51
|
The Spectrum of Endoscopic Ultrasound Intervention in Biliary Diseases: A Single Center's Experience in 31 Cases. Gastroenterol Res Pract 2012; 2012:680753. [PMID: 22654900 PMCID: PMC3357930 DOI: 10.1155/2012/680753] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2011] [Revised: 01/29/2012] [Accepted: 02/12/2012] [Indexed: 12/13/2022] Open
Abstract
Background and Aim. EUS-guided intervention (EGI) for biliary therapy has been increasingly used in recent years. This report aims to describe the spectrum and experience of EUS-guided interventions in biliary diseases in a single-tertiary center.
Methods. All patients with EGI were analyzed retrospectively by retrieving data from a prospectively stored endoscopic database between January 2006 and September 2010. Results. There were 31 cases with EGIs (17 female, 14 male) with a mean age ± SD of 58.03 ± 16.89 years. The majority of cases (17/31; 55%) were ampullary or pancreatic cancers with obstructive jaundice. The major indications for EGI were obstructive jaundice (n = 16) and cholangitis (n = 9). The EGIs were technically successful in 24 of the 31 cases (77%). The success rate for the first 3 years was 8 of 13 procedures (61.5%) as compared to that of the last 2 years (16/18 procedures (89%); P = 0.072). Twenty-three of the 24 cases (96%) with technical success for stent placement also had clinical success in terms of symptom improvement. The complications were major in 4 (13%) and minor in 7 (23%) patients. Conclusion. The EUS-guided drainage for biliary obstruction, acute cholecystitis, bile leak, and biloma was an attractive alternative and should be handled in expert centers.
Collapse
|
52
|
Artifon ELA, Ferreira FC, Sakai P. Endoscopic ultrasound-guided biliary drainage. Korean J Radiol 2012; 13 Suppl 1:S74-82. [PMID: 22563291 PMCID: PMC3341464 DOI: 10.3348/kjr.2012.13.s1.s74] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 12/14/2011] [Indexed: 12/17/2022] Open
Abstract
Objective To demonstrate a comprehensive review of published articles regarding endoscopic ultrasound (EUS)-guided biliary drainage. Materials and Methods Review of studies regarding EUS-guided biliary drainage including case reports, case series and previous reviews. Results EUS-guided hepaticogastrostomy, coledochoduodenostomy and choledoantrostomy are advanced biliary and pancreatic endoscopy procedures, and together make up the echo-guided biliary drainage. Hepaticogastrostomy is indicated in cases of hilar obstruction, while the procedure of choice is the coledochoduodenostomy or choledochoantrostomy in distal lesions. Both procedures must be performed only after unsuccessful ERCPs. The indication of these procedures must be made under a multidisciplinary view while sharing information with the patient or legal guardian. Conclusion Hepaticogastrostomy and coledochoduodenostomy or choledochoantrostomy are feasible when performed by endoscopists with expertise in biliopancreatic endoscopy. Advanced echo-endoscopy should currently be performed under a rigorous protocol in educational institutions.
Collapse
|
53
|
Iwashita T, Lee JG. Endoscopic ultrasonography-guided biliary drainage: rendezvous technique. Gastrointest Endosc Clin N Am 2012; 22:249-58, viii-ix. [PMID: 22632947 DOI: 10.1016/j.giec.2012.04.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The success rate of deep biliary cannulation is high but still not perfect in endoscopic retrograde cholangiopancreatography (ERCP), even with aggressive techniques. With the development of linear-array echoendoscopes, the endoscopic ultrasonography-guided rendezvous technique (EUS-RV) has recently emerged as a salvage method for failed biliary cannulation. This review of current literature establishes that EUS-RV is a feasible and safe technique and should be considered as an alternative to percutaneous or surgical approaches. The availability of a percutaneous salvage (if EUS-RV fails) and well-trained endoscopists for both ERCP and EUS are mandatory in minimizing the potential complications of this procedure.
Collapse
Affiliation(s)
- Takuji Iwashita
- Division of Gastroenterology and Hepatology, H.H. Chao Comprehensive Digestive Disease Center, University of California, Irvine Medical Center, 101 The City Drive, Building 22C, First Floor, Orange, CA 92868, USA
| | | |
Collapse
|
54
|
Abstract
To date, percutaneous transhepatic biliary drainage (PTBD) has been considered as the usual biliary access after failed endoscopic retrograde cholangiopancreatography (ERCP). Since endoscopic ultrasonography (EUS)-guided bile duct puncture was first described in 1996, sporadic case reports of EUS-guided biliary drainage (EUS-BD) have suggested it as an alternative to PTBD after failed ERCP. The potential benefits of EUS-BD include internal drainage, thus avoiding long-term external drainage in cases where external PTBD drainage catheters cannot be internalized. EUS-guided hepaticogastrostomy (EUS-HG) is one form of EUS-BD. This article describes the indications, techniques, and outcomes of published data on EUS-HG.
Collapse
Affiliation(s)
- Do Hyun Park
- Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-Ro 43 Gil, Songpa-gu, Seoul 138-736, Korea.
| |
Collapse
|
55
|
Chavalitdhamrong D, Draganov PV. Endoscopic ultrasound-guided biliary drainage. World J Gastroenterol 2012; 18:491-7. [PMID: 22363114 PMCID: PMC3280393 DOI: 10.3748/wjg.v18.i6.491] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Revised: 04/15/2011] [Accepted: 04/22/2011] [Indexed: 02/06/2023] Open
Abstract
Endoscopic ultrasound (EUS)-guided biliary drainage has emerged as a minimally invasive alternative to percutaneous and surgical interventions for patients with biliary obstruction who had failed endoscopic retrograde cholangiopancreatography (ERCP). EUS-guided biliary drainage has become feasible due to the development of large channel curvilinear therapeutic echo-endoscopes and the use of real-time ultrasound and fluoroscopy imaging in addition to standard ERCP devices and techniques. EUS-guided biliary drainage is an attractive option because of its minimally invasive, single step procedure which provides internal biliary decompression. Multiple investigators have reported high success and low complication rates. Unfortunately, high quality prospective data are still lacking. We provide detailed review of the use of EUS for biliary drainage from the perspective of practicing endoscopists with specific focus on the technical aspects of the procedure.
Collapse
|
56
|
Single-operator, single-session EUS-guided anterograde cholangiopancreatography in failed ERCP or inaccessible papilla. Gastrointest Endosc 2012; 75:56-64. [PMID: 22018554 DOI: 10.1016/j.gie.2011.08.032] [Citation(s) in RCA: 150] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 08/15/2011] [Indexed: 12/13/2022]
Abstract
BACKGROUND ERCP may be challenging or may fail in certain situations, including postsurgical anatomy, periampullary diverticula, ampullary tumor invasion, and high-grade strictures. OBJECTIVE To report a large experience with EUS-guided anterograde cholangiopancreatography (EACP) to facilitate ductal access or perform direct EUS-guided therapy in patients with postsurgical anatomy or failed ERCP. DESIGN Retrospective cohort study. SETTING Tertiary referral center. PATIENTS Ninety-five consecutive patients with failed ERCP or inaccessible papilla over a 4-year period. INTERVENTIONS EACP techniques involved ductal puncture and ductography, followed by either guidewire advancement for rendezvous ERCP in patients with duodenoscope accessible papilla or direct drainage in altered anatomy. For failures, crossover to the alternate EACP technique was performed when appropriate. MAIN OUTCOME MEASUREMENTS Technical success rates and complications. RESULTS EACP procedures were attempted in 95 of 2566 ERCP procedures (3.7%). EUS-guided cholangiography (n = 70) and pancreatography (n = 25) were successful in 97% and 100%, respectively. EUS-guided rendezvous ERCP was successful in 75% of biliary procedures and in 56% of pancreatic procedures. Direct EUS-guided therapy was successful in 86% and 75% of biliary and pancreatic procedures, respectively. Direct interventions included pancreaticogastrostomy (n = 10), anterograde stent across stricture (n = 10), hepaticogastrostomy (n = 8), and choledochoduodenostomy (n = 1). Ten complications (10.5%) related to EACP or subsequent rendezvous ERCP included pancreatitis (n = 5), hematoma (n = 1), bile leak (n = 1), bacteremia (n = 1), pneumoperitoneum (n = 1), and perforation (n = 1). LIMITATIONS Single-center experience; retrospective study. CONCLUSIONS EACP complements ERCP and allows successful pancreaticobiliary therapy in a large proportion of patients with failed ERCP or difficult-to-access papilla.
