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Antiplatelet and/or anticoagulant treatment does not increase hemorrhagic adverse events during EUS-guided biliary drainage. Gastrointest Endosc 2020; 92:659-666. [PMID: 32334019 DOI: 10.1016/j.gie.2020.04.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 04/10/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS No data appear to have been reported regarding bleeding risk among patients receiving antiplatelet and/or anticoagulant treatment (AP/AC) during EUS-guided biliary drainage (BD) procedures. The aim of this study was to assess whether hemorrhagic adverse events associated with EUS-BD are increased in patients on AP/AC. METHODS Patients receiving AP/AC who underwent EUS-BD were retrospectively enrolled between May 2015 and August 2019. Patients who did not receive AP/AC and underwent EUS-BD in the same period were also enrolled as a control group. RESULTS One hundred ninety-five patients who underwent EUS-BD were enrolled in this study. Among these, 154 patients were allocated to the control group and 41 patients to the AP/AC group. Overall frequency of adverse events did not differ significantly between the control group (16.2%, 25/154) and AC/AP group (17.1%, 6/41; P = .80). The overall bleeding event rate was 3.6% (7/195), with no significant difference between the 2 groups. No thromboembolic events were observed with or without interruption of AP/AC. According to logistic regression analysis, the use of AP/AC was not a risk factor significantly associated with bleeding events (odds ratio, 2.96; 95% confidence interval, .56-14.0; P = .18). On the other hand, a long procedure time (>20 minutes) was an independent risk factor associated with bleeding events. CONCLUSIONS Bleeding events appear to be infrequent among patients who undergo EUS-BD while continuing AP/AC.
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Ang TL, Li JW. Endoscopic ultrasound-guided biopsy and endoscopic ultrasound-guided gastrointestinal anastomosis: A tale of twin cities. J Gastroenterol Hepatol 2020; 35:1259-1260. [PMID: 32748455 DOI: 10.1111/jgh.15173] [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: 12/09/2022]
Affiliation(s)
- Tiing Leong Ang
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore.,Medicine Academic Clinical Programme, SingHealth Duke-NUS Academic Medical Centre, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - James Weiquan Li
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore.,Medicine Academic Clinical Programme, SingHealth Duke-NUS Academic Medical Centre, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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103
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Teoh AYB. Endoscopic ultrasound-guided anastomosis: Is it ready for prime time? J Gastroenterol Hepatol 2020; 35:1288-1293. [PMID: 32415861 DOI: 10.1111/jgh.15099] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/08/2020] [Accepted: 05/10/2020] [Indexed: 12/12/2022]
Abstract
Significant advancements in endoscopic ultrasound (EUS)-guided drainage procedures and EUS-guided anastomosis have recently been described. The described procedures include EUS-guided drainage of pancreatic fluid collections, biliary drainage, pancreatic duct drainage, gallbladder drainage, and gastroenterostomy. These procedures have been made possible with novel devices that can reduce the difficulties of the procedures and potentially reducing the risk of adverse events. The procedures are also becoming standardized, which is essential for dissemination of the techniques. Furthermore, results from randomized studies are becoming available showing definite benefits associated with these procedures. In this paper, we will provide a review on EUS-guided anastomotic procedures.
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Affiliation(s)
- Anthony Yuen Bun Teoh
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
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Ogura T, Ueno S, Higuchi K. Impacted intrahepatic bile duct stone removal using transluminal intervention technique. JGH Open 2020. [PMCID: PMC7411547 DOI: 10.1002/jgh3.12287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Takeshi Ogura
- 2nd Department of Internal MedicineOsaka Medical College Osaka Japan
| | - Saori Ueno
- 2nd Department of Internal MedicineOsaka Medical College Osaka Japan
| | - Kazuhide Higuchi
- 2nd Department of Internal MedicineOsaka Medical College Osaka Japan
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Minaga K, Takenaka M, Ogura T, Tamura T, Kuroda T, Kaku T, Uenoyama Y, Noguchi C, Nishikiori H, Imai H, Sagami R, Fujimori N, Higuchi K, Kudo M, Chiba Y, Kitano M. Endoscopic ultrasound-guided biliary drainage for malignant biliary obstruction with surgically altered anatomy: a multicenter prospective registration study. Therap Adv Gastroenterol 2020; 13:1756284820930964. [PMID: 32774461 PMCID: PMC7391429 DOI: 10.1177/1756284820930964] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 05/11/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Endoscopic treatment for malignant biliary obstruction (MBO) in patients bearing surgically altered anatomy (SAA) is not well-established. Although endoscopic ultrasound-guided biliary drainage (EUS-BD) has emerged as a new treatment option for MBO, limited data are available regarding the efficacy and safety of EUS-BD in patients with SAA. We conducted a multicenter prospective registration study to evaluate the efficacy and safety of EUS-BD in this population. METHODS This study involved 10 referral centers in Japan. Patients with SAA who were scheduled to receive EUS-BD for unresectable MBO between May 2016 and September 2018 were prospectively registered. The primary endpoint was technical success and the secondary outcomes were clinical success, procedure time, procedure-related adverse events (AEs), stent patency, and overall survival. RESULTS In total, 40 patients were prospectively enrolled. The surgical reconstruction methods were gastrectomy with Roux-en-Y reconstruction (47.5%), gastrectomy with Billroth-II reconstruction (15%), pancreaticoduodenectomy (27.5%), and hepaticojejunostomy with Roux-en-Y reconstruction (10%). EUS-BD was performed for primary biliary drainage in 31 patients and for rescue biliary drainage in nine patients. Transmural stenting alone (60%), antegrade stenting alone (5%), and a combination of the two techniques (35%) were selected for patients treated with EUS-BD. Technical and clinical success rates were 100% (95% confidence interval, 91.2-100.0%) and 95% (95% confidence interval, 83.1-99.4%), respectively. Mean procedure time was 36.5 min. Early AEs were noted in six patients (15%): three self-limited bile leak, one bile peritonitis, and two pneumoperitonea. Late AEs occurred in six patients (15%): one jejunal ulcer and five stent occlusions. Stent patency rate after 3 months of survival was 95.7% (22/23). Median overall survival was 96 days. CONCLUSION EUS-BD for MBO in patients with SAA appears to be effective and safe not only as a rescue drainage technique after failed endoscopic retrograde cholangiography but also as a primary drainage technique. CLINICAL TRIAL REGISTRATION UMIN000022101.
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Affiliation(s)
- Kosuke Minaga
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Mamoru Takenaka
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Takeshi Ogura
- Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Japan
| | - Takashi Tamura
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Taira Kuroda
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, To-on, Japan
| | - Toyoma Kaku
- Department of Gastroenterology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Yoshito Uenoyama
- Department of Gastroenterology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Chishio Noguchi
- Department of Gastroenterology, Shinbeppu Hospital, Beppu, Japan
| | | | - Hajime Imai
- Department of Gastroenterology, Minami Wakayama Medical Center, Tanabe, Japan
| | - Ryota Sagami
- Department of Gastroenterology, New Tokyo Hospital, Matsudo, Chiba
| | - Nao Fujimori
- Department of Gastroenterology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Kazuhide Higuchi
- Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Japan
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Yasutaka Chiba
- Clinical Research Center, Kindai University Hospital, Osaka-Sayama, Japan
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Pinto-Carta R, Solano J, Cabrera LF, Sanchez A, Moreno L, Pedraza M. Endoscopic ultrasound (EUS) guided choledocoduodenostomy in a patient with irresecable pancreas cancer and biliar obstruction using a luminal apposing metal stent (LAMS). Int J Surg Case Rep 2020; 74:23-26. [PMID: 32771936 PMCID: PMC7415624 DOI: 10.1016/j.ijscr.2020.07.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 07/04/2020] [Accepted: 07/06/2020] [Indexed: 12/13/2022] Open
Abstract
The endoscopic retrograde cholangiopancreatography (ERCP) is the election treatment of biliary obstruction. EUS-guided biliary drainage (EUS-BD) has emerged as an alternative to PTBD with a high technical and clinical success rate, low risk of complications and a better quality of life for the patient. Case presentation we present the first case in Colombia of EUS-guided biliary drainage using luminal apposing metal stent (LAMS) in a patient with unresectable pancreatic adenocarcinoma with biliary obstruction in who ERCP was failed due to neoplastic invasion of the Vater papilla. Discussion Transhepatic biliary drainage has been the most common procedure for treatment of malignant biliary obstruction in cases which ERCP fails due to tumor infiltration of the duodenum or the Vater papilla. During the last decade the development of endoscopic ultrasound (EUS) has implied an alternative for biliary drainage in cases of failed ERCP, demonstrating advantages over Trans hepatic biliary drainage Conclusion Considering that EUS-CD is a safe procedure, with a high rate of technical and clinical success, low risk of complications.
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Affiliation(s)
- Renzo Pinto-Carta
- Department of Gastroenterology and Digestive Endoscopy, Santa Fe Foundation University Hospital of Bogotá, Bogotá, Colombia.
| | - Jaime Solano
- Department of Gastroenterology and Digestive Endoscopy, Santa Fe Foundation University Hospital of Bogotá, Bogotá, Colombia; Department of Surgery, Jose Felix Patiño, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Luis Felipe Cabrera
- Department of Surgery, Jose Felix Patiño, Fundación Santa Fe de Bogotá, Bogotá, Colombia; Department of General Surgery, University El Bosque, Bogotá, Colombia; Department of Medicine, Universidad Los Andes, Bogotá, Colombia.
| | - Alvaro Sanchez
- Department of General Surgery, University El Bosque, Bogotá, Colombia
| | - Luisa Moreno
- Department of Internal Medicine, University El Bosque, Bogotá, Colombia
| | - Mauricio Pedraza
- Department of General Surgery, University El Bosque, Bogotá, Colombia.
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Abstract
PURPOSE OF REVIEW This article provides an overview of standard procedures currently performed in nonoperating room anesthesia (NORA) and highlights anesthetic implications. RECENT FINDINGS Novel noninvasive interventional procedures remain on the rise, accelerating demand for anesthesia support outside the conventional operating room. The field of interventional oncology has introduced a variety of effective minimally invasive therapies making interventional radiology gain a major role in the management of cancer. Technical innovation brings newer ablative and embolotherapy techniques into practice. Flexible bronchoscopy has replaced rigid bronchoscopy for many diagnostic and therapeutic indications. Endobronchial ultrasonography now allows sampling of mediastinal, paratracheal, or subcarinal lymph nodes rendering more invasive procedures such as mediastinoscopy unnecessary. Similarly, endoscopic ultrasonosgraphy currently plays a central position in the management of gastrointestinal disease. Sophisticated catheter techniques for ablating cardiac arrhythmias have become state of the art; Watchman procedure gaining position in the prevention of stroke resulting from atrial fibrillation. SUMMARY NORA is a rapidly evolving field in anesthesia. Employing new technology to treat a wide variety of diseases brings new challenges to the anesthesiologist. Better understanding of emerging interventional techniques is key to safe practice and allows the anesthesia expert to be at the forefront of this swiftly expanding multidisciplinary arena.
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108
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Kanno Y, Koshita S, Masu K, Ogawa T, Kusunose H, Murabayashi T, Sakai T, Kozakai F, Ito K. Efficacy of EUS-guided celiac plexus neurolysis compared with medication alone for unresectable pancreatic cancer in the oxycodone/fentanyl era: a prospective randomized control study. Gastrointest Endosc 2020; 92:120-130. [PMID: 31953188 DOI: 10.1016/j.gie.2020.01.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 01/02/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS The efficacy of celiac plexus neurolysis (CPN) with EUS guidance (EUS-CPN) has not been confirmed in the era of developed opioids. The aim of this study was to evaluate the efficacy of EUS-CPN for patients with pancreatic cancer-associated pain to compare medication using oxycodone and/or fentanyl with and without EUS-CPN. METHODS In this randomized control study involving patients who underwent EUS-CPN and those who did not, pain, quality of life (QOL), and opioid consumption were compared. Standard medicinal treatment using oxycodone and/or fentanyl was performed for both groups. The primary endpoint was defined as the pain evaluated by using a visual analog scale (VAS) rated from a 0 to 10, 4 weeks after the baseline. RESULTS For 48 registered patients, the outcomes of 24 patients in the EUS-CPN group and 22 patients in the control group were analyzed. EUS-CPN was successfully performed and did not induce severe procedure-related adverse events for all patients in the EUS-CPN group. Although the average pain VAS scores for both groups significantly decreased in comparison with baseline, scores were not statistically different between the groups at week 4 (1.3 ± 1.3 for the EUS-CPN group vs 2.3 ± 2.3 for the control group, P = .10). There was no statistical difference or tendency in favor of EUS-CPN at evaluation points of weeks 1, 2, 8, and 12. Moreover, the average VAS scores for QOL and the average opioid consumption between the groups were not different at all evaluation points. CONCLUSIONS EUS-CPN for patients with pancreatic cancer-associated pain did not appear to improve pain, QOL, or opioid consumption compared with those who did not undergo EUS-CPN and medicated with oxycodone/fentanyl. Although EUS-CPN can be an option, it was not found to have a large enough impact to be routinely performed for all patients with pain. (Clinical trial registration number: UMIN 000037172.).
