51
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Sugimoto M, Takagi T, Suzuki R, Waragai Y, Konno N, Asama H, Sato Y, Irie H, Nakamura J, Takasumi M, Hashimoto M, Kato T, Yanagita T, Hikichi T, Ohira H. Factors Associated With Difficult Endoscopic Ultrasonography-guided Biliary Drainage. J Clin Gastroenterol 2024; 58:494-501. [PMID: 37390043 DOI: 10.1097/mcg.0000000000001876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 05/22/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND AND AIMS When endoscopic retrograde cholangiopancreatography-guided biliary drainage is challenging, endoscopic ultrasound-guided biliary drainage (EUS-BD) can be used as an alternate treatment; however, this method requires operator expertise. Therefore, this study aimed to clarify the factors that are associated with a difficult EUS-BD. PATIENTS AND METHODS Patients who successfully underwent EUS-BD were enrolled in this study. The patients were divided into the easy group and difficult group depending on whether the procedural time was more than 60 minutes, which was the cutoff value elicited from past reports. Patient characteristics and procedural factors were compared between the two groups. The factors associated with difficult procedures were also investigated. RESULTS The patient characteristics were not significantly different between the easy group (n=22) and the difficult group (n=19). The diameter of the punctured bile duct was significantly different between the two groups. In the multivariate analysis, the diameter of the punctured bile duct was the only factor associated with a difficult EUS-BD (odds ratio 0.65, 95% confidence interval 0.46-0.91, P value=0.012). The cutoff value for the diameter of the punctured bile duct in predicting a difficult EUS-BD was 7.0 mm (area under the curve: 0.83, sensitivity 84.2%, specificity 86.4%). CONCLUSIONS A nondilated bile duct might be a predictive factor for a difficult EUS-BD. For beginners of EUS-BD, the cutoff value for the punctured bile duct diameter found in this study, 7.0 mm, might become a barometer for puncture point selection.
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Affiliation(s)
- Mitsuru Sugimoto
- Department of Gastroenterology, School of Medicine, Fukushima Medical University
| | - Tadayuki Takagi
- Department of Gastroenterology, School of Medicine, Fukushima Medical University
| | - Rei Suzuki
- Department of Gastroenterology, School of Medicine, Fukushima Medical University
| | - Yuichi Waragai
- Department of Gastroenterology, Soma General Hospital, Niinuma, Soma, Japan
| | - Naoki Konno
- Department of Gastroenterology, School of Medicine, Fukushima Medical University
| | - Hiroyuki Asama
- Department of Gastroenterology, School of Medicine, Fukushima Medical University
| | - Yuki Sato
- Department of Gastroenterology, School of Medicine, Fukushima Medical University
| | - Hiroki Irie
- Department of Gastroenterology, School of Medicine, Fukushima Medical University
| | - Jun Nakamura
- Department of Gastroenterology, School of Medicine, Fukushima Medical University
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima
| | - Mika Takasumi
- Department of Gastroenterology, School of Medicine, Fukushima Medical University
| | - Minami Hashimoto
- Department of Gastroenterology, School of Medicine, Fukushima Medical University
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima
| | - Tsunetaka Kato
- Department of Gastroenterology, School of Medicine, Fukushima Medical University
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima
| | - Takumi Yanagita
- Department of Gastroenterology, School of Medicine, Fukushima Medical University
| | - Takuto Hikichi
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima
| | - Hiromasa Ohira
- Department of Gastroenterology, School of Medicine, Fukushima Medical University
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52
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Deviere J. Hepaticogastrostomy for benign indications: An option in selected cases. Endosc Int Open 2024; 12:E684-E685. [PMID: 38774860 PMCID: PMC11108656 DOI: 10.1055/a-2303-6758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 05/24/2024] Open
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Troncone E, Amendola R, Moscardelli A, De Cristofaro E, De Vico P, Paoluzi OA, Monteleone G, Perez-Miranda M, Del Vecchio Blanco G. Endoscopic Gallbladder Drainage: A Comprehensive Review on Indications, Techniques, and Future Perspectives. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:633. [PMID: 38674279 PMCID: PMC11052411 DOI: 10.3390/medicina60040633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024]
Abstract
In recent years, therapeutic endoscopy has become a fundamental tool in the management of gallbladder diseases in light of its minimal invasiveness, high clinical efficacy, and good safety profile. Both endoscopic transpapillary gallbladder drainage (TGBD) and endoscopic ultrasound (EUS)-guided gallbladder drainage (EUS-GBD) provide effective internal drainage in patients with acute cholecystitis unfit for cholecystectomy, avoiding the drawbacks of external percutaneous gallbladder drainage (PGBD). The availability of dedicated lumen-apposing metal stents (LAMS) for EUS-guided transluminal interventions contributed to the expansion of endoscopic therapies for acute cholecystitis, making endoscopic gallbladder drainage easier, faster, and hence more widely available. Moreover, EUS-GBD with LAMS opened the possibility of several cholecystoscopy-guided interventions, such as gallstone lithotripsy and clearance. Finally, EUS-GBD has also been proposed as a rescue drainage modality in malignant biliary obstruction after failure of standard techniques, with encouraging results. In this review, we will describe the TBGD and EUS-GBD techniques, and we will discuss the available data on clinical efficacy in different settings in comparison with PGBD. Finally, we will comment on the future perspectives of EUS-GBD, discussing the areas of uncertainty in which new data are more strongly awaited.
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Affiliation(s)
- Edoardo Troncone
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Rosa Amendola
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | | | - Elena De Cristofaro
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Pasquale De Vico
- Department of Anaesthesia, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | | | - Giovanni Monteleone
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Manuel Perez-Miranda
- Department of Gastroenterology and Hepatology, University Hospital Rio Hortega, 47012 Valladolid, Spain
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Panzuto F, Parodi MC, Esposito G, Massironi S, Fantin A, Cannizzaro R, Milione M, De Angelis CG, Annibale B. Endoscopic management of gastric, duodenal and rectal NETs: Position paper from the Italian Association for Neuroendocrine Tumors (Itanet), Italian Society of Gastroenterology (SIGE), Italian Society of Digestive Endoscopy (SIED). Dig Liver Dis 2024; 56:589-600. [PMID: 38216439 DOI: 10.1016/j.dld.2023.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/23/2023] [Accepted: 12/26/2023] [Indexed: 01/14/2024]
Abstract
The present paper reflects the position of the Italian Association for Neuroendocrine Tumors (Itanet), the Italian Society of Gastroenterology (SIGE), and the Italian Society of Digestive Endoscopy (SIED) regarding the management of patients affected by gastric, duodenal, and rectal neuroendocrine neoplasms (NENs) amenable to endoscopic treatment. The key questions discussed in this paper are summarized in Table 1. Data were extracted from the MEDLINE database through searches; expert opinions and recommendations are provided in accordance with the available scientific evidence and the authors' expertise. Recommendations are presented alongside a level of evidence and grade of recommendation based on the GRADE system. This paper specifically focuses on subgroups of NENs considered suitable for endoscopic management according to current international guidelines: i. well-differentiated gastric neuroendocrine tumors (gNET) type 1 < 2 cm and selected cases of type 3; ii. well-differentiated duodenal, non-functioning, non-ampullary NET with size < 2 cm; and well-differentiated rectal NET with size < 2 cm.
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Affiliation(s)
- Francesco Panzuto
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Digestive Disease Unit, ENETS Center of Excellence, Sant'Andrea University Hospital, Rome, Italy.
| | - Maria Caterina Parodi
- Department of Gastroenterology and Digestive Endoscopy, IRCCS Teaching Hospital San Martino, Genova, Italy
| | - Gianluca Esposito
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Digestive Disease Unit, ENETS Center of Excellence, Sant'Andrea University Hospital, Rome, Italy
| | - Sara Massironi
- Division of Gastroenterology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Alberto Fantin
- Gastroenterology Unit; Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Renato Cannizzaro
- Oncological Gastroenterology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Italy; Department of Medical, Surgical and Health Sciences, University of Trieste, Italy
| | - Massimo Milione
- Pathology First Division, Department of Pathology and Laboratory Medicine, Fondazione IRCCS - Istituto Nazionale dei Tumori, Milan, Italy
| | - Claudio Giovanni De Angelis
- Gastroenterology Department, Endoscopy Unit, Azienda Ospedaliero Universitaria, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Bruno Annibale
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Digestive Disease Unit, ENETS Center of Excellence, Sant'Andrea University Hospital, Rome, Italy
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Vila JJ, Jusué Irurita V, Rullán Iriarte M. Is ERCP still the elective primary biliary drainage technique in patients with malignant distal biliary obstruction? REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2024; 116:182-185. [PMID: 38095214 DOI: 10.17235/reed.2023.10029/2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) has been established as the first line therapy for the resolution of biliary and pancreatic diseases. The main disadvantage of the procedure is the rate of adverse events, around 10%1. So, despite being a minimally invasive procedure, ERCP has a non-negligible rate of adverse effects (AEs) and secondary mortality.
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Affiliation(s)
- Juan J Vila
- Endoscopy Unit. Gastroenterology Department, Hospital Universitario de Navarra, España
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Coccolini F, Cucinotta E, Mingoli A, Zago M, Altieri G, Biloslavo A, Caronna R, Cengeli I, Cicuttin E, Cirocchi R, Cobuccio L, Costa G, Cozza V, Cremonini C, Del Vecchio G, Dinatale G, Fico V, Galatioto C, Kuriara H, Lacavalla D, La Greca A, Larghi A, Mariani D, Mirco P, Occhionorelli S, Parini D, Polistina F, Rimbas M, Sapienza P, Tartaglia D, Tropeano G, Venezia P, Venezia DF, Zaghi C, Chiarugi M. Acute cholecystitis management in high-risk, critically ill, and unfit-for-surgery patients: the Italian Society of Emergency Surgery and Trauma (SICUT) guidelines. Updates Surg 2024; 76:331-343. [PMID: 38153659 DOI: 10.1007/s13304-023-01729-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 12/05/2023] [Indexed: 12/29/2023]
Abstract
Dealing with acute cholecystitis in high-risk, critically ill, and unfit-for-surgery patients is frequent during daily practice and requires complex management. Several procedures exist to postpone and/or prevent surgical intervention in those patients who temporarily or definitively cannot undergo surgery. After a systematic review of the literature, an expert panel from the Italian Society of Emergency Surgery and Trauma (SICUT) discussed the different issues and statements in subsequent rounds. The final version of the statements was discussed during the annual meeting in Rome (September 2022). The present paper presents the definitive conclusions of the discussion. Fifteen statements based on the literature evidence were provided. The statements gave precise indications regarding the decisional process and the management of patients who cannot temporarily or definitively undergo cholecystectomy for acute cholecystitis. Acute cholecystitis management in high-risk, critically ill, and unfit-for-surgery patients should be multidisciplinary. The different gallbladder drainage methods must be tailored according to each patient and based on the expertise of the hospital. Percutaneous gallbladder drainage is recommended as the first choice as a bridge to surgery or in severely physiologically deranged patients. Endoscopic gallbladder drainage (cholecystoduodenostomy and cholecystogastrostomy) is suggested as a second-line alternative especially as a definitive procedure for those patients not amenable to surgical management. Trans-papillary gallbladder drainage is the last option to be reserved only to those unfit for other techniques. Delayed laparoscopic cholecystectomy in patients with percutaneous gallbladder drainage is suggested in all those patients recovering from the conditions that previously discouraged surgical intervention after at least 6 weeks from the gallbladder drainage.
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Affiliation(s)
- Federico Coccolini
- General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa University, Via Paradisia 1, Pisa, Italy.
| | - Eugenio Cucinotta
- General Surgery Department, Messina University Hospital, Messina, Italy
| | - Andrea Mingoli
- Emergency Department, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Mauro Zago
- General Surgery Department, Lecco Hospital, Lecco, Italy
| | - Gaia Altieri
- Department of Trauma and Emergency Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alan Biloslavo
- General Surgery Department, Trieste University Hospital, Trieste, Italy
| | - Roberto Caronna
- General Surgery Department, Messina University Hospital, Messina, Italy
| | - Ismail Cengeli
- General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa University, Via Paradisia 1, Pisa, Italy
| | - Enrico Cicuttin
- General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa University, Via Paradisia 1, Pisa, Italy
| | - Roberto Cirocchi
- General Surgery Department, Perugia University Hospital, Perugia, Italy
| | - Luigi Cobuccio
- General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa University, Via Paradisia 1, Pisa, Italy
| | - Gianluca Costa
- General Surgery Department, Campus Biomedico University Hospital, Rome, Italy
| | - Valerio Cozza
- Department of Trauma and Emergency Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Camilla Cremonini
- General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa University, Via Paradisia 1, Pisa, Italy
| | | | | | - Valeria Fico
- Department of Trauma and Emergency Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Hayato Kuriara
- Emergency Surgery Department, Policlinico Hospital, Milan, Italy
| | - Domenico Lacavalla
- Emergency Surgery Department, Ferrara University Hospital, Ferrara, Italy
| | - Antonio La Greca
- Department of Trauma and Emergency Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alberto Larghi
- Department of Trauma and Emergency Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Diego Mariani
- General Surgery Department, Legnano Hospital, Legnano, Italy
| | - Paolo Mirco
- Department of Trauma and Emergency Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Dario Parini
- General Surgery Department, Rovigo Hospital, Rovigo, Italy
| | | | - Mihai Rimbas
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
- Department of Internal Medicine, Carol Davila University of Medicine, Bucharest, Romania
| | - Paolo Sapienza
- Emergency Department, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Dario Tartaglia
- General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa University, Via Paradisia 1, Pisa, Italy
| | - Giuseppe Tropeano
- Department of Trauma and Emergency Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Piero Venezia
- General Surgery Department, Bari University Hospital, Bari, Italy
| | | | - Claudia Zaghi
- General Surgery Department, Vicenza Hospital, Vicenza, Italy
| | - Massimo Chiarugi
- General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa University, Via Paradisia 1, Pisa, Italy
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Albouys J, Guilmoteau T, Schaefer M, Jacques J. How to prevent and treat biliary lumen-apposing metal stent dysfunction? Dig Endosc 2024; 36:492-494. [PMID: 38514464 DOI: 10.1111/den.14787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 02/18/2024] [Indexed: 03/23/2024]
Affiliation(s)
- Jérémie Albouys
- Department of Gastroenterology and Digestive Endoscopy, Dupuytren University Hospital, Limoges, France
| | - Thomas Guilmoteau
- Department of Digestive Medicine, Estaing University Hospital, Clermont-Ferrand, France
| | - Marion Schaefer
- Department of Gastroenterology and Digestive Endoscopy, Nancy University Hospital, Nancy, France
| | - Jérémie Jacques
- Department of Gastroenterology and Digestive Endoscopy, Dupuytren University Hospital, Limoges, France
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Stefanovic S, Adler DG, Arlt A, Baron TH, Binmoeller KF, Bronswijk M, Bruno MJ, Chevaux JB, Crinò SF, Degroote H, Deprez PH, Draganov PV, Eisendrath P, Giovannini M, Perez-Miranda M, Siddiqui AA, Voermans RP, Yang D, Hindryckx P. International Consensus Recommendations for Safe Use of LAMS for On- and Off-Label Indications Using a Modified Delphi Process. Am J Gastroenterol 2024; 119:671-681. [PMID: 37934190 DOI: 10.14309/ajg.0000000000002571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/02/2023] [Indexed: 11/08/2023]
Abstract
INTRODUCTION The study aimed to develop international consensus recommendations on the safe use of lumen-apposing metal stents (LAMSs) for on- and off-label indications. METHODS Based on the available literature, statements were formulated and grouped into the following categories: general safety measures, peripancreatic fluid collections, endoscopic ultrasound (EUS)-biliary drainage, EUS-gallbladder drainage, EUS-gastroenterostomy, and gastric access temporary for endoscopy. The evidence level of each statement was determined using the Grading of Recommendations Assessment, Development, and Evaluation methodology.International LAMS experts were invited to participate in a modified Delphi process. When no 80% consensus was reached, the statement was modified based on expert feedback. Statements were rejected if no consensus was reached after the third Delphi round. RESULTS Fifty-six (93.3%) of 60 formulated statements were accepted, of which 35 (58.3%) in the first round. Consensus was reached on the optimal learning path, preprocedural imaging, the need for airway protection and essential safety measures during the procedure, such as the use of Doppler, and measurement of the distance between the gastrointestinal lumen and the target structure. Specific consensus recommendations were generated for the different LAMS indications, covering, among others, careful patient selection, the preferred size of the LAMS, the need for antibiotics, the preferred anatomic location of the LAMS, the need for coaxial pigtail placement, and the appropriate management of LAMS-related adverse events. DISCUSSION Through a modified international Delphi process, we developed general and indication-specific experience- and evidence-based recommendations on the safe use of LAMS.
