Bronchoezofageálne a bronchogastrické fistuly sú zriedkavou komplikáciou chirurgických zákrokov v hrudnej dutine, ako ezofagektómia, malígnych ochorení, dlhodobej endotracheálnej intubácie alebo infekčných ochorení. I keď nie sú časté, dosahujú vysokú morbiditu a mortalitu. Liečba týchto fistúl je náročná a často zdĺhavá s obmedzenou úspešnosťou. V rámci terapie môžeme u niektorých typov fistúl zvoliť endoskopické riešenie, ktorého úspešnosť, napriek veľkému množstvu rôznych metód, je nižšia s malým množstvom konzistentných dôkazov o účinnosti. Súčasne sa objavujú nové zariadenia a technológie s potenciálom na riešenie týchto stavov. Jednou z týchto metód je aj endobronchiálny bloker – Watanabeho spigot, ktorý sa iniciálne používal v pneumológii v terapii perzistentného pneumotoraxu, resp. pyotoraxu s bronchiálnou fistulou. V prezentovaných kazuistikách uvádzame použitie Watanabeho spigotu v kombinácii s over-the-scope klipmi v rámci terapie bronchoezofageálnych fistúl po ezofagektómii. V teoretickej časti článku uvádzame tiež prehľad endoskopických možností terapie uvedených fistúl v kontexte najnovších poznatkov a osobitne diskutujeme dostupné dáta o možnostiach využitia Watanabeho spigotov v liečbe bronchoezofageálnych fistúl.

Bronchoesophageal and bronchogastric fistulas are rare complications of thoracic surgery as esophagectomy, malignancy or prolonged endotracheal intubation. Although uncommon, their morbidity and mortality is substantial. Treatment of these fistulas is challenging and often lengthy with limited success rates. Endoscopic treatment may be the treatment of choice for some types of fistulas, but despite a variety of methods available, the success rate is relatively low with little consistent data about its effectiveness. At the same time, new technologies and devices have become available with a potential to address these complicated conditions. One of them are Watanabe spigots, initially used in pneumology for the treatment of persistent pneumothorax and pyothorax with bronchial fistula. In the presented case reports Watanabe spigots are used in combination with over-the-scope clips in two of our patients with bronchoesophageal fistulas fol lowing esophagectomy with promising results. We also present an overview of endoscopic methods of therapy in the context of and separately discuss available evidence about the possibilities of the use of Watanabeho spigots in the treatment of bronchoesophageal fistulas.

• MeSH
• Bronchial Fistula * surgery   diagnosis   MeSH
• Diagnostic Imaging MeSH
• Adult MeSH
• Endoscopes, Gastrointestinal MeSH
• Esophagectomy methods   MeSH
• Humans MeSH
• Esophageal Neoplasms surgery   drug therapy   MeSH
• Postoperative Complications etiology   therapy   MeSH
• Aged MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Case Reports MeSH

Úvod: Polycystická autozomálne recesívna choroba obličiek (ARPCHO) je raritná, značne fenotypovo variabilná primárna cíliopatia. Poškodenie obličiek a pečene sú typickými prejavmi a prognóza ochorenia závisí od ich progresie v čase. Hlavným extrarenálnym prejavom je fibrocystická prestavba pečene, ktorá sa prejavuje intrahepatálnou portálnouhypertenziou a cholangitídou. Metódy: Retrospektívne zhodnotenie výskytu a vývoja hepatobiliárnych prejavov ochorenia. Výsledky: Do súboru bolo zaradených 8 detí s polycystickou autozomálne recesívnou chorobou obličiek. Poškodenie obličiek a hypertenzia boli prítomné u všetkých detí v súbore. Hepatobiliárne prejavy boli popísané u 5 detí (62,5 %). Trombocytopénia predchádzala splenomegáliu v časovom období jeden rok. Súčasťou výsledkov sú aj tri kazuistiky. Záver: Pacienti s ARPCHO by mali byť cielene vyšetrení so zameraním na posúdenie hepatálnych prejavov ochorenia. #938486

Introduction: Autosomal recessive polycystic kidney disease (ARPKD) is a rare, phenotypically variable primary ciliopathy. Kidney and liver damage are typical manifestations, and the prognosis of the disease depends on their progression over time. The main extrarenal manifestation is fibrocystic rebuilding of the liver, which is manifested by intrahepatic portal hypertension and cholangitis. Methods: The aim of the retrospective study was to evaluate the incidence and development hepatobiliary manifestations. Results: Eight children with polycystic autosomal recessive kidney disease were included in the group. Renal damage and hypertension were present in all children. Hepatobiliary manifestations were described in five children (62.5%). Thrombocytopenia preceded splenomegaly by one year. The results also include three case reports. Conclusion: Patients with ARPKD should be examined with a focus on the presence of hepatic manifestations of the disease.

