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Gornals JB, Sumalla-Garcia A, Luna-Rodriguez D, Puigcerver-Mas M, Velasquez-Rodriguez JG, Salord S, Maisterra S, Busquets J. Long-term outcomes of endoscopic ultrasound-guided pancreatic duct interventions: A single tertiary center experience. GASTROENTEROLOGIA Y HEPATOLOGIA 2024:502221. [PMID: 38906323 DOI: 10.1016/j.gastrohep.2024.502221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 06/08/2024] [Accepted: 06/11/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND AND AIMS Endoscopic ultrasound-guided pancreatic duct intervention (EUS-PDI) is one of the most technically challenging procedures. There remains a knowledge gap due to its rarity. The aim is to report the accumulated EUS-PDI experience in a tertiary center. METHODS Single tertiary center, retrospective cohort study of prospectively collected data during the study period, from January 2013 to June 2021. RESULTS In total, 14 patients (85% male; mean age, 61 years, range 37-81) and 25 EUS-PDI procedures for unsuccessful endoscopic retrograde pancreatography (ERP) were included. Principal etiology was chronic pancreatitis with pancreatic duct obstruction (78%). EUS-guided assisted (colorant and/or guidewire, rendezvous) ERP was performed in 14/25 (56%); and transmural drainage in 11 procedures, including pancreaticogastrosmy in 9/25 (36%) and pancreaticoduodenostomy in 2/25 (8%). Overall technical and clinical success was 78.5% (11/14). Three (21%) patients required a second procedure with success in all cases. Two failed cases required surgery. Three (21%) adverse events (AEs) were noted (fever, n=1; perforation, n=1; pancreatitis, n=1). Patients underwent a median of 58 months (range 24-108) follow-up procedures for re-stenting. Spontaneous stent migration was detected in 50% of cases. CONCLUSIONS EUS-PDI is an effective salvage therapy for unsuccessful ERP, although 21% of patients may still experience AEs. In case of EUS-guided rendezvous failure, it can cross over to a transmural drainage.
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Affiliation(s)
- Joan B Gornals
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, L'Hospitalet de llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute, L'Hospitalet de Llobregat, Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain.
| | - Albert Sumalla-Garcia
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, L'Hospitalet de llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute, L'Hospitalet de Llobregat, Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain
| | - Daniel Luna-Rodriguez
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, L'Hospitalet de llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute, L'Hospitalet de Llobregat, Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain
| | - Maria Puigcerver-Mas
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, L'Hospitalet de llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute, L'Hospitalet de Llobregat, Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain
| | - Julio G Velasquez-Rodriguez
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, L'Hospitalet de llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute, L'Hospitalet de Llobregat, Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain
| | - Silvia Salord
- Bellvitge Biomedical Research Institute, L'Hospitalet de Llobregat, Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain; Hepato-biliary-pancreatic Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sandra Maisterra
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, L'Hospitalet de llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute, L'Hospitalet de Llobregat, Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain
| | - Juli Busquets
- Bellvitge Biomedical Research Institute, L'Hospitalet de Llobregat, Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain; Hepato-biliary-pancreatic Unit, Department of General Surgery, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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Kadkhodayan K, Viana A, Singh S, Kegan J, Amawi Y, Jain D, Yang D, Arain M, Cosgrove N, Shayan I, Hasan MK. Chromo-pancreatoscopy for preoperative evaluation of main duct intraductal pancreatic mucinous neoplasm. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2024; 9:194-196. [PMID: 38618613 PMCID: PMC11009480 DOI: 10.1016/j.vgie.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Affiliation(s)
| | - Artur Viana
- Center for Interventional Endoscopy, AdventHealth, Orlando, Florida
| | - Sanmeet Singh
- Center for Interventional Endoscopy, AdventHealth, Orlando, Florida
| | | | - Yusuf Amawi
- Florida State University College of Medicine, Tallahassee, Florida
| | | | - Dennis Yang
- Center for Interventional Endoscopy, AdventHealth, Orlando, Florida
| | - Mustafa Arain
- Center for Interventional Endoscopy, AdventHealth, Orlando, Florida
| | - Natalie Cosgrove
- Center for Interventional Endoscopy, AdventHealth, Orlando, Florida
| | | | - Muhammad K Hasan