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Affiliation(s)
- Sebastian Stefanovic
- Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium
- Diagnostic Center Bled Group, Bled, Slovenia
| | - Douglas G Adler
- Centura Health, Center for Advanced Therapeutic Endoscopy, Colorado, Englewood, USA
| | - Alexander Arlt
- Department of Internal Medicine and Gastroenterology, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Todd H Baron
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Kenneth F Binmoeller
- Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, California, USA
| | - Michiel Bronswijk
- Gastroenterology and Hepatology, Imelda Hospital Bonheiden and University Hospitals Leuven, Belgium
| | - Marco J Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | | | - Stefano Francesco Crinò
- Department of Medicine, Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University Hospital of Verona, Verona, Italy
| | - Helena Degroote
- Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium
| | - Pierre H Deprez
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Department of Hepatogastroenterology, Brussels, Belgium
| | | | - Pierre Eisendrath
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Saint-Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Marc Giovannini
- Digestive Endoscopy Unit, Paoli Calmettes Institute, Marseille Cedex 9, France
| | - Manuel Perez-Miranda
- Gastroenterology Department, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Ali A Siddiqui
- Department of Gastroenterology and Hepatology, Inova Fairfax Hospital, Falls Church, Virginia, USA
| | - Rogier P Voermans
- Amsterdam University Medical Center, Department of Gastroenterology and Hepatology, University of Amsterdam, Amsterdam, Netherlands
| | - Dennis Yang
- Center for Interventional Endoscopy, AdventHealth, Orlando, Florida, USA
| | - Pieter Hindryckx
- Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium
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Vanella G, Dell'Anna G, van Wanrooij RLJ, Bronswijk M, Voermans RP, Laleman W, van Malenstein H, Fockens P, Van der Merwe S, Arcidiacono PG. Managing dysfunctions and reinterventions in endoscopic ultrasound-guided choledochoduodenostomy with lumen apposing metal stents: Illustrated technical review (with videos). Dig Endosc 2024; 36:481-491. [PMID: 37852797 DOI: 10.1111/den.14708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/15/2023] [Indexed: 10/20/2023]
Abstract
Endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) with lumen apposing metal stent is emerging both as a rescue strategy and a primary treatment for distal malignant biliary obstruction. The large-scale diffusion of the procedure and improved overall survival of patients with pancreatobiliary neoplasms is resulting in a growing population of long-term EUS-CDS lumen apposing metal stent carriers. Recent studies have reported a need for reintervention during follow-up as high as 55%, and the Leuven-Amsterdam-Milan Study Group classification has been developed, identifying five mechanisms of stent dysfunction and 11 possible rescue strategies aimed at restoring biliary drainage. This illustrated technical review aims to further dissect the recent classification through a comprehensive analysis of nine illustrative cases, offering insights into the pathophysiology underlying dysfunction and clinical reasoning behind rescue interventions, as well as technical considerations and practical tips and tricks. By exploring mechanisms of dysfunction, this review also assists clinicians in selecting the ideal candidates for EUS-CDS while identifying patients deemed high risk for dysfunction or clinical failure.
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Affiliation(s)
- Giuseppe Vanella
- Pancreatobiliary Endoscopy and Endosonography Division, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Giuseppe Dell'Anna
- Pancreatobiliary Endoscopy and Endosonography Division, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Roy L J van Wanrooij
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology and Metabolism, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Michiel Bronswijk
- Department of Gastroenterology and Hepatology, University Hospitals Gasthuisberg, University of Leuven, Leuven, Belgium
- Department of Gastroenterology and Hepatology, Imelda General Hospital, Bonheiden, Belgium
| | - Rogier P Voermans
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Wim Laleman
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology and Metabolism, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Hannah van Malenstein
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology and Metabolism, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Paul Fockens
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology and Metabolism, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Schalk Van der Merwe
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology and Metabolism, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Paolo Giorgio Arcidiacono
- Pancreatobiliary Endoscopy and Endosonography Division, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
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60
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Larghi A, van Wanrooij RLJ, Bronswijk M, Vanella G, Kunda R, Pérez-Miranda M, Van-Hooft JE, Barthet MA, Arcidiacono PG, Van der Merwe SW. Cholecystectomy following EUS-guided gallbladder drainage in patients with acute cholecystitis at high surgical risk: friend or foe? Gut 2024:gutjnl-2024-332273. [PMID: 38519123 DOI: 10.1136/gutjnl-2024-332273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 02/27/2024] [Indexed: 03/24/2024]
Affiliation(s)
- Alberto Larghi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Roy L J van Wanrooij
- Gastroenterology and Hepatology, Amsterdam UMC, Locatie VUmc, Amsterdam, Noord-Holland, The Netherlands
| | - Michiel Bronswijk
- Gastroenterology-Hepatology, Department of Gastroenterology and Hepatology, Imelda General Hospital, Belgium, Bonheiden, Belgium
| | - Giuseppe Vanella
- Pancreatobiliary Endoscopy and Endosonography Division, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Rastislav Kunda
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Manuel Pérez-Miranda
- Gastroenterology and Hepatology, University Hospital Rio Hortega, Valladolid, Spain
| | - Jeanin E Van-Hooft
- Gastroenterology & Hepatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Marc A Barthet
- Gastroenterology, Hopital Nord, Marseille Cedex 20, France
| | - Paolo Giorgio Arcidiacono
- Pancreatobiliary Endoscopy and Endosonography Division, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Oh D, Han SY, Lee SH, Kim SH, Paik WH, Chon HK, Song TJ, Park SW, Cho JH. Comparison of long-term outcomes of endoscopic ultrasound-guided hepaticogastrostomy and choledochoduodenostomy for distal malignant biliary obstruction: a multicenter retrospective study. Therap Adv Gastroenterol 2024; 17:17562848241239551. [PMID: 38510458 PMCID: PMC10953094 DOI: 10.1177/17562848241239551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 02/27/2024] [Indexed: 03/22/2024] Open
Abstract
Background Endoscopic ultrasound-guided biliary drainage (EUS-BD), classified as choledochoduodenostomy (CDS) and hepaticogastrostomy (HGS), is a feasible and effective alternative for distal malignant biliary obstruction (MBO) in failed endoscopic retrograde cholangiopancreatography. However, the preferred technique for better outcomes has not yet been evaluated. Objectives We compared the long-term outcomes between the techniques. Design Retrospective comparative study. Methods We reviewed consecutive patients who underwent EUS-CDS or EUS-HGS with transmural stent placement for distal MBO between 2009 and 2022. The primary outcome was the stent patency. The secondary outcomes were technical and clinical success, adverse events (AEs) of each technique, and independent risk factors for stent dysfunction. Results In all, 115 patients were divided into EUS-CDS (n = 56) and EUS-HGS (n = 59) groups. Among them, technical success was achieved in 98.2% of EUS-CDS and 96.6% of EUS-HGS groups. Furthermore, clinical success was 96.4% in EUS-CDS and 88.1% in EUS-HGS groups, without significant difference (p = 0.200). The mean duration of stent patency for EUS-CDS was 770.3 days while that for EUS-HGS was 164.9 days (p = 0.010). In addition, the only independent risk factor for stent dysfunction was systematic treatment after EUS-BD [hazard ratio and 95% confidence interval 0.238 (0.066-0.863), p = 0.029]. The incidence of stent dysfunction of EUS-HGS was higher than EUS-CDS (35.1% versus 18.2%, 0.071), despite no significant differences even in late AEs. Conclusion In distal MBO, EUS-CDS may be better than EUS-HGS with longer stent patency and fewer AEs. Furthermore, systematic treatment after EUS-BD is recommended for the improvement of stent patency.
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Affiliation(s)
- Dongwook Oh
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung Yong Han
- Division of Gastroenterology and Hepatology, Internal Medicine and Biomedical Research Institute, Pusan National University Hospital and school of medicine, Pusan National University, Busan, Republic of korea
| | - Sang Hyub Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seong-Hun Kim
- Department of Internal Medicine, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Woo Hyun Paik
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyung-Ku Chon
- Division of Gastroenterology, Department of Internal Medicine, Wonkwang University College of Medicine, Iksan, Republic of Korea
| | - Tae Jun Song
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Se Woo Park
- Division of Gastroenterology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, 7, Keunjaebong-gil, Hwaseong-si, Gyeonggi-do 18450, Republic of Korea
| | - Jae Hee Cho
- Division of Gastroenterology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul 03722, Republic of Korea
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Fabbri C, Scalvini D, Paolo G, Binda C, Mauro A, Coluccio C, Mazza S, Trebbi M, Torello Viera F, Anderloni A. Complications and management of interventional endoscopic ultrasound: A critical review. Best Pract Res Clin Gastroenterol 2024; 69:101888. [PMID: 38749575 DOI: 10.1016/j.bpg.2024.101888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 01/30/2024] [Indexed: 07/13/2024]
Abstract
In the last decades, Endoscopic ultrasound (EUS) has rapidly grown and evolved from being mainly a diagnostic procedure, to being an interventional and therapeutic tool in several pathological clinical scenarios. With the progressive growth in technical expertise and dedicated devices, interventional endoscopic ultrasound procedures (IEUSP) have shown high rates of technical and clinical success, together with a relatively safe profile. However, the description and the standardization of different and specific types of adverse events (AEs) are still scarce in literature, and, consequently, even less the management of AEs. The aim of this study is to critical review and to describe AEs related to each of the main IEUSP, and to provide an overview on the possible management strategies of endoscopic complications. Future studies and guidelines are surely required to reach a better standardization of different AEs and their best management.
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Affiliation(s)
- Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì, Italy
| | - Davide Scalvini
- Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Giuffrida Paolo
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì, Italy.
| | - Cecilia Binda
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì, Italy
| | - Aurelio Mauro
- Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Chiara Coluccio
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì, Italy
| | - Stefano Mazza
- Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Margherita Trebbi
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì, Italy
| | - Francesca Torello Viera
- Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Andrea Anderloni
- Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Chantarojanasiri T, Siripun A, Pinyotheppratarn R, Kongkam P, Pausawasdi N, Ratanachu-ek T. Revolution of hands-on model for interventional EUS: How to make a training model. Endosc Ultrasound 2024; 13:76-82. [PMID: 38947748 PMCID: PMC11213597 DOI: 10.1097/eus.0000000000000046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/02/2024] Open
Abstract
EUS interventions have an increasing role in the treatment for hepatobiliary-pancreatic diseases. However, the procedure itself is not frequently performed, needs expertise, and carries a high risk of complications. With these limitations, the hands-on practice model is very important for the endoscopist in training for EUS intervention. There have been various hands-on models for EUS interventions, ranging from in vivo living pig model to all-synthetic model. Although a living model provides realistic sensation, the preparation is complex and increases concerns for zoonotic issues. All-synthetic models are easier to prepare and store but not realistic and still need the room for improvement. Hybrid ex vivo model is more widely available and provides various training procedures but still needs special preparation for the porcine tissue.