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Affiliation(s)
- Yoshihide Kanno
- Department of Gastroenterology, Sendai City Medical Center, Miyagi, Japan
| | - Shinsuke Koshita
- Department of Gastroenterology, Sendai City Medical Center, Miyagi, Japan
| | - Kaori Masu
- Department of Gastroenterology, Sendai City Medical Center, Miyagi, Japan
| | - Takahisa Ogawa
- Department of Gastroenterology, Sendai City Medical Center, Miyagi, Japan
| | - Hiroaki Kusunose
- Department of Gastroenterology, Sendai City Medical Center, Miyagi, Japan
| | - Toji Murabayashi
- Department of Gastroenterology, Sendai City Medical Center, Miyagi, Japan
| | - Toshitaka Sakai
- Department of Gastroenterology, Sendai City Medical Center, Miyagi, Japan
| | - Fumisato Kozakai
- Department of Gastroenterology, Sendai City Medical Center, Miyagi, Japan
| | - Kei Ito
- Department of Gastroenterology, Sendai City Medical Center, Miyagi, Japan
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EUS-Guided Versus Percutaneous Celiac Neurolysis for the Management of Intractable Pain Due to Unresectable Pancreatic Cancer: A Randomized Clinical Trial. J Clin Med 2020; 9:jcm9061666. [PMID: 32492883 PMCID: PMC7356927 DOI: 10.3390/jcm9061666] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 05/18/2020] [Accepted: 05/28/2020] [Indexed: 02/07/2023] Open
Abstract
Although endoscopic ultrasound-guided celiac neurolysis (EUS-CN) and percutaneous celiac neurolysis (PCN) are utilized to manage intractable pain in pancreatic cancer patients, no direct comparison has been made between the two methods. We compared the efficacy and safety of EUS-CN and PCN in managing intractable pain in such patients. Sixty pancreatic cancer patients with intractable pain were randomly assigned to EUS-CN (n = 30) or PCN (n = 30). The primary outcomes were pain reduction in numerical rating scale (NRS) and opioid requirement reduction. Secondary outcomes were: successful pain response (NRS decrease ≥50% or ≥3-point reduction from baseline); quality of life; patient satisfaction; adverse events; and survival rate at 3 months postintervention. Both groups reported sustained decreases in pain scores up to 3 months postintervention (mean reductions in abdominal pain: 0.9 (95% confidence interval (CI): -0.8 to 4.2) and 1.7 (95% CI: -0.3 to 2.1); back pain: 1.3 (95% CI: -0.9 to 3.4) and 2.5 (95% CI: -0.2 to 5.2) in EUS-CN, and PCN groups, respectively). The differences in mean pain scores between the two groups at baseline and 3 months were -0.5 (p = 0.46) and -1.4 (p = 0.11) for abdominal pain and 0.1 (p = 0.85) and -0.9 (p = 0.31) for back pain in favor of PCN. No significant differences were noted in opioid requirement reduction and other outcomes. EUS-CN and PCN were similarly effective and safe in managing intractable pain in pancreatic cancer patients. Either methods may be used depending on the resources and expertise of each institution.
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110
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Nakai Y, Isayama H, Wang H, Rerknimitr R, Khor C, Yasuda I, Kogure H, Moon JH, Lau J, Lakhtakia S, Ratanachu‐ek T, Seo DW, Lee DK, Makmun D, Dy F, Liao W, Draganov PV, Almadi M, Irisawa A, Katanuma A, Kitano M, Ryozawa S, Fujisawa T, Wallace MB, Itoi T, Devereaux B. International consensus statements for endoscopic management of distal biliary stricture. J Gastroenterol Hepatol 2020; 35:967-979. [PMID: 31802537 PMCID: PMC7318125 DOI: 10.1111/jgh.14955] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 12/01/2019] [Accepted: 12/02/2019] [Indexed: 02/05/2023]
Abstract
Distal biliary strictures (DBS) are common and may be caused by both malignant and benign pathologies. While endoscopic procedures play a major role in their management, a comprehensive review of the subject is still lacking. Our consensus statements were formulated by a group of expert Asian pancreatico-biliary interventional endoscopists, following a proposal from the Digestive Endoscopy Society of Taiwan, the Thai Association for Gastrointestinal Endoscopy, and the Tokyo Conference of Asian Pancreato-biliary Interventional Endoscopy. Based on a literature review utilizing Medline, Cochrane library, and Embase databases, a total of 19 consensus statements on DBS were made on diagnosis, endoscopic drainage, benign biliary stricture, malignant biliary stricture, and management of recurrent biliary obstruction and other complications. Our consensus statements provide comprehensive guidance for the endoscopic management of DBS.
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Affiliation(s)
- Yousuke Nakai
- Department of Gastroenterology, Graduate School of MedicineThe University of TokyoTokyoJapan,Department of Endoscopy and Endoscopic Surgery, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Hiroyuki Isayama
- Department of Gastroenterology, Graduate School of MedicineThe University of TokyoTokyoJapan,Department of Gastroenterology, Graduate School of MedicineJuntendo UniversityTokyoJapan
| | - Hsiu‐Po Wang
- Department of Internal Medicine, College of MedicineNational Taiwan UniversityTaipeiTaiwan
| | - Rungsun Rerknimitr
- Division of Gastroenterology, Department of MedicineChulalongkorn UniversityBangkokThailand
| | - Christopher Khor
- Department of Gastroenterology and HepatologySingapore General Hospital and Duke‐NUS Medical SchoolSingaporeSingapore
| | - Ichiro Yasuda
- Third Department of Internal Medicine, Graduate School of MedicineUniversity of ToyamaToyamaJapan
| | - Hirofumi Kogure
- Department of Gastroenterology, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Jong Ho Moon
- Digestive Disease Center and Research Institute, Department of Internal MedicineSoonChunHyang University School of MedicineBucheon/SeoulSouth Korea
| | - James Lau
- Department of Surgery, Endoscopic Center, Prince of Wales HospitalThe Chinese University of Hong KongHong Kong, China
| | | | | | - Dong Wan Seo
- Department of Internal MedicineUniversity of Ulsan College of Medicine, Asan Medical CenterSeoulSouth Korea
| | - Dong Ki Lee
- Department of Internal Medicine, Gangnam Severance HospitalYonsei University College of MedicineSeoulSouth Korea
| | - Dadang Makmun
- Division of Gastroenterology, Department of Internal Medicine, Faculty of MedicineUniversitas Indonesia/Cipto Mangunkusumo National General HospitalJakartaIndonesia
| | - Frederick Dy
- Section of Gastroenterology, Department of Internal Medicine, Faculty of Medicine and SurgeryUniversity of Santo Tomas HospitalManilaPhilippines
| | - Wei‐Chih Liao
- Department of Internal Medicine, College of MedicineNational Taiwan UniversityTaipeiTaiwan
| | - Peter V Draganov
- Department of MedicineUniversity of FloridaGainesvilleFloridaUSA
| | - Majid Almadi
- Division of Gastroenterology, King Khalid University HospitalKing Saud UniversityRiyadhSaudi Arabia
| | - Atsushi Irisawa
- Department of GastroenterologyDokkyo Medical UniversityTochigiJapan
| | - Akio Katanuma
- Center for GastroenterologyTeine‐Keijinkai HospitalSapporoJapan
| | - Masayuki Kitano
- Second Department of Internal MedicineWakayama Medical UniversityWakayamaJapan
| | - Shomei Ryozawa
- Department of GastroenterologySaitama Medical University International Medical CenterSaitamaJapan
| | - Toshio Fujisawa
- Department of Gastroenterology, Graduate School of MedicineJuntendo UniversityTokyoJapan
| | | | - Takao Itoi
- Department of Gastroenterology and HepatologyTokyo Medical UniversityTokyoJapan
| | - Benedict Devereaux
- University of QueenslandRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
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Thomaidis T, Kallimanis G, May G, Zhou P, Sivanathan V, Mosko J, Triantafillidis JK, Teshima C, Moehler M. Advances in the endoscopic management of malignant biliary obstruction. Ann Gastroenterol 2020; 33:338-347. [PMID: 32624653 PMCID: PMC7315700 DOI: 10.20524/aog.2020.0497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 04/28/2020] [Indexed: 12/11/2022] Open
Abstract
Biliary obstruction is common in pancreatobiliary malignancies and has a negative impact on the patient’s quality of life, postoperative complications, and survival rates. Particularly in the last decade, there has been enormous progress regarding the diagnostic and therapeutic options in patients with malignant biliary obstruction. Endoscopy has given a new insight in this direction and novel techniques have been developed for the better characterization and treatment of malignant strictures. We herein summarize the available data on the different endoscopic techniques, and clarify their role in the diagnosis and treatment of malignant biliary obstructive disease. Finally, we propose an algorithm that can facilitate management decisions in these patients.
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Affiliation(s)
- Thomas Thomaidis
- 2 Gastroenterology Clinic, Hygeia Hospital, Athens, Greece (Thomas Thomaidis, George Kallimanis).,Johannes Gutenberg University, Mainz, Germany (Thomas Thomaidis, Visvakanth Sivanathan, Markus Moehler)
| | - George Kallimanis
- 2 Gastroenterology Clinic, Hygeia Hospital, Athens, Greece (Thomas Thomaidis, George Kallimanis)
| | - Gary May
- Division of Therapeutic Endoscopy, St. Michael's Hospital, University of Toronto, Toronto, Canada (Gary May, Jeff Mosko, Christopher Teshima)
| | - Pinghong Zhou
- Interventional endoscopy, Zhongshan Hospital, Fudan University, Shanghai, China (Pinghong Zhou)
| | - Visvakanth Sivanathan
- Johannes Gutenberg University, Mainz, Germany (Thomas Thomaidis, Visvakanth Sivanathan, Markus Moehler)
| | - Jeff Mosko
- Division of Therapeutic Endoscopy, St. Michael's Hospital, University of Toronto, Toronto, Canada (Gary May, Jeff Mosko, Christopher Teshima)
| | | | - Christopher Teshima
- Division of Therapeutic Endoscopy, St. Michael's Hospital, University of Toronto, Toronto, Canada (Gary May, Jeff Mosko, Christopher Teshima)
| | - Markus Moehler
- Johannes Gutenberg University, Mainz, Germany (Thomas Thomaidis, Visvakanth Sivanathan, Markus Moehler)
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112
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Sugawara S, Sone M, Morita S, Hijioka S, Sakamoto Y, Kusumoto M, Arai Y. Radiologic Assessment for Endoscopic US-guided Biliary Drainage. Radiographics 2020; 40:667-683. [PMID: 32216704 DOI: 10.1148/rg.2020190158] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Endoscopic US-guided biliary drainage (BD) is performed for various types of biliary obstruction and is mainly indicated for unsuccessful conventional transpapillary endoscopic retrograde cholangiodrainage. In endoscopic US BD, an extra-anatomic drainage route between the gastrointestinal (GI) tract and the biliary system is created with a covered metallic stent or plastic stent. Procedural types of endoscopic US BD include hepaticogastrostomy, hepaticojejunostomy (after gastrectomy), choledochoduodenostomy, hepaticoduodenostomy, and endoscopic US-guided gallbladder drainage. The technical and clinical success rates of endoscopic US BD are reported to be 94%-97% and 88%-100%, respectively. CT is crucial both in preprocedural assessment and postprocedural monitoring. CT is used to determine the indications for endoscopic US BD, which include the type of biliary obstruction, collateral vessels in the puncture route, ascites, the volume of the liver segment, the distribution of an intrahepatic tumor, and GI tract patency. After endoscopic US BD, common subclinical findings are a small amount of intraperitoneal gas, localized edematous change in the GI tract, a notch in the placed stent, and localized biliary dilatation caused by stent placement. Stent malfunction after endoscopic US BD is caused by impaction of debris and/or food, stent migration into the GI tract, or tumor overgrowth and/or hyperplasia. Complications that can occur include internal stent migration, intraperitoneal biloma, arterial bleeding or pseudoaneurysm, perforation of the GI tract, and portobiliary fistula. The incidence of clinical endoscopic US BD-related complications is 11%-23%. ©RSNA, 2020.