Collapse
|
57
|
Itoi T, Isayama H, Sofuni A, Itokawa F, Kurihara T, Tsuchiya T, Tsuji S, Ishii K, Ikeuchi N, Tanaka R, Umeda J, Moriyasu F, Kawakami H. Stent selection and tips on placement technique of EUS-guided biliary drainage: transduodenal and transgastric stenting. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2011; 18:664-72. [PMID: 21688214 DOI: 10.1007/s00534-011-0410-9] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Endoscopic ultrasonography-guided biliary drainage (EUS-BD) has been carried out as an alternative to the percutaneous or surgical approach when endoscopic retrograde cholangiopancreatography fails. However, there is no standard technique or device for EUS-BD. In this review, we focus on how we choose the stents and described our tips on this EUS-BD technique. The plastic stent (PS) and the self-expandable metallic stent (SEMS) are used for EUS-BD. The latter is further divided into the fully covered SEMS (FCSEMS), partially covered SEMS (PCSEMS), and uncovered SEMS (UCSEMS) types. Although PS is not expensive, the duration of stent patency is short. SEMS is expensive but the duration of stent patency is long. With UCSEMS, basically there is no stent malpositioning; however, if the gap between the bile duct and the GI tract becomes displaced, bile leakage from the mesh of the stent is likely to occur. Though there is no bile leakage with FCSEMS, the side branch of the bile duct may become occluded, and migration and dislocation sometimes occur. PCSEMS is basically similar to FCSEMS. When EUS-BD was first developed, drainage by PS was common, although reports on drainage by SEMS have increased recently.
Collapse
Affiliation(s)
- Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjukuku, Tokyo, Japan.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
58
|
Belletrutti PJ, DiMaio CJ, Gerdes H, Schattner MA. Endoscopic ultrasound guided biliary drainage in patients with unapproachable ampullae due to malignant duodenal obstruction. J Gastrointest Cancer 2011; 42:137-42. [PMID: 20549387 DOI: 10.1007/s12029-010-9175-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE When endoscopic retrograde cholangiopancreatography (ERCP) is not possible due to duodenal obstruction, endoscopic ultrasound-guided biliary drainage (EUS-BD) has emerged as an alternate mode of biliary decompression. This study aims to determine the safety and outcomes of performing EUS-BD in such patients. METHODS A retrospective review of our endoscopy procedure database was carried out to identify patients with malignant biliary obstruction and failed ERCP in whom EUS-BD was attempted. RESULTS Seven patients were identified. The technical success rate was 6/7 (86%). Four patients were treated with a choledochoduodenostomy; two had hepaticogastrostomies; drainage was not attempted in one due to unfavorable anatomy on EUS. In three patients, EUS-BD was performed immediately after unsuccessful ERCP as a single procedure. The initial choice of stent was plastic in two, self-expanding uncovered metal in two, and fully covered metal in two. The median follow-up was 15.5 weeks. There were no immediate complications. Bilirubin decreased in 5/6 (83%) and jaundice resolved in 4/6 (67%). Pruritus resolved in 4/4 (100%). Chemotherapy was restarted in 4/6 (67%). Reintervention due to stent blockage occurred twice. Both were converted to fully covered metal stents. No instances of stent migration were observed. CONCLUSIONS In our series, EUS-BD is a feasible, safe, and effective method of internal drainage in appropriately selected patients with biliary obstruction and unapproachable ampullae due to malignant duodenal obstruction. EUS-BD can be performed immediately after a failed ERCP under the same anesthesia. Covered metal stents may be preferred, but further study is required.
Collapse
Affiliation(s)
- Paul J Belletrutti
- Gastroenterology and Nutrition Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, P.O. Box 273, New York, NY 10065, USA
| | | | | | | |
Collapse
|
59
|
Park DH, Jang JW, Lee SS, Seo DW, Lee SK, Kim MH. EUS-guided biliary drainage with transluminal stenting after failed ERCP: predictors of adverse events and long-term results. Gastrointest Endosc 2011; 74:1276-84. [PMID: 21963067 DOI: 10.1016/j.gie.2011.07.054] [Citation(s) in RCA: 220] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Accepted: 07/18/2011] [Indexed: 12/11/2022]
Abstract
BACKGROUND EUS-guided biliary drainage (EUS-BD) has been proposed as an effective alternative for percutaneous transhepatic biliary drainage (PTBD) after failed ERCP. To date, the risk factors for adverse events and long-term outcomes of EUS-BD with transluminal stenting (EUS-BDS) have not been fully explored. OBJECTIVE To evaluate risk factors for adverse events and long-term outcomes of EUS-BDS. DESIGN Prospective follow-up study. SETTING Tertiary-care academic center. PATIENTS This study involved 57 consecutive patients with malignant or benign biliary obstruction undergoing EUS-BDS after failed ERCP. INTERVENTION EUS-guided hepaticogastrostomy (EUS-HGS) and EUS-guided choledochoduodenostomy with transluminal stenting (EUS-CDS). MAIN OUTCOME MEASUREMENTS Risk factors for postprocedure and late adverse events and clinical outcomes of EUS-BDS. RESULTS The overall technical and functional success rates, respectively, in the EUS-BDS group were 96.5% (intention-to-treat, n = 55/57) and 89% (per-protocol, n = 49/55). Postprocedure adverse events developed after EUS-BDS in 11 patients (20%, n = 11/55). This included bile peritonitis (n = 2), mild bleeding (n = 2), and self-limited pneumoperitoneum (n = 7). In multivariate analysis, needle-knife use was the single risk factor for postprocedure adverse events after EUS-BDS (odds ratio 12.4; P = .01). A late adverse event in EUS-BDS was distal stent migration (7%, n = 4/55). The mean stent patencies with EUS-HGS and EUS-CDS were 132 days and 152 days, respectively. LIMITATIONS Single-operator performed, nonrandomized study. CONCLUSION EUS-HGS and EUS-CDS may be relatively safe and can be used as an alternative to PTBD after failed ERCP. Both techniques offer durable and comparable stent patency. The use of a needle-knife for fistula dilation in EUS-BDS should be avoided if possible.
Collapse
Affiliation(s)
- Do Hyun Park
- Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
| | | | | | | | | | | |
Collapse
|
60
|
Binmoeller KF, Nguyen-Tang T. Endoscopic ultrasound-guided anterograde cholangiopancreatography. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2011; 18:319-31. [PMID: 21190119 DOI: 10.1007/s00534-010-0358-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) may fail in 10-15% of cases. A growing percentage of such cases are due to the inaccessible papilla after gastric bypass surgery for the treatment of obesity. Endoscopic ultrasonography (EUS) offers an alternative route of access to the bile and pancreatic ducts. Using the curved linear array echoendoscope, access to the bile and pancreatic ducts is possible under real-time EUS guidance. The route of access is 'anterograde', in contrast to the 'retrograde' approach of ERCP. We have coined the term "EUS-guided anterograde cholangiopancreatography (EACP)" to cover the spectrum of EUS-guided techniques for accessing and draining the bile and pancreatic ducts. These techniques are reviewed in this paper. The literature has validated the feasibility of EACP but complication rates have been high; the safety profile of EACP must improve. This will require tools, designed for EUS-guided applications, that enable safer transenteric access and drainage.
Collapse
Affiliation(s)
- Kenneth F Binmoeller
- Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, CA, USA.
| | | |
Collapse
|
61
|
Abstract
The technical advances in endoscopic ultrasonograpy (EUS) and accessories have enabled performing EUS-guided intervention in the pancreas and biliary tract. Many research centers have been performing or investigating EUS-guided drainage, EUS-guided celiac plexus neurolysis and block, EUS-guided anastomosis that includes choledocho-enterostomy and choledocho-gastrostomy, EUS-guided ablation and injection therapy mainly for pancreatic neoplasm, EUS-guided photodynamic therapy and EUS-guided brachytherapy. Some of these are currently clinical applications and others are under investigations in clinical studies or animal models. Further detailed randomized controlled clinical trials and the development of materials will bring us into a new era of therapeutic EUS.