- Center for Interventional Endoscopy, AdventHealth, Orlando, Florida
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Kamal F, Khan MA, Lee-Smith W, Sharma S, Acharya A, Farooq U, Tarar ZI, Faggen AE, Aziz M, Chandan S, Ahmed Z, Kouanda A, Dai SC, Munroe CA, Adler DG. Efficacy and safety of EUS-guided biliary drainage for benign biliary obstruction - A systematic review and meta-analysis. Endosc Ultrasound 2023; 12:228-236. [PMID: 36751758 PMCID: PMC10237615 DOI: 10.4103/eus-d-22-00077] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 10/09/2022] [Indexed: 02/09/2023] Open
Abstract
Background and Objectives ERCP is the first line of treatment for benign and malignant biliary obstruction and EUS-guided biliary drainage (EUS-BD) is usually used for patients who have failed ERCP. Recently, several studies have evaluated the role of EUS-BD in the management of benign biliary obstruction. This meta-analysis evaluates the efficacy and safety of EUS-BD in the management of benign biliary obstruction. Methods We reviewed several databases from inception to July 8, 2022, to identify studies evaluating the efficacy and safety of EUS-BD in the management of benign biliary obstruction. Our outcomes of interest were technical success, clinical success, and adverse events. Pooled rates with 95% confidence intervals (CIs) for all outcomes were calculated using a random effects model. Subgroup analyses were performed including patients with normal anatomy versus surgically altered anatomy (SAA). Heterogeneity was assessed by I2 statistic. Results We included 14 studies with 329 patients. The pooled rate (95% CI) of technical success was 88% (83%, 92%). The pooled rate (95% CI) of technical success for patients with SAA and normal anatomy was 92% (85%, 96%) and 83% (75%, 89%), respectively. The pooled rates (95% CI) of clinical success and adverse events were 89% (83%, 93%) and 19% (13%, 26%), respectively. We found low heterogeneity in most of the analyses. Conclusions EUS-BD is an effective and safe option in patients with benign biliary obstruction and should be considered after a failed attempt at ERCP or when ERCP is not technically possible.
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Affiliation(s)
- Faisal Kamal
- Division of Gastroenterology, University of California-San Francisco, San Francisco, CA, USA
| | - Muhammad Ali Khan
- Department of Gastroenterology, Hepatology and Nutrition, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wade Lee-Smith
- Mulford Health Sciences Library, University of Toledo, Toledo, OH, USA
| | - Sachit Sharma
- Division of Gastroenterology, Virginia Commonwealth University, Richmond, VA, USA
- Department of Medicine, University of Toledo, Toledo, OH, USA
| | - Ashu Acharya
- Department of Medicine, University of Toledo, Toledo, OH, USA
| | - Umer Farooq
- Department of Medicine, Loyola Medicine/MacNeal Hospital, Berwyn, IL, USA
| | - Zahid Ijaz Tarar
- Department of Medicine, University of Missouri, Columbia, MO, USA
| | - Alec E. Faggen
- Division of Gastroenterology, University of California-San Francisco, San Francisco, CA, USA
| | - Muhammad Aziz
- Division of Gastroenterology, University of Toledo, Toledo, OH, USA
| | - Saurabh Chandan
- Division of Gastroenterology, Creighton University Medical Center, Omaha, NE, USA
| | - Zohaib Ahmed
- Department of Medicine, University of Toledo, Toledo, OH, USA
| | - Abdul Kouanda
- Division of Gastroenterology, University of California-San Francisco, San Francisco, CA, USA
| | - Sun-Chuan Dai
- Division of Gastroenterology, University of California-San Francisco, San Francisco, CA, USA
| | - Craig A. Munroe
- Division of Gastroenterology, University of California-San Francisco, San Francisco, CA, USA
| | - Douglas G. Adler
- Center for Advanced Therapeutic Endoscopy, Porter Adventist Hospital, Denver, Colorado, USA
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Consiglieri CF, Ramos E, Gornals JB. The Endoscopic-White test: detection of a Whipple anastomotic leakage using linoleic ac. as an endoscopic dye. GASTROENTEROLOGIA Y HEPATOLOGIA 2022; 45:464-465. [DOI: 10.1016/j.gastrohep.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/23/2021] [Accepted: 01/05/2022] [Indexed: 10/19/2022]
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Puga M, Pallar�s N, Velásquez-Rodríguez J, García-Sumalla A, Consiglieri CF, Busquets J, Laquente B, Calvo M, Fabregat J, Castellote J, Gornals JB. Endoscopic biliary drainage in unresectable biliary obstruction: the role of endoscopic ultrasound-guidance in a cohort study. REVISTA ESPAÑOLA DE ENFERMEDADES DIGESTIVAS 2019; 111. [DOI: 10.17235/reed.2019.6225/2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Shiomi H, Yamao K, Hoki N, Hisa T, Ogura T, Minaga K, Masuda A, Matsumoto K, Kato H, Kamada H, Goto D, Imai H, Takenaka M, Noguchi C, Nishikiori H, Chiba Y, Kutsumi H, Kitano M. Endoscopic Ultrasound-Guided Rendezvous Technique for Failed Biliary Cannulation in Benign and Resectable Malignant Biliary Disorders. Dig Dis Sci 2018; 63:787-796. [PMID: 29349694 DOI: 