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Affiliation(s)
- Shunsuke Sugawara
- Department of Diagnostic Radiology (S.S., M.S., M.K., Y.A.) and Department of Hepatobiliary and Pancreatic Oncology (S.H., Y.S.), National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan; and Department of Gastroenterology and Hepatology, Uonuma Institute of Community Medicine, Niigata University Hospital, Minamiuonuma, Niigata, Japan (S.M.)
| | - Miyuki Sone
- Department of Diagnostic Radiology (S.S., M.S., M.K., Y.A.) and Department of Hepatobiliary and Pancreatic Oncology (S.H., Y.S.), National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan; and Department of Gastroenterology and Hepatology, Uonuma Institute of Community Medicine, Niigata University Hospital, Minamiuonuma, Niigata, Japan (S.M.)
| | - Shinichi Morita
- Department of Diagnostic Radiology (S.S., M.S., M.K., Y.A.) and Department of Hepatobiliary and Pancreatic Oncology (S.H., Y.S.), National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan; and Department of Gastroenterology and Hepatology, Uonuma Institute of Community Medicine, Niigata University Hospital, Minamiuonuma, Niigata, Japan (S.M.)
| | - Susumu Hijioka
- Department of Diagnostic Radiology (S.S., M.S., M.K., Y.A.) and Department of Hepatobiliary and Pancreatic Oncology (S.H., Y.S.), National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan; and Department of Gastroenterology and Hepatology, Uonuma Institute of Community Medicine, Niigata University Hospital, Minamiuonuma, Niigata, Japan (S.M.)
| | - Yasunari Sakamoto
- Department of Diagnostic Radiology (S.S., M.S., M.K., Y.A.) and Department of Hepatobiliary and Pancreatic Oncology (S.H., Y.S.), National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan; and Department of Gastroenterology and Hepatology, Uonuma Institute of Community Medicine, Niigata University Hospital, Minamiuonuma, Niigata, Japan (S.M.)
| | - Masahiko Kusumoto
- Department of Diagnostic Radiology (S.S., M.S., M.K., Y.A.) and Department of Hepatobiliary and Pancreatic Oncology (S.H., Y.S.), National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan; and Department of Gastroenterology and Hepatology, Uonuma Institute of Community Medicine, Niigata University Hospital, Minamiuonuma, Niigata, Japan (S.M.)
| | - Yasuaki Arai
- Department of Diagnostic Radiology (S.S., M.S., M.K., Y.A.) and Department of Hepatobiliary and Pancreatic Oncology (S.H., Y.S.), National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan; and Department of Gastroenterology and Hepatology, Uonuma Institute of Community Medicine, Niigata University Hospital, Minamiuonuma, Niigata, Japan (S.M.)
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Minaga K, Takenaka M, Yamao K, Kamata K, Omoto S, Nakai A, Yamazaki T, Okamoto A, Ishikawa R, Yoshikawa T, Chiba Y, Watanabe T, Kudo M. Clinical utility of treatment method conversion during single-session endoscopic ultrasound-guided biliary drainage. World J Gastroenterol 2020; 26:947-959. [PMID: 32206005 PMCID: PMC7081009 DOI: 10.3748/wjg.v26.i9.947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 02/13/2020] [Accepted: 02/21/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although several techniques for endoscopic ultrasound-guided biliary drainage (EUS-BD) are available at present, an optimal treatment algorithm of EUS-BD has not yet been established.
AIM To evaluate the clinical utility of treatment method conversion during single endoscopic sessions for difficult cases in initially planned EUS-BD.
METHODS This was a single-center retrospective analysis using a prospectively accumulated database. Patients with biliary obstruction undergoing EUS-BD between May 2008 and April 2016 were included. The primary outcome was to evaluate the improvement in EUS-BD success rates by converting the treatment methods during a single endoscopic session. Secondary outcomes were clarification of the factors leading to the conversion from the initial EUS-BD and the assessment of efficacy and safety of the conversion as judged by technical success, clinical success, and adverse events (AEs).
RESULTS A total of 208 patients underwent EUS-BD during the study period. For 18.8% (39/208) of the patients, the treatment methods were converted to another EUS-BD technique from the initial plan. Biliary obstruction was caused by pancreatobiliary malignancies, other malignant lesions, biliary stones, and other benign lesions in 22, 11, 4, and 2 patients, respectively. The reasons for the difficulty with the initial EUS-BD were classified into the following 3 procedures: Target puncture (n = 13), guidewire manipulation (n = 18), and puncture tract dilation (n = 8). Technical success was achieved in 97.4% (38/39) of the cases and clinical success was achieved in 89.5% of patients (34/38). AEs occurred in 10.3% of patients, including bile leakage (n = 2), bleeding (n = 1), and cholecystitis (n = 1). The puncture target and drainage technique were altered in subsequent EUS-BD procedures in 25 and 14 patients, respectively. The final technical success rate with 95%CI for all 208 cases was 97.1% (95%CI: 93.8%-98.9%), while that of the initially planned EUS-BD was 78.8% (95%CI: 72.6%-84.2%).
CONCLUSION Among multi-step procedures in EUS-BD, guidewire manipulation appeared to be the most technically challenging. When initially planned EUS-BD is technically difficult, treatment method conversion in a single endoscopic session may result in successful EUS-BD without leading to severe AEs.
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Affiliation(s)
- Kosuke Minaga
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama 589-8511, Japan
| | - Mamoru Takenaka
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama 589-8511, Japan
| | - Kentaro Yamao
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama 589-8511, Japan
| | - Ken Kamata
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama 589-8511, Japan
| | - Shunsuke Omoto
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama 589-8511, Japan
| | - Atsushi Nakai
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama 589-8511, Japan
| | - Tomohiro Yamazaki
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama 589-8511, Japan
| | - Ayana Okamoto
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama 589-8511, Japan
| | - Rei Ishikawa
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama 589-8511, Japan
| | - Tomoe Yoshikawa
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama 589-8511, Japan
| | - Yasutaka Chiba
- Clinical Research Center, Kindai University Hospital, Osaka-Sayama 589-8511, Japan
| | - Tomohiro Watanabe
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama 589-8511, Japan
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama 589-8511, Japan
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Teoh AYB, Bapaye A, Lakhtakia S, Ratanachu T, Reknimitr R, Chan SM, Choi HJ, Gadhikar HP, Kongkam P, Korrapati SK, Lee YN, Medarapalem J, Ridtitid W, Moon JH. Prospective multicenter international study on the outcomes of a newly developed self-approximating lumen-apposing metallic stent for drainage of pancreatic fluid collections and endoscopic necrosectomy. Dig Endosc 2020; 32:391-398. [PMID: 31343773 DOI: 10.1111/den.13494] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 07/15/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND A novel self-approximating lumen-apposing metallic stent (LAMS; Niti-S Spaxus, Taewoong Medical, Gyeonggi-do, Korea) has recently become available. The aim of the present study was to evaluate the outcomes for drainage of pancreatic fluid collections (PFC). METHODS This was a prospective international multicentered study conducted in six high-volume institutions across Asia. Consecutive patients suffering from pancreatic pseudocyst or walled-off pancreatic necrosis (WOPN) requiring endoscopic ultrasonography-guided drainage were recruited. Outcomes included technical and clinical success, adverse events, procedural events, interventions through the stent and recurrence rates. RESULTS Between August 2016 and November 2017, 59 patients were recruited to this study. Thirty-nine patients (66.1%) had WOPN and mean (SD) size of PFC was 11.5 (5.1) cm. Technical and clinical success rates were 100%. Mean (SD) procedural time was 35.0 (17.2) minutes. Sixteen-millimeter stents were used in 66.1% of the patients. Fifty-four sessions of necrosectomy were carried out with the stent in situ in 17 patients. Stent-related adverse event (AE) rate was 6.8%. Three patients (5.1%) suffered from bleeding after stenting and one required angiographic embolization. Two patients (3.4%) suffered from recurrence during a mean (SD) follow-up time of 325.6 (355.5) days. There were no differences in outcomes between those with pseudocysts or WOPN except for the duration of hospital stay (P = 0.012). CONCLUSION Use of a self-approximating LAMS for drainage of PFC was safe and effective. Endoscopic necrosectomy could be carried out through the stent with ease. The device was associated with a low rate of stent-related AE.
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Affiliation(s)
- Anthony Yuen Bun Teoh
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Amol Bapaye
- Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, India
| | - Sundeep Lakhtakia
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | | | - Rungsun Reknimitr
- Division of Gastroenterology, Department of Medicine, King Chulalongkorn University, Bangkok, Thailand
| | - Shannon Melissa Chan
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Hyun Jong Choi
- Department of Internal Medicine, Soon Chun Hyang University College of Medicine, Bucheon Hospital, Bucheon/Seoul, Korea
| | - Harshal P Gadhikar
- Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, India
| | - Pradermchai Kongkam
- Division of Gastroenterology, Department of Medicine, King Chulalongkorn University, Bangkok, Thailand
| | - Sravan Kumar Korrapati
- Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, India
| | - Yun Nah Lee
- Department of Internal Medicine, Soon Chun Hyang University College of Medicine, Bucheon Hospital, Bucheon/Seoul, Korea
| | - Jahangeer Medarapalem
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Wiriyaporn Ridtitid
- Division of Gastroenterology, Department of Medicine, King Chulalongkorn University, Bangkok, Thailand
| | - Jong Ho Moon
- Department of Internal Medicine, Soon Chun Hyang University College of Medicine, Bucheon Hospital, Bucheon/Seoul, Korea
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115
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Khoo S, Do NDT, Kongkam P. Efficacy and safety of EUS biliary drainage in malignant distal and hilar biliary obstruction: A comprehensive review of literature and algorithm. Endosc Ultrasound 2020; 9:369-379. [PMID: 33318375 PMCID: PMC7811708 DOI: 10.4103/eus.eus_59_20] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Malignant biliary obstruction (MBO) encompasses a variety of malignancies arising from the pancreaticobiliary system. This can be divided into malignant hilar biliary obstruction (MHBO) or malignant distal biliary obstruction (MDBO) biliary obstruction to which clinical outcomes and technical considerations of various biliary drainage methods may differ. EUS biliary drainage (EUS-BD) has been increasingly influential in the management of MBO together with other familiar biliary drainage methods such as ERCP and percutaneous transhepatic biliary drainage (PTBD). Conventionally, ERCP has always been the primary choice of endoscopic biliary drainage in both MHBO and MDBO and that PTBD or EUS-BD is used as a salvage method when ERCP fails for which current guidelines recommends PTBD, especially for MHBO. This review was able to show that with today's evidence, EUS-BD is equally efficacious and possesses a better safety profile in the management of MBO and should be on the forefront of endoscopic biliary drainage. Therefore, EUS-BD could be used either as a primary or preferred salvage biliary drainage method in these cases.
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Affiliation(s)
- Stanley Khoo
- Department of Medicine, Gastroenterology and Hepatology Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nhan Duc Tri Do
- Department of Endoscopy, Can Tho General Hospital, Can Tho; Department of General Surgery, Can Tho General Hospital, Can Tho, Vietnam
| | - Pradermchai Kongkam
- Department of Medicine, Division of Gastroenterology, Gastrointestinal Endoscopy Excellence Center, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok; Pancreas Research Unit, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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116
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Yamamoto Y, Ogura T, Nishioka N, Yamada T, Yamada M, Ueno S, Higuchi K. Risk factors for adverse events associated with bile leak during EUS-guided hepaticogastrostomy. Endosc Ultrasound 2020; 9:110-115. [PMID: 32295968 PMCID: PMC7279085 DOI: 10.4103/eus.eus_68_19] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background and Objective: EUS-guided hepaticogastrostomy (HGS) is performed for patients with advanced cancer because of poor prognosis and compromised status, and bile peritonitis may prove critical for such patients. This adverse event has the possibility of decreasing quality of life by prolonging the time until the start of oral intake, hospital stay, or chemotherapy. Predictors of bile peritonitis in EUS-HGS thus have considerable clinical impact. The aim of this study was to retrospectively determine risk factors of bile peritonitis as adverse events of EUS-HGS. Patients and Methods: As risk factors of bile peritonitis, baseline characteristics of patients, characteristics of procedures such as number of punctures, types of fistula dilation, mean procedure time were analyzed. Furthermore, a receiver operating characteristic (ROC) curve was plotted to assess the influence of this distance and bile peritonitis and determine the optimum cutoff score for predicting the risk of bile peritonitis. Multivariate analysis using logistic regression was performed to examine factors of bile peritonitis. Results: A total of 68 patients were enrolled in this study. A distance of 2.50 cm offered 90.3% sensitivity and 87.5% specificity in predicting bile peritonitis according to the ROC curve. Number of punctures (>1), procedure time (>20 min), distance to the hepatic parenchyma (<2.50 cm), and presence of acute cholangitis were significantly associated with bile peritonitis in univariate analysis. However, according to this multivariate analysis, distance to the hepatic parenchyma (<2.50 cm, odds ratio 96.98, 95% confidence interval 10.12–929.12, P < 0.001) were only significantly associated with bile peritonitis. Conclusions: The short distance of hepatic parenchyma may be a risk factor of bile peritonitis.