Collapse
Affiliation(s)
- Kwang Hyuck Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | | |
Collapse
|
62
|
Lee KH, Lee JK. Interventional endoscopic ultrasonography: present and future. Clin Endosc 2011; 44:6-12. [PMID: 22741106 PMCID: PMC3363050 DOI: 10.5946/ce.2011.44.1.6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Revised: 09/18/2011] [Accepted: 09/19/2011] [Indexed: 12/22/2022] Open
Abstract
The technical advances in endoscopic ultrasonograpy (EUS) and accessories have enabled performing EUS-guided intervention in the pancreas and biliary tract. Many research centers have been performing or investigating EUS-guided drainage, EUS-guided celiac plexus neurolysis and block, EUS-guided anastomosis that includes choledocho-enterostomy and choledocho-gastrostomy, EUS-guided ablation and injection therapy mainly for pancreatic neoplasm, EUS-guided photodynamic therapy and EUS-guided brachytherapy. Some of these are currently clinical applications and others are under investigations in clinical studies or animal models. Further detailed randomized controlled clinical trials and the development of materials will bring us into a new era of therapeutic EUS.
Collapse
Affiliation(s)
- Kwang Hyuck Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | | |
Collapse
|
63
|
Wu DS, Chen WX, Wang XD, Acharya R, Jiang XH. Pancreaticobiliary duct changes of periampullary carcinomas: quantitative analysis at MR imaging. Eur J Radiol 2011; 81:2112-7. [PMID: 21908124 DOI: 10.1016/j.ejrad.2011.08.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Revised: 08/16/2011] [Accepted: 08/17/2011] [Indexed: 02/05/2023]
Abstract
PURPOSE To quantitatively analyse the pancreaticobiliary duct changes of periampullary carcinomas with volumetric interpolated breath-hold examination (VIBE) and true fast imaging with steady-state precession (true FISP) sequence, and investigate the value of these findings in differentiation and preoperative evaluation. MATERIALS AND METHODS Magnetic resonance (MR) images of 71 cases of periampullary carcinomas (34 cases of pancreatic head carcinoma, 16 cases of intrapancreatic bile duct carcinoma and 21 cases of ampullary carcinoma) confirmed histopathologically were analysed. The maximum diameter of the common bile duct (CBD) and main pancreatic duct (MPD), dilated pancreaticobiliary duct angle and the distance from the end of the proximal dilated pancreaticobiliary duct to the major papilla were measured. Analysis of variance and the Chi-squared test were performed. RESULTS These findings showed significant differences among the three subtypes: the distance from the end of proximal dilated pancreaticobiliary duct to the major papilla and pancreaticobiliary duct angle. The distance and the pancreaticobiliary duct angle were least for ampullary carcinoma among the three subtypes. The percentage of dilated CBD was 94.1%, 93.8%, and 100% for pancreatic head carcinoma, intrapancreatic bile duct carcinoma and ampullary carcinoma, respectively. And that for the dilated MPD was 58.8%, 43.8%, and 42.9%, respectively. CONCLUSION Quantitative analysis of the pancreaticobiliary ductal system can provide accurate and objective assessment of the pancreaticobiliary duct changes. Although benefit in differential diagnosis is limited, these findings are valuable in preoperative evaluation for both radical resection and palliative surgery.
Collapse
Affiliation(s)
- Dong Sheng Wu
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, PR China.
| | | | | | | | | |
Collapse
|
64
|
Abstract
The echoendoscopic biliary drainage is an option to treat obstructive jaundices when ERCP drainage fails. These procedures compose alternative methods to the side of surgery and percutaneous transhepatic biliary drainage, and it was only possible by the continuous development and improvement of echoendoscopes and accessories. The development of linear setorial array echoendoscopes in early 1990 brought a new approach to diagnostic and therapeutic dimenion on echoendoscopy capabilities, opening the possibility to perform punction over direct ultrasonographic view. Despite of the high success rate and low morbidity of biliary drainage obtained by ERCP, difficulty could be found at the presence of stent tumor ingrown, tumor gut compression, periampulary diverticula, and anatomic variation. The echoendoscopic technique starts performing punction and contrast of the left biliary tree. When performed from gastric wall, the access is made through hepatic segment III. From duodenum, direct common bile duct punction. Dilatation is required before stent introduction, and a plastic or metallic stent is introduced. This phrase should be replaced by: diathermic dilatation of the puncturing tract is required using a 6F cystostome. The technical success of hepaticogastrostomy is near 98%, and complications are present in 36%: pneumoperitoneum, choleperitoneum, infection, and stent disfunction. To prevent bile leakage, we have used the 2 stent techniques, the first stent introduced was a long uncovered metallic stent (8 or 10 cm), and inside this first stent a second fully covered stent of 6 cm was delivered to bridge the bile duct and the stomach. Choledochoduodenostomy overall success rate is 92% and described complications include, in frequency order, pneumoperitoneum and focal bile peritonitis, present in 19%. By the last 10 years, the technique was especially performed in reference centers, by ERCP experienced groups, and this seems to be a general guideline to safer procedure execution.
Collapse
|
65
|
Lee JH. Self-expandable metal stents for malignant distal biliary strictures. Gastrointest Endosc Clin N Am 2011; 21:463-80, viii-ix. [PMID: 21684465 DOI: 10.1016/j.giec.2011.04.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Obstructive jaundice can result from benign or malignant etiologies. The common benign conditions include primary sclerosing cholangitis, chronic pancreatitis, and gallstones. Malignant biliary obstruction can be caused by direct tumor infiltration, extrinsic compression by enlarged lymph nodes or malignant lesions, adjacent inflammation, desmoplastic reaction from a tumor, or a combination of these factors. Malignant diseases causing biliary obstruction include pancreatic cancer, ampullary cancer, cholangiocarcinoma, and metastatic diseases. This article focuses on malignant distal biliary obstruction and its management.
Collapse
Affiliation(s)
- Jeffrey H Lee
- Department of Gastroenterology, Hepatology, and Nutrition, MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1466, Houston, TX 77030-4009, USA.
| |
Collapse
|
66
|
Artifon ELA, Okawa L, Takada J, Gupta K, Moura EGH, Sakai P. EUS-guided choledochoantrostomy: an alternative for biliary drainage in unresectable pancreatic cancer with duodenal invasion. Gastrointest Endosc 2011; 73:1317-20. [PMID: 21195404 DOI: 10.1016/j.gie.2010.10.041] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Accepted: 10/25/2010] [Indexed: 12/11/2022]
|
67
|
Horaguchi J, Fujita N, Noda Y, Kobayashi G, Ito K, Obana T, Koshita S, Kanno Y, Ogawa T, Yamashita Y, Kato Y. Endosonography-guided biliary drainage with one-step placement of a newly designed fully covered metal stent for malignant biliary obstruction. Dig Endosc 2011; 23:207. [PMID: 21429037 DOI: 10.1111/j.1443-1661.2010.01081.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
|
68
|
Hara K, Yamao K, Mizuno N, Hijioka S, Sawaki A, Tajika M, Kawai H, Kondo S, Shimizu Y, Niwa Y. Interventional endoscopic ultrasonography for pancreatic cancer. World J Clin Oncol 2011; 2:108-14. [PMID: 21603319 PMCID: PMC3095471 DOI: 10.5306/wjco.v2.i2.108] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Revised: 09/27/2010] [Accepted: 10/04/2010] [Indexed: 02/06/2023] Open
Abstract
Endoscopic ultrasonography (EUS) represents the combination of endoscopy and intraluminal ultrasonography. This allows use of a high-frequency transducer (5-20 MHz) that, due to the short distance to the target lesion, provides ultrasonographic images of higher resolution than those obtained from other imaging modalities, including multiple-detector-row-computed tomography, magnetic resonance imaging, and positron emission tomography. EUS is now a widely accepted modality for diagnosing pancreatic diseases. However, the most important limitation of EUS has been the lack of specificity in differentiating between benign and malignant changes. In 1992, EUS-guided fine needle aspiration (FNA) of lesions in the pancreas head was introduced into clinical practice, using a curved linear-array echoendoscope. Since then, EUS has evolved from EUS imaging to EUS-FNA and wider applications. Interventional EUS for pancreatic cancer includes EUS-FNA, EUS-guided fine needle injection, EUS-guided biliary drainage and anastomosis, EUS-guided celiac neurolysis, radiofrequency ablation, brachytherapy, and delivery of a growing number of anti-tumor agents. This review focuses on interventional EUS, including EUS-FNA and therapeutic EUS for pancreatic cancer.
