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Irani SS, Sharma NR, Storm AC, Shah RJ, Chahal P, Willingham FF, Swanstrom L, Baron TH, Shlomovitz E, Kozarek RA, Peetermans JA, McMullen E, Ho E, van der Merwe SW. Endoscopic Ultrasound-guided Transluminal Gallbladder Drainage in Patients With Acute Cholecystitis: A Prospective Multicenter Trial. Ann Surg 2023; 278:e556-e562. [PMID: 36537290 PMCID: PMC10414151 DOI: 10.1097/sla.0000000000005784] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To evaluate the safety and efficacy of endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) using a lumen-apposing metal stent (LAMS). BACKGROUND For patients with acute cholecystitis who are poor surgical candidates, EUS-GBD using a LAMS is an important treatment alternative to percutaneous gallbladder drainage. METHODS We conducted a regulatory-compliant, prospective multicenter trial at 7 tertiary referral centers in the United States of America and Belgium. Thirty consecutive patients with mild or moderate acute cholecystitis who were not candidates for cholecystectomy were enrolled between September 2019 and August 2021. Eligible patients had a LAMS placed transmurally with 30 to 60-day indwell if removal was clinically indicated, and 30-day follow-up post-LAMS removal. Endpoints included days until acute cholecystitis resolution, reintervention rate, acute cholecystitis recurrence rate, and procedure-related adverse events (AEs). RESULTS Technical success was 93.3% (28/30) for LAMS placement and 100% for LAMS removal in 19 patients for whom removal was attempted. Five (16.7%) patients required reintervention. Mean time to acute cholecystitis resolution was 1.6±1.5 days. Acute cholecystitis symptoms recurred in 10.0% (3/30) after LAMS removal. Five (16.7%) patients died from unrelated causes. Procedure-related AEs were reported to the FDA in 30.0% (9/30) of patients, including one fatal event 21 days after LAMS removal; however, no AEs were causally related to the LAMS. CONCLUSIONS For selected patients with acute cholecystitis who are at elevated surgical risk, EUS-GBD with LAMS is an alternative to percutaneous gallbladder drainage. It has high technical and clinical success, with low recurrence and an acceptable AE rate. Clinicaltrials.gov, Number: NCT03767881.
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Affiliation(s)
- Shayan S. Irani
- Division of Gastroenterology, Virginia Mason Medical Center, Seattle, WA
| | - Neil R. Sharma
- Division of Interventional Oncology and Surgical Endoscopy (IOSE), Parkview Cancer Institute, Ft. Wayne, IN
| | - Andrew C. Storm
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - Raj J. Shah
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Prabhleen Chahal
- Division of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Cleveland, OH
| | - Field F. Willingham
- Division of Digestive Diseases, Department of Medicine, Emory University, Atlanta, GA
| | - Lee Swanstrom
- IHU—Strasbourg, Institute for Image Guided Surgery, Strasbourg, France
| | - Todd H. Baron
- Division of Gastroenterology and Hepatology, Director of Advanced Therapeutic Endoscopy, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Eran Shlomovitz
- Department of Interventional Radiology, University of Toronto, Toronto, ON, Canada
| | - Richard A. Kozarek
- Division of Gastroenterology, Virginia Mason Medical Center, Seattle, WA
| | | | - Edmund McMullen
- Endoscopy Division, Boston Scientific Corporation, Marlborough, MA
| | - Evelyne Ho
- Endoscopy Division, Boston Scientific Corporation, Marlborough, MA
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Keswani RN, Duloy A, Nieto JM, Panganamamula K, Murad MH, Bazerbachi F, Shaukat A, Elmunzer BJ, Day LW. Interventions to improve the performance of ERCP and EUS quality indicators. Gastrointest Endosc 2023; 97:825-838. [PMID: 36967249 DOI: 10.1016/j.gie.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 12/11/2022] [Indexed: 04/21/2023]
Affiliation(s)
- Rajesh N Keswani
- Division of Gastroenterology, Department of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Anna Duloy
- Division of Gastroenterology, Department of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Jose M Nieto
- Digestive Disease Consultants, Jacksonville, Florida, USA
| | - Kashyap Panganamamula
- Division of Gastroenterology, Department of Medicine, University of Pennsylvania, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania, USA
| | - M Hassan Murad