• MeSH
• Cystic Fibrosis physiopathology   MeSH
• Child MeSH
• Esophageal and Gastric Varices MeSH
• Liver pathology   MeSH
• Humans MeSH
• Polycystic Kidney, Autosomal Recessive * complications   physiopathology   MeSH
• Retrospective Studies MeSH
• Thrombocytopenia MeSH
• Check Tag
• Child MeSH
• Humans MeSH

• Publication type
• Meeting Abstract MeSH

Hepatolithiasis is a benign disease, where stones are localized proximal to the confluence of hepatic ducts. The clinical picture may differ depending on whether the stones cause complete, partial, or intermittent biliary obstruction. The course can vary from asymptomatic to fatal, thus, early diagnosis and treatment is critical for a good prognosis. The gold standard in imaging is magnetic resonance cholangiopancreatography (MRCP). However, correct diagnosis can be challenging due to atypical clinical picture and laboratory findings. We present a case where hepatolithiasis was misdiagnosed initially due to incomplete reporting and documentation of MRCP. Choledocholithiasis was diagnosed based on initial MRCP, and endoscopic stone extraction was indicated. However, an unusual post-interventional course and signs of obstructive cholangitis led to an endoscopic re-intervention, which confirmed absence of pathology in extrahepatic biliary ducts. The cholangitis recurrence required intensive antibiotic treatment, and CT examination revealed intrahepatic S3 bile duct dilatation. Thus, a re-evaluation of initial MRCP and repeated MRCP confirmed hepatolithiasis. Further, laparoscopic bisegmentectomy was chosen as the definitive treatment due to the location of the lesion. The patient recovered and remained symptom free upon a 12 month follow up.

• MeSH
• Diagnosis, Differential MeSH
• Hepatectomy MeSH
• Laparoscopy MeSH
• Humans MeSH
• Lithiasis diagnostic imaging   surgery   MeSH
• Cholangiopancreatography, Magnetic Resonance MeSH
• Liver Diseases diagnostic imaging   surgery   MeSH
• Tomography, X-Ray Computed MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH

Táto práca popisuje kazuistiku 26-ročného pacienta referovaného na naše pracovisko za účelom realizácie diferenciálnej diagnostiky dysfágie. Pacient podstúpil endoskopické vyšetrenie horného tráviaceho traktu s nálezom externého útlaku dolnej tretiny pažeráka. Následne bolo realizované kontrastné CT vyšetrenie s nálezom dvoch cystických tumorov zadného mediastína. Následne bola na našom pracovisku doplnená endoskopická ultrasonografia s nálezom dvoch duplikačných cýst pažeráka.

This case report describes a 26-year-old patient referred to our department for the purpose of differential diagnosis of dysphagia. The patient underwent an endoscopic examination of the upper gastrointestinal tract with the finding of external compression of the lower third of the esophagus. Subsequently, a contrast CT examination was performed with the finding of two cystic tumors of the posterior mediastinum. Additionally, endoscopic ultrasonography was performed at our department, with a finding of two duplicating esophageal cysts.

• Keywords
• du,
• MeSH
• Cysts * diagnosis   MeSH
• Adult MeSH
• Endoscopy, Digestive System methods   MeSH
• Esophagus * diagnostic imaging   pathology   MeSH
• Humans MeSH
• Tomography, X-Ray Computed methods   MeSH
• Deglutition Disorders * etiology   MeSH
• Ultrasonography methods   MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Male MeSH
• Publication type
• Case Reports MeSH

• MeSH
• Endoscopy, Gastrointestinal MeSH
• Inflammatory Bowel Diseases * MeSH
• Congresses as Topic MeSH
• Publication type
• News MeSH

Dehiscence of colorectal anastomosis is a serious complication that is associated with increased mortality, impaired functional and oncological outcomes. The hypothesis was that anastomosis reinforcement and vacuum trans-anal drainage could eliminate some risk factors, such as mechanically stapled anastomosis instability and local infection. Patients with rectal cancer within 10 cm of the anal verge and low anterior resection with double-stapled technique were included consecutively. A stapler anastomosis was supplemented by trans-anal reinforcement and vacuum drainage using a povidone-iodine-soaked sponge. Modified reinforcement using a circular mucosa plication was developed and used. Patients were followed up by postoperative endoscopy and outcomes were acute leak rate, morbidity, and diversion rate. The procedure was successfully completed in 52 from 54 patients during time period January 2019-October 2020. The mean age of patients was 61 years (lower-upper quartiles 54-69 years). There were 38/52 (73%) males and 14/52 (27%) females; the neoadjuvant radiotherapy was indicated in a group of patients in 24/52 (46%). The mean level of anastomosis was 3.8 cm (lower-upper quartiles 3.00-4.88 cm). The overall morbidity was 32.6% (17/52) and Clavien-Dindo complications ≥ 3 grade appeared in 3/52 (5.7%) patients. No loss of anastomosis was recorded and no patient died postoperatively. The symptomatic anastomotic leak was recorded in 2 (3.8%) patients and asymptomatic blind fistula was recorded in one patient 1/52 (1.9%). Diversion ileostomy was created in 1/52 patient (1.9%). Reinforcement of double-stapled anastomosis using a circular mucosa plication with combination of vacuum povidone-iodine-soaked sponge drainage led to a low acute leak and diversion rate. This pilot study requires further investigation.Registered at ClinicalTrials.gov.: Trial registration number is NCT04735107, date of registration February 2, 2021, registered retrospectively.

