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Abstract Introduction Percutaneous transhepatic biliary drainage (PTBD) is a useful alternative treatment for malignant biliary obstruction (MBO) when patients have difficulty with endoscopic transpapillary drainage. We examined the feasibility of conversion of PTBD to endoscopic ultrasound‐guided biliary drainage (EUS‐BD) in patients with MBO unsuited for endoscopic transpapillary biliary drainage. Methods This retrospective study included patients who underwent conversion of PTBD to EUS‐BD between March 2017 and December 2019. Eligible patients had unresectable MBO, required palliative biliary drainage, and were not suited for endoscopic transpapillary drainage. Initial PTBD had been performed for acute cholangitis or obstructive jaundice in all patients. EUS‐BD was performed following improvements in cholangitis. Sixteen patients underwent conversion of PTBD to EUS‐BD. We evaluated technical success, procedure time, clinical success (defined as subsequent external catheter removal), adverse events (AEs), time to recurrent biliary obstruction (TRBO), and re‐intervention rates. Results Technical success was achieved in all patients (100%). The median procedure time was 45.0 minutes (interquartile range [IQR] 30.0–50.0 minutes). Clinical success was achieved in all patients (100%). There were mild early AEs in two patients (12.5%) (acute cholangitis: 1, bile peritonitis: 1), which improved with antibiotic administration alone. Recurrent biliary obstruction (RBO) occurred in six patients (37.5%). Kaplan‐Meier analysis revealed a 50% TRBO of 95 days (IQR 41–246 days). Endoscopic treatment was possible in all RBO cases, and repeat PTBD was not required. Conclusions Conversion of PTBD to EUS‐BD for the management of MBO is both feasible and safe. This approach is expected to be widely practiced at centers with little experience in EUS‐BD.

Abstract Background and aims Drug‐eluting devices (DEDs) are usually used as a standard therapy for revascularization in femoropopliteal artery disease. Randomized controlled trails have found that DEDs with paclitaxel result in superior patency rates and decreased target lesion revascularization. A meta‐analysis by Katsanos et al indicated an increased long‐term mortality in patients treated with paclitaxel‐coated devices. The aim of this observational clinical study was to assess the long‐term clinical outcomes and mortality risk after paclitaxel‐coated balloon angioplasty in patients with symptomatic peripheral artery disease. Methods We retrospectively evaluated 287 patients with peripheral interventions, including 173 drug‐coated balloon (DCB) angioplasties and 114 plain old balloon angioplasties (POBA), performed at our center between 2015 and 2018. Results There were no significant differences in mortality rates between patients who received DCB angioplasty and those who received POBA. In the first year, the hazard ratio (HR) for DCB angioplasty was 0.59 (95% confidence interval [CI] 0.31 to 1.12, P = .104). After 2 years, this HR was 0.64 (95% CI 0.36‐1.17, P = .145), while the 3‐year and 4‐year HR increased to 0.71 and 1.30 (3‐year: 95% CI 0.37‐1.33, P = ,283; 4‐year: 95% CI 0.55‐3.08, P = .546). No paclitaxel dose‐response relationship with mortality rate was identified when adjusted for key predictors of mortality. Conclusions Analyses of patient level data identified no significant mortality differences between DCB angioplasty and POBA after 4 years of follow‐up. Furthermore, there was no dose‐response relationship between paclitaxel and mortality. These findings demonstrate that paclitaxel DCB is safe. Further long‐term multicenter studies are needed to determine the risk of late mortality.

Objective: To estimate the rate and risk factors of re-intervention for patients with uterine fibroids (UFs) undergoing high-intensity focused ultrasound (HIFU) at different age distributions., Method: A retrospective cohort study was conducted in Nanchong Central Hospital, recruiting a total of 672 patients with UFs undergoing HIFU from June 2017 to December 2019. Using univariate and multivariate logistic regression, risk factors for re-intervention were assessed., Results: Among 401 patients with UFs who completed the follow-up visits (median 47 months, range 34-61), 50 (12.46%) patients underwent re-intervention (such as high-intensity focused ultrasound, uterine artery embolization, myomectomy and hysterectomy). In the different age distributions, the re-intervention rate was 17.5% (34/194) in patients aged <45 years and 7.7% (16/207) in those aged ≥45 years. Regarding the younger patient group (aged <45 years), hypo- or iso-intensive fibroids in T2-weighted magnetic resonance imaging (T2WI) intensity may elevate the risk of re-intervention for UFs (odds ratio [OR] 2.96, 95% confidence interval [CI] 1.37-6.62; P = 0.007). Among the older patient group (aged ≥45 years), preoperative anemic patients had an increased risk of re-intervention compared with those without anemia (OR 3.30, 95% CI 1.01-10.37; P = 0.041)., Conclusion: The re-intervention rate of HIFU decreased with increasing age. Among those aged <45 years, T2WI intensity was the independent risk factor for re-intervention, and among those aged ≥45 years, preoperative anemic status may be related to re-intervention outcome., (© 2023 International Federation of Gynecology and Obstetrics.)