Collapse
Affiliation(s)
- Kazuo Hara
- Kazuo Hara, Kenji Yamao, Nobumasa Mizuno, Susumu Hijioka, Akira Sawaki, Masahiro Tajika, Hiroki Kawai, Shinya Kondo, Yasumasa Niwa, Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
69
|
Horaguchi J, Fujita N, Noda Y, Kobayashi G, Ito K, Koshita S, Kanno Y, Ogawa T. One-step placement of a fully-covered metal stent in endosonography-guided biliary drainage for malignant biliary obstruction. Intern Med 2011; 50:2089-93. [PMID: 21963724 DOI: 10.2169/internalmedicine.50.5466] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Although reports on endosonography-guided biliary drainage (ESBD) have been increasing, only a few discuss deployment of a self-expandable metal stent (SEMS) in the first session. OBJECTIVE To evaluate the safety and efficacy of ESBD with the one-step placement of a newly designed fully-covered SEMS. PATIENT AND METHODS Five patients with malignant biliary obstruction in whom one-step placement of an anti-migration designed SEMS in the first session of ESBD had been attempted between January 2007 and October 2009 were included in this study. Main outcome measurements were technical and clinical successes, early complications, and short-term results. RESULTS ESBD was attempted to bridge the extrahepatic bile duct and the duodenum and one-step SEMS placement was successful in all cases. There were no early complications related to ESBD and excellent biliary decompression was obtained in all cases. SEMS dysfunction such as stent migration and occlusion was not seen during the follow-up period (mean follow-up 138 days, range 102-184 days). CONCLUSION One-step placement of a fully-covered SEMS in ESBD is possibly a safe and effective treatment for biliary obstruction.
Collapse
Affiliation(s)
- Jun Horaguchi
- Department of Gastroenterology, Sendai City Medical Center, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
70
|
Interventional Endoscopic Ultrasound (EUS): Current Status. APOLLO MEDICINE 2010. [DOI: 10.1016/s0976-0016(12)60023-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
71
|
Wilson JA, Hoffman B, Hawes RH, Romagnuolo J. EUS in patients with surgically altered upper GI anatomy. Gastrointest Endosc 2010; 72:947-53. [PMID: 21034896 DOI: 10.1016/j.gie.2010.07.016] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Accepted: 07/12/2010] [Indexed: 02/08/2023]
Abstract
BACKGROUND Information regarding the safety and feasibility of EUS-guided FNA (EUS/FNA) in surgically altered anatomy is limited. OBJECTIVE The aim of this study was to describe EUS outcomes for Billroth I and II, Whipple, Puestow, Roux-en-Y (including gastric bypass), esophagectomy, and Nissen fundoplication surgeries. DESIGN Retrospective study. SETTING Single tertiary-care center. PATIENTS This study involved 188 EUS procedures performed in patients with surgically altered anatomy by 6 endosonographers from July 1995 to October 2008. INTERVENTION EUS and FNA. MAIN OUTCOME MEASUREMENTS Type of surgery, EUS indication, limitations to imaging, reasons for limitations, FNA results, and EUS/FNA complications. RESULTS Of 188 patients, 96 were men (mean age 57 years; range, 16-92 years). Of patients with Billroth II anatomy (n = 39), 10 had limited (common bile duct [CBD], head of pancreas [HOP]) imaging because intubation of the afferent limb failed (n = 6) or was not attempted (n = 4). Roux-en-Y (n = 18) encompased a variety of surgeries, but in general (n = 13) the proximal duodenum was not reached and the HOP and CBD were not imaged. For Roux-en-Y gastric bypass (n = 7), the HOP and CBD were not imaged, with the exception of 1 case (in which staple-line dehiscence permitted access to the proximal duodenum). For the remaining procedures, EUS and FNA were successful with few exceptions. There were no significant adverse events (95% confidence interval, 0% to 1.9%). LIMITATIONS Retrospective descriptive study. CONCLUSION EUS is generally successful and safe in patients with surgically altered anatomy in this tertiary-care setting, and a very low rate of adverse events is possible. Exceptions included imaging the HOP and CBD after Roux-en-Y surgery. After Billroth II surgery, if the afferent limb was intubated, the majority of patients were able to have a complete pancreaticobiliary examination, including FNA.
Collapse
Affiliation(s)
- Jason A Wilson
- Digestive Disease Center, Department of Medicine, Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina, USA
| | | | | | | |
Collapse
|
72
|
Endosonography-guided biliary drainage with one-step placement of a newly developed fully covered metal stent followed by duodenal stenting for pancreatic head cancer. DIAGNOSTIC AND THERAPEUTIC ENDOSCOPY 2010; 2010:426534. [PMID: 20981314 PMCID: PMC2958512 DOI: 10.1155/2010/426534] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Accepted: 09/29/2010] [Indexed: 12/20/2022]
Abstract
An 83-year-old man was admitted to our department, presenting with jaundice, fever, and nausea. CT revealed a pancreatic head tumor with duodenal invasion. Endoscopic transpapillary biliary drainage was unsuccessful due to stenosis at the second portion of the duodenum and tumor invasion to the papilla of Vater. Using a convex linear array echoendoscope, a fully-covered metal stent was placed across the puncture tract to bridge the duodenum and the bile duct. After improvement of jaundice, a duodenal metal stent was placed across the stricture of the duodenum. No procedure-related complications occurred. Neither migration nor obstruction of the two stents was observed during the three months followup period.
Combination of ESBD using a fully covered metal stent and duodenal stenting is a feasible technique and possibly a less invasive treatment option for malignant biliary and duodenal obstruction compared to surgery.
Collapse
|
73
|
Abstract
The role of endoscopic ultrasound (EUS) has greatly expanded since the first clinical examination performed nearly 30 years ago. The introduction of linear instruments allowed tissue sampling (Kulesza and Eltoum Clin Gastroenterol Hepatol 5:1248-1254, 2007; Levy and Wiersema Gastrointest Endosc 62:417-426, 2005) and therapeutic interventions applications, including celiac plexus and ganglia blockade and neurolysis (Wiersema and Wiersema Gastrointest Endosc 44:656-662, 1996; Levy and Wiersema Gastroenterol Clin North Am, 35:153-165, 2006; Levy et al. Am J Gastroenterol 103:98-103, 2008), pancreatic fluid drainage (Lopes et al. Arq Gastroenterol 45:17-21, 2008; Norton et al. Mayo Clin Proc 76:794-798, 2001; Kruger et al. Gastrointest Endosc 63:409-416, 2006; Seifert et al.: Endoscopy 32:255-259, 2000), cholecystenterostomy (Kwan et al. Gastrointest Endosc 66:582-586, 2007), and delivery of cytotoxic agents (eg, chemotherapy, radioactive seeds, and gene therapy) (Chang et al.: Cancer 88:1325-1335, 2000; Chang Endoscopy 38(Suppl 1):S88-S93, 2006). The continued need to develop less invasive alternatives to surgical and interventional radiologic therapies drove the development of EUS-guided methods for biliary and pancreatic intervention. This article reviews existing data and focuses on established and emerging EUS techniques for accessing and draining the bile and pancreatic ducts.