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Affiliation(s)
- Yoshitaro Yamamoto
- Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Takeshi Ogura
- Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Nobu Nishioka
- Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Tadahiro Yamada
- Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Masanori Yamada
- Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Saori Ueno
- Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Kazuhide Higuchi
- Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Osaka, Japan
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Sato E, Mitani S, Nishio N, Kitani T, Sanada T, Ugumori T, Christopher Holsinger F, Baik FM, Hato N. Development of proficiency-based knot-tying and suturing curriculum for otolaryngology residents: A pilot study. Auris Nasus Larynx 2019; 47:291-298. [PMID: 31870599 DOI: 10.1016/j.anl.2019.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 11/27/2019] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Basic surgical skills such as knot-tying and suturing are important for all otolaryngologists, regardless of subspecialty. The present study was undertaken in order to assess basic surgical techniques such as knot-tying and suturing required for novice otolaryngology residents with taking the variety of subspecialties into consideration, and evaluate the impact of a proficiency-based training curriculum based on these techniques. METHODS A prospective study was performed for developing of proficiency-based knot-tying and suturing curriculum for otolaryngology residents in the third post-graduate year (PGY-3). The proficiency-based training curriculum was developed based on the tasks selected by RAND/UCLA method with expert panel, which is an iterative and anonymous survey used to establish consensus among participants. Expert panelists were selected from various divisions to reflect variety of their subspecialties. PGY-3 residents trained with the developed curriculum that included proctored pre-test, self-training to proficiency, and proctored post-test. Visual analogue scale (VAS) of trainees' overall competence in the operating room was self-assessed by each resident, before and after completing the training curriculum. RESULTS Nine PGY-3 residents were enrolled as trainees. Eleven experts chosen as panelists had various subspecialty, including 2 from otology, 2 from rhinology, 2 from laryngology, 2 from head and neck surgery, and 3 from general otolaryngology. Seven tasks were selected from RAND/UCLA method and used to develop the curriculum. Trainee scores at pre-test were significantly lower than expert scores for all 7 tasks (p < 0.01) and each coefficient of variation of trainee score was larger than that of expert score (p < 0.05), supporting construct validity. The mean of composite scores between pre-test and post-test had statistical significance (68.6 ± 11.6 vs 95.9 ± 3.6, p < 0.01), documenting substantial improvement after training. Self-assessment VAS was also improved pre- to post-training (1.2 ± 0.9 vs 4.5 ± 1.4, p < 0.01). A follow-up questionnaire showed that trainees felt the educational curriculum to be beneficial. CONCLUSION In the present study, seven basic technical skills were selected using the RAND/UCLA method and used to create a proficiency-based training curriculum. Our results indicate that this curriculum significantly improves proficiency of basic surgical skills of junior otolaryngology residents.
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Affiliation(s)
- Eriko Sato
- Department of Otolaryngology-Head and Neck Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan; Division of Gastrointestinal Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi, Sunto District, Shizuoka 411-0934, Japan
| | - Sohei Mitani
- Department of Otolaryngology-Head and Neck Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan; Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University, 875 Blake Wilbur Drive, Palo Alto, CA 94305, United States.
| | - Naoki Nishio
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University, 875 Blake Wilbur Drive, Palo Alto, CA 94305, United States; Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa Ward, Nagoya, Aichi 466-8560, Japan
| | - Takashi Kitani
- Department of Otolaryngology-Head and Neck Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Tomoyoshi Sanada
- Department of Otolaryngology-Head and Neck Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Toru Ugumori
- Department of Otolaryngology-Head and Neck Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan; Ugumori ENT Clinic, 3 Chome-10-25 Yougonishi, Matsuyama, Ehime 790-0046, Japan
| | - F Christopher Holsinger
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University, 875 Blake Wilbur Drive, Palo Alto, CA 94305, United States
| | - Fred M Baik
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University, 875 Blake Wilbur Drive, Palo Alto, CA 94305, United States
| | - Naohito Hato
- Department of Otolaryngology-Head and Neck Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
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118
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Zhu H, Lin H, Kong X, Jin Z, Li Z, Du Y. Lumen-apposing metal stent acted as an interim role in walled-off necrosis drainage. Gut 2019; 68:2255-2256. [PMID: 30368455 DOI: 10.1136/gutjnl-2018-317494] [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: 08/29/2018] [Revised: 10/09/2018] [Accepted: 10/12/2018] [Indexed: 12/08/2022]
Affiliation(s)
- Huiyun Zhu
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University (Naval Medical University), Shanghai, China
| | - Han Lin
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University (Naval Medical University), Shanghai, China
| | - Xiangyu Kong
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University (Naval Medical University), Shanghai, China
| | - Zhendong Jin
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University (Naval Medical University), Shanghai, China
| | - Zhaoshen Li
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University (Naval Medical University), Shanghai, China
| | - Yiqi Du
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University (Naval Medical University), Shanghai, China
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119
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Leung Ki EL, Napoleon B. EUS-specific stents: Available designs and probable lacunae. Endosc Ultrasound 2019; 8:S17-S27. [PMID: 31897375 PMCID: PMC6896438 DOI: 10.4103/eus.eus_50_19] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 07/08/2019] [Indexed: 12/13/2022] Open
Affiliation(s)
- En-Ling Leung Ki
- Department of Hepato-Gastroenterology, Ramsay Private Hospital Jean-Mermoz, Lyon, France.,Department of Hepato-Gastroenterology, La Tour Hospital, Geneva, Switzerland
| | - Bertrand Napoleon
- Department of Hepato-Gastroenterology, Ramsay Private Hospital Jean-Mermoz, Lyon, France
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120
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Artifon ELDA, Visconti TAC, Brunaldi VO. Choledochoduodenostomy: Outcomes and limitations. Endosc Ultrasound 2019; 8:S72-S78. [PMID: 31897383 PMCID: PMC6896435 DOI: 10.4103/eus.eus_62_19] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 08/27/2019] [Indexed: 12/21/2022] Open
Abstract
The EUS-guided biliary drainage (EUS-BD) has gained broad acceptance as the preferred approach after failed ERCP for malignant biliary obstruction. Despite the drainage route, namely, transhepatic or transduodenal, the technical and clinical success rates are high. Because of such good outcomes with tolerable adverse events (AEs) rate, the EUS-BD might soon even replace the ERCP for primary biliary decompression in patients at high risk of failed biliary cannulation. Among the EUS-BD techniques, the choledochoduodenostomy seems to carry the lower risk of AEs and should be considered the first-line EUS approach for biliary decompression.
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Affiliation(s)
- Everson Luiz De Almeida Artifon
- Department of Surgery, Hospital Das Clínicas, University of Sao Paulo Medical School, São Paulo, Brazil.,Gastrointestinal Endoscopy Unit, Hospital Das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Thiago A C Visconti
- Gastrointestinal Endoscopy Unit, Hospital Das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Vitor O Brunaldi
- Gastrointestinal Endoscopy Unit, Hospital Das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
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121
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Almadi MA. Bile duct drainage: Terminology. Endosc Ultrasound 2019; 8:S3-S6. [PMID: 31897372 PMCID: PMC6896430 DOI: 10.4103/eus.eus_54_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 07/15/2019] [Indexed: 11/04/2022] Open
Affiliation(s)
- Majid Abdularahman Almadi
- Division of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.,Division of Gastroenterology, The McGill University Health Center, Montreal General Hospital, McGill University, Montreal, Canada
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122
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Teoh AYB, Seo DW, Brugge W, Dewitt J, Kongkam P, Linghu E, Moyer MT, Ryu JK, Ho KY. Position statement on EUS-guided ablation of pancreatic cystic neoplasms from an international expert panel. Endosc Int Open 2019; 7:E1064-E1077. [PMID: 31475223 PMCID: PMC6715424 DOI: 10.1055/a-0959-5870] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 04/11/2019] [Indexed: 02/08/2023] Open
Abstract
Background and aim Recently, several guidelines with divergent recommendations on management of pancreatic cystic neoplasm have been published but the role of endoscopic ultrasound (EUS)-guided pancreatic cyst ablation has not been thoroughly addressed. The aim of the current paper is to explore the issues surrounding EUS-guided pancreatic cyst ablation by generating a list of clinical questions and providing answers based on best scientific evidence available. Methods An expert panel in EUS-guided pancreatic cyst ablation was recruited from members of the Asian EUS group and an international expert panel. A list of clinical questions was created and each question allocated to one member to generate a statement in response. The statements were then discussed in three Internet conference meetings between October 2016 and October 2017. The statements were changed until consensus was obtained. Afterwards, the complete set of statements was sent to all the panelist to vote on strength of the statements, classification of the statement sand grading of the evidence. Results Twenty-three statements on EUS-guided drainage of pancreatic cyst ablation were formulated. The statements addressed indications for the procedures, technical aspects, pre-procedure and post-procedure management, management of complications, and competency and training in the procedures. Conclusion The current set of statements on EUS-guided pancreatic cyst ablation are the first to be published by any endoscopic society. Clinicians interested in developing the technique should reference these statements and future studies should address the key issues raised in the document.
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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,Corresponding author Prof. Anthony Yuen Bun Teoh Department of SurgeryThe Chinese University of Hong KongPrince of Wales HospitalShatin, New TerritoriesHong Kong SARChina+852-2637-7974
| | - Dong Wan Seo
- Department of Gastroenterology, Asan Medical Centre, Seoul, Korea
| | - William Brugge
- Pancreas Biliary Center, Gastrointestinal Unit, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - John Dewitt
- Division of Gastroenterology, Department of Medicine, Indiana University Hospital, Indianapolis, Indiana, United States
| | - Pradermchai Kongkam
- Pancreas Research Unit and Gastrointestinal Endoscopy Excellent Center, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Enqiang Linghu
- Department of Gastroenterology, Chinese PLA General Hospital, Beijing, China
| | - Matthew T. Moyer
- Division of GI-Hepatology and Penn State University Cancer Institute, Penn State Hershey Medical Center, Hershey, Pennsylvania, United States
| | - Ji Kon Ryu
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Khek Yu Ho
- Department of Medicine, National University of Singapore, Singapore
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Minaga K, Ogura T, Shiomi H, Imai H, Hoki N, Takenaka M, Nishikiori H, Yamashita Y, Hisa T, Kato H, Kamada H, Okuda A, Sagami R, Hashimoto H, Higuchi K, Chiba Y, Kudo M, Kitano M. Comparison of the efficacy and safety of endoscopic ultrasound-guided choledochoduodenostomy and hepaticogastrostomy for malignant distal biliary obstruction: Multicenter, randomized, clinical trial. Dig Endosc 2019; 31:575-582. [PMID: 30908711 DOI: 10.1111/den.13406] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 03/19/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM Endoscopic ultrasound-guided biliary drainage (EUS-BD) can be carried out by two different approaches: choledochoduodenostomy (CDS) and hepaticogastrostomy (HGS). We compared the efficacy and safety of these approaches in malignant distal biliary obstruction (MDBO) patients using a prospective, randomized clinical trial. METHODS Patients with malignant distal biliary obstruction after failed endoscopic retrograde cholangiopancreatography were randomly selected for either CDS or HGS. The procedures were carried out at nine tertiary centers from September 2013 to March 2016. Primary endpoint was technical success rate, and the noninferiority of HGS to CDS was examined with a one-sided significance level of 5%, where the noninferiority margin was set at 15%. Secondary endpoints were clinical success, adverse events (AE), stent patency, survival time, and overall technical success including alternative EUS-BD procedures. RESULTS Forty-seven patients (HGS, 24; CDS, 23) were enrolled. Technical success rates were 87.5% and 82.6% in the HGS and CDS groups, respectively, where the lower limit of the 90% confidence interval of the risk difference was -12.2% (P = 0.0278). Clinical success rates were 100% and 94.7% in the HGS and CDS groups, respectively (P = 0.475). Overall AE rate, stent patency, and survival time did not differ between the groups. Overall technical success rates were 100% and 95.7% in the HGS and CDS groups, respectively (P = 0.983). CONCLUSIONS This study suggests that HGS is not inferior to CDS in terms of technical success. When one procedure is particularly challenging, readily switching to the other could increase technical success.