• MeSH
• Anastomosis, Surgical MeSH
• Drainage MeSH
• Middle Aged MeSH
• Humans MeSH
• Rectal Neoplasms * surgery   MeSH
• Anastomotic Leak MeSH
• Pilot Projects MeSH
• Rectum * surgery   MeSH
• Retrospective Studies MeSH
• Mucous Membrane MeSH
• Vacuum MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

Súhrn: Úvod: Achalázia je zriedkavá primárna porucha motility pažeráka charakterizovaná absenciou peristaltiky so súčasnou poruchou relaxácie dolného ezofageálneho zvierača. Významným pokrokom v liečbe bolo zavedenie novej techniky – perorálnej endoskopickej myotómie (POEM). V tejto práci sme sa rozhodli zamerať na periprocedurálne komplikácie POEMu v súbore našich pacientov. Metódy: Retrospektívne sme zhodnotili výskyt periprocedurálnych komplikácií u pacientov s achaláziou pažeráka, ktorý podstúpili POEM. Výsledky: Z celkové počtu 136 pacientov bol POEM úspešne realizovaný u 132 pacientov. U väčšiny pacientov bol realizovaný POEM anterior (n = 109), POEM posterior bol vykonaný u 23 pacientoch. Počas výkonu sa vyskytol nejaký druh komplikácie u celkovo 50 pacientov (38 %). Najčastejšie prítomnou komplikáciou bolo termické poškodenie sliznice pažeráka (27,3 %). Druhou najčastejšou komplikáciou bolo kapnoperitoneum (14 %). U 5 pacientov (3,8 %) bolo prítomné tenzné kapnoperitoneum. Podkožný emfyzém sme zaznamenali u 6 pacientov (4,5 %). U 7 pacientov (6 %) sa vyskytla periprocedurálna perforácia. Zo všetkých komplikácií vyžadovali následnú chirurgickú liečbu dve. V súbore našich pacientov sa nevyskytlo úmrtie asociované s výkonom. Záver a diskusia: POEM je celosvetovo akceptovanou terapiou achalázie. Vo všeobecnosti sa považuje za metódu bezpečnú s nízkym výskytom závažných nežiadúcich komplikácií. Údaje o incidencii peroperačných komplikácií sa rôznia, hlavne v tom, čo je považované za komplikáciu a čo je normálna súčasť chirurgického výkonu. Dôležitým však zostáva fakt, že závažné komplikácie ohrozujúce život pacienta sú zriedkavé.

Summary: Introduction: Achalasia is a rare primary esophageal motility disorder characterized by aperistalsis and the concomitant absence of relaxation of the lower esophageal sphincter. The introduction of a new technique, called peroral endoscopic myotomy (POEM), signifi cantly advanced treatment of this condition. This study focused on the periprocedural complications of POEM. Methods: The incidence of periprocedural complications in patients with esophageal achalasia who had undergone POEM was retrospectively analyzed. Results: POEM was successfully performed in 132 of 136 patients. POEM was anterior in most patients (n = 109) and posterior in 23 patients. Fifty patients (38%) experienced complications during surgery. The most frequent complication was thermal damage of the mucosa (27.3%). The second most common complication was capnoperitoneum (14%). Severe capnoperitoneum occurred in fi ve patients (3.8%). Subcutaneous emphysema was observed in six patients (4.5%). Seven patients (6%) experienced periprocedural perforation. Among all patients who developed complications, two required subsequent surgical treatment. There was no performance-related death in our patient population. Conclusion and discussion: POEM is a worldwide accepted therapy for achalasia. It is generally considered to be a safe method with a low incidence of serious complications. Data concerning the incidence of perioperative complications vary, particularly with regard to what is considered to be a complication and what is a normal part of surgery. However, severe life-threatening complications are rare.

• Keywords
• POEM - (perorální endoskopická myotomie),
• MeSH
• Esophageal Achalasia * surgery   complications   physiopathology   MeSH
• Esophageal Sphincter, Lower surgery   physiopathology   MeSH
• Natural Orifice Endoscopic Surgery * methods   MeSH
• Humans MeSH
• Intraoperative Complications MeSH
• Retrospective Studies MeSH
• Check Tag
• Humans MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH

• Publication type
• Meeting Abstract MeSH

• Publication type
• Meeting Abstract MeSH