Collapse
|
74
|
Noda Y, Fujita N, Kobayashi G, Ito K, Obana T, Horaguchi J, Koshita S, Kanno Y, Sawai T. Transgastric transhepatic endosonography-guided biliary drainage: histological assessment of its sinus tract in an autopsy case. Dig Endosc 2010; 22:341-4. [PMID: 21175493 DOI: 10.1111/j.1443-1661.2010.01027.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Endosonography-guided biliary drainage (ESBD) is gaining attention as a promising drainage technique for obstructive jaundice. However, histological changes resulting from ESBD have not been well understood. We had an opportunity to histologically investigate the influence of ESBD, established between the left hepatic duct and the stomach, on the relevant organs in an autopsy case with bile duct cancer extending from the pancreatic head to the hepatic hilum with duodenal invasion. Localized fibrous connective tissues were present around and along the sinus tract, including the connection between the surfaces of the left lobe of the liver and the gastric serosa, without hemorrhage, inflammatory changes, or cancer invasion. The inside of the ESBD stent was slightly stenotic at the intramural portion of the stomach due to proliferation of granulation tissue. No bile stasis or abscess was observed in the left lobe. These results are quite suggestive of the high safety and efficacy of ESBD with adequate performance.
Collapse
Affiliation(s)
- Yutaka Noda
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan.
| | | | | | | | | | | | | | | | | |
Collapse
|
75
|
Yamao K, Hara K, Mizuno N, Sawaki A, Hijioka S, Niwa Y, Tajika M, Kawai H, Kondo S, Shimizu Y, Bhatia V. EUS-Guided Biliary Drainage. Gut Liver 2010; 4 Suppl 1:S67-75. [PMID: 21103298 DOI: 10.5009/gnl.2010.4.s1.s67] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Endoscopic ultrasonography (EUS) combines endoscopy and intraluminal ultrasonography, and allows imaging with a high-frequency transducer over a short distance to generate high-resolution ultrasonographic images. EUS is now a widely accepted modality for diagnosing pancreatobiliary diseases. EUS-guided fine-needle aspiration (EUS-FNA) using a curved linear-array echoendoscope was initially described more than 20 years ago, and since then many researchers have expanded its indications to sample diverse lesions and have also used it for various therapeutic purposes. EUS-guided biliary drainage (EUS-BD) is one of the therapeutic procedures that has been developed using a curved linear-array echoendoscope. Technically, EUS-BD includes rendezvous techniques via transesophageal, transgastric, and transduodenal routes, EUS-guided choledochoduodenostomy (EUS-CDS), and EUS-guided hepaticogastrostomy (EUS-HGS). Published data have demonstrated a high success rate, albeit with a comparatively high rate of nonfatal complications for EUS-CDS and EUS-HGS, and a comparatively low success rate with a low complication rate for the rendezvous technique. At present, these procedures represent an alternative to surgery or percutaneous transhepatic biliary drainage (PTBD) for patients with obstructive jaundice when endoscopic biliary drainage (EBD) has failed. However, these procedures should be performed in centers with extensive experience in linear EUS and therapeutic biliary ERCP. Large prospective studies are needed in the near future to establish standardized EUS-BD procedures as well as to perform controlled comparative trials between EUS-BD and PTBD, between rendezvous techniques and direct-access techniques (EUS-CDS and EUS-HGS), and between EBD and EUS-BD.
Collapse
Affiliation(s)
- Kenji Yamao
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
76
|
Kaul V, Adler DG, Conway JD, Farraye FA, Kantsevoy SV, Kethu SR, Kwon RS, Mamula P, Pedrosa MC, Rodriguez SA, Tierney WM. Interventional EUS. Gastrointest Endosc 2010; 72:1-4. [PMID: 20381044 DOI: 10.1016/j.gie.2010.01.023] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Accepted: 01/13/2010] [Indexed: 02/08/2023]
Abstract
The American Society for Gastrointestinal Endoscopy (ASGE) Technology Committee provides reviews of new or emerging endoscopic technologies that have the potential to have an impact on the practice of GI endoscopy. Evidence-based methodology is used by performing a MEDLINE literature search to identify pertinent preclinical and clinical studies on the topic and a MAUDE (U.S. Food and Drug Administration Center for Devices and Radiological Health) database search to identify the reported complications of a given technology. Both are supplemented by accessing the "related articles" feature of PubMed and by scrutinizing pertinent references cited by the identified studies. Controlled clinical trials are emphasized, but, in many cases, data from randomized, controlled trials are lacking. In such cases, large case series, preliminary clinical studies, and expert opinions are used. Technical data are gathered from traditional and Web-based publications, proprietary publications, and informal communications with pertinent vendors. For this review, the MEDLINE database was searched through August 2009 by using the keywords "interventional endoscopic ultrasound," "EUS," and "interventional endoscopy." Reports on Emerging Technologies are drafted by 1 or 2 members of the ASGE Technology Committee, reviewed and edited by the committee as a whole, and approved by the Governing Board of the ASGE. These reports are scientific reviews provided solely for educational and informational purposes. Reports on Emerging Technologies are not rules and should not be construed as establishing a legal standard of care or as encouraging, advocating, requiring, or discouraging any particular treatment or payment for such treatment.
Collapse
|
77
|
Ito K, Fujita N, Horaguchi J, Noda Y, Kobayashi G. Current issues regarding endosonography-guided biliary drainage for biliary obstruction. Dig Endosc 2010; 22 Suppl 1:S132-6. [PMID: 20590762 DOI: 10.1111/j.1443-1661.2010.00971.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Transpapillary endoscopic biliary drainage is a well-accepted technique for patients with biliary obstruction. However, transpapillary access to the bile duct is not always possible, especially in patients with duodenal stenosis or difficult cannulation of the bile duct during endoscopic retrograde cholangiopancreatography. Percutaneous transhepatic biliary drainage or surgical bypass has been performed in cases of unsuccessful endoscopic retrograde cholangiopancreatography. Recently, endosonography-guided biliary drainage (ESBD) has been developed as a new biliary drainage technique. Current issues regarding ESBD are discussed in this article. Proper indications for ESBD should be established for widespread performance. Technical standardization and dedicated instruments for ESBD are also mandatory.
Collapse
Affiliation(s)
- Kei Ito
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan.
| | | | | | | | | |
Collapse
|
78
|
Larghi A, Seerden TC, Galasso D, Carnuccio A, Familiari P, Mutignani M, Zachariah K, Costamagna G. EUS-guided therapeutic interventions for uncommon benign pancreaticobiliary disorders by using a newly developed forward-viewing echoendoscope (with videos). Gastrointest Endosc 2010; 72:213-5. [PMID: 20207354 DOI: 10.1016/j.gie.2009.11.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2009] [Accepted: 11/02/2009] [Indexed: 01/27/2023]
Affiliation(s)
- Alberto Larghi
- Digestive Endoscopy Unit, Catholic University, Rome, Italy
| | | | | | | | | | | | | | | |
Collapse
|
79
|
Perez-Miranda M, de la Serna C, Diez-Redondo P, Vila JJ. Endosonography-guided cholangiopancreatography as a salvage drainage procedure for obstructed biliary and pancreatic ducts. World J Gastrointest Endosc 2010; 2:212-22. [PMID: 21160936 PMCID: PMC2998937 DOI: 10.4253/wjge.v2.i6.212] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Revised: 05/25/2010] [Accepted: 06/01/2010] [Indexed: 02/05/2023] Open
Abstract
Endoscopic ultrasound allows transmural access to the bile or pancreatic ducts and subsequent contrast injection to provide ductal drainage under fluoroscopy using endoscopic retrograde cholangiopancreatography (ERCP)-based techniques. Differing patient specifics and operator techniques result in six possible variant approaches to this procedure, known as endosonography-guided cholangiopancreatography (ESCP). ESCP has been in clinical use for a decade now, with over 300 cases reported. It has become established as a salvage procedure after failed ERCP in the palliation of malignant biliary obstruction. Its role in the management of clinically severe chronic/relapsing pancreatitis remains under scrutiny. This review aims to clarify the concepts underlying the use of ESCP and to provide technical tips and a detailed step-by-step procedural description.
Collapse
Affiliation(s)
- Manuel Perez-Miranda
- Manuel Perez-Miranda, Carlos de la Serna, Pilar Diez-Redondo, Endoscopy Unit. Hospital Universitario Rio Hortega, Valladolid 47012, Spain
| | | | | | | |
Collapse
|
80
|
Shami VM, Kahaleh M. Endoscopic ultrasound-guided cholangiopancreatography and rendezvous techniques. Dig Liver Dis 2010; 42:419-24. [PMID: 19897427 DOI: 10.1016/j.dld.2009.09.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Accepted: 09/24/2009] [Indexed: 12/11/2022]
Abstract
Endoscopic ultrasound-guided cholangiopancreatography (EUCP) has become an alternative to percutaneous drainage or surgery in patients with obstructive jaundice or pancreatic obstruction after failed conventional ERCP. The different techniques of biliary and pancreatic drainage are described and the literature is reviewed. Due to the technical complexity associated with this procedure, it should be reserved for endoscopists at tertiary care centers with advanced training in both EUS and ERCP.