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Affiliation(s)
- Tanyaporn Chantarojanasiri
- The Thai Association for Gastrointestinal Endoscopy (TAGE), Bangkok, Thailand
- Division of Gastroenterology, Department of Internal Medicine, Rajavithi hospital, College of Medicine, Rangsit University, Bangkok, Thailand
| | - Aroon Siripun
- The Thai Association for Gastrointestinal Endoscopy (TAGE), Bangkok, Thailand
- Department of Gastroenterology, Bangkok Hospital, Bangkok, Thailand
| | | | - Pradermchai Kongkam
- The Thai Association for Gastrointestinal Endoscopy (TAGE), Bangkok, Thailand
- Excellence Center for Gastrointestinal Endoscopy and Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Nonthalee Pausawasdi
- The Thai Association for Gastrointestinal Endoscopy (TAGE), Bangkok, Thailand
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Thawee Ratanachu-ek
- The Thai Association for Gastrointestinal Endoscopy (TAGE), Bangkok, Thailand
- Department of Surgery, Rajavithi hospital, Bangkok, Thailand
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64
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Fugazza A, Khalaf K, Spadaccini M, Facciorusso A, Colombo M, Andreozzi M, Carrara S, Binda C, Fabbri C, Anderloni A, Hassan C, Baron T, Repici A. Outcomes predictors in endoscopic ultrasound-guided choledochoduodenostomy with lumen-apposing metal stent: Systematic review and meta-analysis. Endosc Int Open 2024; 12:E456-E462. [PMID: 38550768 PMCID: PMC10978093 DOI: 10.1055/a-2271-2145] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/11/2024] [Indexed: 07/22/2024] Open
Abstract
Background and study aims EUS-guided choledochoduodenostomy (EUS-CDS) is a minimally invasive procedure used to treat malignant biliary obstruction (MBO) by transduodenal placement of a lumen-apposing metal stent (LAMS) into the extrahepatic bile duct. To identify factors that contribute to safe and effective EUS-CDS using LAMS, we performed a systematic review of the literature and meta-analysis. Methods The methodology of our analysis was based on PRISMA recommendations. Electronic databases (Medline, Scopus, EMBASE) were searched up to November 2022. Full articles that included patients with distal malignant biliary obstruction who underwent EUS-CDS using LAMS after failed endoscopic retrograde cholangiopancreatography were eligible. Random-effect meta-analysis was performed reporting pooled rates of technical success, clinical success, and adverse events (AEs) by means of a random model. Multivariate meta-regression and subgroup analysis were performed to assess possible associations between the outcomes and selected variables to assess the correlation between outcomes and different variables. Results were also stratified according to stent size. Results Twelve studies with 845 patients were included in the meta-analysis. Pooled technical and clinical success rates were 96% (95% confidence interval [CI] 94%-98%; I 2 = 52.29%) and 96% (95%CI 95%-98%), respectively, with no significant association with baseline characteristics, such are sex, age, common bile duct diameter, or stent size. The pooled AE rate was 12% (95%CI: 8%-16%; I 2 = 71.62%). The AE rate was significantly lower when using an 8 × 8 mm stent as compared with a 6 × 8 mm LAMS (odds ratio 0.59, 0.35-0.99; P = 0.04), with no evidence of heterogeneity (I 2 = 0%). Conclusions EUS-CDS with LAMS is a safe and effective option for relief of MBO. Selecting an appropriate stent size is crucial for achieving optimal safety outcomes.
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Affiliation(s)
- Alessandro Fugazza
- Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | - Kareem Khalaf
- Division of Gastroenterology, St Michael's Hospital, Toronto, Canada
| | - Marco Spadaccini
- Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | | | - Matteo Colombo
- Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | - Marta Andreozzi
- Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | - Silvia Carrara
- Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | - Cecilia Binda
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, Ausl Romagna, Forlì-Cesena, Italy
| | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, Ausl Romagna, Forlì-Cesena, Italy
| | - Andrea Anderloni
- Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Cesare Hassan
- Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Todd Baron
- Gastroenterology & Hepatology, University of North Carolina, Chapel Hill, United States
| | - Alessandro Repici
- Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
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65
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Tian S, Shi H, Chen W, Li S, Han C, Du F, Wang W, Wen H, Lei Y, Deng L, Tang J, Zhang J, Lin J, Shi L, Ning B, Zhao K, Miao J, Wang G, Hou H, Huang X, Kong W, Jin X, Ding Z, Lin R. Artificial intelligence-based diagnosis of standard endoscopic ultrasonography scanning sites in the biliopancreatic system: a multicenter retrospective study. Int J Surg 2024; 110:1637-1644. [PMID: 38079604 PMCID: PMC10942157 DOI: 10.1097/js9.0000000000000995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/27/2023] [Indexed: 03/16/2024]
Abstract
BACKGROUND There are challenges for beginners to identify standard biliopancreatic system anatomical sites on endoscopic ultrasonography (EUS) images. Therefore, the authors aimed to develop a convolutional neural network (CNN)-based model to identify standard biliopancreatic system anatomical sites on EUS images. METHODS The standard anatomical structures of the gastric and duodenal regions observed by EUS was divided into 14 sites. The authors used 6230 EUS images with standard anatomical sites selected from 1812 patients to train the CNN model, and then tested its diagnostic performance both in internal and external validations. Internal validation set tests were performed on 1569 EUS images of 47 patients from two centers. Externally validated datasets were retrospectively collected from 16 centers, and finally 131 patients with 85 322 EUS images were included. In the external validation, all EUS images were read by CNN model, beginners, and experts, respectively. The final decision made by the experts was considered as the gold standard, and the diagnostic performance between CNN model and beginners were compared. RESULTS In the internal test cohort, the accuracy of CNN model was 92.1-100.0% for 14 standard anatomical sites. In the external test cohort, the sensitivity and specificity of CNN model were 89.45-99.92% and 93.35-99.79%, respectively. Compared with beginners, CNN model had higher sensitivity and specificity for 11 sites, and was in good agreement with the experts (Kappa values 0.84-0.98). CONCLUSIONS The authors developed a CNN-based model to automatically identify standard anatomical sites on EUS images with excellent diagnostic performance, which may serve as a potentially powerful auxiliary tool in future clinical practice.
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Affiliation(s)
- Shuxin Tian
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
- Department of Gastroenterology, The First Affiliated Hospital of Medical College, Shihezi University, Shihezi
- National Health Commission Key Laboratory of Central Asia High Incidence Disease Prevention and Control, Shihezi
| | - Huiying Shi
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Weigang Chen
- Department of Gastroenterology, The First Affiliated Hospital of Medical College, Shihezi University, Shihezi
- National Health Commission Key Laboratory of Central Asia High Incidence Disease Prevention and Control, Shihezi
| | - Shijie Li
- National Health Commission Key Laboratory of Central Asia High Incidence Disease Prevention and Control, Shihezi
- Department of Endoscopy Center, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing
| | - Chaoqun Han
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Fan Du
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Weijun Wang
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Hongxu Wen
- Department of Gastroenterology, Lanzhou Second People’s Hospital, Lanzhou
| | - Yali Lei
- Department of Gastroenterology, Weinan Central Hospital, Weinan
| | - Liang Deng
- Department of Gastroenterology, The First Affiliated Hospital of Chongqing Medical University, Chongqing
| | - Jing Tang
- Department of Gastroenterology, Fuling Hospital Affiliated to Chongqing University, Chongqing
| | - Jinjie Zhang
- Department of Gastroenterology, The Second Affiliated Hospital of Baotou Medical College, Baotou
| | - Jianjiao Lin
- Department of Gastroenterology, Longgang District People’s Hospital, Shenzhen
| | - Lei Shi
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou
| | - Bo Ning
- Department of Gastroenterology, The Second Affiliated Hospital Chongqing Medical University, Chongqing
| | - Kui Zhao
- Department of Gastroenterology, The First Affiliated Hospital of Chendu Medical College, Chengdu
| | - Jiarong Miao
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Kunming
- Yunnan Province Clinical Research Center for Digestive Diseases, Kunming
| | - Guobao Wang
- Department of endoscopy, Sun Yat-sen University Cancer Center,Guangzhou
| | - Hui Hou
- Department of Gastroenterology, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi
| | - Xiaoxi Huang
- Department of Gastroenterology, Haikou People’s Hospital, Haikou
| | - Wenjie Kong
- Department of Gastroenterology, People’s Hospital of Xinjiang Autonomous Region, Urumqi
| | - Xiaojuan Jin
- Department of Gastroenterology, Suining Central Hospital, Suining, People’s Republic of China
| | - Zhen Ding
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
- Department of Endoscopy Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou
| | - Rong Lin
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
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Cho SH, Song TJ, Oh D, Park DH, Seo DW, Lee SK. Endoscopic ultrasound-guided hepaticoduodenostomy versus percutaneous drainage for right intrahepatic duct dilatation in malignant hilar obstruction. J Gastroenterol Hepatol 2024; 39:552-559. [PMID: 38110804 DOI: 10.1111/jgh.16442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 06/20/2023] [Accepted: 11/22/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND AND AIM Endoscopic ultrasound (EUS)-guided biliary drainage is being increasingly performed as an alternative to percutaneous transhepatic biliary drainage (PTBD) to treat malignant hilar obstruction (MHO) after failed endoscopic retrograde cholangiopancreatography (ERCP). However, no study has compared EUS-guided hepaticoduodenostomy (EUS-HDS) with PTBD for right intrahepatic duct (IHD) obstruction after failed ERCP in patients with unresectable MHO. METHODS We retrospectively reviewed the data of consecutive patients with right IHD obstruction developed by unresectable MHO who underwent EUS-HDS or PTBD after a previous placement of a stent in the left and/or right IHD between March 2018 and October 2021. Technical success, clinical success, stent or tube-related adverse events, frequency of reintervention, and stent patency were evaluated. RESULTS A total of 42 patients (18 EUS-HDS, 24 PTBD) were analyzed. Both groups did not show significant differences in technical success (EUS-HDS, 94% vs PTBD, 100%; P = 0.429), clinical success (83% vs 83%; P = 0.999), early adverse events (24% vs 46%; P = 0.144), and stent or tube-related late adverse events (29% vs 54%; P = 0.116). During follow-up, the EUS-HDS group had a longer median duration of patency (131 days vs 58.5 days; P = 0.041), and lower mean frequency of reinterventions per patient (0.35 vs 1.92; P = 0.030) than the PTBD group. CONCLUSIONS EUS-HDS showed comparable efficacy and safety to PTBD for drainage of the right biliary system and produced longer duration of patency and lower frequency of reinterventions in patients with unresectable MHO.
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Affiliation(s)
- Sung Hyun Cho
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Tae Jun Song
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Dongwook Oh
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Do Hyun Park
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Dong-Wan Seo
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Sung Koo Lee
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
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Soga K. Single-pigtail plastic stent made from endoscopic nasobiliary drainage tubes in endoscopic ultrasound-guided gallbladder drainage: a retrospective case series. Clin Endosc 2024; 57:263-267. [PMID: 37011902 PMCID: PMC10984743 DOI: 10.5946/ce.2022.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/01/2022] [Accepted: 09/01/2022] [Indexed: 04/05/2023] Open
Abstract
Technical failure of endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is often attributed to device failure. To rectify this problem, we developed a single-pigtail plastic stent (SPPS) for EUS-GBD. We retrospectively reviewed the cases of four patients who underwent EUS-GBD for acute cholecystitis. To prepare the SPPS, a 7.5-Fr endoscopic nasobiliary drainage tube was cut to an appropriate length. The use of SPPS during EUS-GBD was successful from both technical and clinical standpoints. The SPPS spontaneously detached 57 days after the procedure in patient 4 and 412 days after the procedure in patient 1. Patient 1 developed cholecystitis after 426 days and was managed with antibiotics. The other three patients did not develop any complications after surgery. In conclusion, we designed a new SPPS dedicated to EUS-GBD and established its technical feasibility and clinical effectiveness.
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Affiliation(s)
- Koichi Soga
- Department of Gastroenterology, Omihachiman Community Medical Center, Shiga, Japan
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68
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Mangiavillano B, Moon JH, Facciorusso A, Vargas-Madrigal J, Di Matteo F, Rizzatti G, De Luca L, Forti E, Mutignani M, Al-Lehibi A, Paduano D, Bulajic M, Decembrino F, Auriemma F, Franchellucci G, De Marco A, Gentile C, Shin IS, Rea R, Massidda M, Calabrese F, Mirante VG, Ofosu A, Crinò SF, Hassan C, Repici A, Larghi A. Endoscopic ultrasound-guided gallbladder drainage as a first approach for jaundice palliation in unresectable malignant distal biliary obstruction: Prospective study. Dig Endosc 2024; 36:351-358. [PMID: 37253185 DOI: 10.1111/den.14606] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/29/2023] [Indexed: 06/01/2023]
Abstract
OBJECTIVES Endoscopic retrograde cholangiopancreatography (ERCP) represents the gold standard for jaundice palliation in patients with distal malignant biliary obstruction (DMBO). Biliary drainage using electrocautery lumen apposing metal stent (EC-LAMS) is currently a well-established procedure when ERCP fails. In a palliative setting the endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) could represent an easy and valid option. We performed a prospective study with a new EC-LAMS with the primary aim to assess the clinical success rate of EUS-GBD as a first-line approach to the palliation of DMBO. METHODS In all, 37 consecutive patients undergoing EUS-GBD with a new EC-LAMS were prospectively enrolled. Clinical success was defined as bilirubin level decrease >15% within 24 h and >50% within 14 days after EC-LAMS placement. RESULTS The mean age was 73.5 ± 10.8 years; there were 17 male patients (45.9%). EC-LAMS placement was technically feasible in all patients (100%) and the clinical success rate was 100%. Four patients (10.8%) experienced adverse events, one bleeding, one food impaction, and two cystic duct obstructions because of disease progression. No stent-related deaths were observed. The mean hospitalization was 7.7 ± 3.4 days. Median overall survival was 4 months (95% confidence interval 1-8). CONCLUSION Endoscopic ultrasound-guided gallbladder drainage with the new EC-LAMS is a valid option in palliative endoscopic biliary drainage as a first-step approach in low survival patients with malignant jaundice unfit for surgery. A smaller diameter EC-LAMS should be preferred, particularly if the drainage is performed through the stomach, to avoid potential food impaction, which could result in stent dysfunction.