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Affiliation(s)
- Kosuke Minaga
- Therapeutic Endoscopic Ultrasound Group, Osaka, Japan.,Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan.,Department of Gastroenterology, Japanese Red Cross Wakayama Center, Wakayama, Japan
| | - Takeshi Ogura
- Therapeutic Endoscopic Ultrasound Group, Osaka, Japan.,Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Hideyuki Shiomi
- Therapeutic Endoscopic Ultrasound Group, Osaka, Japan.,Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Hajime Imai
- Therapeutic Endoscopic Ultrasound Group, Osaka, Japan.,Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Noriyuki Hoki
- Therapeutic Endoscopic Ultrasound Group, Osaka, Japan.,Department of Gastroenterology, Bellland General Hospital, Osaka, Japan
| | - Mamoru Takenaka
- Therapeutic Endoscopic Ultrasound Group, Osaka, Japan.,Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan.,Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Hidefumi Nishikiori
- Therapeutic Endoscopic Ultrasound Group, Osaka, Japan.,Department of Gastroenterology, Oita San-ai Medical Center, Oita, Japan
| | - Yukitaka Yamashita
- Therapeutic Endoscopic Ultrasound Group, Osaka, Japan.,Department of Gastroenterology, Japanese Red Cross Wakayama Center, Wakayama, Japan
| | - Takeshi Hisa
- Therapeutic Endoscopic Ultrasound Group, Osaka, Japan.,Department of Gastroenterology, Saku Central Hospital Advanced Care Center, Nagano, Japan
| | - Hironari Kato
- Therapeutic Endoscopic Ultrasound Group, Osaka, Japan.,Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hideki Kamada
- Therapeutic Endoscopic Ultrasound Group, Osaka, Japan.,Department of Gastroenterology and Neurology, Kagawa University Faculty of Medicine, Kagawa, Japan
| | - Atsushi Okuda
- Therapeutic Endoscopic Ultrasound Group, Osaka, Japan.,Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Ryota Sagami
- Therapeutic Endoscopic Ultrasound Group, Osaka, Japan.,Department of Gastroenterology, Oita San-ai Medical Center, Oita, Japan
| | - Hiroaki Hashimoto
- Therapeutic Endoscopic Ultrasound Group, Osaka, Japan.,Department of Gastroenterology, Bellland General Hospital, Osaka, Japan
| | - Kazuhide Higuchi
- Therapeutic Endoscopic Ultrasound Group, Osaka, Japan.,Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Yasutaka Chiba
- Therapeutic Endoscopic Ultrasound Group, Osaka, Japan.,Clinical Research Center, Kindai University Hospital, Osaka, Japan
| | - Masatoshi Kudo
- Therapeutic Endoscopic Ultrasound Group, Osaka, Japan.,Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Masayuki Kitano
- Therapeutic Endoscopic Ultrasound Group, Osaka, Japan.,Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan.,Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
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Anderloni A, Troncone E, Fugazza A, Cappello A, Del Vecchio Blanco G, Monteleone G, Repici A. Lumen-apposing metal stents for malignant biliary obstruction: Is this the ultimate horizon of our experience? World J Gastroenterol 2019; 25:3857-3869. [PMID: 31413524 PMCID: PMC6689812 DOI: 10.3748/wjg.v25.i29.3857] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/20/2019] [Accepted: 07/03/2019] [Indexed: 02/06/2023] Open
Abstract
In the last years, endoscopic ultrasonography (EUS) has evolved from a purely diagnostic technique to a more and more complex interventional procedure, with the possibility to perform several type of therapeutic interventions. Among these, EUS-guided biliary drainage (BD) is gaining popularity as a therapeutic approach after failed endoscopic retrograde cholangiopancreatography in distal malignant biliary obstruction (MBO), due to the avoidance of external drainage, a lower rate of adverse events and re-interventions, and lower costs compared to percutaneous trans-hepatic BD. Initially, devices created for luminal procedures (e.g., luminal biliary stents) have been adapted to the new trans-luminal EUS-guided interventions, with predictable shortcomings in technical success, outcome and adverse events. More recently, new metal stents specifically designed for transluminal drainage, namely lumen-apposing metal stents (LAMS), have been made available for EUS-guided procedures. An electrocautery enhanced delivery system (EC-LAMS), which allows direct access of the delivery system to the target lumen, has subsequently simplified the classic multi-step procedure of EUS-guided drainages. EUS-BD using LAMS and EC-LAMS has been demonstrated effective and safe, and currently seems one of the most performing techniques for EUS-BD. In this Review, we summarize the evolution of the EUS-BD in distal MBO, focusing on the novelty of LAMS and analyzing the unresolved questions about the possible role of EUS as the first therapeutic option to achieve BD in this setting of patients.
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Affiliation(s)
- Andrea Anderloni
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Milan 20089, Italy
| | - Edoardo Troncone
- Department of Systems Medicine, University of Rome “Tor Vergata”, Rome 00133, Italy
| | - Alessandro Fugazza
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Milan 20089, Italy
| | - Annalisa Cappello
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Milan 20089, Italy
| | | | - Giovanni Monteleone
- Department of Systems Medicine, University of Rome “Tor Vergata”, Rome 00133, Italy
| | - Alessandro Repici
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Milan 20089, Italy
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas University, Milan 20089, Italy
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125
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Teoh A, Perez-Miranda M, Kunda R, Lee SS, Irani S, Yeaton P, Sun S, Baron TH, Moon JH, Holt B, Khor CJ, Rerknimitr R, Bapaye A, Chan SM, Choi HJ, James TW, Kongkam P, Lee YN, Parekh P, Ridtitid W, Serna-Higuera C, Tan DM, Torres-Yuste R. Outcomes of an international multicenter registry on EUS-guided gallbladder drainage in patients at high risk for cholecystectomy. Endosc Int Open 2019; 7:E964-E973. [PMID: 31367676 PMCID: PMC6656552 DOI: 10.1055/a-0915-2098] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 04/10/2019] [Indexed: 12/15/2022] Open
Abstract
Background and study aims The aim of the current study was to review the outcomes of a large-scale international registry on endoscopic ultrasound-guided gallbladder drainage (EGBD) that encompasses different stent systems in patients who are at high-risk for cholecystectomy. Patients and methods This was a retrospective international multicenter registry on EGBD created by 13 institutions around the world. Consecutive patients who received EGBD for several indications were included. Outcomes include technical and clinical success, unplanned procedural events (UPE), adverse events (AEs), mortality, recurrent cholecystitis and learning curve of the procedure. Results Between June 2011 and November 2017, 379 patients were recruited to the study. Technical and clinical success were achieved in 95.3 % and 90.8 % of the patients, respectively. The 30-day AE rate was 15.3 % and 30-day mortality was 9.2 %. UPEs were significantly more common in patients with EGBD performed for conversion of cholecystostomy and symptomatic gallstones ( P < 0.001); and by endoscopists with experience of fewer than 25 procedures ( P = 0.033). Both presence of clinical failure ( P = 0.014; RR 8.69 95 %CI [1.56 - 48.47]) and endoscopist experience with fewer than 25 procedures ( P = 0.002; RR 4.68 95 %CI [1.79 - 12.26]) were significant predictors of 30-day AEs. Presence of 30-day AEs was a significant predictor of mortality ( P < 0.001; RR 103 95 %CI [11.24 - 944.04]). Conclusion EGBD was associated with high success rates in this large-scale study. EGBD performed for indications other than acute cholecystitis was associated with higher UPEs. The number of cases required to gain competency with the technique by experienced interventional endosonographers was 25 procedures.
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Affiliation(s)
- A.Y. Teoh
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | | | - Rastislav Kunda
- Department of Surgical Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Sang Soo Lee
- Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Shayan Irani
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, United States
| | - Paul Yeaton
- Department of Gastroenterology, Carilion Clinic, Roanoke, Virginia, United States
| | - Siyu Sun
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Todd Huntley Baron
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Jong Ho Moon
- Department of Internal Medicine, SoonChunHyang University College of Medicine, Bucheon Hospital, Bucheon/Seoul, Republic of Korea
| | - Bronte Holt
- Division of Gastroenterology, St Vincentʼs Hospital, Melbourne, Australia
| | - Christopher J.L. Khor
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
| | - Rungsun Rerknimitr
- Division of Gastroenterology, Department of Medicine, King Chulalongkorn Memorial Hospital, Bangkok
| | - Amol Bapaye
- Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, India
| | - Shannon Melissa Chan
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Hyun Jong Choi
- Department of Internal Medicine, SoonChunHyang University College of Medicine, Bucheon Hospital, Bucheon/Seoul, Republic of Korea
| | - Theodore William James
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Pradermchai Kongkam
- Division of Gastroenterology, Department of Medicine, King Chulalongkorn Memorial Hospital, Bangkok
| | - Yun Nah Lee
- Department of Internal Medicine, SoonChunHyang University College of Medicine, Bucheon Hospital, Bucheon/Seoul, Republic of Korea
| | - Parth Parekh
- Eastern Virginia Medical School, Norfolk, Virginia, United States
| | - Wiriyaporn Ridtitid
- Division of Gastroenterology, Department of Medicine, King Chulalongkorn Memorial Hospital, Bangkok
| | | | - Damien M.Y. Tan
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
| | - Raul Torres-Yuste
- Department of Medicine, University Hospital Rio Hortega, Valladolid, Spain
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126
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Leung Ki EL, Napoleon B. Endoscopic ultrasound-guided biliary drainage: A change in paradigm? World J Gastrointest Endosc 2019; 11:345-353. [PMID: 31205595 PMCID: PMC6556485 DOI: 10.4253/wjge.v11.i5.345] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 05/11/2019] [Accepted: 05/14/2019] [Indexed: 02/06/2023] Open
Abstract
Endoscopic ultrasound-guided biliary drainage (EUS-BD) has been developed as an alternative means of biliary drainage for malignant biliary obstruction (MBO). Compared to percutaneous transhepatic biliary drainage, EUS-BD offers effective internal drainage in a single session in the event of failed endoscopic retrograde cholangiopancreatography and has fewer adverse events (AE). In choosing which technique to use for EUS-BD, a combination of factors appears to be important in decision-making; technical expertise, the risk of AE, and anatomy. With the advent of novel all-in-one EUS-BD specific devices enabling simpler and safer techniques, as well as the growing experience and training of endosonographers, EUS-BD may potentially become a first-line technique in biliary drainage for MBO.
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Affiliation(s)
- En-Ling Leung Ki
- Department of Gastroenterology, Jean Mermoz Private Hospital, 55 avenue Jean Mermoz, Lyon 69008, France
| | - Bertrand Napoleon
- Department of Gastroenterology, Jean Mermoz Private Hospital, 55 avenue Jean Mermoz, Lyon 69008, France
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127
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Affiliation(s)
- Anthony Yuen Bun Teoh
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
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128
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Yasuda I, Ryozawa S, Dung HDQ. Current status and future perspectives of interventional endoscopic ultrasonography in Japan. Dig Endosc 2019; 31 Suppl 1:47-49. [PMID: 30994226 DOI: 10.1111/den.13359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Ichiro Yasuda
- Third Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Shomei Ryozawa
- Department of Gastroenterology, Saitama Medical University International Medical Center, Hidaka, Japan
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129
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Nakai Y, Kogure H, Koike K. Double-guidewire technique for endoscopic ultrasound-guided pancreatic duct drainage. Dig Endosc 2019; 31 Suppl 1:65-66. [PMID: 30994222 DOI: 10.1111/den.13333] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Yousuke Nakai
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hirofumi Kogure
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazuhiko Koike
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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130
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Wang Z, Zhao S, Meng Q, Wang S, Chen Y, Wang F, Li Q, Yao J, Du Y, Jin Z, Bai Y, Li Z, Wang D. Comparison of three different stents for endoscopic ultrasound-guided drainage of pancreatic fluid collection: A large retrospective study. J Gastroenterol Hepatol 2019; 34:791-798. [PMID: 30475420 DOI: 10.1111/jgh.14557] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 11/12/2018] [Accepted: 11/19/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM Endoscopic transmural drainage has been recognized as the first-line treatment for pancreatic fluid collection (PFC). Currently, three different types of stents have been extensively applied, including double pigtail plastic stent (PS), fully covered self-expanding metal stent (FCSEMS), and novel lumen-apposing metal stent (LAMS). Nonetheless, limited data are available about the comparison among them in terms of their clinical outcomes and safety for endoscopic ultrasound-guided drainage of PFC. METHODS The current retrospective study was carried on 160 PFC patients undergoing endoscopic ultrasound-guided drainage from 2010 to 2018 at a single tertiary care center. Patients were divided into three groups based on different drainage ways: drainage using PS, FCSEMS, or LAMS. RESULTS A total of 160 PFC patients (104 male and 56 female) were analyzed in this retrospective study, including 62 patients drained with PS, 28 with FCSEMS, and 70 with LAMS. Typically, the technical success (93.5% vs 96.4% vs 94.3%, P = 1.000) and treatment success rates (84.6% vs 85.2% vs 89.2%, P = 0.763) were similar between PS, FCSEMS, and LAMS. With regard to major adverse events, four patients (FCSEMS: n = 2 and LAMS: n = 2) with pseudoaneurysms developed severe bleeding; among them, 75% (3/4) of patients were observed within 2 weeks after intervention, and two patients in LAMS group died. CONCLUSIONS There are no significant differences in the clinical outcomes of PFC patients treated with PS, FCSEMS, or LAMS. Nonetheless, severe (or even fatal) bleeding may occur at the early stage after metal stent placement, which should be paid particular attention to.