Collapse
Affiliation(s)
- Vanessa M Shami
- Digestive Health Center of Excellence, University of Virginia Health System, Charlottesville, VA 22908-0708, United States
| | | |
Collapse
|
81
|
Abstract
Endoscopic biliary drainage (EBD) may be unsuccessful in some patients, because of failed biliary cannulation or tumor infiltration, limiting endoscopic access to major papilla. The alternative method of percutaneous transhepatic biliary drainage carries a risk of complications, such as bleeding, portal vein thrombus, portal vein occlusion and intra- or extra-abdominal bile leakage. Recently, endoscopic ultrasonography (EUS)-guided biliary stent placement has been described in patients with malignant biliary obstruction. Technically, EUS-guided biliary drainage is possible via transgastric or transduodenal routes or through the small intestine using a direct access or rendezvous technique. We describe herein a technique for direct stent insertion from the duodenal bulb for the management of patients with jaundice caused by malignant obstruction of the lower extrahepatic bile duct. We think transduodenal direct access is the best treatment in patients with jaundice caused by inoperable malignant obstruction of the lower extrahepatic bile duct when EBD fails.
Collapse
|
82
|
Vila JJ, Goñi S, Arrazubi V, Bolado F, Ostiz M, Javier Jiménez F. Endoscopic ultrasonography-guided transgastric biliary drainage aided by Soehendra stent retriever. Am J Gastroenterol 2010; 105:959-60. [PMID: 20372144 DOI: 10.1038/ajg.2009.690] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
83
|
EUS-guided hepaticogastrostomy with a fully covered metal stent as the biliary diversion technique for an occluded biliary metal stent after a failed ERCP (with videos). Gastrointest Endosc 2010; 71:413-9. [PMID: 20152319 DOI: 10.1016/j.gie.2009.10.015] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2009] [Accepted: 10/14/2009] [Indexed: 12/11/2022]
Abstract
BACKGROUND Percutaneous transhepatic biliary drainage (PTBD) may be the last resort for an occluded biliary metal stent when the ERCP was unsuccessful. OBJECTIVE Because an EUS-guided biliary drainage has been proposed as an effective alternative for PTBD after a failed ERCP, we conducted this study to determine the feasibility and usefulness of an EUS-guided hepaticogastrostomy (EUS-HG) with a fully covered self-expandable metal stent (FCSEMS) for an occluded biliary metal stent after a failed ERCP. DESIGN A case study. SETTING A tertiary referral center. PATIENTS AND INTERVENTIONS Five patients who had an occluded biliary metal stent inserted after a hilar bilateral metal stent or a combined duodenal and biliary metal stent insertion and for whom reinterventional ERCP was unsuccessful underwent an EUS-HG with an FCSEMS for alternative PTBD. MAIN OUTCOME MEASUREMENTS Technical and functional success, procedural complications, reinterventional rate after EUS-HG with an FCSEMS, and short-term stent patency. RESULTS In all 5 patients, an EUS-HG with an FCSEMS was technically successful. No procedural complications, such as bile peritonitis, cholangitis, and pneumoperitoneum, were observed. Functional success was also 100% (5/5). During the follow-up period (median 152 days, range 64-184 days), no late complications, such as stent migration and occlusion, were observed. Thus, no biliary reintervention was performed during the follow-up period. LIMITATIONS A small series of patients without a control group. CONCLUSIONS The EUS-HG with an FCSEMS may be feasible, effective, and an alternative PTBD for an occluded biliary metal stent after a failed ERCP.
Collapse
|
84
|
Endoscopic ultrasound in the evaluation of pancreaticobiliary disorders. Dig Liver Dis 2010; 42:6-15. [PMID: 19665951 DOI: 10.1016/j.dld.2009.06.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2009] [Accepted: 06/24/2009] [Indexed: 12/11/2022]
Abstract
The close proximity of the endoscopic ultrasound probe to the pancreas coupled with the ability to perform fine needle aspiration has made endoscopic ultrasound an extremely important technique for the evaluation of both benign and malignant pancreaticobiliary disorders. In parallel to the widespread importance of diagnostic endoscopic ultrasound, the therapeutic and interventional applications of this procedure are expanding and may become a major breakthrough in the management of pancreaticobiliary diseases. This article focuses on the utility and recent advances of endoscopic ultrasound in the diagnostic evaluation pancreaticobiliary disorders and analyses the data of well established interventional procedures such as celiac plexus neurolysis and pseudocyst drainage. Moreover, the more innovative procedures, such endoscopic ultrasound-guided biliary and pancreatic ducts access and drainage and the experimental use of direct endoscopic ultrasound-guided therapy of both solid and cystic pancreatic lesions will also be reviewed.
Collapse
|
85
|
Abstract
Endoscopic ultrasound (EUS) is an increasingly available diagnostic and therapeutic tool used within the U.K. it has wide applications both in the gastrointestinal tract and mediastinum with its current main uses being in the staging of luminal malignancies and assessment of pancreatic and subepithelial lesions. The emergence of linear EUS has opened up new therapeutic avenues with fine needle aspiration, trucut biopsies, coeliac plexus blocks and transmural pseudocyst drainage all now possible. Future developments include localised brachytherapy/chemotherapy and alcohol ablation of unresectable pancreatic malignancies and EUS-guided endoscopic surgery.
Collapse
|
86
|
Itoi T, Sofuni A, Itokawa F, Tsuchiya T, Kurihara T, Ishii K, Tsuji S, Ikeuchi N, Umeda J, Moriyasu F, Tsuchida A. Endoscopic ultrasonography-guided biliary drainage. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2009; 17:611-6. [DOI: 10.1007/s00534-009-0196-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2009] [Accepted: 09/01/2009] [Indexed: 12/11/2022]
Affiliation(s)
- Takao Itoi
- Department of Gastroenterology and Hepatology; Tokyo Medical University; Shinjuku-ku, Nishishinjuku 6-7-1 Tokyo Japan
| | - Atsushi Sofuni
- Department of Gastroenterology and Hepatology; Tokyo Medical University; Shinjuku-ku, Nishishinjuku 6-7-1 Tokyo Japan
| | - Fumihide Itokawa
- Department of Gastroenterology and Hepatology; Tokyo Medical University; Shinjuku-ku, Nishishinjuku 6-7-1 Tokyo Japan
| | - Takayoshi Tsuchiya
- Department of Gastroenterology and Hepatology; Tokyo Medical University; Shinjuku-ku, Nishishinjuku 6-7-1 Tokyo Japan
| | - Toshio Kurihara
- Department of Gastroenterology and Hepatology; Tokyo Medical University; Shinjuku-ku, Nishishinjuku 6-7-1 Tokyo Japan
| | - Kentaro Ishii
- Department of Gastroenterology and Hepatology; Tokyo Medical University; Shinjuku-ku, Nishishinjuku 6-7-1 Tokyo Japan
| | - Shujiro Tsuji
- Department of Gastroenterology and Hepatology; Tokyo Medical University; Shinjuku-ku, Nishishinjuku 6-7-1 Tokyo Japan
| | - Nobuhito Ikeuchi
- Department of Gastroenterology and Hepatology; Tokyo Medical University; Shinjuku-ku, Nishishinjuku 6-7-1 Tokyo Japan
| | - Junko Umeda
- Department of Gastroenterology and Hepatology; Tokyo Medical University; Shinjuku-ku, Nishishinjuku 6-7-1 Tokyo Japan
| | - Fuminori Moriyasu
- Department of Gastroenterology and Hepatology; Tokyo Medical University; Shinjuku-ku, Nishishinjuku 6-7-1 Tokyo Japan
| | - Akihiko Tsuchida
- Third Department of Surgery; Tokyo Medical University; Tokyo Japan
| |
Collapse
|
87
|
Horaguchi J, Fujita N, Noda Y, Kobayashi G, Ito K, Obana T, Takasawa O, Koshita S, Kanno Y. Endosonography-guided biliary drainage in cases with difficult transpapillary endoscopic biliary drainage. Dig Endosc 2009; 21:239-44. [PMID: 19961522 DOI: 10.1111/j.1443-1661.2009.00899.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Recently, reports on a new endoscopic biliary drainage technique utilizing endosonographic guidance (endosonography-guided biliary drainage [ESBD]) have been increasing. The aim of this study was to evaluate the efficacy of ESBD in cases with difficult transpapillary endoscopic biliary drainage (EBD). PATIENTS AND METHODS Sixteen patients with obstructive jaundice who underwent ESBD because of difficult EBD between January 2007 and September 2008 were included. The technical success, complications, and clinical efficacy of ESBD were prospectively evaluated. RESULTS ESBD was performed via the duodenum, stomach, and esophagus in eight, six and two patients, respectively. Stent placement was successful in all cases and excellent biliary decompression was achieved in all but one patient. One patient developed localized peritonitis following guidewire migration and re-puncture of the bile duct. In another patient, stent migration was observed one week after ESBD and re-ESBD was carried out. Three patients underwent surgery for their primary diseases, and stent exchange was carried out in 10 patients during the course. CONCLUSIONS ESBD is an effective treatment for obstructive jaundice that will replace percutaneous transhepatic biliary drainage in cases of difficult EBD and is a possible alternative to EBD in selected cases.