10.1007/s10620-018-4908-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 01/02/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Endoscopic ultrasound-guided rendezvous technique (EUS-RV) has emerged as an effective salvage method for unsuccessful biliary cannulation. However, its application for benign and resectable malignant biliary disorders has not been fully evaluated. AIMS To assess the efficacy and safety of EUS-RV for benign and resectable malignant biliary disorders. METHODS This was a multicenter prospective study from 12 Japanese referral centers. Patients who underwent EUS-RV after failed biliary cannulation for biliary disorder were candidates for this study. Inclusion criteria were unsuccessful biliary cannulation for therapeutic endoscopic retrograde cholangiopancreatography with benign and potentially resectable malignant biliary obstruction. Exclusion criteria included unresectable malignant biliary obstruction, inaccessible papillae due to surgically altered upper gastrointestinal anatomy or duodenal stricture, and previous sphincterotomy and/or biliary stent placement. The primary outcome was the technical success rate of biliary cannulation; procedure time, adverse events, and clinical outcomes were secondary outcomes. RESULTS Twenty patients were prospectively enrolled. The overall technical success rate and median procedure time were 85% and 33 min, respectively. Guidewire manipulation using a 4-Fr tapered tip catheter contributed to the success in advancing the guidewire into the duodenum. Adverse events were identified in 15% patients, including 2 with biliary peritonitis and 1 mild pancreatitis. EUS-RV did not affect surgical maneuvers or complications associated with surgery, or postoperative course. CONCLUSIONS EUS-RV may be a safe and feasible salvage method for unsuccessful biliary cannulation for benign or resectable malignant biliary disorders. Use of a 4-Fr tapered tip catheter may improve the overall EUS-RV success rate.
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Affiliation(s)
- Hideyuki Shiomi
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan
| | - Kentaro Yamao
- Department of Gastroenterology and Hepatology, Kinki University Faculty of Medicine, Osaka-sayama, 589-8511, Japan
| | - Noriyuki Hoki
- Department of Gastroenterology, Bellland General Hospital, Sakai, Osaka, 599-8247, Japan
| | - Takeshi Hisa
- Department of Internal Medicine, Saku Central Hospital Advanced Care Center, Nagano, 384-0301, Japan
| | - Takeshi Ogura
- Second Department of Internal Medicine, Osaka Medical College, Takatsuki, 569-8686, Japan
| | - Kosuke Minaga
- Department of Gastroenterology and Hepatology, Kinki University Faculty of Medicine, Osaka-sayama, 589-8511, Japan.,Department of Gastroenterology and Hepatology, Japanese Red Cross Society Wakayama Medical Center, Wakayama, 640-8558, Japan
| | - Atsuhiro Masuda
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan
| | - Kazuya Matsumoto
- Department of Gastroenterology, Tottori University Hospital, Yonago, 683-8504, Japan
| | - Hironari Kato
- Departments of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, 700-8558, Japan
| | - Hideki Kamada
- Department of Gastroenterology and Neurology, Kagawa University Faculty of Medicine, Kagawa, 761-0793, Japan
| | - Daisuke Goto
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tottori Red Cross Hospital, Tottori, 680-8517, Japan
| | - Hajime Imai
- Department of Gastroenterology and Hepatology, Kinki University Faculty of Medicine, Osaka-sayama, 589-8511, Japan
| | - Mamoru Takenaka
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan.,Department of Gastroenterology and Hepatology, Kinki University Faculty of Medicine, Osaka-sayama, 589-8511, Japan
| | - Chishio Noguchi
- Department of Gastroenterology, Shinbeppu Hospital, 3898 Tsurumi, Beppu-shi, Oita, 874-0833, Japan
| | - Hidefumi Nishikiori
- Department of Gastroenterology, Oita Sanai Medical Center, Oita, 870-1151, Japan
| | - Yasutaka Chiba
- Clinical Research Center, Kinki University Hospital, Osaka-sayama, 589-8511, Japan
| | - Hiromu Kutsumi
- Center for Clinical Research and Advanced Medicine Establishment, Shiga University of Medical Science, Otsu, 520-2192, Japan
| | - Masayuki Kitano
- Second Department of Internal Medicine, Wakayama Medical University School of Medicine, 811-1 Kimiidera, Wakayama, 641-8509, Japan.
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Elmunzer BJ, Piraka CR. EUS-Guided Methylene Blue Injection to Facilitate Pancreatic Duct Access After Unsuccessful ERCP. Gastroenterology 2016; 151:809-810. [PMID: 27639800 DOI: 10.1053/j.gastro.2016.08.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Revised: 08/22/2016] [Accepted: 08/24/2016] [Indexed: 01/27/2023]
Affiliation(s)
- B Joseph Elmunzer
- Division of Gastroenterology & Hepatology, Medical University of South Carolina, Charleston, South Carolina
| | - Cyrus R Piraka
- Division of Gastroenterology, Henry Ford Health System, Detroit, Michigan
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