping procedures. Thirty-four procedures were clipping after endoscopic mucosal resection (EMR) in the colon (33) or stomach (1), 16 after polypectomy, two for hemostasis of active bleeding, and one each for fistula closure, per-oral endoscopic myotomy mucosal closure, or anchoring a feeding tube. Complete defect closure was achieved in 32 of 33 colon EMR defects and 21 of 22 other defects. All clips were placed per labeled directions for use. In 41 patients (82.0%), prophylaxis of delayed bleeding was reported as an indication for endoscopic clipping. There were three instances of delayed bleeding. There were no device-related SAEs. The only technical difficulty was one instance of premature clip deployment. Conclusions A novel TTSC with anchor prongs showed success in a range of defect closures, an acceptable safety profile, and low incidence of technical difficulties.
  • Thumbnail Image
    Item
    Covered and uncovered biliary metal stents provide similar relief of biliary obstruction during neoadjuvant therapy in pancreatic cancer: a randomized trial
    (Elsevier, 2019) Seo, Dong Wan; Sherman, Stuart; Dua, Kulwinder S.; Slivka, Adam; Roy, Andre; Costamagna, Guido; Deviere, Jacques; Peetermans, Joyce; Rousseau, Matthew; Nakai, Yousuke; Isayama, Hiroyuki; Kozarek, Richard; Medicine, School of Medicine
    Background and Aims Preoperative biliary drainage with self-expanding metal stents (SEMSs) brings liver function within acceptable range in preparation for neoadjuvant therapy (NATx) and provides relief of obstructive symptoms in patients with pancreatic cancer. We compared fully covered SEMSs (FCSEMSs) and uncovered SEMSs (UCSEMSs) for sustained biliary drainage before and during NATx. Methods Patients with pancreatic cancer and planned NATx needing treatment of jaundice and/or cholestasis before pancreaticoduodenectomy were randomized to FCSEMS versus UCSEMS. Primary endpoint was sustained biliary drainage, defined as absence of reinterventions for biliary obstructive symptoms, and was assessed from SEMS placement until curative intent surgery (CIS) or 1 year. Results The intent-to-treat population had 119 patients (59 FCSEMS, 60 UCSEMS). Sustained biliary drainage was equally successful with FCSEMS and UCSEMS (72.2% vs 72.9%, noninferiority P=0.01). Reasons for FCSEMS and UCSEMS failure differed significantly between groups and included tumor ingrowth in 0 versus 16.7%, P<0.01, and stent migration in 6.8% vs. 0, P=0.03, respectively. Serious adverse event rates related to stent placement were insignificantly different in both groups (23.7% (14/59) vs 20.0% (12/60), P=0.66), as were acute cholecystitis rates when gallbladder in situ (9.3% (4/43) vs 4.8% (2/42), P=0.68) for FCSEMSs and UCSEMSs, respectively. In our study, independent of stent type, predictors of reinterventions were 4 cm stent length and presence of gallbladder. Conclusion FCSEMSs and UCSEMSs provide similar preoperative management of biliary obstruction in pancreatic cancer patients receiving NATx, but mechanisms of stent dysfunction depend on stent type, stent length, and presence of the gallbladder.