Collapse
Affiliation(s)
- Jun Horaguchi
- Department of Gastroenterology, Sendai City Medical Center, Miyagino-ku, Sendai, Japan.
| | | | | | | | | | | | | | | | | |
Collapse
|
88
|
EUS-guided biliary drainage with one-step placement of a fully covered metal stent for malignant biliary obstruction: a prospective feasibility study. Am J Gastroenterol 2009; 104:2168-74. [PMID: 19513026 DOI: 10.1038/ajg.2009.254] [Citation(s) in RCA: 143] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Endoscopic ultrasound (EUS)-guided biliary drainage (EUSBD) with plastic stents has been introduced as an alternative to percutaneous transhepatic biliary drainage (PTBD) in cases of biliary obstruction when endoscopic retrograde cholangiopancreatography (ERCP) is unsuccessful. Although self-expandable metallic stents with a larger diameter might offer long-lasting patency compared with plastic stents, to date, EUSBD with one-step placement of a fully covered self-expandable metal stent (FCSEMS) has not been evaluated. We conducted this study to determine the feasibility and usefulness of EUSBD with one-step placement of FCSEMS. METHODS A prospective feasibility study on EUSBD with one-step placement of FCSEMS was carried out in 14 patients with malignant biliary obstruction who were candidates for alternative techniques for biliary decompression because of unsuccessful ERCP. RESULTS The technical and functional success rate was 100% (14/14). Nine patients were treated using the intrahepatic approach. The remaining five patients were treated using the extrahepatic approach. With the intrahepatic approach, two patients showed self-limited pneumoperitoneum. With the extrahepatic approach, no patients had pneumoperitoneum. No bile peritonitis or cholangitis was observed after the procedure in any of the patients treated using the intra- or extrahepatic approach. During follow-up periods (median 6 months), one case of re-intervention (7%, 1/14) necessitated by distal stent migration was observed. CONCLUSIONS EUSBD with one-step placement of an FCSEMS may be feasible, safe, and effective as an alternative to PTBD in cases of malignant biliary obstruction when ERCP is unsuccessful. Prospective randomized trials of EUSBD with plastic stent vs. EUSBD with FCSEMS may be needed.
Collapse
|
89
|
Brauer BC, Chen YK, Fukami N, Shah RJ. Single-operator EUS-guided cholangiopancreatography for difficult pancreaticobiliary access (with video). Gastrointest Endosc 2009; 70:471-9. [PMID: 19560768 DOI: 10.1016/j.gie.2008.12.233] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2008] [Accepted: 12/20/2008] [Indexed: 02/06/2023]
Abstract
BACKGROUND When conventional ERCP methods fail because of periampullary or ductal obstruction, EUS-guided cholangiopancreatography (EUS-CP) may aid in pancreaticobiliary access. OBJECTIVE To report our experience when using single-operator EUS-CP. SETTING An academic tertiary-referral center. METHODS Consecutive patients undergoing EUS-CP were prospectively identified. These patients had undergone failed attempt(s) at therapeutic ERCP. A data sheet was used to record indications, reasons for failed ERCP, EUS-CP visualization of the duct of interest, transpapillary or transenteric intervention, clinical follow-up, and complications. MAIN OUTCOME MEASUREMENTS Technical success was decompression of the duct of interest. Clinical success was resolution of jaundice or a > or = 50% reduction in pain or narcotics, as applicable. RESULTS Between February 2003 and June 2007, EUS-CP was attempted in 20 patients (11 men, 9 women; mean [SD] age 58 +/- 14.9 years). Indications included jaundice (n = 8), biliary stones (n = 3), chronic pancreatitis (n = 6), acute pancreatitis (n = 2), and papillary stenosis (n = 1). Reasons for failed ERCP included periampullary mass (n = 8), intradiverticular papillae (n = 4), and pancreatic duct (PD) stricture (n = 7) or stone (n = 1). Technical success was achieved in 18 of 20 patients (90%). Biliary decompression was obtained in 11 of 12 patients (92%) (7 transpapillary and 4 transenteric-transcholedochal). Pancreatic decompression was obtained in 7 of 8 patients (88%) (3 transpapillary, 4 transgastric). On follow-up, clinical improvement was noted in 15 of 20 patients (70%). For treatment of pain associated with chronic pancreatitis, pain scores decreased by a mean of 1.75 (P = .18). Complications (in 2 of 20 [10%]) included perforation (n = 1) and respiratory failure (n = 1). LIMITATIONS A single-center nonrandomized observational study with a small patient population. CONCLUSIONS At our academic referral center, single-operator EUS-CP provided decompression of obstructed ducts and may be performed after a failed attempt at conventional ERCP during the same endoscopic session.
Collapse
Affiliation(s)
- Brian C Brauer
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Colorado Denver, Aurora, Colorado 80045, USA
| | | | | | | |
Collapse
|
90
|
Pancreatobiliary drainage using the EUS-FNA technique: EUS-BD and EUS-PD. ACTA ACUST UNITED AC 2009; 16:598-604. [PMID: 19649561 DOI: 10.1007/s00534-009-0131-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2009] [Accepted: 03/31/2009] [Indexed: 12/27/2022]
Abstract
The recent progression of endoscopic ultrasonography (EUS) enables EUS-guided transmural drainage based on the EUS-guided fine-needle aspiration biopsy technique. Prior to the development of EUS-guided drainage procedures, the options for treating obstruction of the pancreatobiliary system included surgical drainage, percutaneous drainage using ultrasound and radiological guidance, and endoscopic (non EUS-guidance) transmural drainage. Today, using EUS guidance and dedicated accessories, it is possible to create bilio- or pancreato-digestive anastomosis, EUS-guided biliary drainage (EUS-BD), and EUS-guided pancreatic drainage (EUS-PD). The recent literature describes that EUS-BD and EUS-PD have acceptable success and complication rates. These procedures are anticipated for use as alternatives to surgery or percutaneous drainage when endoscopic transpapillary procedures fail.
Collapse
|
91
|
Abstract
Development of the curved linear (convex) array echoendoscope has enabled procedures that utilize interventional endoscopic ultrasonography (EUS), such as EUS-guided drainage. EUS-guided pseudocyst drainage creates a fistula between the pseudocyst and the gastric or duodenal lumen. This treatment is superior to conventional endoscopic transmural drainage with respect to prevention from complications such as bleeding, because ultrasonographic observation permits easy visualization of the interposing vessels and real-time visualization of needle procedure. Endoscopic ultrasonography-guided drainage can also be applied to pancreatobiliary drainage. In cases where endoscopic retrograde cholangiopancreatography (ERCP) is unsuccessful in the treatment of obstructive jaundice and chronic obstructive pancreatitis, transmural drainage of bile and pancreatic juice under EUS guidance may supplant the percutaneous transhepatic biliary drainage and the surgical treatment.