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Affiliation(s)
- Zhijie Wang
- Department of Gastroenterology, Second Military Medical University, Shanghai, China.,Department of Gastroenterology, Gongli Hospital, Second Military Medical University, Shanghai, China
| | - Shengbing Zhao
- Department of Gastroenterology, Second Military Medical University, Shanghai, China
| | - Qianqian Meng
- Department of Gastroenterology, Second Military Medical University, Shanghai, China
| | - Shuling Wang
- Department of Gastroenterology, Second Military Medical University, Shanghai, China
| | - Yan Chen
- Department of Gastroenterology, Second Military Medical University, Shanghai, China
| | - Fuming Wang
- Intervention Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Qiang Li
- Department of Gastroenterology, Zaozhuang Hospital of Zaozhuang Mining Group, Zaozhuang, Shandong, China
| | - Jun Yao
- Department of Gastroenterology, Jinan University of Second Clinical Medical Sciences, Shenzhen Municipal People's Hospital, Shenzhen City, Guangdong, China
| | - Yiqi Du
- Department of Gastroenterology, Second Military Medical University, Shanghai, China
| | - Zhendong Jin
- Department of Gastroenterology, Second Military Medical University, Shanghai, China
| | - Yu Bai
- Department of Gastroenterology, Second Military Medical University, Shanghai, China
| | - Zhaoshen Li
- Department of Gastroenterology, Second Military Medical University, Shanghai, China
| | - Dong Wang
- Department of Gastroenterology, Second Military Medical University, Shanghai, China.,Department of Gastroenterology, Gongli Hospital, Second Military Medical University, Shanghai, China
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131
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Nakai Y, Kogure H, Isayama H, Koike K. Endoscopic Ultrasound-Guided Biliary Drainage for Benign Biliary Diseases. Clin Endosc 2019; 52:212-219. [PMID: 30866611 PMCID: PMC6547351 DOI: 10.5946/ce.2018.188] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 12/05/2018] [Indexed: 12/15/2022] Open
Abstract
Although endoscopic retrograde cholangiopancreatography (ERCP) is the first-line treatment for benign biliary diseases, this procedure is technically difficult in some conditions such as a surgically altered anatomy and gastric outlet obstruction. After a failed ERCP, a surgical or a percutaneous approach is selected as a rescue procedure; however, various endoscopic ultrasound (EUS)-guided interventions are increasingly utilized in pancreatobiliary diseases, including EUS-guided rendezvous for failed biliary cannulation, EUS-guided antegrade treatment for stone management, and EUS-guided hepaticogastrostomy for anastomotic strictures in patients with a surgically altered anatomy. There are some technical hurdles in EUS-guided interventions for benign biliary diseases owing to the difficulty in puncturing a relatively small bile duct and in subsequent guidewire manipulation, as well as the lack of dedicated devices. A recent major advancement in this field is the introduction of a 2-step approach, in which EUS-guided drainage is placed in the first session and antegrade treatment is performed in subsequent sessions. This approach allows the use of various techniques such as mechanical lithotripsy and cholangioscopy without a risk of bile leak. In summary, EUS-guided interventions are among the treatment options for benign biliary diseases; however, standardization of the procedure and development of a treatment algorithm are needed.
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Affiliation(s)
- Yousuke Nakai
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hirofumi Kogure
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Isayama
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Kazuhiko Koike
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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132
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Mishra A, Tyberg A. Endoscopic ultrasound guided biliary drainage: a comprehensive review. Transl Gastroenterol Hepatol 2019; 4:10. [PMID: 30976713 DOI: 10.21037/tgh.2019.01.03] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 01/11/2019] [Indexed: 12/13/2022] Open
Abstract
Endoscopic ultrasound-guided biliary drainage (EUS-BD) has become widely accepted over the past several years for complicated biliary drainage. When conventional endoscopic retrograde cholangiopancreatography (ERCP) is not successful or feasible due to a variety of constraints, an ultrasound-guided technique through intrahepatic and extrahepatic approaches allows adequate management of hepatobiliary obstruction. Other management alternatives include percutaneous transhepatic biliary drainages (PTBD) and complicated surgical approaches, both of which can be associated with increased morbidity and mortality. There are various technical approaches to allow successful biliary drainage which will be reviewed in this article.
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Affiliation(s)
- Avantika Mishra
- Department of Gastroenterology, Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
| | - Amy Tyberg
- Department of Gastroenterology, Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
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133
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Ge PS, Young JY, Dong W, Thompson CC. EUS-guided gastroenterostomy versus enteral stent placement for palliation of malignant gastric outlet obstruction. Surg Endosc 2019; 33:3404-3411. [PMID: 30725254 DOI: 10.1007/s00464-018-06636-3] [Citation(s) in RCA: 134] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 12/19/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND EUS-guided gastroenterostomy (EUS-GE) is a novel procedure for palliation of malignant gastric outlet obstruction (GOO); however, data comparing EUS-GE to enteral stent placement are limited. We aimed to compare clinical outcomes between EUS-GE and enteral stent placement in the palliation of malignant GOO. METHODS Retrospective analysis of a prospectively collected database on patients who underwent EUS-GE or enteral stent placement for palliation of malignant GOO from 2014 to 2017 was conducted. Primary outcome was the rate of stent failure requiring repeat intervention. Secondary outcomes included technical and clinical success, time to repeat intervention, length of hospital stay, and adverse events. RESULTS A total of 100 consecutive patients (mean age 65.9 ± 11.9 years, 44.0% female) were identified, of which 78 underwent enteral stent placement, and 22 underwent EUS-GE. Rate of stent failure requiring repeat intervention was higher in the enteral stent group than the EUS-GE group (32.0% vs. 8.3%, p = 0.021). Technical success was achieved in 100% in both groups. Higher initial clinical success was attained in the EUS-GE group than the enteral stent group (95.8% vs. 76.3%, p = 0.042). Mean length of hospital stay following stent placement was similar between groups (p = 0.821). The enteral stent group trended towards increased adverse events (40.2% vs. 20.8%, p = 0.098). Kaplan-Meier analysis showed decreased stent function in the enteral stent group (p = 0.013). CONCLUSION Compared to enteral stent placement, EUS-GE has a higher rate of initial clinical success and lower rate of stent failure requiring repeat intervention. EUS-GE may be offered for selected patients with malignant GOO in centers with extensive experience.
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Affiliation(s)
- Phillip S Ge
- Developmental Endoscopy Lab, Harvard Medical School, Boston, MA, USA.,Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Joyce Y Young
- Developmental Endoscopy Lab, Harvard Medical School, Boston, MA, USA
| | - William Dong
- Developmental Endoscopy Lab, Harvard Medical School, Boston, MA, USA
| | - Christopher C Thompson
- Developmental Endoscopy Lab, Harvard Medical School, Boston, MA, USA. .,Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
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134
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Ueshima K, Ogura T, Nishioka N, Miyano A, Okuda A, Imanishi M, Higuchi K. Technical feasibility of EUS-guided antegrade dilation for hepaticojejunostomy anastomotic stricture using novel endoscopic device (with videos). United European Gastroenterol J 2019; 7:419-423. [PMID: 31019711 DOI: 10.1177/2050640618823662] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 12/12/2018] [Indexed: 01/11/2023] Open
Abstract
Background A novel endoscopic dilation device (EZ Dilator; Zeon Medical Co, Tokyo, Japan) is now available in Japan that might affect dilation for biliary strictures under endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) guidance because it has good push ability. We evaluated the technical feasibility of this device under EUS guidance in a case series of patients with hepaticojejunostomy anastomotic stricture (HJAS) that led to further complications. Method We enrolled 14 patients with HJAS leading to obstructive jaundice or repeated cholangitis in this study. Technical success was defined as insertion of the EZ Dilator into the intestine across the stricture site without the need for other dilation devices. Deployed plastic stents were removed after three months to evaluate anastomosis sites. Results The median procedural duration was 25 minutes. Rates of technical and clinical success were 100% and 78.5%, respectively. One patient developed an adverse event of abdominal pain. Contrast medium flowed across the anastomosis site in 11 patients after stent removal, indicating a clinical success rate of 78.5% (11 of 14). Plastic stents were deployed again in the remaining three patients. Conclusion Although a prospective evaluation with long-term follow up is needed, the EZ Dilator shows clinical promise for treating benign biliary strictures under ERCP and EUS guidance.
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Affiliation(s)
- Kazuya Ueshima
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Takeshi Ogura
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Nobu Nishioka
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Akira Miyano
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Atsushi Okuda
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Miyuki Imanishi
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Kazuhide Higuchi
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
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Dietrich CF, Arcidiacono PG, Braden B, Burmeister S, Carrara S, Cui X, Di Leo M, Dong Y, Fusaroli P, Gilja OH, Healey AJ, Hocke M, Hollerbach S, Garcia JI, Ignee A, Jürgensen C, Kahaleh M, Kitano M, Kunda R, Larghi A, Möller K, Napoleon B, Oppong KW, Petrone MC, Saftoiu A, Puri R, Sahai AV, Santo E, Sharma M, Soweid A, Sun S, Teoh AYB, Vilmann P, Jenssen C. What should be known prior to performing EUS? Endosc Ultrasound 2019; 8:3-16. [PMID: 30777940 PMCID: PMC6400085 DOI: 10.4103/eus.eus_54_18] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Direct referral of patients for EUS – instead of preprocedural consultation with the endosonographer – has become standard practice (like for other endoscopic procedures) as it is time- and cost-effective. To ensure appropriate indications and safe examinations, the endosonographer should carefully consider what information is needed before accepting the referral. This includes important clinical data regarding relevant comorbidities, the fitness of the patient to consent and undergo the procedure, and the anticoagulation status. In addition, relevant findings from other imaging methods to clarify the clinical question may be necessary. Appropriate knowledge and management of the patients’ anticoagulation and antiplatelet therapy, antibiotic prophylaxis, and sedation issues can avoid unnecessary delays and unsafe procedures. Insisting on optimal preparation, appropriate indications, and clear clinical referral questions will increase the quality of the outcomes of EUS. In this paper, important practical issues regarding EUS preparations are raised and discussed from different points of view.