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Fateh Bazerbachi
- CentraCare, Interventional Endoscopy Program, St Cloud Hospital, St Cloud, Minnesota, USA
| | - Aasma Shaukat
- Division of Gastroenterology and Hepatology, NYU Grossman School of Medicine, New York, New York, USA
| | - B Joseph Elmunzer
- Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Lukejohn W Day
- Division of Gastroenterology, Department of Medicine, Zuckerberg San Francisco General Hospital and University of San Francisco, San Francisco, California, USA
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Sánchez-Ocaña R, Foruny Olcina JR, Vila Costas J, Gallego Rojo F, Jiménez Pérez J, Domínguez-Muñoz E, González Huix F, Pons Beltrán V, Gornals Soler J, Sánchez Hernández E, Gómez Oliva C, Dolz Abadía C, Aparicio Tormo JR. SEED Consensus Document on SpyGlass-DS. GASTROENTEROLOGIA Y HEPATOLOGIA 2023; 46:69-79. [PMID: 36179947 DOI: 10.1016/j.gastrohep.2022.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/07/2022] [Accepted: 08/26/2022] [Indexed: 01/18/2023]
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is the technique of choice for the treatment of biliopancreatic pathology. However, fluoroscopic imaging does not always allow an adequate diagnosis. On the other hand, some large stones cannot be removed by the usual methods. In these situations, cholangioscopy has proven to be an essential tool for the diagnosis of biliary strictures and the treatment of large stones. Its role in pancreatic pathology is also increasing. The development of a single-operator, disposable cholangioscope has made it possible to expand the technique to a large number of hospitals that perform ERCP. For this reason, the Spanish Society of Digestive Endoscopy has developed this consensus document on the use of the Spyglass-DS cholangioscope. The document has been prepared by a group of endoscopists with expertise in cholangioscopy, reviewing the scientific evidence on the main current indications for cholangiopancreatoscopy.
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Affiliation(s)
- Ramón Sánchez-Ocaña
- Servicio de Medicina Digestiva, Hospital Universitario Río Hortega, Valladolid, España
| | - José Ramón Foruny Olcina
- Unidad de Endoscopia, Servicio de Medicina Digestiva, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Juan Vila Costas
- Unidad de Endoscopia, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
| | | | - Javier Jiménez Pérez
- Unidad de Endoscopia, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
| | - Enrique Domínguez-Muñoz
- Servicio de Gastroenterología, Hospital Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, España
| | | | - Vicente Pons Beltrán
- Endoscopia Digestiva, Hospital Universitari i Politecnic La Fe, Valencia, España
| | - Joan Gornals Soler
- Endoscopia Digestiva, Hospital Universitari Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | | | | | - Carlos Dolz Abadía
- Aparato Digestivo, Hospital Universitario Son Llàtzer, Palma de Mallorca, España
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Machicado JD, Raijman I, Shah RJ. Future of Cholangioscopy. Gastrointest Endosc Clin N Am 2022; 32:583-596. [PMID: 35691698 DOI: 10.1016/j.giec.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This article highlights the current status of cholangioscopy. In addition, the authors present their view on the future directions of cholangioscopy, including novel clinical applications, the need for technologic developments, and the expansion on the use of cholangioscopy in clinical practice. The authors envision that cholangioscopy will eventually become a conventional tool in the shelf of any biliary endoscopist. Future technologic improvements including optics, maneuverability, and full device accessories, plus the introduction of real-time artificial intelligence algorithms, will optimize the outcomes of cholangioscopy, but baseline proficiency in therapeutic endoscopic retrograde cholangiopancreatography will remain necessary for its successful utilization.
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Affiliation(s)
- Jorge D Machicado
- Division of Gastroenterology and Hepatology, University of Michigan, 1500 East Medical Center Drive, Floor 3, Reception D, Ann Arbor, MI 48109, USA
| | - Isaac Raijman
- Texas Digestive Disease Consultants, 4100 South Sheperd Drive, Houston, TX 77098, USA
| | - Raj J Shah
- Pancreas and Biliary Endoscopy, Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, 1635 Aurora Court, Mail Stop F735, Aurora, CO 80045, USA.