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Affiliation(s)
- Benedetto Mangiavillano
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Varese, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Jong Ho Moon
- Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon, South Korea
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Jorge Vargas-Madrigal
- Department of Gastroenterology and Endoscopy, Hospital Enrique Baltodano Briceño, Liberia, Costa Rica
| | | | - Gianenrico Rizzatti
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luca De Luca
- Endoscopic Unit, ASST Santi Paolo e Carlo, Milan, Italy
| | - Edoardo Forti
- Digestive and Interventional Endoscopy Unit, Niguarda Hospital, ASST Niguarda, Milan, Italy
| | - Massimiliano Mutignani
- Digestive and Interventional Endoscopy Unit, Niguarda Hospital, ASST Niguarda, Milan, Italy
| | - Abed Al-Lehibi
- King Fahad Medical City, Faculty of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Danilo Paduano
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Varese, Italy
| | - Milutin Bulajic
- Digestive Endoscopy, Fatebenefratelli Isola Tiberina - Gemelli Isola, Rome, Italy
| | - Francesco Decembrino
- UOC Gastroenterologia ed Endoscopia Digestiva, Ente Ecclesiastico-Ospedale Generale Regionale "F.Miulli", Bari, Italy
| | | | - Gianluca Franchellucci
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Varese, Italy
- Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Alessandro De Marco
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Varese, Italy
- Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Carmine Gentile
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Varese, Italy
| | - Il Sang Shin
- Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon, South Korea
| | - Roberta Rea
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | | | - Vincenzo Giorgio Mirante
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Andrew Ofosu
- Division of Digestive Diseases, University of Cincinnati, Cincinnati, USA
| | - Stefano Francesco Crinò
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, Verona, Italy
| | - Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Alessandro Repici
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Alberto Larghi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Todorov I, Trayanova D, Tsenovski Y. Short-term clinical outcomes of percutaneous biliary tract interventions: analysis of success and complication rates. Folia Med (Plovdiv) 2024; 66:46-58. [PMID: 38426465 DOI: 10.3897/folmed.66.e116660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 12/29/2023] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION Obstructive jaundice is a clinical syndrome that is commonly seen in gastroenterology. Endoscopic retrograde cholangiopancreatography (ERCP) has been recognized as a first-choice therapeutic approach, with percutaneous biliary interventions (PBIs) being a viable alternative. Recent data questions the performance and safety profile of PBIs.
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Bang JY, Arnoletti JP, Wagner A, Varadarajulu S. EUS-guided gallbladder drainage in acute cholecystitis: long-term problems with surgical approach. Gut 2024; 73:395-397. [PMID: 38050116 PMCID: PMC10894811 DOI: 10.1136/gutjnl-2023-331245] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 11/12/2023] [Indexed: 12/06/2023]
Affiliation(s)
- Ji Young Bang
- Digestive Health Institute, Orlando Health, Orlando, Florida, USA
| | | | - Andrew Wagner
- Department of Interventional Radiology, Orlando Health, Orlando, Florida, USA
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Debourdeau A, Daniel J, Caillo L, Assenat E, Bertrand M, Bardol T, Souche FR, Pouderoux P, Gerard R, Lorenzo D, Bourgaux JF. Effectiveness of endoscopic ultrasound (EUS)-guided choledochoduodenostomy vs. EUS-guided gallbladder drainage for jaundice in patients with malignant distal biliary obstruction after failed endoscopic retrograde cholangiopancreatography: Retrospective, multicenter study (GALLBLADEUS Study). Dig Endosc 2024. [PMID: 38380564 DOI: 10.1111/den.14750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 12/24/2023] [Indexed: 02/22/2024]
Abstract
OBJECTIVES The aim of this study was to compare endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) vs. EUS-gallbladder drainage (EUS-GBD) in cases of failed endoscopic retrograde cholangiopancreatography (ERCP) for jaundice resulting from malignant distal biliary obstruction (MDBO). METHODS This multicenter retrospective study included patients with obstructive jaundice secondary to MDBO who underwent EUS-GBD or EUS-CDS with lumen-apposing metal stents after failed ERCP. The primary end-point was clinical success rate. Secondary end-points were technical success, periprocedural adverse events rate (<24 h), late adverse events rate (>24 h), overall survival, and time to recurrent biliary obstruction. RESULTS A total of 78 patients were included: 41 underwent EUS-GBD and 37 underwent EUS-CDS. MDBO was mainly the result of pancreatic cancer (n = 63/78, 80.7%). Clinical success rate was similar for both procedures: 87.8% for EUS-GBD and 89.2% for EUS-CDS (P = 0.8). Technical success rate was 100% for EUS-GBD and 94.6% for EUS-CDS (P = 0.132). Periprocedural morbidity (<24 h) rates were similar between both groups: 4/41 (9.8%) for EUS-GBD and 5/37 (13.5%) for EUS-CDS (P = 0.368). There was a significantly higher rate of late morbidity (>24 h) among patients in the EUS-CDS group (8/37 [21.6%]) than in the EUS-GBD group (3/41 [7.3%]) (P = 0.042). The median follow-up duration was 4.7 months. Overall survival and time to recurrent biliary obstruction did not significantly differ between the groups. DISCUSSION After failed ERCP for MDBO, EUS-GBD and EUS-CDS show comparable clinical success rates and technical success. EUS-GBD appears to be a promising alternative for MDBO, even as a second-line treatment after failed ERCP. Further studies are needed to validate these findings and compare the long-term outcomes of EUS-GBD and EUS-CDS.
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Affiliation(s)
- Antoine Debourdeau
- Hepatogastroenterology Department, Nimes University Hospital, University of Montpellier, Nimes, France
- Hepatogastroenterology Department, Montpellier University Hospital, University of Montpellier, Montpellier, France
| | - Jules Daniel
- Hepatogastroenterology Department, Nimes University Hospital, University of Montpellier, Nimes, France
| | - Ludovic Caillo
- Hepatogastroenterology Department, Nimes University Hospital, University of Montpellier, Nimes, France
| | - Eric Assenat
- Hepatogastroenterology Department, Montpellier University Hospital, University of Montpellier, Montpellier, France
| | - Martin Bertrand
- Surgery Department, Nimes University Hospital, University of Montpellier, Nimes, France
| | - Thomas Bardol
- Surgery Department, Montpellier University Hospital, University of Montpellier, Montpellier, France
| | - François-Régis Souche
- Surgery Department, Montpellier University Hospital, University of Montpellier, Montpellier, France
| | - Philippe Pouderoux
- Hepatogastroenterology Department, Nimes University Hospital, University of Montpellier, Nimes, France
| | - Romain Gerard
- Hepatogastroenterology Department, Lille University Hospital, Lille University, Lille, France
| | - Diane Lorenzo
- Hepatogastroenterology Department, Beaujon University Hospital, Paris Cité University, Paris, France
| | - Jean-François Bourgaux
- Hepatogastroenterology Department, Nimes University Hospital, University of Montpellier, Nimes, France
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Conti Bellocchi MC, Gasparini E, Stigliano S, Ramai D, Bernardoni L, Di Matteo FM, Facciorusso A, Frulloni L, Crinò SF. Endoscopic Ultrasound-Guided Gastroenterostomy versus Enteral Stenting for Malignant Gastric Outlet Obstruction: A Retrospective Propensity Score-Matched Study. Cancers (Basel) 2024; 16:724. [PMID: 38398115 PMCID: PMC10887005 DOI: 10.3390/cancers16040724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) using lumen apposing metal stent has emerged as a minimally invasive treatment for the management of malignant gastric outlet obstruction (mGOO). We aimed to compare EUS-GE with enteral stenting (ES) for the treatment of mGOO. METHODS Patients who underwent EUS-GE or ES for mGOO between June 2017 and June 2023 at two Italian centers were retrospectively identified. The primary outcome was stent dysfunction. Secondary outcomes included technical success, clinical failure, safety, and hospital length of stay. A propensity score-matching analysis was performed using multiple covariates. RESULTS Overall, 198 patients were included (66 EUS-GE and 132 ES). The stent dysfunction rate was 3.1% and 16.9% following EUS-GE and ES, respectively (p = 0.004). Using propensity score-matching, 45 patients were allocated to each group. The technical success rate was 100% for both groups. Stent dysfunction was higher in the ES group compared with the EUS-GE group (20% versus 4.4%, respectively; p = 0.022) without differences in clinical efficacy (p = 0.266) and safety (p = 0.085). A significantly shorter hospital stay was associated with EUS-GE compared with ES (7.5 ± 4.9 days vs. 12.5 ± 13.0 days, respectively; p = 0.018). Kaplan-Meier analyses confirmed a higher stent dysfunction-free survival rate after EUS-GE compared with ES (log-rank test; p = 0.05). CONCLUSION EUS-GE offers lower rates of stent dysfunction, longer stent patency, and shorter hospital stay compared with ES.
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Affiliation(s)
- Maria Cristina Conti Bellocchi
- Diagnostic and Interventional Endoscopy of Pancreas, The Pancreas Institute, G.B. Rossi University Hospital, 37134 Verona, Italy; (E.G.); (L.B.); (L.F.); (S.F.C.)
| | - Enrico Gasparini
- Diagnostic and Interventional Endoscopy of Pancreas, The Pancreas Institute, G.B. Rossi University Hospital, 37134 Verona, Italy; (E.G.); (L.B.); (L.F.); (S.F.C.)
| | - Serena Stigliano
- Unit of Gastroenterology and Digestive Endoscopy, Campus Bio Medico University, 00128 Rome, Italy; (S.S.); (F.M.D.M.)
| | - Daryl Ramai
- Gastroenterology and Hepatology, University of Utah Hospital, Salt Lake City, UT 84112, USA;
| | - Laura Bernardoni
- Diagnostic and Interventional Endoscopy of Pancreas, The Pancreas Institute, G.B. Rossi University Hospital, 37134 Verona, Italy; (E.G.); (L.B.); (L.F.); (S.F.C.)
| | - Francesco Maria Di Matteo
- Unit of Gastroenterology and Digestive Endoscopy, Campus Bio Medico University, 00128 Rome, Italy; (S.S.); (F.M.D.M.)
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Medical Sciences, University of Foggia, 00161 Foggia, Italy;
| | - Luca Frulloni
- Diagnostic and Interventional Endoscopy of Pancreas, The Pancreas Institute, G.B. Rossi University Hospital, 37134 Verona, Italy; (E.G.); (L.B.); (L.F.); (S.F.C.)
| | - Stefano Francesco Crinò
- Diagnostic and Interventional Endoscopy of Pancreas, The Pancreas Institute, G.B. Rossi University Hospital, 37134 Verona, Italy; (E.G.); (L.B.); (L.F.); (S.F.C.)
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Rodríguez de Santiago E, Herreros-de-Tejada A, Albéniz E, Ramos Zabala F, Fernández-Esparrach G, Nogales O, Rosón P, Peñas García B, Uchima H, Terán Á, Rodríguez Sánchez J, de Frutos D, Parejo Carbonell S, Santiago J, Díaz Tasende J, Guarner Argente C, de María Pallarés P, Amorós A, Barranco D, Álvarez de Castro D, Muñoz González R, Marín-Gabriel JC. Implementation of esophageal endoscopic submucosal dissection in Spain: Results from the nationwide registry. GASTROENTEROLOGIA Y HEPATOLOGIA 2024; 47:119-129. [PMID: 36870477 DOI: 10.1016/j.gastrohep.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/24/2023] [Accepted: 02/21/2023] [Indexed: 03/06/2023]
Abstract
INTRODUCTION AND AIMS The outcomes of endoscopic submucosal dissection (ESD) in the esophagus have not been assessed in our country. Our primary aim was to analyze the effectiveness and safety of the technique. MATERIAL AND METHODS Analysis of the prospectively maintained national registry of ESD. We included all superficial esophageal lesions removed by ESD in 17 hospitals (20 endoscopists) between January 2016 and December 2021. Subepithelial lesions were excluded. The primary outcome was curative resection. We conducted a survival analysis and used logistic regression analysis to assess predictors of non-curative resection. RESULTS A total of 102 ESD were performed on 96 patients. The technical success rate was 100% and the percentage of en-bloc resection was 98%. The percentage of R0 and curative resection was 77.5% (n=79; 95%CI: 68%-84%) and 63.7% (n=65; 95%CI: 54%-72%), respectively. The most frequent histology was Barrett-related neoplasia (n=55 [53.9%]). The main reason for non-curative resection was deep submucosal invasion (n=25). The centers with a lower volume of ESD obtained worse results in terms of curative resection. The rate of perforation, delayed bleeding and post-procedural stenosis were 5%, 5% and 15.7%, respectively. No patient died or required surgery due to an adverse effect. After a median follow-up of 14months, 20patients (20.8%) underwent surgery and/or chemoradiotherapy, and 9 patients died (mortality 9.4%). CONCLUSIONS In Spain, esophageal ESD is curative in approximately two out of three patients, with an acceptable risk of adverse events.
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Affiliation(s)
- Enrique Rodríguez de Santiago
- Servicio de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, España.