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Affiliation(s)
- Christoph F Dietrich
- Medical Department 2, Caritas-Krankenhaus, Uhlandstr 7, D-97980 Bad Mergentheim, Germany; Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Paolo Giorgio Arcidiacono
- Pancreatico/Biliary Endoscopy & Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy
| | - Barbara Braden
- Translational Gastroenterology Unit I John Radcliffe Hospital I Oxford OX3 9DU, UK
| | - Sean Burmeister
- Surgical Gastroenterology unit, Groote Schuur Hospital, Cape Town, South Africa
| | - Silvia Carrara
- Humanitas Clinical and Research Center- IRCCS- Digestive Endoscopy Unit, Division of Gastroenterology, Rozzano, Milan, Italy
| | - Xinwu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Milena Di Leo
- Humanitas Clinical and Research Center- IRCCS- Digestive Endoscopy Unit, Division of Gastroenterology, Rozzano, Milan, Italy
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Pietro Fusaroli
- Department of Medical and Surgical Sciences, Gastroenterology Unit, University of Bologna/Imola Hospital, Imola, Italy
| | - Odd Helge Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen and Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Andrew J Healey
- General and HPB Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Michael Hocke
- Medical Department, Helios Klinikum Meiningen, Germany
| | - Stephan Hollerbach
- Department of Gastroenterology, Allgemeines Krankenhaus Celle, Celle, Germany
| | - Julio Iglesias Garcia
- Department of Gastroenterology and Hepatology, Health Research Institute of Santiago de Compostela (IDIS), University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - André Ignee
- Medical Department 2, Caritas-Krankenhaus, Uhlandstr 7, D-97980 Bad Mergentheim, Germany
| | | | - Michel Kahaleh
- Department of Gastroenterology, The State University of New Jersey, New Jersey, USA
| | - Masayuki Kitano
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Rastislav Kunda
- Department of Surgical Gastroenterology, Aarhus University Hospital, Aarhus, Denmark; Department of Surgery and Department of Advanced Interventional Endoscopy, University Hospital Brussels, Brussels, Belgium
| | - Alberto Larghi
- Digestive Endoscopy Unit, IRCCS Foundation University Hospital, Policlinico A. Gemelli, Rome, Italy
| | - Kathleen Möller
- Medical Department I/Gastroenterology, SANA Hospital Lichtenberg, Berlin, Germany
| | - Bertrand Napoleon
- Digestive Endoscopy Unit, Hopital Privé J Mermoz Ramsay Générale de Santé, Lyon, France
| | | | - Maria Chiara Petrone
- Pancreatico/Biliary Endoscopy & Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy
| | - Adrian Saftoiu
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Rajesh Puri
- Interventional Gastroenterology, Institute of Digestive and Hepatobiliary Sciences Medanta the Medicity, Gurugram, Haryana, India
| | - Anand V Sahai
- Center Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Erwin Santo
- Department of Gastroenterology and Liver Diseases, Tel Aviv, Sourasky Medical Center, Tel Aviv, Israel
| | - Malay Sharma
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Meerut, Uttar Pradesh, India
| | - Assaad Soweid
- Endosonography and advanced therapeutic endoscopy, Division of Gastroenterology, The American University of Beirut, Medical Center, Beirut, Lebanon
| | - Siyu Sun
- Endoscopy Center, ShengJing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Anthony Yuen Bun Teoh
- Division of Upper Gastrointestinal and Metabolic Surgery, Department of Surgery, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Peter Vilmann
- GastroUnit, Department of Surgery, Copenhagen University, Hospital Herlev, Denmark
| | - Christian Jenssen
- Department of Internal Medicine, Krankenhaus Maerkisch-Oderland, D-15344 Strausberg and Brandenburg Institute of Clinical Ultrasound at Medical University Brandenburg, Germany
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Abstract
Endoscopic transpapillary or transanastomotic pancreatic duct drainage (PD) is the mainstay of drainage in symptomatic pancreatic duct obstruction or leakage. However, transpapillary or transanastomotic PD can be technically difficult due to the tight stricture or surgically altered anatomy (SAA), and endoscopic ultrasound (EUS)-guided PD (EUS-PD) is now increasingly used as an alternative technique. There are two approaches in EUS-PD: EUS-guided rendezvous (EUS-RV) and EUS-guided transmural drainage (EUS-TMD). In cases with normal anatomy, EUS-RV should be the first approach, whereas EUS-TMD can be selected in cases with SAA or duodenal obstruction. In our literature review, technical success and adverse event rates were 78.7% and 21.8%, respectively. The technical success rate of EUS-RV appeared lower than EUS-TMD due to the difficulty in guidewire passage. In future, development of dedicated devices and standardization of EUS-PD procedure are necessary.
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Affiliation(s)
- Yousuke Nakai
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan,Address for correspondence: Dr. Yousuke Nakai, Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo Bunkyo-ku, Tokyo - 113-8655, Japan. E-mail:
| | - Hirofumi Kogure
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Isayama
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Kazuhiko Koike
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Ogura T, Takenaka M, Shiomi H, Goto D, Tamura T, Hisa T, Kato H, Nishioka N, Minaga K, Masuda A, Onoyama T, Kudo M, Higuchi K, Kitano M. Long-term outcomes of EUS-guided transluminal stent deployment for benign biliary disease: Multicenter clinical experience (with videos). Endosc Ultrasound 2019; 8:398-403. [PMID: 31552912 PMCID: PMC6927148 DOI: 10.4103/eus.eus_45_19] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background and Objectives: Biliary drainage (BD) under EUS guidance is usually indicated for malignant biliary obstruction. Recently, EUS-guided transluminal treatment has been applied to benign biliary disease (BBD). This multicenter retrospective study evaluated the clinical impact of EUS-guided transluminal stent deployment for BBD with long-term follow-up. Patients and Methods: This retrospective study investigated patients treated between September 2015 and October 2016 at participating hospitals in the therapeutic endoscopic group. The inclusion criteria comprised complications with BBD obstructive jaundice or cholangitis and failed endoscopic retrograde cholangiopancreatography or inaccessible ampulla of Vater. Results: Twenty-six patients underwent EUS-guided transluminal stent deployment. Indications for EUS-guided transluminal stent deployment comprised anastomotic biliary stricture (n = 17), bile duct stones (n = 5), inflammatory biliary stricture (n = 3), and acute pancreatitis prevention (n = 1). Thirteen of these 26 patients underwent scheduled reintervention, with technical success achieved in all 13 patients. None of the deployed stents became dysfunctional. Among the 13 patients who underwent reintervention on demand, stents had become dysfunctional in six patients (stent patency: 48, 90, 172, 288, 289, and 608 days). Reintervention was successfully performed in all patients. During follow-up (median, 749 days), severe adverse events were not seen in any patients. Conclusion: We concluded that EUS-guided transluminal stent deployment for BBD is feasible and safe. Because metal stent dysfunction was more frequent when deployed on demand, such stents should be exchanged for plastic stents in a scheduled manner if a metal stent is used.
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Affiliation(s)
- Takeshi Ogura
- Therapeutic Endoscopic Ultrasound Group: TEUS; 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Mamoru Takenaka
- Therapeutic Endoscopic Ultrasound Group: TEUS; Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Hideyuki Shiomi
- Therapeutic Endoscopic Ultrasound Group: TEUS; Department of Internal Medicine, Division of Gastroenterology, Graduate School of Medicine, Kobe University, Hyogo, Japan
| | - Daisuke Goto
- Therapeutic Endoscopic Ultrasound Group: TEUS; Department of Internal Medicine, Division of Gastroenterology and Hepatology, Tottori Red Cross Hospital, Tottori, Japan
| | - Takashi Tamura
- Therapeutic Endoscopic Ultrasound Group: TEUS; Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takeshi Hisa
- Therapeutic Endoscopic Ultrasound Group: TEUS; Department of Gastroenterology, Saku Central Hospital Advanced Care Center, Nagano, Japan
| | - Hironari Kato
- Therapeutic Endoscopic Ultrasound Group: TEUS; Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Nobu Nishioka
- Therapeutic Endoscopic Ultrasound Group: TEUS; 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Kosuke Minaga
- Therapeutic Endoscopic Ultrasound Group: TEUS; Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Atsuhiro Masuda
- Therapeutic Endoscopic Ultrasound Group: TEUS; Department of Internal Medicine, Division of Gastroenterology, Graduate School of Medicine, Kobe University, Hyogo, Japan
| | - Takumi Onoyama
- Therapeutic Endoscopic Ultrasound Group: TEUS; Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Masatoshi Kudo
- Therapeutic Endoscopic Ultrasound Group: TEUS; Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Kazuhide Higuchi
- Therapeutic Endoscopic Ultrasound Group: TEUS; 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Masayuki Kitano
- Therapeutic Endoscopic Ultrasound Group: TEUS; Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
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138
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Anderloni A, Fugazza A, Troncone E, Auriemma F, Carrara S, Semeraro R, Maselli R, Di Leo M, D'Amico F, Sethi A, Repici A. Single-stage EUS-guided choledochoduodenostomy using a lumen-apposing metal stent for malignant distal biliary obstruction. Gastrointest Endosc 2019; 89:69-76. [PMID: 30189198 DOI: 10.1016/j.gie.2018.08.047] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 08/23/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS EUS-guided choledochoduodenostomy (EUS-CD) using a lumen-apposing metal stent (LAMS) has recently been reported as an alternative treatment approach for patients with malignant obstructive jaundice and failed ERCP. We analyzed the safety and technical and clinical efficacy of EUS-CD using LAMSs in patients with malignant obstructive jaundice. METHODS This was a retrospective study of consecutive patients with inoperable malignant distal bile duct obstruction who underwent EUS-CD using an electrocautery-enhanced (EC)-LAMS over a 3-year period (2015-2018). The main outcome measures were technical and clinical success (defined as a decline in serum bilirubin level by 50% at 2-week follow-up). Secondary outcomes were occurrence of adverse events, procedure time, and stent patency. RESULTS Forty-six patients (47.8% women; median age, 73.1 ± 12.6 years) underwent direct EUS-CD using the biliary EC-LAMS. The procedure was technically successful in 43 patients (93.5%). The rate of clinical success was 97.7%. Adverse events occurred in 5 (11.6%) patients and included the following: 1 fatal bleeding 17 days after stent placement, 3 episodes of stent occlusion (food impaction), and 1 spontaneous migration (all 4 requiring reintervention). The mean follow-up was 114.37 days (95% confidence interval, 73.2-155.4). CONCLUSIONS EUS-CD using the EC-LAMS is effective. The rate of adverse events including one fatal event is not negligible and should be carefully considered before using the stent in this clinical setting. Prospective studies are required to validate our preliminary findings to fully assess the long-term efficacy and safety of the stent.
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Affiliation(s)
- Andrea Anderloni
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Alessandro Fugazza
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Edoardo Troncone
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Francesco Auriemma
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Silvia Carrara
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Rossella Semeraro
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Roberta Maselli
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Milena Di Leo
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Ferdinando D'Amico
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Amrita Sethi
- Pancreaticobiliary Endoscopy Services, Division of Digestive and Liver Disease, Columbia University Medical Center-New York Presbyterian Hospital, New York, New York, USA
| | - Alessandro Repici
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy; Humanitas University, Rozzano, Milan, Italy
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Yoon WJ, Park DH, Choi JH, Jang S, Samarasena J, Lee TH, Paik WH, Oh D, Song TJ, Choi JH, Hara K, Iwashita T, Perez-Miranda M, Lee JG, Vazquez-Sequeiros E, Naitoh I, Vila JJ, Brugge WR, Takenaka M, Lee SS, Seo DW, Lee SK, Kim MH. The underutilization of EUS-guided biliary drainage: Perception of endoscopists in the East and West. Endosc Ultrasound 2019; 8:188-193. [PMID: 30719996 PMCID: PMC6590002 DOI: 10.4103/eus.eus_57_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background and Objectives EUS-guided biliary drainage (EUS-BD) is increasingly utilized to manage unresectable malignant biliary obstruction after a failed ERCP. However, there is no data on how endoscopists perceive EUS-BD. The aim of this study was to investigate the perception of endoscopists on EUS-BD. Patients and Methods A survey questionnaire of six topics with 22 survey statements was developed. A total of 17 pancreatobiliary endoscopists (10 from East and 7 from West) were invited to survey. The participants were asked to answer the multiple choice questionnaire and give comments. The opinions of the participants for individual survey statements were assessed using 5-point Likert scale. Results All participants completed the survey. The endoscopists had a trend to perceive EUS-BD as a procedure indicated after a failed ERCP. Various EUS-BD methods were regarded as having different efficacy and safety. The superiority of EUS-BD over percutaneous transhepatic BD (PTBD) with regard to efficacy, procedure-related adverse events, and unscheduled re-intervention was not in agreement. Conclusions EUS-BD was not yet perceived as the initial procedure to relieve the unresectable malignant biliary obstruction. Various EUS-BD methods were regarded as having different efficacy and safety. The superiority of EUS-BD over PTBD was not in agreement. Refining the procedure, developing dedicated devices, and gaining expertise in the procedure are necessary to popularize EUS-BD.