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Lee TH, Moon JH, Lee YN, Yoo HW, Yang JK, Cha SW, Cho YD, Park SH. A Preliminary Study on the Efficacy of Single-Operator Cholangioscopy with a New Basket for Residual Stone Retrieval After Mechanical Lithotripsy. Dig Dis Sci 2022; 67:2571-2576. [PMID: 34089137 DOI: 10.1007/s10620-021-07068-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 05/17/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM The detection of residual or fragmented common bile duct (CBD) stones after lithotripsy can be improved by the high-resolution imaging quality of digital, single-operator cholangioscopy (SOC). However, therapeutic interventions for the removal of residual CBD stones are limited by the lack of appropriate tools. We retrospectively evaluated the role of SOC and the newly developed Dormia basket for the evaluation and removal of stones remaining after lithotripsy. METHODS Thirty-four patients who had undergone lithotripsy for retained CBD stones with no evidence of filling defects in occluded balloon cholangiography from March 2017 to October 2018 were included in the study. After balloon cholangiography, the bile duct was evaluated by SOC for complete evacuation of the stones. The detected residual CBD stones were directly retrieved by inserting the newly developed Dormia basket into the working channel of the SOC. The incidence of residual stones detected by SOC and the success rate of residual stone retrieval by SOC were investigated. RESULTS Digital SOC was successfully performed in all patients. Of these, 11 patients (32.4%) had residual CBD stones. The residual stones were successfully removed in 10 patients (90.9%) by SOC using the Dormia basket, except in one case of residual stones left in the hepatic duct. There were no adverse events associated with the SOC procedures or direct stone removal. CONCLUSIONS Digital SOC combined with the newly developed Dormia basket was useful for the detection and extraction of residual CBD stones under direct visualization after lithotripsy.
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Affiliation(s)
- Tae Hoon Lee
- Division of Gastroenterology, Department of Internal Medicine, SoonChunHyang University College of Medicine, Cheonan Hospital, Cheonan, Republic of Korea
| | - Jong Ho Moon
- Division of Gastroenterology, Department of Internal Medicine, SoonChunHyang University College of Medicine, Bucheon Hospital, Bucheon, Republic of Korea.
| | - Yun Nah Lee
- Division of Gastroenterology, Department of Internal Medicine, SoonChunHyang University College of Medicine, Bucheon Hospital, Bucheon, Republic of Korea
| | - Hae Won Yoo
- Division of Gastroenterology, Department of Internal Medicine, SoonChunHyang University College of Medicine, Bucheon Hospital, Bucheon, Republic of Korea
| | - Jae Kook Yang
- Division of Gastroenterology, Department of Internal Medicine, SoonChunHyang University College of Medicine, Cheonan Hospital, Cheonan, Republic of Korea
| | - Sang-Woo Cha
- Division of Gastroenterology, Department of Internal Medicine, SoonChunHyang University College of Medicine, Seoul Hospital, Seoul, Republic of Korea
| | - Young Deok Cho
- Division of Gastroenterology, Department of Internal Medicine, SoonChunHyang University College of Medicine, Seoul Hospital, Seoul, Republic of Korea
| | - Sang-Heum Park
- Division of Gastroenterology, Department of Internal Medicine, SoonChunHyang University College of Medicine, Cheonan Hospital, Cheonan, Republic of Korea
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Abstract
Despite advances in noninvasive techniques for imaging the pancreaticobiliary system, several disease processes including indeterminate biliary strictures as well as neuroendocrine tumors, inflammatory pseudotumors, and complex cysts of the pancreas remain difficult to characterize. New endoscopic imaging technologies have emerged to address these challenges. Cholangioscopy and intraductal ultrasound (IDUS) are powerful tools to characterize subtle biliary concretions and strictures. Confocal Laser Endomicroscopy (CLE) and Optical Coherence Tomography (OCT) are emerging approaches for the most difficult biliary lesions. Contrast harmonic endoscopic ultrasound (CH-EUS), elastography, and 3D-EUS are improving the approach to subtle pancreatic lesions, particularly in the context of indeterminate tissue sampling. Pancreatoscopy, pancreatic IDUS, and intracystic CLE hold promise to further improve the assessment of pancreatic cysts. We aim to comprehensively review the emerging clinical evidence for these innovative endoscopic imaging techniques.
