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Medicine Nov 2016Preoperative biliary drainage (PBD) has been widely used to treat patients with malignant biliary obstruction. However, it is still unclear which method of PBD... (Comparative Study)
Comparative Study Meta-Analysis Review
BACKGROUND
Preoperative biliary drainage (PBD) has been widely used to treat patients with malignant biliary obstruction. However, it is still unclear which method of PBD (endoscopic nasobiliary drainage or endoscopic biliary stenting) is more effective. Thus, we carried out a meta-analysis to compare the safety and efficacy of endoscopic nasobiliary drainage (ENBD) and endoscopic biliary stenting (EBS) in malignant biliary obstruction in terms of preoperative and postoperative complications.
METHODS
We conducted a literature search of EMBASE databases, PubMed, and the Cochrane Library to identify relevant available articles that were published in English, and we then compared ENBD and EBS in malignant biliary obstruction patients. The preoperative cholangitis rate, the preoperative pancreatitis rate, the incidence of stent dysfunction, the postoperative pancreatic fistula rate, and morbidity were analyzed. Odds ratios (ORs) with 95% confidence intervals (CIs) were used to express the pooled effect on dichotomous variables, and the pooled analyses were performed using RevMan 5.3.
RESULTS
Seven published studies (n = 925 patients) were included in this meta-analysis. We determined that patients with malignant biliary obstruction who received ENBD had reductions in the preoperative cholangitis rate (OR = 0.35, 95% CI = 0.25-0.51, P < 0.0001), the postoperative pancreatic fistula rate (OR = 0.38, 95% CI = 0.18-0.82, P = 0.01), the incidence of stent dysfunction (OR = 0.39, 95% CI = 0.28-0.56, P < 0.0001), and morbidity (OR = 0.47, 95% CI = 0.27-0.82, P = 0.008) compared with patients who received EBS.
CONCLUSIONS
The current meta-analysis suggests that ENBD is better than EBS for malignant biliary obstruction in terms of the preoperative cholangitis rate, the postoperative pancreatic fistula rate, the incidence of stent dysfunction, and morbidity. However, a limitation is that there are no data from randomized controlled trials.
Topics: Biliary Tract Surgical Procedures; Cholestasis; Drainage; Humans; Nose; Stents; Treatment Outcome
PubMed: 27861347
DOI: 10.1097/MD.0000000000005253 -
Pancreatology : Official Journal of the... Jan 2020Pancreatic pseudocyst (PP) and walled-off necrosis can be managed endoscopically, percutaneously or surgically, but with diverse efficacy. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Pancreatic pseudocyst (PP) and walled-off necrosis can be managed endoscopically, percutaneously or surgically, but with diverse efficacy.
AIMS & METHODS
A comprehensive literature search was carried out from inception to December 2018, to identify articles which compared at least two of the three kinds of treatment modalities, regarding the mortality, clinical success, recurrence, complications, cost and length of hospitalisation (LOH).
RESULTS
The outcomes of endoscopic (ED) and percutaneous drainage (PD) were comparable in six articles. The clinical success of endoscopic intervention was better considering any types of fluid collections (OR = 3.36; 95% confidence interval (CI) 1.48, 7.63; p = 0.004). ED was preferable regarding recurrence of PP (OR = 0.23; 95% CI 0.08, 0.66; p = 0.006). Fifteen articles compared surgical intervention with ED. Significant difference was found in postoperative LOH (WMD (days) = -4.61; 95%CI -7.89, -1.33; p = 0.006) and total LOH (WMD (days) = -3.67; 95%CI -5.00, -2.34; p < 0.001) which favored endoscopy, but ED had lower rate of clinical success (OR = 0.54; 95% CI 0.35, 0.85; p = 0.007) and higher rate of recurrence (OR = 1.80; 95% CI 1.16, 2.79; p = 0.009) in the treatment of PP. Eleven studies compared surgical and percutaneous intervention. PD resulted in higher rate of recurrence (OR = 4.91; 95% CI 1.82, 13.22; p = 0.002) and lower rate of clinical success (OR = 0.13; 95% CI 0.07, 0.22, p < 0.001).