| | - Alberto Herreros-de-Tejada
- Servicio de Digestivo, Hospital Universitario Puerta de Hierro, Instituto de Investigación Puerta de Hierro-Segovia de Arana (IDIPHISA), Majadahonda, Madrid, España; Hospital La Luz, QuirónSalud, Madrid, España
| | - Eduardo Albéniz
- Unidad de Endoscopia, Servicio de Gastroenterología, Hospital Universitario de Navarra NavarraBiomed, Universidad Pública de Navarra (UPNA), IdisNA, Pamplona, España
| | - Felipe Ramos Zabala
- Servicio de Gastroenterología, Hospital Universitario HM Montepríncipe, Grupo HM hospitales, Boadilla del Monte, Madrid, España
| | - Gloria Fernández-Esparrach
- Sección de Endoscopia, Servicio de Gastroenterología, ICMDM, Hospital Clínic de Barcelona; Institut d'Investigacions Biomèdiques August Pi i Sunyer. CIBEREHD. Universidad de Barcelona, Barcelona, España
| | - Oscar Nogales
- Servicio de Gastroenterología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Pedro Rosón
- Servicio de Aparato Digestivo, Hospital Vithas Xanit internacional Málaga, Málaga, España
| | - Beatriz Peñas García
- Servicio de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, España
| | - Hugo Uchima
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España; Centro Médico Teknon, Barcelona, España
| | - Álvaro Terán
- Servicio de Gastroenterología, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla (IDIVAL), Santander, España
| | - Joaquín Rodríguez Sánchez
- Servicio de Medicina del Aparato Digestivo, Unidad de Endoscopias, Hospital Universitario 12 de Octubre; Instituto de Investigación «i+12», Madrid, España; Servicio de Gastroenterología, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - Diego de Frutos
- Servicio de Digestivo, Hospital Universitario Puerta de Hierro, Instituto de Investigación Puerta de Hierro-Segovia de Arana (IDIPHISA), Majadahonda, Madrid, España
| | - Sofía Parejo Carbonell
- Servicio de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, España
| | - José Santiago
- Servicio de Digestivo, Hospital Universitario Puerta de Hierro, Instituto de Investigación Puerta de Hierro-Segovia de Arana (IDIPHISA), Majadahonda, Madrid, España
| | - José Díaz Tasende
- Servicio de Medicina del Aparato Digestivo, Unidad de Endoscopias, Hospital Universitario 12 de Octubre; Instituto de Investigación «i+12», Madrid, España
| | - Charly Guarner Argente
- Servicio de Gastroenterología, Hospital de la Santa Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, España
| | | | - Ana Amorós
- Servicio de Gastroenterología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, España
| | - Daniel Barranco
- Unidad de Endoscopia, Servicio de Gastroenterología, Hospital Universitario de Navarra NavarraBiomed, Universidad Pública de Navarra (UPNA), IdisNA, Pamplona, España
| | - Daniel Álvarez de Castro
- Servicio de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, España
| | - Raquel Muñoz González
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España; Centro Médico Teknon, Barcelona, España
| | - José Carlos Marín-Gabriel
- Servicio de Medicina del Aparato Digestivo, Unidad de Endoscopias, Hospital Universitario 12 de Octubre; Instituto de Investigación «i+12», Madrid, España
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Yoon SB, Yang MJ, Shin DW, Soh JS, Lim H, Kang HS, Moon SH. Endoscopic ultrasound-rendezvous versus percutaneous-endoscopic rendezvous endoscopic retrograde cholangiopancreatography for bile duct access: Systematic review and meta-analysis. Dig Endosc 2024; 36:129-140. [PMID: 37432952 DOI: 10.1111/den.14636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 07/06/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVES Endoscopic ultrasound (EUS) or percutaneous-assisted antegrade guidewire insertion can be used to achieve biliary access when standard endoscopic retrograde cholangiopancreatography (ERCP) fails. We conducted a systematic review and meta-analysis to evaluate and compare the effectiveness and safety of EUS-assisted rendezvous (EUS-RV) and percutaneous rendezvous (PERC-RV) ERCP. METHODS We searched multiple databases from inception to September 2022 to identify studies reporting on EUS-RV and PERC-RV in failed ERCP. A random-effects model was used to summarize the pooled rates of technical success and adverse events with 95% confidence interval (CI). RESULTS In total, 524 patients (19 studies) and 591 patients (12 studies) were managed by EUS-RV and PERC-RV, respectively. The pooled technical successes were 88.7% (95% CI 84.6-92.8%, I2 = 70.5%) for EUS-RV and 94.1% (95% CI 91.1-97.1%, I2 = 59.2%) for PERC-RV (P = 0.088). The technical success rates of EUS-RV and PERC-RV were comparable in subgroups of benign diseases (89.2% vs. 95.8%, P = 0.068), malignant diseases (90.3% vs. 95.5%, P = 0.193), and normal anatomy (90.7% vs. 95.9%, P = 0.240). However, patients with surgically altered anatomy had poorer technical success after EUS-RV than after PERC-RV (58.7% vs. 93.1%, P = 0.036). The pooled rates of overall adverse events were 9.8% for EUS-RV and 13.4% for PERC-RV (P = 0.686). CONCLUSIONS Both EUS-RV and PERC-RV have exhibited high technical success rates. When standard ERCP fails, EUS-RV and PERC-RV are comparably effective rescue techniques if adequate expertise and facilities are feasible. However, in patients with surgically altered anatomy, PERC-RV might be the preferred choice over EUS-RV because of its higher technical success rate.
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Affiliation(s)
- Seung Bae Yoon
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Min Jae Yang
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, South Korea
| | - Dong Woo Shin
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon, South Korea
| | - Jae Seung Soh
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon, South Korea
| | - Hyun Lim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon, South Korea
| | - Ho Suk Kang
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon, South Korea
| | - Sung-Hoon Moon
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon, South Korea
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Januszewicz W, Asif S, Inavolu P, Kalapala R, Reddy DN, Lakhtakia S. Migrated lumen-apposing stent trapped within a pancreatic fluid collection: Forward-view EUS for the rescue! VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2024; 9:75-77. [PMID: 38357022 PMCID: PMC10861940 DOI: 10.1016/j.vgie.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
Video 1Migrated lumen-apposing stent trapped within a pancreatic fluid collection: forward-view EUS for the rescue!
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Affiliation(s)
- Wladyslaw Januszewicz
- Department of Gastroenterology, Hepatology, and Clinical Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Shujaath Asif
- Department of Medical Gastroenterology, AIG Hospitals and Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Pradev Inavolu
- Department of Medical Gastroenterology, AIG Hospitals and Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Rakesh Kalapala
- Department of Medical Gastroenterology, AIG Hospitals and Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - D. Nageshwar Reddy
- Department of Medical Gastroenterology, AIG Hospitals and Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Sundeep Lakhtakia
- Department of Medical Gastroenterology, AIG Hospitals and Asian Institute of Gastroenterology, Hyderabad, Telangana, India
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Ziogas D, Vasilakis T, Kapizioni C, Koukoulioti E, Tziatzios G, Gkolfakis P, Facciorusso A, Papanikolaou IS. Revealing Insights: A Comprehensive Overview of Gastric Outlet Obstruction Management, with Special Emphasis on EUS-Guided Gastroenterostomy. Med Sci (Basel) 2024; 12:9. [PMID: 38390859 PMCID: PMC10885047 DOI: 10.3390/medsci12010009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/21/2024] [Accepted: 01/29/2024] [Indexed: 02/24/2024] Open
Abstract
Gastric outlet obstruction (GOO) poses a common and challenging clinical scenario, characterized by mechanical blockage in the pylorus, distal stomach, or duodenum, resulting in symptoms such as nausea, vomiting, abdominal pain, and early satiety. Its diverse etiology encompasses both benign and malignant disorders. The spectrum of current treatment modalities extends from conservative approaches to more invasive interventions, incorporating procedures like surgical gastroenterostomy (SGE), self-expandable metallic stents (SEMSs) placement, and the advanced technique of endoscopic ultrasound-guided gastroenterostomy (EUS-GE). While surgery is favored for longer life expectancy, stents are preferred in malignant gastric outlet stenosis. The novel EUS-GE technique, employing a lumen-apposing self-expandable metal stent (LAMS), combines the immediate efficacy of stents with the enduring benefits of gastroenterostomy. Despite its promising outcomes, EUS-GE is a technically demanding procedure requiring specialized expertise and facilities.
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Affiliation(s)
- Dimitrios Ziogas
- 1st Department of Internal Medicine, 251 Hellenic Air Force & VA General Hospital, 3 Kanellopoulou str., 11525 Athens, Greece
| | - Thomas Vasilakis
- Hepatology and Gastroenterology Clinic, Charité Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany;
| | - Christina Kapizioni
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (C.K.); (E.K.); (I.S.P.)
| | - Eleni Koukoulioti
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (C.K.); (E.K.); (I.S.P.)
| | - Georgios Tziatzios
- Department of Gastroenterology, “Konstantopoulio-Patision” General Hospital, 3-5, Theodorou Konstantopoulou Street, Nea Ionia, 14233 Athens, Greece; (G.T.); (P.G.)
| | - Paraskevas Gkolfakis
- Department of Gastroenterology, “Konstantopoulio-Patision” General Hospital, 3-5, Theodorou Konstantopoulou Street, Nea Ionia, 14233 Athens, Greece; (G.T.); (P.G.)
| | - Antonio Facciorusso
- Department of Medical Sciences, University of Foggia, Section of Gastroenterology, 71122 Foggia, Italy;
| | - Ioannis S. Papanikolaou
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (C.K.); (E.K.); (I.S.P.)
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Bazaga S, García-Alonso FJ, Aparicio Tormo JR, Martinez Moreno B, Sanchiz V, Gornals JB, Loras C, Terán Á, Vazquez-Sequeiros E, Pedraza Sanz R, Súbtil JC, Pérez-Millan A, Uceda Porta F, Vila JJ, de la Serna-Higuera C, Couto-Worner I, Guarner-Argente C, Perez-Miranda M. Endoscopic ultrasound-guided gallbladder drainage with long-term lumen-apposing metal stent indwell: 1-year results from a prospective nationwide observational study. J Gastroenterol Hepatol 2024; 39:360-368. [PMID: 37920889 DOI: 10.1111/jgh.16392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND AND AIM This study aimed to determine safety and risk factors for adverse events (AEs) of endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) with long-term indwell of lumen-apposing metal stents (LAMS). METHODS This study is a multicenter prospective observational study on consecutive high surgical-risk patients requiring gallbladder drainage who underwent EUS-GBD with LAMS over 12 months. Centralized telephone follow-up interviews were conducted every 3 months for 1 year. Patients were censored at LAMS removal, cholecystectomy, or death. AE-free survival was determined using log-rank tests. Cumulative risks were estimated using life-table analysis. RESULTS Eighty-two patients were included (53.7% male, median [interquartile range] age of 84.6 [76.5-89.8] years, and 85.4% with acute cholecystitis). Technical success was achieved in 79 (96.3%), and clinical success in 73 (89%). No patient was lost to follow-up; 45 patients (54.9%) completed 1-year follow-up with in situ LAMS. Median (interquartile range) LAMS indwell time was 364 (47-367) days. Overall, 12 (14.6%) patients presented 14 AEs, including 5 (6.1%) recurrent biliary events (3 acute cholangitis, 1 mild acute pancreatitis, and 1 acute cholecystitis). Patients with pancreatobiliary malignancy had an increased risk of recurrent biliary events (33% vs 1.5%, P = 0.001). The overall 1-year cumulative risk of recurrent biliary events was 9.7% (4.1-21.8%). The 1-year risk of AEs and of severe AEs was 18.8% (11-31.2%) and 7.9% (3.3-18.2%), respectively. Pancreatobiliary malignancy was the single risk factor for recurrent biliary events; LAMS misdeployment was the strongest risk factor for AEs. CONCLUSIONS Long-term LAMS indwell does not increase the risk of delayed AEs following EUS-GBD.
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Affiliation(s)
- Sergio Bazaga
- Department of Gastroenterology, Hospital Universitario Rio Hortega, Valladolid, Spain
- Department of Medicine, Universitat Autónoma de Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | | | | | - Joan B Gornals
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Barcelona, Spain
| | - Carme Loras
- Department of Gastroenterology, Hospital Universitari Mútua Terrassa, Fundació per la Recerca Mútua Terrassa, Terrassa, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Álvaro Terán
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Enrique Vazquez-Sequeiros
- Endoscopy Unit, Department of Gastroenterology and Hepatology, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain
| | | | - José Carlos Súbtil
- Department of Gastroenterology, Endoscopy Unit, University of Navarra Clinic, University of Navarra, Pamplona, Spain
| | | | | | - Juan J Vila
- Complejo Hospitalario de Navarra, Pamplona, Spain
| | | | | | - Carlos Guarner-Argente
- Department of Medicine, Universitat Autónoma de Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Perez-Miranda
- Department of Gastroenterology, Hospital Universitario Rio Hortega, Valladolid, Spain
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Teoh AYB, Lakhtakia S, Tarantino I, Perez-Miranda M, Kunda R, Maluf-Filho F, Dhir V, Basha J, Chan SM, Ligresti D, Ma MTW, de la Serna-Higuera C, Yip HC, Ng EKW, Chiu PWY, Itoi T. Endoscopic ultrasonography-guided gastroenterostomy versus uncovered duodenal metal stenting for unresectable malignant gastric outlet obstruction (DRA-GOO): a multicentre randomised controlled trial. Lancet Gastroenterol Hepatol 2024; 9:124-132. [PMID: 38061378 DOI: 10.1016/s2468-1253(23)00242-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/21/2023] [Accepted: 07/24/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND Endoscopic ultrasonography-guided gastroenterostomy (EUS-GE) is a novel endoscopic method to palliate malignant gastric outlet obstruction. We aimed to assess whether the use of EUS-GE with a double balloon occluder for malignant gastric outlet obstruction could reduce the need for reintervention within 6 months compared with conventional duodenal stenting. METHODS The was an international, multicentre, randomised, controlled trial conducted at seven sites in Hong Kong, Belgium, Brazil, India, Italy, and Spain. Consecutive patients (aged ≥18 years) with malignant gastric outlet obstruction due to unresectable primary gastroduodenal or pancreatobiliary malignancies, a gastric outlet obstruction score (GOOS) of 0 (indicating an inability in intake food or liquids orally), and an Eastern Cooperative Oncology Group performance status score of 3 or lower were included and randomly allocated (1:1) to receive either EUS-GE or duodenal stenting. The primary outcome was the 6-month reintervention rate, defined as the percentage of patients requiring additional endoscopic intervention due to stent dysfunction (ie, restenosis of the stent due to tumour ingrowth, tumour overgrowth, or food residue; stent migration; or stent fracture) within 6 months, analysed in the intention-to-treat population. Prespecified secondary outcomes were technical success (successful placement of a stent), clinical success (1-point improvement in gastric outlet obstruction score [GOOS] within 3 days), adverse events within 30 days, death within 30 days, duration of stent patency, GOOS at 1 month, and quality-of-life scores. This study is registered with ClinicalTrials.gov (NCT03823690) and is completed. FINDINGS Between Dec 1, 2020, and Feb 28, 2022, 185 patients were screened and 97 (46 men and 51 women) were recruited and randomly allocated (48 to the EUS-GE group and 49 to the duodenal stent group). Mean age was 69·5 years (SD 12·6) in the EUS-GE group and 64·8 years (13·0) in the duodenal stent group. All randomly allocated patients completed follow-up and were analysed. Reintervention within 6 months was required in two (4%) patients in the EUS-GE group and 14 (29%) in the duodenal stent group [p=0·0020; risk ratio 0·15 [95% CI 0·04-0·61]). Stent patency was longer in the EUS-GE group (median not reached in either group; HR 0·13 [95% CI 0·08-0·22], log-rank p<0·0001). 1-month GOOS was significantly better in the EUS-GE group (mean 2·41 [SD 0·7]) than the duodenal stent group (1·91 [0·9], p=0·012). There were no statistically significant differences between the EUS-GE and duodenal stent groups in death within 30 days (ten [21%] vs six [12%] patients, respectively, p=0·286), technical success, clinical success, or quality-of-life scores at 1 month. Adverse events occurred 11 (23%) patients in the EUS-GE group and 12 (24%) in the duodenal stent group within 30 days (p=1·00); three cases of pneumonia (two in the EUS-GE group and one in the duodenal stent group) were considered to be procedure related. INTERPRETATION In patients with malignant gastric outlet obstruction, EUS-GE can reduce the frequency of reintervention, improve stent patency, and result in better patient-reported eating habits compared with duodenal stenting, and the procedure should be used preferentially over duodenal stenting when expertise and required devices are available. FUNDING Research Grants Council (Hong Kong Special Administrative Region, China) and Sociedad Española de Endoscopia Digestiva.