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Lin YY, Wang YD, Yue P, Zhang XZ, Leung JW, Jiao PP, Yang M, Wang HP, Bai B, Liu Y, Zhang JD, Chen HB, Meng WB, Li X. Could saline irrigation clear all residual common bile duct stones after lithotripsy? A self-controlled prospective cohort study. World J Gastroenterol 2021; 27:358-370. [PMID: 33584068 PMCID: PMC7852583 DOI: 10.3748/wjg.v27.i4.358] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 12/11/2020] [Accepted: 12/29/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A previous study showed that irrigation with 100 mL saline reduced residual common bile duct (CBD) stones, which potentially cause recurrent stones after endoscopic retrograde cholangiopancreatography.
AIM To determine whether saline irrigation can improve CBD clearance after lithotripsy.
METHODS This prospective self-controlled study enrolled patients receiving mechanical lithotripsy for large (> 1.2 cm) CBD stones. After occlusion cholangiography confirmed CBD stone clearance, peroral cholangioscopy (POC) was performed to determine clearance scores based on the number of residual stones. The amounts of residual stones spotted via POC were graded on a 5-point scale (score 1, worst; score 5, best). Scores were documented after only stone removal (control) and after irrigation with 50 mL and 100 mL saline, respectively. The stone composition was analyzed using infrared spectroscopy.
RESULTS Between October 2018 and January 2020, 47 patients had CBD clearance scores of 2.4 ± 1.1 without saline irrigation, 3.5 ± 0.7 with 50 mL irrigation, and 4.6 ± 0.6 with 100 mL irrigation (P < 0.001). Multivariate analysis showed that CBD diameter > 15 mm [odds ratio (OR) = 0.08, 95% confidence interval (CI): 0.01-0.49; P = 0.007] and periampullary diverticula (PAD) (OR = 6.51, 95%CI: 1.08-39.21; P = 0.041) were independent risk factors for residual stones. Bilirubin pigment stones constituted the main residual stones found in patients with PAD (P = 0.004).
CONCLUSION Irrigation with 100 mL of saline may not clear all residual CBD stones after lithotripsy, especially in patients with PAD and/or a dilated (> 15 mm) CBD. Pigment residual stones are soft and commonly found in patients with PAD. Additional saline irrigation may be required to remove retained stones.
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Affiliation(s)
- Yan-Yan Lin
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- Clinical Medical College Cancer Center of Lanzhou University, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- Key Laboratory of Biological Therapy and Regenerative Medicine Transformation of Gansu Province, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Yu-Dong Wang
- Department of General Surgery, The First Affiliated Hospital of Henan Polytechnic University, Jiaozuo 454001, Henan Province, China
| | - Ping Yue
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- Clinical Medical College Cancer Center of Lanzhou University, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- Key Laboratory of Biological Therapy and Regenerative Medicine Transformation of Gansu Province, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Xian-Zhuo Zhang
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- The First School of Clinical Medicine, Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Joseph W Leung
- Department of Gastroenterology, Sacramento VA Medical Center, Mather, CA 95655-4200, United States
- Department of Gastroenterology and Hepatology, UC Davis Medical Center, Sacramento, CA 95817, United States
| | - Pan-Pan Jiao
- The First School of Clinical Medicine, Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Man Yang
- Department of Gastroenterology, Songgang People’s Hospital, Shenzhen 518105, Guangdong Province, China
| | - Hai-Ping Wang
- Clinical Medical College Cancer Center of Lanzhou University, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- Key Laboratory of Biological Therapy and Regenerative Medicine Transformation of Gansu Province, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Bing Bai
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- Clinical Medical College Cancer Center of Lanzhou University, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- Key Laboratory of Biological Therapy and Regenerative Medicine Transformation of Gansu Province, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Ying Liu
- School of Foreign Languages and Literatures, Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Jin-Duo Zhang
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- Clinical Medical College Cancer Center of Lanzhou University, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- Key Laboratory of Biological Therapy and Regenerative Medicine Transformation of Gansu Province, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Hong-Bo Chen
- School of Pharmaceutical Sciences, Sun Yat-sen University, Shenzhen 518105, Guangdong Province, China
| | - Wen-Bo Meng
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- Clinical Medical College Cancer Center of Lanzhou University, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- Key Laboratory of Biological Therapy and Regenerative Medicine Transformation of Gansu Province, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Xun Li
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- Clinical Medical College Cancer Center of Lanzhou University, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- Key Laboratory of Biological Therapy and Regenerative Medicine Transformation of Gansu Province, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
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