CONCLUSION
Both endoscopy and surgery are preferable over percutaneous intervention, furthermore endoscopic treatment is associated with shorter hospitalisation than surgery.
Topics: Body Fluids; Drainage; Humans; Pancreas; Pancreatic Pseudocyst; Treatment Outcome
PubMed: 31706819
DOI: 10.1016/j.pan.2019.10.006 -
The Pan African Medical Journal 2020The aim of this study is to compare the use of flutter valve drainage bag system as an alternative to conventional underwater seal drainage bottle in the management of... (Comparative Study)
Comparative Study
INTRODUCTION
The aim of this study is to compare the use of flutter valve drainage bag system as an alternative to conventional underwater seal drainage bottle in the management of non-massive malignant/paramalignant pleural effusion.
METHODS
Forty-one patients with non-massive malignant and paramalignant pleural effusions were randomized into two groups. Group A (21patients) had their chest tubes connected to an underwater seal drainage bottle, while group B (20 patients) had their chest tubes connected to a flutter bag drainage device. Data obtained was analyzed with SPSS statistical package (version 16.0).
RESULTS
Breast cancer was the malignancy present at diagnosis in 24(58%) patients. Complication rates were similar, 9.5% in the underwater seal group and 10 % in the flutter bag drainage group. The mean duration to full mobilization was 35.0±20.0 hours in the flutter bag group and 52.7±18.5 hours in the underwater seal group, p-value 0.007. The mean length of hospital was 7.9±2.2 days in the flutter bag group and 9.8±2.7 days in the underwater seal group. This was statistically significant, p-value of 0.019. There was no difference in the effectiveness of drainage between both groups, complete lung re-expansion was observed in 16(80%) of the flutter bag group and 18(85.7%) of the underwater seal drainage group, p-value 0.70.
CONCLUSION
The flutter valve drainage bag is an effective and safe alternative to the standard underwater seal drainage bottle in the management of non-massive malignant and paramalignant pleural effusion.
Topics: Adult; Aged; Aged, 80 and over; Chest Tubes; Drainage; Female; Humans; Male; Middle Aged; Pleural Effusion; Pleural Effusion, Malignant; Time Factors; Young Adult
PubMed: 32117519
DOI: 10.11604/pamj.2020.35.3.19197 -
The British Journal of Radiology Apr 2021Hemorrhagic complications are uncommon after percutaneous transhepatic biliary drainage. The presenting features include bleeding through or around the drainage... (Review)
Review
Hemorrhagic complications are uncommon after percutaneous transhepatic biliary drainage. The presenting features include bleeding through or around the drainage catheter, hematemesis or melena. Diagnosis requires cholangiography, CT angiography or conventional angiography. Minor venous hemorrhage is managed by catheter repositioning, clamping or upgrading to a larger bore catheter. Major vascular injuries require percutaneous or endovascular procedures like embolization or stenting. A complete knowledge of these complications will direct the interventional radiologist to take adequate precautions to reduce their incidence and necessary steps in their management. This review presents and discusses various hemorrhagic complications occurring after percutaneous transhepatic biliary drainage along with their treatment options and suggests a detailed algorithm.
Topics: Angiography; Bile Ducts; Catheterization; Cholangiography; Cholestasis; Computed Tomography Angiography; Drainage; Fluoroscopy; Hemorrhage; Humans; Internship and Residency; Punctures; Radiology, Interventional; Ultrasonography
PubMed: 33529044
DOI: 10.1259/bjr.20200879 -
BioMed Research International 2020Bedside biliary drainage by endoscopic retrograde cholangiopancreatography (ERCP) without fluoroscopy for critically ill patients in the intensive care unit (ICU)...
BACKGROUND
Bedside biliary drainage by endoscopic retrograde cholangiopancreatography (ERCP) without fluoroscopy for critically ill patients in the intensive care unit (ICU) remains challenging for endoscopists. The present study was to evaluate the efficacy and safety of radiation-free ERCP for these patients.