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Affiliation(s)
- Won Jae Yoon
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Do Hyun Park
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jun Ho Choi
- Department of Internal Medicine, Dankook University College of Medicine, South Korea
| | - Sunguk Jang
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA
| | - Jason Samarasena
- Department of Medicine, University of California-Irvine, Orange, CA, USA
| | - Tae Hoon Lee
- Department of Internal Medicine, Soonchunhyang University School of Medicine, Cheonan, South Korea
| | - Woo Hyun Paik
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Dongwook Oh
- Department of Gastroenterology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea
| | - Tae Jun Song
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Joon Hyuk Choi
- Department of Internal Medicine, Inje University College of Medicine, Busan, South Korea
| | - Kazuo Hara
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Takuji Iwashita
- First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan
| | - Manuel Perez-Miranda
- Department of Gastroenterology and Hepatology, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - John G Lee
- Department of Medicine, University of California-Irvine, Orange, CA, USA
| | - Enrique Vazquez-Sequeiros
- Department of Gastroenterology and Hepatology, University Hospital Ramon Y Cajal, IRYCIS, Madrid, Spain
| | - Itaru Naitoh
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Juan J Vila
- Endoscopy Unit, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - William R Brugge
- Division of Gastroenterology, Mount Auburn Hospital, Cambridge, MA, USA
| | - Mamoru Takenaka
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Sang Soo Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dong-Wan Seo
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sung Koo Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Myung-Hwan Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Ogura T, Nishioka N, Higuchi K. Transluminal intrahepatic bile duct stone removal using coaxial basket catheter via the previously created EUS-guided hepaticogastrostomy tract (with videos). Endosc Ultrasound 2019; 8:133-135. [PMID: 30880726 PMCID: PMC6482608 DOI: 10.4103/eus.eus_68_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Takeshi Ogura
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Nobu Nishioka
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Kazuhide Higuchi
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
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141
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Abstract
PURPOSE OF REVIEW Pain is the most common symptom of chronic pancreatitis, having a profound effect on patients and a broad socioeconomic impact. Endoscopy is guideline recommended as first-line management for chronic pancreatitis pain in certain clinical scenarios. Herein, we provide an evidence-based review of the endoscopic treatment of pain due to chronic pancreatitis while highlighting some important confounders in the measurement of this outcome in clinical practice and research. RECENT FINDINGS Multiple recent studies have reported on the efficacy of current endoscopic therapies for chronic pancreatitis pain. Despite the high technical success rates of these procedures, pain outcomes remain disappointing. Complex mechanisms beyond ductal hypertension, such as central sensitization, visceral hypersensitivity and inflammatory neuritis account for some of the discordance observed between the rates of technical and clinical success. In addition, the sham effect is increasingly recognized as a confounder when interpreting the procedural benefit. Nevertheless, there are multiple promising innovations in the field of pancreatic endoscopy that are aimed to improve technical and clinical outcomes, but rigorous investigation is necessary to establish their role in clinical practice. SUMMARY Endoscopic therapy for chronic pancreatitis pain appears to be safe and effective in certain contexts and recent innovations in the field will hopefully further improve outcomes. In addition to evaluating the technical success of endotherapy in chronic pancreatitis, methodologically rigorous research focusing on patient-centered outcomes and accounting for the sham effect is necessary to advance this field.
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142
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Zhu HY, Xie P, Song YX, Li ZS, Jin ZD, Du YQ. Lumen-apposing metal stents (LAMS) versus plastic stents for EUS-guided drainage of walled-off necrosis (WON) (LVPWON): study protocol for a multicenter randomized controlled trial. Trials 2018; 19:549. [PMID: 30305160 PMCID: PMC6180448 DOI: 10.1186/s13063-018-2901-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 09/03/2018] [Indexed: 12/12/2022] Open
Abstract
Background Endoscopic ultrasonography (EUS)-guided drainage has become the first-line therapy for late peri-pancreatic fluid collection (PFC). Double pigtail plastic stents (DPPS) and lumen-apposing metal stents (LAMS) are commonly used for PFC drainage. Recently, a multi-institutional consensus on PFC drainage has recommended that LAMS should be the standard care for patients with walled-off necrosis (WON). However, given the poor quality of evidence, we aim to perform a large-scale randomized controlled trial to determine whether LAMS is superior to DPPS for WON drainage. Methods/design The study is an open-label, prospective, parallel-group, superiority, multicenter randomized controlled trial. Two hundred and fifty-six patients with WON who will attend 18 tertiary hospitals in China will be randomly allocated to the LAMS or DPPS group before the procedure. The primary endpoint is the clinical success at one month after drainage (reduction in the size of WON to < 2 cm). Secondary endpoints include technical success, operation time, recurrence, adverse events, and secondary interventions. Discussion The LVPWON trial is designed to determine whether LAMS is effective, safe, and superior to DPPS for WON drainage. Trial registration ClinicalTrials.gov, NCT03027895. Registered on 14 January 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-2901-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hui-Yun Zhu
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University/ Naval Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Pei Xie
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University/ Naval Medical University, 168 Changhai Road, Shanghai, 200433, China.,Digestive Endoscopy Center, Changhai Hospital, Second Military Medical University/ Naval Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Ying-Xiao Song
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University/ Naval Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Zhao-Shen Li
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University/ Naval Medical University, 168 Changhai Road, Shanghai, 200433, China. .,Digestive Endoscopy Center, Changhai Hospital, Second Military Medical University/ Naval Medical University, 168 Changhai Road, Shanghai, 200433, China. .,Shanghai Institute of Pancreatic Diseases, Shanghai, China. .,National Clinical Research Center of Digestive Diseases, Shanghai, China.
| | - Zhen-Dong Jin
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University/ Naval Medical University, 168 Changhai Road, Shanghai, 200433, China. .,Digestive Endoscopy Center, Changhai Hospital, Second Military Medical University/ Naval Medical University, 168 Changhai Road, Shanghai, 200433, China. .,Shanghai Institute of Pancreatic Diseases, Shanghai, China. .,National Clinical Research Center of Digestive Diseases, Shanghai, China.
| | - Yi-Qi Du
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University/ Naval Medical University, 168 Changhai Road, Shanghai, 200433, China. .,Digestive Endoscopy Center, Changhai Hospital, Second Military Medical University/ Naval Medical University, 168 Changhai Road, Shanghai, 200433, China. .,Shanghai Institute of Pancreatic Diseases, Shanghai, China. .,National Clinical Research Center of Digestive Diseases, Shanghai, China.
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Anderloni A, Leo MD, Carrara S, Fugazza A, Maselli R, Buda A, Amato A, Auriemma F, Repici A. Endoscopic ultrasound-guided transmural drainage by cautery-tipped lumen-apposing metal stent: exploring the possible indications. Ann Gastroenterol 2018; 31:735-741. [PMID: 30386125 PMCID: PMC6191873 DOI: 10.20524/aog.2018.0299] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 06/25/2018] [Indexed: 02/07/2023] Open
Abstract
Background The recently introduced Hot AXIOS™ system for endoscopic ultrasound (EUS)-guided transenteric drainage has the potential to change interventional endoscopy significantly. The aim of our study was to assess the effectiveness and safety of this new type of lumen-apposing metal stent (LAMS) with cautery system for pancreatic collection, and gallbladder and biliary tree drainage. Methods We retrospectively reviewed consecutive patients undergoing EUS-guided drainage by LAMS with cautery system in a tertiary-care academic medical center between March 2014 and March 2017. All patients were included in our prospectively maintained institutional EUS database. The main outcome measures were technical success, clinical effectiveness, and adverse events. Results A total of 45 patients (20 men, mean age 69.6 years) underwent LAMS placement. Indications were pancreatic fluid collections (19 patients, 42.2%), acute cholecystitis (10 patients, 22.2%), and biliary drainage (16 patients, 35.5%). Technical success was achieved in all patients except one (97.7%). Clinical success was achieved in 86.4% (38/44) of cases and adverse events occurred in 5 (11.4%) of patients. Conclusions In our experience, EUS-guided LAMS placement performed by expert endoscopists was feasible and effective in the endoscopic management of pancreatic fluid collection, and biliary and gallbladder drainage. Optimization of transmural drainage by new dedicated devices could improve efficacy and safety in appropriately selected patients.
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Affiliation(s)
- Andrea Anderloni
- Digestive Endoscopy Unit, Department of Gastroenterology, Humanitas Research Hospital, Milan (Andrea Anderloni, Milena Di Leo, Silvia Carrara, Alessandro Fugazza, Roberta Maselli, Francesco Auriemma, Alessandro Repici)
| | - Milena Di Leo
- Digestive Endoscopy Unit, Department of Gastroenterology, Humanitas Research Hospital, Milan (Andrea Anderloni, Milena Di Leo, Silvia Carrara, Alessandro Fugazza, Roberta Maselli, Francesco Auriemma, Alessandro Repici).,Humanitas University, Rozzano, Milan (Milena Di Leo, Alessandro Repici)
| | - Silvia Carrara
- Digestive Endoscopy Unit, Department of Gastroenterology, Humanitas Research Hospital, Milan (Andrea Anderloni, Milena Di Leo, Silvia Carrara, Alessandro Fugazza, Roberta Maselli, Francesco Auriemma, Alessandro Repici)
| | - Alessandro Fugazza
- Digestive Endoscopy Unit, Department of Gastroenterology, Humanitas Research Hospital, Milan (Andrea Anderloni, Milena Di Leo, Silvia Carrara, Alessandro Fugazza, Roberta Maselli, Francesco Auriemma, Alessandro Repici)
| | - Roberta Maselli
- Digestive Endoscopy Unit, Department of Gastroenterology, Humanitas Research Hospital, Milan (Andrea Anderloni, Milena Di Leo, Silvia Carrara, Alessandro Fugazza, Roberta Maselli, Francesco Auriemma, Alessandro Repici)
| | - Andrea Buda
- Digestive Endoscopy Unit, Feltre (Andrea Buda)
| | - Arnaldo Amato
- Gastroenterology Division, Valduce, Como (Arnaldo Amato), Italy
| | - Francesco Auriemma
- Digestive Endoscopy Unit, Department of Gastroenterology, Humanitas Research Hospital, Milan (Andrea Anderloni, Milena Di Leo, Silvia Carrara, Alessandro Fugazza, Roberta Maselli, Francesco Auriemma, Alessandro Repici)
| | - Alessandro Repici
- Digestive Endoscopy Unit, Department of Gastroenterology, Humanitas Research Hospital, Milan (Andrea Anderloni, Milena Di Leo, Silvia Carrara, Alessandro Fugazza, Roberta Maselli, Francesco Auriemma, Alessandro Repici).,Humanitas University, Rozzano, Milan (Milena Di Leo, Alessandro Repici)
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Phillip V, Braren R, Lukas N, Schmid RM, Geisler F. Arterial Pseudoaneurysm within a Pancreatic Pseudocyst. Case Rep Gastroenterol 2018; 12:513-518. [PMID: 30283285 PMCID: PMC6167644 DOI: 10.1159/000492459] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 07/20/2018] [Indexed: 12/19/2022] Open
Abstract
The formation of pancreatic pseudocysts and (pseudo-)aneurysms of intestinal vessels are rare but life-threatening complications in acute and chronic pancreatitis. Here we report the rare case of a patient suffering from chronic pancreatitis with an arterial pseudoaneurysm within a pancreatic pseudocyst and present its successful therapeutic management by angioembolization to prevent critical bleeding. A 67-year-old male with a history of chronic pancreatitis presented with severe acute abdominal pain and vomiting to the emergency department. Seven weeks prior to the present admission, a CT scan had displayed a pancreatic pseudocyst with a maximum diameter of 53 mm. A laboratory examination revealed an elevated white blood cell count (15.40 × 103/μL), as well as elevated serum lipase (191 U/L), bilirubin (1.48 mg/dL), and blood glucose (353 mg/dL) levels. Sonographically, the previously described pancreatic pseudocyst revealed a slightly increased maximum diameter of 65 mm and an inhomogeneous echo of the cystic content. A contrast-enhanced CT scan showed a further increase in maximum diameter to 70 mm of the known pseudocyst. Inside the pseudocyst, a pseudoaneurysm originating from the splenic artery with a maximum diameter of 41 mm was visualized. After interdisciplinary consultation, prophylactic coil embolization of the splenic artery was immediately performed. The pseudoaneurysm was shut off from blood supply by back-door/front-door occlusion employing 27 coils, resulting in complete exclusion of the pseudoaneurysm from the circulation. Pseudoaneurysms are a rare complication of acute and chronic pancreatitis which has been shown to be efficiently treated by coil embolization.
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Affiliation(s)
- Veit Phillip
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Rickmer Braren
- Institut für Diagnostische und Interventionelle Radiologie, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Nikolaus Lukas
- Klinik für Innere Medizin I, Klinikum Freising, akademisches Lehrkrankenhaus der Technischen Universität München, Freising, Germany
| | - Roland M. Schmid
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Fabian Geisler
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
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