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Affiliation(s)
- Anthony Yuen Bun Teoh
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
| | - Sundeep Lakhtakia
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Ilaria Tarantino
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT, Palermo, Italy
| | - Manuel Perez-Miranda
- Department of Gastroenterology and Hepatology, University Hospital Rio Hortega, Valladolid, Spain
| | - Rastislav Kunda
- Department of Surgery, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium; Department of Gastroenterology-Hepatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium; Department of Advanced Interventional Endoscopy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Fauze Maluf-Filho
- Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil; Department of Gastroenterology of University of São Paulo, São Paulo, Brazil; National Council for Scientific and Technological Development-CNPq, Brazil
| | - Vinay Dhir
- Institute of Digestive and Liver Care, SL Raheja Hospital, Mumbai, India
| | - Jahangeer Basha
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Shannon Melissa Chan
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Dario Ligresti
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT, Palermo, Italy
| | - Mark Tsz Wah Ma
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | | | - Hon Chi Yip
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Enders Kwok Wai Ng
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Philip Wai Yan Chiu
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Japan
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Ban T, Kubota Y, Joh T. Simple endoscopic ultrasound-guided gallbladder aspiration/irrigation using a double-pigtail plastic stent system. Dig Endosc 2024; 36:239-241. [PMID: 37936538 DOI: 10.1111/den.14710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 10/22/2023] [Indexed: 11/09/2023]
Abstract
Watch a video of this article.
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Affiliation(s)
- Tesshin Ban
- Department of Gastroenterology and Hepatology, Gamagori City Hospital, Aichi, Japan
| | - Yoshimasa Kubota
- Department of Gastroenterology and Hepatology, Gamagori City Hospital, Aichi, Japan
| | - Takashi Joh
- Department of Gastroenterology and Hepatology, Gamagori City Hospital, Aichi, Japan
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80
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Guilmoteau T, Albouys J, Taibi A, Legros R, Schaefer M, Jacques J. Will Endoscopic-Ultrasound-Guided Choledocoduodenostomy with Electrocautery-Enhanced Lumen-Apposing Metal Stent Placement Replace Endoscopic Retrograde Cholangiopancreatography When Treating Distal Malignant Biliary Obstructions? MEDICINA (KAUNAS, LITHUANIA) 2024; 60:220. [PMID: 38399508 PMCID: PMC10889952 DOI: 10.3390/medicina60020220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/09/2024] [Accepted: 01/25/2024] [Indexed: 02/25/2024]
Abstract
Malignant distal biliary obstructions are becoming increasingly common, especially in patients with cancers of the pancreatic head, despite progress in medical oncology research. ERCP is the current gold standard for management of such strictures, but the emergence of EC-LAMS has rendered EUS-CDS both safe and efficient. It is a "game changer"; originally intended for ERCP failure, two randomised clinical trials recently proposed EUS-CDS as a first-intent procedure in palliative settings. For resectable diseases, the absence of iatrogenic pancreatitis associated with a lower rate of postsurgical adverse events (compared with ERCP) leads us to believe that EUS-CDS might be used in first-intent as a pre-operative endoscopic biliary drainage.
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Affiliation(s)
- Thomas Guilmoteau
- Hepatogastroenterology, Centre Hospitalier Universitaire Dupuytren, 87000 Limoges, France; (T.G.); (J.A.); (A.T.); (R.L.)
| | - Jérémie Albouys
- Hepatogastroenterology, Centre Hospitalier Universitaire Dupuytren, 87000 Limoges, France; (T.G.); (J.A.); (A.T.); (R.L.)
| | - Abdelkader Taibi
- Hepatogastroenterology, Centre Hospitalier Universitaire Dupuytren, 87000 Limoges, France; (T.G.); (J.A.); (A.T.); (R.L.)
| | - Romain Legros
- Hepatogastroenterology, Centre Hospitalier Universitaire Dupuytren, 87000 Limoges, France; (T.G.); (J.A.); (A.T.); (R.L.)
| | - Marion Schaefer
- Hepatogastroenterology, Nancy Regional University Hospital Center, 54500 Nancy, France;
| | - Jérémie Jacques
- Hepatogastroenterology, Centre Hospitalier Universitaire Dupuytren, 87000 Limoges, France; (T.G.); (J.A.); (A.T.); (R.L.)
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81
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Asenov K, Dimov R, Kraeva M, Basheva-Kraeva Y. EUS-Guided Combined Injection Therapy as a Secondary Prophylaxis of Gastric Variceal Bleeding in a Patient Contraindicated for TIPS: Case Report. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:116. [PMID: 38256377 PMCID: PMC10820955 DOI: 10.3390/medicina60010116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 12/31/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024]
Abstract
Background: Although bleeding from gastric varices is less observed than esophageal variceal bleeding (VB) (25% vs. 64%), it is associated with an exceedingly high mortality rate of up to 45%. Current guidelines suggest that endoscopic cyanoacrylate injection therapy (ECI) is the first-line treatment for gastric variceal bleeding (GVB). A major concern, however, is the possibility of embolic incidents, which are clinically evident in approximately 1% of cases. There are no guidelines for secondary prophylaxis of GVB. Radiological treatments using a transjugular intrahepatic portosystemic shunt (TIPS) or balloon occlusive transvenous obliteration (BRTO) are considered viable. However, they are not universally inapplicable; for instance, in the setting of pulmonary hypertension (TIPS). EUS-guided combined injection therapy (EUS-CIT) (embolization coils + cyanoacrylate) is an emerging procedure with a perceived reduced risk of systemic embolization. Case presentation: A patient with alcoholic liver cirrhosis was subjected to EUS-CIT as a secondary prophylaxis for GVB. He had three VB episodes of prior presentation treated by endoscopic band ligation (EBL) and ECI. Due to recurrent episodes of bleeding, he was referred to TIPS, but was considered contraindicated due to severe pulmonary hypertension. EUS-CIT was conducted with two embolization coils inserted into the varix, followed by an injection of 1.5 mL of cyanoacrylate glue. A 19 Ga needle, 0.035″ 14/70 mm coils, non-diluted n-butyl-caynoacrylate, and a transgastric approach were utilized. There were no immediate complications. Complete obliteration of the GV was observed in a follow-up endoscopy on day 30. Subsequent endoscopies in months three and six showed no progression of gastric varices. Conclusions: Our initial experience with EUS-CIT suggests that it can be successfully used as secondary prophylaxis for recurrent GVB.
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Affiliation(s)
- Krasimir Asenov
- Section “Gastroenterology”, Second Department of Internal Diseases, Medical Faculty, Medical University—Plovdiv, 4000 Plovdiv, Bulgaria;
- Gastroenterology Clinic, University Hospital “Kaspela”, 4000 Plovdiv, Bulgaria
| | - Rosen Dimov
- Department of Special Surgery, Medical Faculty, Medical University—Plovdiv, 4000 Plovdiv, Bulgaria;
- Surgical Department, University Hospital “Kaspela”, 4000 Plovdiv, Bulgaria
| | - Maria Kraeva
- Department of Otorhynolaryngology, Medical Faculty, Medical University—Plovdiv, 4000 Plovdiv, Bulgaria
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82
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Monino L, Moreels TG. Patient Radiation Exposure during Enteroscopy-Assisted Endoscopic Retrograde Cholangiopancreatography in Surgically Altered Anatomy (with Video). Diagnostics (Basel) 2024; 14:142. [PMID: 38248019 PMCID: PMC10814473 DOI: 10.3390/diagnostics14020142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/01/2024] [Accepted: 01/03/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Fluoroscopy must be used cautiously during endoscopic retrograde cholangiopancreatography (ERCP). Radiation exposure data in patients with surgically altered anatomy undergoing enteroscopy-assisted ERCP (EA-ERCP) are scarce. METHODS 34 consecutive EA-ERCP procedures were compared with 68 conventional ERCP (C-ERCP) procedures. Patient and procedure characteristics and radiation data were collected. RESULTS Surgical reconstructions were gastrojejunostomy, Roux-en-Y hepaticojejunostomy, Roux-en-Y total gastrectomy, Roux-en-Y gastric bypass and Whipple's duodenopancreatectomy. Procedures were restricted to biliary indications. Mean fluoroscopy time was comparable in both groups (370 ± 30 s EA-ERCP vs. 393 ± 40 s C-ERCP, p = 0.7074), whereas total mean radiation dose was lower in EA-ERCP (83 ± 6 mGy) compared to C-ERCP (110 ± 11 mGy, p = 0.0491) and dose area product (DAP) was higher in EA-ERCP (2216 ± 173 µGy*m2) compared to C-ERCP (1600 ± 117 µGy*m2, p = 0.0038), as was total procedure time (77 ± 5 min vs. 39 ± 3 min, p < 0.0001). Enteroscope insertion to reach the bile duct during EA-ERCP took 28 ± 4 min, ranging from 4 to 90 min. These results indicate that C-ERCP procedures are generally more complex, needing magnified fluoroscopy, whereas EA-ERCP procedures take more time for enteroscope insertion under wide field fluoroscopic guidance (increased DAP) with less complex ERCP manipulation (lower total radiation dose). CONCLUSIONS Radiation exposure during EA-ERCP in surgically altered anatomy is different as compared to C-ERCP. EA-ERCP takes longer with a higher DAP because of the enteroscope insertion, but with lower total radiation dose because these ERCP procedures are usually less complex.
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Affiliation(s)
| | - Tom G. Moreels
- Department of Gastroenterology & Hepatology, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium;
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Fugazza A, Khalaf K, Pawlak KM, Spadaccini M, Colombo M, Andreozzi M, Giacchetto M, Carrara S, Ferrari C, Binda C, Mangiavillano B, Anderloni A, Repici A. Use of endoscopic ultrasound-guided gallbladder drainage as a rescue approach in cases of unsuccessful biliary drainage. World J Gastroenterol 2024; 30:70-78. [PMID: 38293324 PMCID: PMC10823897 DOI: 10.3748/wjg.v30.i1.70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/14/2023] [Accepted: 12/22/2023] [Indexed: 01/06/2024] Open
Abstract
This narrative review provides an overview of the utilization of endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) as a salvage approach in cases of unsuccessful conventional management. EUS-GBD is a minimally invasive and effective technique for drainage in patients with acute cholecystitis with high risk of surgery. The procedure has demonstrated impressive technical and clinical success rates with low rates of adverse events, making it a safe and effective option for appropriate candidates. Furthermore, EUS-GBD can also serve as a rescue option for patients who have failed endoscopic retrograde cholangiopancreatography or EUS biliary drainage for relief of jaundice in malignant biliary stricture. However, patient selection is critical for the success of EUS-GBD, and proper patient selection and risk assessment are important to ensure the safety and efficacy of the procedure. As the field continues to evolve and mature, ongoing research will further refine our understanding of the benefits and limitations of EUS-GBD, ultimately leading to improved outcomes for patients.
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Affiliation(s)
- Alessandro Fugazza
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital - IRCCS, Rozzano 20089, Milano, Italy
| | - Kareem Khalaf
- Division of Gastroenterology, St. Michael’s Hospital, University of Toronto, Toronto M5B 1W8, ON, Canada
| | - Katarzyna M Pawlak
- Division of Gastroenterology, St. Michael’s Hospital, University of Toronto, Toronto M5B 1W8, ON, Canada
| | - Marco Spadaccini
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital - IRCCS, Rozzano 20089, Milano, Italy
| | - Matteo Colombo
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital - IRCCS, Rozzano 20089, Milano, Italy
| | - Marta Andreozzi
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital - IRCCS, Rozzano 20089, Milano, Italy
| | - Marco Giacchetto
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital - IRCCS, Rozzano 20089, Milano, Italy
| | - Silvia Carrara
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital - IRCCS, Rozzano 20089, Milano, Italy
| | - Chiara Ferrari
- Department of Anesthesia, Humanitas Research Hospital - IRCCS, Rozzano 20089, Milano, Italy
| | - Cecilia Binda
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, Romagna 47121, Italy
| | | | - Andrea Anderloni
- Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia 27100, Italy
| | - Alessandro Repici
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital - IRCCS, Rozzano 20089, Milano, Italy
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Casadio C, Tassinari E, Carloni R, Rossi R, Tenti MV, Fabbri L, Maltoni M. Appropriateness of Mini-Invasive Approaches for Nausea and Vomiting Refractory to Medical Therapy in Palliative Care Setting: A Case Report. Case Rep Oncol 2024; 17:264-270. [PMID: 38362443 PMCID: PMC10869145 DOI: 10.1159/000536218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 01/03/2024] [Indexed: 02/17/2024] Open
Abstract
Introduction Nausea and vomiting are frequent multifactorial symptoms in oncological patients. These manifestations, mainly affecting the advanced disease stages, may lead to existential, psychological, and physical suffering, with a negative impact on the quality of life (QoL) of the individual and his family. The medical approach makes use of a wide range of drugs, with different antiemetic potency and various mechanisms of action, taking into account the etiology and the patient's response to the different therapeutic strategies. In recent years, in addition to pharmacological treatments, some endoscopic procedures have been integrated into clinical practice as promising palliative approaches. Case Presentation Herein, we describe and discuss a case of a 64-year-old female affected by advanced stage pancreatic adenocarcinoma, in which different techniques - both medical and endoscopic - have been used to approach a refractory symptomatology with a negative impact on the patient's QoL. In the context of a multidisciplinary approach in primary palliative care, a tailored intervention encompassing invasive methods for palliative purposes, may be considered adequate and appropriate when the prognostic expectation and the physical functionality indices allow it. Conclusion Minimally invasive palliative interventions should be offered to patients with advanced cancer when symptoms become refractory to standard medical therapies, as part of the holistic approach in modern treatments. Therefore, the integration of an early palliative approach into the patient's therapeutic path becomes essential for the management of all the individual's needs.