METHODS
Consecutive ICU patients with severe pancreaticobiliary disorders who underwent bedside radiation-free ERCP were retrospectively analyzed.
RESULTS
Radiation-free ERCP was performed in 80 patients with acute physiology and chronic health evaluation (APACHE II) score of 24.1 ± 6.2. Cannulation was achieved in 75 (93.75%) patients. Biliary drainage was successfully conducted in 74 (92.5%) patients, including 54 (67.5%) and 20 (25.0%) cases of endoscopic retrograde biliary drainage (ERBD) and endoscopic nasobiliary drainage (ENBD), respectively. Adverse event (mild post-ERCP pancreatitis (PEP)) occurred only in 1 case. The 30-day mortality rate of these patients was 36.25% (29/80) and was much more higher in patients with ERBD in contrast to that of patients with ENBD, 40.7% (22/54) vs. 20% (4/20), OR = 2.750, 95%CI = 0.810 - 9.3405, = 0.110. The APACHE II score in nonsurvivors was significantly higher than survivors, 27.6 ± 4.3 versus 22.2 ± 6.3, = 0.009. The APACHE II score > 22 was an independent risk factor for mortality, 50% versus 10.7%, 95%CI = 2.148 - 31.569, = 0.002.
CONCLUSIONS
Radiation-free ERCP guided bedside biliary drainage is effective and safe for critically ill patients, and ENBD may be an optimal procedure due to a low mortality in these patients.
Topics: Aged; Aged, 80 and over; Catheterization; Cholangiopancreatography, Endoscopic Retrograde; Cholelithiasis; Critical Illness; Drainage; Female; Humans; Male; Middle Aged; Pancreatitis; Postoperative Complications; Retrospective Studies
PubMed: 32626738
DOI: 10.1155/2020/2850540 -
Anaesthesia Feb 1993The physics and the physiological principles of pleural or chest drainage systems are reviewed. The clinical management and complications of pleural drainage are...
The physics and the physiological principles of pleural or chest drainage systems are reviewed. The clinical management and complications of pleural drainage are summarised.
Topics: Drainage; Equipment Design; Humans; Pleura; Pleural Effusion; Pressure
PubMed: 8460765
DOI: 10.1111/j.1365-2044.1993.tb06859.x -
Der Chirurg; Zeitschrift Fur Alle... Jan 2019Endoscopic negative-pressure therapy (ENPT) is becoming a valuable tool in surgical complication management of transmural intestinal defects and wounds in the upper and... (Review)
Review
Endoscopic negative-pressure therapy (ENPT) is becoming a valuable tool in surgical complication management of transmural intestinal defects and wounds in the upper and lower gastrointestinal tract. Innovative materials for drains have been developed, endoscopic techniques adapted, and new indications for ENPT have been found. Based on our broad clinical experience, numerous tips and tricks are described, which contribute to the safety of dealing with the new therapy. The aim of this work is to present these methods. The focus is on describing the treatment in the esophagus.
Topics: Drainage; Endoscopy; Esophagus; Gastrointestinal Tract; Negative-Pressure Wound Therapy
PubMed: 30280205
DOI: 10.1007/s00104-018-0725-z -
International Journal of Surgery... Aug 2018Chest tube drainage is a common procedure performed by physicians in the emergency setting. Complications may arise in up to 25% of the cases. These vary from drain... (Review)
Review
BACKGROUND
Chest tube drainage is a common procedure performed by physicians in the emergency setting. Complications may arise in up to 25% of the cases. These vary from drain misplacement to lethal iatrogenic injuries. Ultrasound provides adequate visualization and correct identification of the insertion site, allows the exclusion of a vulnerable intercostal artery, and enables timely diagnosis of drain malpositioning. Although feasible, ultrasound-guided techniques are underused and seldom applied during chest drainage. One reason for that is the lack of a comprehensive step-by-step description incorporating these techniques. This article aims to describe a standardized ultrasound-guided chest tube drainage technique, and also review the evidence supporting its potential benefits.
