Endotherapy of postcholecystectomy biliary strictures (PCBS) with multiple plastic stents (MPSs): Long-term results in a large cohort of patients @GIE_Journalsciencedirect.com/science/articl…
Methods & Design: 196 pts with benign biliary stricture (BBS) treated with endoscopic MPS identified retrospectively from ERCP database with a 7 year follow-up period.
Results: in 154 patients, MPS treatment success rate was 96.7%
Early ERCP-related AEs occurred in 6/151 pts. PCBS recurrence rate was 9.4% after a mean follow-up time of 11.2 yrs. 16.5% of pts repeated ERCP due to cholangitis There was no procedure related mortality
- Conclusion: MPSs could be considered effective& low cost 1st line treatment for PCBS
- Strengths: study looked at MPS treatment in PCBS exclusively + good follow-up data
- Limitations: Lack of control group + more data needed comparing FC-SEMS vs MPS for BBSs caused by PCBS
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@MondayNightIBD@DCharabaty 1/ Thiopurines are associated with an increased risk of NMSC (non-melanoma skin cancer)
Which of the following is true about this risk relative to non-exposed IBD pts, duration of thiopurine use , and after thiopurine cessation 🛑#Back2Basics#MondayNightIBD
@MondayNightIBD@DCharabaty 32 y/o M with UC here for f/u. In remission x7 yrs on AZA 75mg/d. He is here to discuss his concerns about his risk of lymphoma associated w/ AZA. (HSTCL= hepatosplenic T cell; EBV-L= EBV assoc lymphoma) Which statement is true? #Back2Basics#MondayNightIBD
@MondayNightIBD@SobiaMujtabaMD@JasonHouMD@DCharabaty 1/ 65 y/o M new dx #Crohns ileitis after he presented w abdo pain,diarrhea, wt loss, anemia. CLN: deep linear ulcers in TI. He has an active lifestyle,stable CAD. Symptoms recur when prednisone<15 mg. What is the LEAST effective strategy to keep this pt in remission? #Back2Basics
@MondayNightIBD@ibdnaik@SobiaMujtabaMD@ibdleuven@DCharabaty 2/ Let’s talk #Crohn’s intestinal complications
CD can present w stricturing/perforating complications
50-60% CD will develop strictures, fistulas or abscesses over time
70% require surgical✂️by 15yrs of dx
Surgery not curative, most pts will have endo recurrence 1 yr post-IC✂️
@MondayNightIBD@SobiaMujtabaMD@NabilQuraishi@CholestasisDoc@DCharabaty 1/ 35 y/o M presents with fatigue & generalized pruritus x 6weeks. No skin rash, No abdo pain, diarrhea or 🩸 in stool. AST 62 ALT 64 ALP 435 Tbili 1.3. MRI/MRCP: multifocal strictures & areas of dilatation of intra +extra hepatic ducts. What’s the next step?💡 #Back2Basics#B2B
@MondayNightIBD@SobiaMujtabaMD@FezaRemziMD@DCharabaty 1/ 35 yo F panUC on IFX 10mg q4wk, admitted with abdo pain, hematochezia, malaise. T 39 BP 95/63 HR 110 FCP 900 mcg/g. Abdo distended, TTP; CT: colonic wall thickening+edematous mucosa. Cdiff neg; WBC 15, Hb 6. No improvement despite IVCS+Abx. Which surgery is indicated #B2BPoll
@MondayNightIBD@SobiaMujtabaMD@SchwartzbergMD@DCharabaty 1/ 27 yo F, crohns colitis on AZA, presents w 2wk perianal pain. One week ago a “boil” developed adjacent to the anus, painful to touch and draining cloudy fluid. PE: Perianal fistulous opening tender & draining pus on palpation. What is the next best step ? #B2B
@MondayNightIBD@SobiaMujtabaMD@SchwartzbergMD@DCharabaty 2/Recap #Crohns:
📌Transmural inflammation involving any part of GIT
📌B for Phenotypes: inflammatory/stricturing/penetrating
📌L for location: UGI,SB,Colon
📌Penetrating Behaviors:
Fistulae
Perforations
Intra-abdominal abscesses(IAA)