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Affiliation(s)
- Chiara Casadio
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Elisa Tassinari
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Riccardo Carloni
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Romina Rossi
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
| | | | - Laura Fabbri
- Palliative Care Unit, Azienda Unità Sanitaria Locale (AUSL) Romagna, Forli, Italy
| | - Marco Maltoni
- Palliative Care Unit, Azienda Unità Sanitaria Locale (AUSL) Romagna, Forli, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Fritzsche JA, Fockens P, Besselink MG, Busch OR, Daams F, Montazeri NSM, Wilmink JW, Voermans RP, Van Wanrooij RLJ. Endoscopic ultrasound-guided choledochoduodenostomy using single-step lumen-apposing metal stents for primary drainage of malignant distal biliary obstruction (SCORPION-p): a prospective pilot study. Endoscopy 2024; 56:47-52. [PMID: 37473780 PMCID: PMC11321721 DOI: 10.1055/a-2134-3537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 07/20/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND This study aimed to assess the safety and feasibility of endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) using a lumen-apposing metal stent (LAMS) as a primary drainage strategy in patients with distal malignant biliary obstruction (MBO). METHODS A prospective, single-center, pilot study was conducted in patients with pathology-confirmed MBO without gastric outlet obstruction. The primary outcome was technical success. Secondary outcomes included clinical success, adverse events (AEs), and reinterventions. The study was registered in the Netherlands Trial Registry (registry number NL9757). RESULTS 22 patients were enrolled (median age 69.5 years [interquartile range 64-75.3]). Technical success was achieved in 20/22 patients (91 %). AEs occurred in one patient, namely perforation following inadequate stent deployment (5 %), which was treated in the same procedure. Clinical success was achieved in 19/22 patients (86 %). Stent dysfunction was observed in 11/20 patients (55 %) after technically successful EUS-CDS: two patients were treated conservatively and nine patients underwent reintervention(s). One patient died within ≤ 30 days due to fulminant disease progression. CONCLUSIONS The results confirmed the safety and feasibility of EUS-CDS using LAMS as a primary drainage strategy. The high incidence of stent dysfunction should be improved before EUS-CDS with LAMS can be seen as a valid alternative to endoscopic retrograde cholangiopancreatography.
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Affiliation(s)
- Jeska A. Fritzsche
- Department of Gastroenterology and Hepatology, Amsterdam UMC, location
University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Research Institute,
Amsterdam, The Netherlands
- Treatment and Quality of life, Cancer Center Amsterdam, Amsterdam, The
Netherlands
| | - Paul Fockens
- Department of Gastroenterology and Hepatology, Amsterdam UMC, location
University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Research Institute,
Amsterdam, The Netherlands
- Treatment and Quality of life, Cancer Center Amsterdam, Amsterdam, The
Netherlands
- Department of Gastroenterology and Hepatology, Amsterdam UMC, location Vrije
Universiteit, Amsterdam, The Netherlands
| | - Marc G. Besselink
- Amsterdam Gastroenterology Endocrinology Metabolism, Research Institute,
Amsterdam, The Netherlands
- Treatment and Quality of life, Cancer Center Amsterdam, Amsterdam, The
Netherlands
- Department of Surgery, Amsterdam UMC, location University of Amsterdam,
Amsterdam, The Netherlands
| | - Olivier R. Busch
- Amsterdam Gastroenterology Endocrinology Metabolism, Research Institute,
Amsterdam, The Netherlands
- Treatment and Quality of life, Cancer Center Amsterdam, Amsterdam, The
Netherlands
- Department of Surgery, Amsterdam UMC, location University of Amsterdam,
Amsterdam, The Netherlands
| | - Freek Daams
- Amsterdam Gastroenterology Endocrinology Metabolism, Research Institute,
Amsterdam, The Netherlands
- Treatment and Quality of life, Cancer Center Amsterdam, Amsterdam, The
Netherlands
- Department of Surgery, Amsterdam UMC, location Vrije Universiteit, Amsterdam,
The Netherlands
| | - Nahid S. M. Montazeri
- Amsterdam Gastroenterology Endocrinology Metabolism, Research Institute,
Amsterdam, The Netherlands
- Department of Gastroenterology and Hepatology, Biostatistics Unit, Amsterdam
UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Johanna W. Wilmink
- Amsterdam Gastroenterology Endocrinology Metabolism, Research Institute,
Amsterdam, The Netherlands
- Treatment and Quality of life, Cancer Center Amsterdam, Amsterdam, The
Netherlands
- Department of Medical Oncology, Amsterdam UMC, location University of
Amsterdam, Amsterdam, The Netherlands
| | - Rogier P. Voermans
- Department of Gastroenterology and Hepatology, Amsterdam UMC, location
University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Research Institute,
Amsterdam, The Netherlands
- Treatment and Quality of life, Cancer Center Amsterdam, Amsterdam, The
Netherlands
| | - Roy L. J. Van Wanrooij
- Amsterdam Gastroenterology Endocrinology Metabolism, Research Institute,
Amsterdam, The Netherlands
- Treatment and Quality of life, Cancer Center Amsterdam, Amsterdam, The
Netherlands
- Department of Gastroenterology and Hepatology, Amsterdam UMC, location Vrije
Universiteit, Amsterdam, The Netherlands
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86
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Vanella G, Dell'Anna G, di Capua F, Cesana GC, Olmi S, Arcidiacono PG. Two clues make a proof: EUS-directed transgastric ERCP in twice-surgically altered anatomy-Roux-en-Y gastric bypass conversion of a sleeve gastrectomy. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2024; 9:25-28. [PMID: 38261841 PMCID: PMC10793384 DOI: 10.1016/j.vgie.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
Video 1EUS-directed transgastric ERCP in twice-surgically-altered anatomy: Roux-en-Y gastric bypass conversion of a sleeve gastrectomy.
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Affiliation(s)
- Giuseppe Vanella
- Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, IRCC San Raffaele Scientific Institute and University, Milan, Italy
| | - Giuseppe Dell'Anna
- Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, IRCC San Raffaele Scientific Institute and University, Milan, Italy
| | - Francesco di Capua
- General and Oncologic Surgery Department, Centre of Advanced Laparoscopic Surgery, Centre of Bariatric Surgery, San Marco Hospital GSD, Osio Sotto, Italy
| | - Giovanni Carlo Cesana
- General and Oncologic Surgery Department, Centre of Advanced Laparoscopic Surgery, Centre of Bariatric Surgery, San Marco Hospital GSD, Osio Sotto, Italy
| | - Stefano Olmi
- General and Oncologic Surgery Department, Centre of Advanced Laparoscopic Surgery, Centre of Bariatric Surgery, San Marco Hospital GSD, Osio Sotto, Italy
| | - Paolo Giorgio Arcidiacono
- Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, IRCC San Raffaele Scientific Institute and University, Milan, Italy
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87
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Bronswijk M, Persyn D, van Malenstein H, Laleman W, van der Merwe S. Outcomes of minor versus major papilla rendez-vous for EUS-guided pancreatic duct drainage. Dig Liver Dis 2024; 56:170-175. [PMID: 37558573 DOI: 10.1016/j.dld.2023.07.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/22/2023] [Accepted: 07/25/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVES EUS-guided pancreatic duct drainage (EUS-PD) using rendez-vous has been suggested as a safer alternative to pancreatogastrostomy. Fibrostenotic disease in the pancreatic head may however preclude major papilla rendez-vous, leading to preferential guidewire advancement through the minor papilla. Our aim was to compare the outcomes of minor and major papilla rendez-vous. METHODS This is a tertiary single-center retrospective analysis of all consecutive EUS-PD procedures performed from 2015 to April 2022. EUS-PD was only performed following failed retrograde attempts. Successful EUS-PD rendez-vous cases were included and minor and major papilla procedures were compared. RESULTS Thirty-three patients were included in the final analysis (66.6% male, mean age 56.1 [SD±14.8] years, 54.6% active smokers). In 21 patients (63.6%), minor papilla rendez-vous was attained. Clinical success was achieved in 81.0% vs. 58.3% in the major papilla group (p = 0.230). The overall incidence of AE was similar in both groups (9 [42.9%] vs. 4 [33.3%] events, p = 0.719), with a comparable distribution in severe, moderate and mild AE. Incidence of recurrent pancreatitis was almost identical (28.6% vs. 25.0%, p = 1.000). CONCLUSIONS For patients with symptomatic chronic pancreatitis, EUS-PD using minor or major papilla rendez-vous attained similar results, suggesting that pancreatic duct drainage through the minor papilla can be considered as equally effective.
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Affiliation(s)
- Michiel Bronswijk
- Department of Gastroenterology and Hepatology, University Hospital Gasthuisberg, University of Leuven, Herestraat 49, Leuven 3000, Belgium; Department of Gastroenterology and Hepatology, Imelda Hospital Bonheiden, Belgium; Imelda GI Research Center, Bonheiden, Belgium.
| | - Diederik Persyn
- Department of Gastroenterology and Hepatology, University Hospital Gasthuisberg, University of Leuven, Herestraat 49, Leuven 3000, Belgium; Department of Gastroenterology and Hepatology, AZ Damiaan, Oostende, Belgium
| | - Hannah van Malenstein
- Department of Gastroenterology and Hepatology, University Hospital Gasthuisberg, University of Leuven, Herestraat 49, Leuven 3000, Belgium
| | - Wim Laleman
- Department of Gastroenterology and Hepatology, University Hospital Gasthuisberg, University of Leuven, Herestraat 49, Leuven 3000, Belgium
| | - Schalk van der Merwe
- Department of Gastroenterology and Hepatology, University Hospital Gasthuisberg, University of Leuven, Herestraat 49, Leuven 3000, Belgium
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88
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Fiumana G, Pancaldi A, Bertani H, Boarino V, Cellini M, Iughetti L. Asparaginase-associated Pancreatitis Complicated by Pancreatic Fluid Collection Treated with Endoscopic Cistogastrostomy in Pediatric Acute Lymphoblastic Leukemia: A Case Report and Systematic Review of the Literature. Clin Hematol Int 2023; 5:51-61. [PMID: 38817959 PMCID: PMC10742384 DOI: 10.46989/001c.90958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/21/2023] [Indexed: 06/01/2024] Open
Abstract
Asparaginase-associated pancreatitis complicates 2-10% of patients treated for acute lymphoblastic leukemia, causing morbidity and discontinuation of asparaginase administration. Among acute complications, pancreatic fluid collections can be managed conservatively, but intervention is indicated when associated with persistent insulin therapy need and recurrent abdominal pain. Endoscopic treatment has become the standard approach in adult patients, with increasing favorable evidence in children. This work compares the characteristics of a pediatric oncology patient treated at our institution with reported literature experiences, showing feasibility, safety and effectiveness of endoscopic approach.
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Affiliation(s)
- Giulia Fiumana
- Post Graduate School of Pediatrics, Department of Medical and Surgical Sciences of the Mothers, Children, and AdultsUniversity of Modena and Reggio Emilia
| | | | - Helga Bertani
- Gastroenterology and Endoscopy UnitPoliclinico di Modena
| | | | | | - Lorenzo Iughetti
- Post Graduate School of Pediatrics, Department of Medical and Surgical Sciences of the Mothers, Children, and AdultsUniversity of Modena and Reggio Emilia, Italy
- Pediatric Hematology Oncology UnitAzienda Ospedaliero Universitaria Policlinico di Modena, Italy
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89
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Černe ŽP, Sever N, Strniša L, Plut S, Drnovšek J, Hanžel J, Siuka D, Štabuc B, Drobne D. Performance of European and American Societies of Gastrointestinal Endoscopy Guidelines for Prediction of Choledocholithiasis in Patients with Acute Biliary Pancreatitis. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2176. [PMID: 38138279 PMCID: PMC10744392 DOI: 10.3390/medicina59122176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 11/27/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: Up to one-third of patients with acute biliary pancreatitis also present with choledocholithiasis. Guidelines from the European Society of Gastrointestinal Endoscopy (ESGE) and the American Society for Gastrointestinal Endoscopy (ASGE) for investigating suspected choledocholithiasis suggest endoscopic retrograde cholangiopancreatography in patients with high-likelihood (ESGE)/high-probability (ASGE) predictors and endoscopic ultrasound in those with intermediate-likelihood (ESGE)/intermediate-probability (ASGE) predictors. Although both guidelines are similar, they are not identical. Furthermore, these algorithms were mainly developed from cohorts of patients without pancreatitis and are therefore poorly validated in a subset of patients with acute pancreatitis. We aimed to assess the performance of the ESGE and ASGE algorithms for the prediction of choledocholithiasis in patients with acute biliary pancreatitis. Materials and Methods: This was a retrospective analysis of 86 consecutive patients admitted to a tertiary referral centre in the year 2020 due to acute biliary pancreatitis. Results: Choledocholithiasis was confirmed in 29/86 (33.7%) of patients (13 with endoscopic retrograde cholangiopancreatography and 16 with endoscopic ultrasound). All 10/10 (100%) ESGE high-likelihood and 14/19 (73.7%) ASGE high-probability patients had choledocholithiasis. Only 19/71 (26.8%) patients with ESGE intermediate likelihood and 15/67 (22.4%) with ASGE intermediate probability had choledocholithiasis. Only 8/13 (61.5%) patients with the ASGE high-probability predictor of dilated common bile duct plus bilirubin > 68.4 µmol/mL had choledocholithiasis. Since this predictor is not considered high likelihood by ESGE, this resulted in a superior specificity of the European compared to the American guideline (100% vs. 91.2%). Following the American instead of the European guidelines would have resulted in five unnecessary endoscopic retrograde cholangiopancreatographies and five unnecessary endoscopic ultrasound examinations. Conclusions: This retrospective analysis suggests that the European guidelines may perform better than the American guidelines at predicting choledocholithiasis in the setting of acute pancreatitis. This was because dilated common bile duct plus bilirubin > 68.4 µmol/mL was not a reliable predictor for persistent bile duct stones.
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Affiliation(s)
- Žan Peter Černe
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia; (Ž.P.Č.); (J.D.); (B.Š.)
| | - Nejc Sever
- Department of Gastroenterology, University Medical Centre Ljubljana, Japljeva 2, 1000 Ljubljana, Slovenia; (N.S.); (L.S.); (S.P.); (J.H.); (D.S.)
| | - Luka Strniša
- Department of Gastroenterology, University Medical Centre Ljubljana, Japljeva 2, 1000 Ljubljana, Slovenia; (N.S.); (L.S.); (S.P.); (J.H.); (D.S.)
| | - Samo Plut
- Department of Gastroenterology, University Medical Centre Ljubljana, Japljeva 2, 1000 Ljubljana, Slovenia; (N.S.); (L.S.); (S.P.); (J.H.); (D.S.)
| | - Jan Drnovšek
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia; (Ž.P.Č.); (J.D.); (B.Š.)