MATERIALS AND METHODS
we conducted a thorough literature search on ultrasound techniques regarding the identification of the diaphragm, the neurovascular intercostal bundle, and the position of the chest drain. Also, we analyzed published articles about complications of chest drainage.
RESULTS
we propose a feasible step-by-step ultrasound-guided technique of chest drainage and discuss why this technique should be incorporated in the routine practice.
CONCLUSION
ultrasound guidance should be incorporated in chest drainage in a stepwise fashion. Although intuitively safer, future randomized studies are warranted to support this technique.
Topics: Anatomic Landmarks; Chest Tubes; Drainage; Emergency Medical Services; Humans; Standard of Care; Thorax; Ultrasonography, Interventional
PubMed: 30033379
DOI: 10.1016/j.ijsu.2018.07.002 -
Computational and Mathematical Methods... 2022To synthesize the evidence regarding the effect and safety of drainage after the hip arthroplasty in randomized control trials. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To synthesize the evidence regarding the effect and safety of drainage after the hip arthroplasty in randomized control trials.
BACKGROUND
Although the standard of hip replacement has matured in recent years, the need for postoperative drainage is still controversial which also is a clinical problem that needs to be addressed.
DESIGN
A systematic review and meta-analysis based on the Cochrane methods and Prisma guideline. . A systematic search of the Cochrane Library, PubMed, EMBASE, CINAHL, Ovid, Wan Fang database, CNKI, and CBM database was carried out from January 1, 2000, to December, 2021. . The quality of included randomized controlled trials was assessed individually by two reviewers independently using criteria recommended in the Cochrane Handbook for Systematic Reviews of Interventions 5.1.0.
RESULTS
Nineteen randomized control trials involving 3354 participants were included in this analysis. From the above analysis, we can know that compared with nondrainage, there was a statistically significant difference in VAS score on the postoperative first day (SD = -0.6; 95% CI: -0.79, -0.41) and second day (SD = -0.38, 95% CI: -0.58, -0.18), hematocrit reduction (MD =2.89; 95% CI: 1.3, 4.48), blood transfusion rate (OR =1.47; 95% CI: 1.12, 1.92), change of thigh circumstance (SMD = -0.48; 95% CI: -0.66, -0.31), and hospital stay (MD = 1.06; 95% CI: 0.73, 1.39) in drainage. However, there were no statistically significant differences in hemoglobin and hematocrit level, hip function, total blood loss, transfusion volume, dressing use, and complications between them.
CONCLUSION
Drainage after hip arthroplasty can reduce swelling in the thigh and relieve pain while no drainage can bring down hematocrit reduction, decrease dressing uses, and shorten the hospital stay which promotes rapid recovery. This review provides a detailed theoretical reference for the proper clinical application of drains and improves the efficient use of resources.
Topics: Arthroplasty, Replacement, Hip; Computational Biology; Drainage; Edema; Female; Humans; Male; Negative-Pressure Wound Therapy; Pain, Postoperative; Postoperative Care; Postoperative Hemorrhage; Visual Analog Scale
PubMed: 35251296
DOI: 10.1155/2022/2069468 -
Postgraduate Medical Journal Jul 2007Pneumothorax is a relatively common clinical problem which can occur in individuals of any age. Irrespective of aetiology (primary, or secondary to antecedent lung... (Review)
Review
Pneumothorax is a relatively common clinical problem which can occur in individuals of any age. Irrespective of aetiology (primary, or secondary to antecedent lung disorders or injury), immediate management depends on the extent of cardiorespiratory impairment, degree of symptoms and size of pneumothorax. Guidelines have been produced which outline appropriate strategies in the care of patients with a pneumothorax, while the emergence of video-assisted thoracoscopic surgery has created a more accessible and successful tool by which to prevent recurrence in selected individuals. This evidence based review highlights current practices involved in the management of patients with a pneumothorax.
Topics: Aerospace Medicine; Chest Tubes; Cystic Fibrosis; Drainage; HIV Infections; Humans; Oxygen; Pneumothorax; Referral and Consultation
PubMed: 17621614
DOI: 10.1136/pgmj.2007.056978