Collapse
Affiliation(s)
- Masayuki Kitano
- Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Japan.
| | | | | | | |
Collapse
|
92
|
Hanada K, Iiboshi T, Ishii Y. Endoscopic ultrasound-guided choledochoduodenostomy for palliative biliary drainage in cases with inoperable pancreas head carcinoma. Dig Endosc 2009; 21 Suppl 1:S75-8. [PMID: 19691742 DOI: 10.1111/j.1443-1661.2009.00855.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Endoscopic transpapillary biliary drainage (EBD) or stenting is the gold standard treatment for inoperable malignant biliary obstruction. When the papilla cannot be traversed because of pyloric or duodenal stenosis, or the catheter cannot be introduced, or because of previous surgery, the usual alternative method is considered to be percutaneous transhepatic biliary drainage (PTBD). We herein report our experiences with four cases with inoperable pancreatic head carcinoma associated with obstructive jaundice treated by endoscopic ultrasonography-guided biliary drainage (EUS-BD). METHODS Between September 2006 and December 2007, methods of EUS-BD were performed in four cases with inoperable pancreas head carcinoma. In three out of four cases, EBD and PTBD were unsuccessful because of previous surgery, or duodenal stenosis, or nondilated intrahepatic bile ducts. In one case, although PTBD was successful, internal drainage could not be established. RESULTS EUS-BD was successful for all cases. The obstructed biliary system was successfully decompressed by the creation of a choledochoduodenal fistula and the insertion of a transduodenal biliary plastic stent. No complication was encountered in all cases. CONCLUSIONS EUS-BD may have the potential of replacing PTBD in cases with inoperable pancreatic head carcinoma associated with obstructive jaundice.
Collapse
Affiliation(s)
- Keiji Hanada
- Center for Gastroendoscopy, Onomichi General Hospital, Japan.
| | | | | |
Collapse
|
93
|
Yamao K, Bhatia V, Mizuno N, Sawaki A, Shimizu Y, Irisawa A. Interventional endoscopic ultrasonography. J Gastroenterol Hepatol 2009; 24:509-19. [PMID: 19220671 DOI: 10.1111/j.1440-1746.2009.05783.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Endoscopic ultrasonography (EUS) is the combination of endoscopy and intraluminal ultrasonography. This allows use of a high frequency transducer, which, due to the short distance to the target lesion, enables ultrasonographic images of high resolution to be obtained. Endoscopic ultrasonography is now a widely accepted modality for the diagnosis of pancreatobiliary diseases. It can be used to determine the depth of invasion of gastrointestinal malignancies, and often for visualizing lesions more precisely than other imaging modalities. The most important early limitation of EUS was the lack of specificity in the differentiation between benign and malignant changes. In 1992, EUS-guided fine needle aspiration (EUS-FNA) of lesions in the pancreas head has been made possible using a curved linear array echoendoscope. Since then, many researchers have expanded the indication of EUS-FNA to various kinds of lesions and also for a variety of therapeutic purposes. In this review, we particularly focus on the present and future roles of interventional EUS, including EUS-FNA and therapeutic EUS.
Collapse
Affiliation(s)
- Kenji Yamao
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan.
| | | | | | | | | | | |
Collapse
|
94
|
Barthet M. [Therapeutic EUS for the management of pancreatic and biliary diseases]. GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 2009; 33:258-265. [PMID: 19303729 DOI: 10.1016/j.gcb.2009.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- M Barthet
- Département d'hépatogastroentérologie, hôpital Nord, chemin des Bourrely, 13915 Marseille cedex 20, France.
| |
Collapse
|
95
|
Papanikolaou IS, Fockens P, Hawes R, Rösch T. Update on endoscopic ultrasound: how much for imaging, needling, or therapy? Scand J Gastroenterol 2009; 43:1416-24. [PMID: 18821273 DOI: 10.1080/00365520701737252] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Ioannis S Papanikolaou
- Central Interdisciplinary Endoscopy Unit, Department of Gastroenterology, Virchow Hospital, Charite University Hospitals, Berlin, Germany
| | | | | | | |
Collapse
|
96
|
Affiliation(s)
- Kenji Yamao
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| |
Collapse
|
97
|
Savides TJ, Varadarajulu S, Palazzo L. EUS 2008 Working Group document: evaluation of EUS-guided hepaticogastrostomy. Gastrointest Endosc 2009; 69:S3-7. [PMID: 19179166 DOI: 10.1016/j.gie.2008.10.060] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2008] [Accepted: 10/28/2008] [Indexed: 12/12/2022]
Affiliation(s)
- Thomas J Savides
- Division of Gastroenterology, University of California, San Diego, California, USA
| | | | | |
Collapse
|
98
|
Takasawa O, Fujita N, Noda Y, Kobayashi G, Ito K, Horaguchi J, Obana T. Endosonography-guided gallbladder drainage for acute cholecystitis following covered metal stent deployment. Dig Endosc 2009; 21:43-7. [PMID: 19691802 DOI: 10.1111/j.1443-1661.2008.00822.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Endosonography-guided biliary drainage (ESBD) is gaining acceptance as an effective treatment for obstructive jaundice. Only a few reports on the application of this technique to the gallbladder (endosonography-guided gallbladder drainage [ESGBD]) have been published in the literature. In order to relieve acute cholecystitis which developed in a patient with unresectable malignant biliary obstruction after deployment of a covered metal stent (CMS), we applied this technique. ESGBD was carried out by using an electronic curved linear array echoendoscope. After visualization of the gallbladder and determination of the puncture route, a needle knife papillotome was advanced with electrocautery to pierce the gastric and gallbladder walls. Under the guidance of a guidewire inserted through the needle sheath into the gallbladder, a 7.2 Fr, 30 cm-long, single pigtail plastic tube was placed to bridge the gallbladder and the stomach. No complications relevant to the procedure were encountered. ESGBD was quite effective in ameliorating the patient's acute cholecystitis and the drainage tube was removed after 10 days without sequelae. Acute cholecystitis following CMS deployment is considered to be a good indication for ESGBD.
Collapse
Affiliation(s)
- Osamu Takasawa
- Department of Gastroenterology, Sendai City Medical Center, Miyagino-ku, Sendai, Japan.
| | | | | | | | | | | | | |
Collapse
|
99
|
Geller A. Klatskin tumor--palliative therapy: the jury is still out or may be not yet in... Gastrointest Endosc 2009; 69:63-5. [PMID: 19111687 DOI: 10.1016/j.gie.2008.06.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2008] [Accepted: 06/22/2008] [Indexed: 12/10/2022]
|
100
|
Papanikolaou IS, Adler A, Neumann U, Neuhaus P, Rösch T. Endoscopic ultrasound in pancreatic disease--its influence on surgical decision-making. An update 2008. Pancreatology 2008; 9:55-65. [PMID: 19077455 DOI: 10.1159/000178875] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Endoscopic ultrasonography (EUS) was introduced about 25 years ago with the primary aim of better visualization of the pancreas as compared to transabdominal ultrasonography. This review discusses the current evidence in 2008 concerning the role of EUS in the clinical management of patients, with a special emphasis on its impact on surgical therapy. According to the literature, good indications are detection of common bile duct stones (e.g. in acute pancreatitis), the detection of small exo- and endocrine pancreatic tumors, the performance of fine-needle aspiration in pancreatic masses depending on therapeutic consequences. In other areas such as diagnosis of chronic pancreatitis and cystic pancreatic lesions, the contribution of EUS seems limited. Pancreatic cancer staging is discussed controversially due to conflicting evidence and certainly has lost grounds due to improvements in CT technology. Therapeutic EUS is, however, more widely accepted and may replace other techniques, e.g. in pancreatic cyst drainage and celiac plexus neurolysis; further techniques of interest are being developed.
Collapse
Affiliation(s)
- Ioannis S Papanikolaou
- Department of Gastroenterology, Charité-Medical University of Berlin, Campus Virchow Clinic, Berlin, Germany
| | | | | | | | | |
Collapse
|