- Department of Gastroenterology, University Medical Centre Ljubljana, Japljeva 2, 1000 Ljubljana, Slovenia; (N.S.); (L.S.); (S.P.); (J.H.); (D.S.)
| | - Jurij Hanžel
- Department of Gastroenterology, University Medical Centre Ljubljana, Japljeva 2, 1000 Ljubljana, Slovenia; (N.S.); (L.S.); (S.P.); (J.H.); (D.S.)
| | - Darko Siuka
- Department of Gastroenterology, University Medical Centre Ljubljana, Japljeva 2, 1000 Ljubljana, Slovenia; (N.S.); (L.S.); (S.P.); (J.H.); (D.S.)
| | - Borut Štabuc
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia; (Ž.P.Č.); (J.D.); (B.Š.)
- Department of Gastroenterology, University Medical Centre Ljubljana, Japljeva 2, 1000 Ljubljana, Slovenia; (N.S.); (L.S.); (S.P.); (J.H.); (D.S.)
| | - David Drobne
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia; (Ž.P.Č.); (J.D.); (B.Š.)
- Department of Gastroenterology, University Medical Centre Ljubljana, Japljeva 2, 1000 Ljubljana, Slovenia; (N.S.); (L.S.); (S.P.); (J.H.); (D.S.)
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90
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Mulki R, Qayed E, Yang D, Chua TY, Singh A, Yu JX, Bartel MJ, Tadros MS, Villa EC, Lightdale JR. The 2022 top 10 list of endoscopy topics in medical publishing: an annual review by the American Society for Gastrointestinal Endoscopy Editorial Board. Gastrointest Endosc 2023; 98:1009-1016. [PMID: 37977661 DOI: 10.1016/j.gie.2023.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/09/2023] [Accepted: 08/29/2023] [Indexed: 11/19/2023]
Abstract
Using a systematic literature search of original articles published during 2022 in Gastrointestinal Endoscopy and other high-impact medical and gastroenterology journals, the 10-member Editorial Board of the American Society for Gastrointestinal Endoscopy composed a list of the 10 most significant topic areas in GI endoscopy during the study year. Each Editorial Board member was directed to consider 3 criteria in generating candidate lists-significance, novelty, and global impact on clinical practice-and subject matter consensus was facilitated by the Chair through electronic voting. The 10 identified areas collectively represent advances in the following endoscopic spheres: artificial intelligence, endoscopic submucosal dissection, Barrett's esophagus, interventional EUS, endoscopic resection techniques, pancreaticobiliary endoscopy, management of acute pancreatitis, endoscopic environmental sustainability, the NordICC trial, and spiral enteroscopy. Each board member was assigned a consensus topic area around which to summarize relevant important articles, thereby generating this précis of the "top 10" endoscopic advances of 2022.
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Affiliation(s)
- Ramzi Mulki
- Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Emad Qayed
- Division of Digestive Diseases, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Dennis Yang
- Center of Interventional Endoscopy (CIE) Advent Health, Orlando, Florida, USA
| | - Tiffany Y Chua
- Division of Digestive Diseases, Harbor-University of California Los Angeles, Torrance, California, USA
| | - Ajaypal Singh
- Division of Digestive Diseases and Nutrition, Rush University Medical Center, Chicago, Illinois, USA
| | - Jessica X Yu
- Division of Gastroenterology and Hepatology, Oregon Health & Science University, Portland, Oregon, USA
| | | | | | - Edward C Villa
- NorthShore University Health System, Chicago, Illinois, USA
| | - Jenifer R Lightdale
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
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91
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Ni M, Shen S, Zhang B, Wang L. Endoscopic ultrasound-guided colocolostomy for malignant transverse colon obstruction after failure of enteral stenting. Endoscopy 2023; 55:E517-E518. [PMID: 36894147 PMCID: PMC9998228 DOI: 10.1055/a-2032-3319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Affiliation(s)
- Muhan Ni
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Shanshan Shen
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Bin Zhang
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Lei Wang
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
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92
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Vara-Luiz F, Nunes G, Pinto-Marques P, Oliveira C, Mendes I, Patita M, Fonseca J. Endoscopic treatment of bile duct stones after bariatric Roux-en-Y gastric bypass through endoscopic ultrasound-directed transgastric ERCP. Endoscopy 2023; 55:E1065-E1067. [PMID: 37734414 PMCID: PMC10513776 DOI: 10.1055/a-2161-3450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Affiliation(s)
- Francisco Vara-Luiz
- Gastroenterology Department, Hospital Garcia de Orta, Almada, Portugal
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health and Science, Caparica, Portugal
| | - Gonçalo Nunes
- Gastroenterology Department, Hospital Garcia de Orta, Almada, Portugal
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health and Science, Caparica, Portugal
| | | | - Carla Oliveira
- Gastroenterology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Ivo Mendes
- Gastroenterology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Marta Patita
- Gastroenterology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Jorge Fonseca
- Gastroenterology Department, Hospital Garcia de Orta, Almada, Portugal
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health and Science, Caparica, Portugal
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93
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Quintana-Carbo S, Puigcerver-Mas M, Luna-Rodriguez D, Garcia-Sumalla A, Maisterra S, Gornals JB. Hepaticogastrostomy as salvage treatment in a case of clinical failure of cholecystoduodenostomy due to tumoral obstruction of the cystic duct. Endoscopy 2023; 55:E783-E784. [PMID: 37308148 PMCID: PMC10260359 DOI: 10.1055/a-2092-0393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Sergi Quintana-Carbo
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Barcelona, Catalonia, Spain
- Universitat de Barcelona, Catalonia, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain
| | - Maria Puigcerver-Mas
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Barcelona, Catalonia, Spain
- Universitat de Barcelona, Catalonia, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain
| | - Daniel Luna-Rodriguez
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Barcelona, Catalonia, Spain
- Universitat de Barcelona, Catalonia, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain
| | - Albert Garcia-Sumalla
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Barcelona, Catalonia, Spain
- Universitat de Barcelona, Catalonia, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain
| | - Sandra Maisterra
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Barcelona, Catalonia, Spain
- Universitat de Barcelona, Catalonia, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain
| | - Joan B Gornals
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Barcelona, Catalonia, Spain
- Universitat de Barcelona, Catalonia, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain
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94
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Lattanzi B, Ramai D, Gkolfakis P, Facciorusso A. Predictive models in EUS/ERCP. Best Pract Res Clin Gastroenterol 2023; 67:101856. [PMID: 38103924 DOI: 10.1016/j.bpg.2023.101856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 07/30/2023] [Indexed: 12/19/2023]
Abstract
Predictive models (PMs) in endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) have the potential to improve patient outcomes, enhance diagnostic accuracy, and guide therapeutic interventions. This review aims to summarize the current state of predictive models in ERCP and EUS and their clinical implications. To be considered useful in clinical practice a PM should be accurate, easy to perform, and may consider objective variables. PMs in ERCP estimate correct indication, probability of success, and the risk of developing adverse events. These models incorporate patient-related factors and technical aspects of the procedure. In the field of EUS, these models utilize clinical and imaging data to predict the likelihood of malignancy, presence of specific lesions, or risk of complications related to therapeutic interventions. Further research, validation, and refinement are necessary to maximize the utility and impact of these models in routine clinical practice.
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Affiliation(s)
- Barbara Lattanzi
- Gastroenterology and Emergency Endoscopy Unit, Sandro Pertini Hospital of Rome, Italy.
| | - Daryl Ramai
- Gastroenterology and Hepatology, University of Utah Hospital, Utah, USA.
| | - Paraskevas Gkolfakis
- Department of Gastroenterology, General Hospital of Nea Ionia "Konstantopoulio-Patision", 14233, Athens, Greece.
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Medical Sciences, University of Foggia, Via Pinto 1, 71122, Foggia, Italy.
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95
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Li JS, Lin K, Tang J, Liu F, Fang J. EUS-guided gastroenterostomy for gastric outlet obstruction: a comprehensive meta-analysis. MINIM INVASIV THER 2023; 32:285-299. [PMID: 37310282 DOI: 10.1080/13645706.2023.2221336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 05/18/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVE A comprehensive meta-analysis was performed to evaluate the efficacy and safety of endoscopic ultrasound-guided gastroenterostomy (EUS-GE) for benign and malignant gastric outlet obstruction (GOO). MATERIAL AND METHODS PubMed, Embase, Web of Science and Cochrane Library were searched to identify relevant studies. The primary outcomes evaluated technical success, clinical success, and adverse events (AEs). RESULTS Twenty‑six studies with 1493 patients were included in this meta-analysis. The pooled rates of technical success, clinical success, and overall AEs of EUS-GE were 94.0%, 89.9%, and 13.1%, respectively. Eight studies were included in the subgroup meta-analysis for comparative evaluation of EUS-GE and surgical gastroenterostomy (SGE), while seven studies were for EUS-GE and enteral stenting (ES). Compared with SGE, the pooled odds ratios (ORs) of technical success, clinical success, and overall AEs of EUS-GE were 0.17 (p = .003), 1.42 (p = .40), and 0.15 (p < .00001), respectively. When compared with ES, the above corresponding pooled ORs were 0.55 (p = .11), 2.64 (p < .0001), and 0.41 (p = .01), respectively. CONCLUSION Although it is technically challenging, this largest meta-analysis indicates that EUS‑GE has comparable and high technical and clinical success rates and hence a very effective minimally invasive procedure for GOO.
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Affiliation(s)
- Jia-Su Li
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Kun Lin
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jian Tang
- Digestive Endoscopy Center, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Feng Liu
- Digestive Endoscopy Center, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jun Fang
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China
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96
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Mochizuki M, Nakamura K, Arahata K, Takarabe S, Kishikawa H, Hisamatsu T, Nishida J. Electrohydraulic lithotripsy for ball valve syndrome due to stent-stone complex after endoscopic ultrasound-guided hepaticogastrostomy. Endoscopy 2023; 55:E798-E799. [PMID: 37321268 PMCID: PMC10270755 DOI: 10.1055/a-2092-4224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Affiliation(s)
- Moegi Mochizuki
- Department of Gastroenterology, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Kenji Nakamura
- Department of Gastroenterology, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan
| | - Kyoko Arahata
- Department of Gastroenterology, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan
| | - Sakiko Takarabe
- Department of Gastroenterology, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan
| | - Hiroshi Kishikawa
- Department of Gastroenterology, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan
| | - Tadakazu Hisamatsu
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Jiro Nishida
- Department of Gastroenterology, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan
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97
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Kuo YT, Wang HP. A tent-like sign during endoscopic ultrasound-guided gastroenterostomy: an indication of a misdeployed stent in the peritoneum. Endoscopy 2023; 55:E934-E935. [PMID: 37500085 PMCID: PMC10374396 DOI: 10.1055/a-2106-1544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Affiliation(s)
- Yu-Ting Kuo
- Division of Endoscopy, Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hsiu-Po Wang
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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98
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Chen YI, Menard C, Khashab M, May G, Miller C, Forbes N, White S, Bessissow A. EUS-guided gastroenterostomy using a novel through-the-scope exchangeable dual-balloon enteroclysis catheter: a potentially secure and scalable approach. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2023; 8:500-502. [PMID: 38155826 PMCID: PMC10751377 DOI: 10.1016/j.vgie.2023.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Abstract
Video 1Clinical case of dual-balloon through-the-scope exchangeable enteroclysis catheter-assisted EUS-guided gastroenterostomy.
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Affiliation(s)
- Yen-I Chen
- Division of Gastroenterology and Hepatology, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Charles Menard
- Division of Gastroenterology, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Mouen Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Gary May
- Division of Gastroenterology, St-Michael's Hospital, University of Toronto, Ontario, Canada
| | - Corey Miller
- Division of Gastroenterology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Nauzer Forbes
- Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada
| | - Sheryl White
- Division of Gastroenterology and Hepatology, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Ali Bessissow
- Department of Radiology, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
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El-Domiaty N, Alric H, Di Gaeta A, Tenorio-González E, Cellier C, Rahmi G, Pérez-Cuadrado-Robles E. Transjejunal ERCP through an endoscopic ultrasound-guided jejuno-duodenal anastomosis in a patient with gastric bypass without excluded stomach. Endoscopy 2023; 55:E1027-E1028. [PMID: 37714208 PMCID: PMC10504025 DOI: 10.1055/a-2155-4622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Affiliation(s)
- Nada El-Domiaty
- Department of Gastroenterology, Georges-Pompidou European Hospital, AP-HP Centre, Paris, France
- Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Hadrien Alric
- Department of Gastroenterology, Georges-Pompidou European Hospital, AP-HP Centre, Paris, France
- University of Paris-Cité, Paris, France
| | - Alessandro Di Gaeta
- Department of Interventional Radiology, Georges-Pompidou European Hospital, AP-HP Centre, Paris, France
| | - Elena Tenorio-González
- Department of Gastroenterology, Georges-Pompidou European Hospital, AP-HP Centre, Paris, France
| | - Christophe Cellier
- Department of Gastroenterology, Georges-Pompidou European Hospital, AP-HP Centre, Paris, France
- University of Paris-Cité, Paris, France
| | - Gabriel Rahmi
- Department of Gastroenterology, Georges-Pompidou European Hospital, AP-HP Centre, Paris, France
- University of Paris-Cité, Paris, France
| | - Enrique Pérez-Cuadrado-Robles
- Department of Gastroenterology, Georges-Pompidou European Hospital, AP-HP Centre, Paris, France
- University of Paris-Cité, Paris, France
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100
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Omoto S, Takenaka M, Fukunaga T, Takashima K, Komeda Y, Jeong S, Kudo M. The "echo-free space" technique: a safe and reliable method for endoscopic ultrasound scope insertion. Endoscopy 2023; 55:E698-E699. [PMID: 37142249 PMCID: PMC10159774 DOI: 10.1055/a-2062-5718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Affiliation(s)
- Shunsuke Omoto
- Departments of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Mamoru Takenaka
- Departments of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Tomohiro Fukunaga
- Departments of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Kota Takashima
- Departments of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Yoriaki Komeda
- Departments of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Seok Jeong
- Division of Gastroenterology Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, South Korea
| | - Masatoshi Kudo
- Departments of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
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