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Takano Y, Tamai N, Yamawaki M, Noda J, Matsubara D, Azami T, Niiya F, Nishimoto F, Maruoka N, Yamagami T, Nagahama M. Endoscopic ultrasound-guided infectious liver cyst drainage associated with autosomal dominant polycystic kidney disease in which percutaneous approach is impossible. DEN OPEN 2024; 4:e314. [PMID: 37927950 PMCID: PMC10625053 DOI: 10.1002/deo2.314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/17/2023] [Accepted: 10/25/2023] [Indexed: 11/07/2023]
Abstract
A man in his 70s on maintenance dialysis for autosomal dominant polycystic kidney disease was admitted with epigastralgia and a fever lasting for 1 week. Computed tomography showed a thickened liver cyst measuring 121 mm in the caudate lobe, suggesting infection. Percutaneous drainage was impossible because multiple liver cysts and ascites entered the puncture route. Endoscopic ultrasound (EUS) revealed a huge liver cyst with debris-like echoes. Transgastric EUS-guided drainage was performed, and internal and external drainage was performed without adverse events. After the procedure, the symptoms quickly improved, and the external drain was removed after 12 days. The internal drainage stent remained in place, and the patient was discharged from the hospital 53 days after the EUS-guided drainage. EUS-guided drainage is an effective alternative treatment for infected liver cysts where a percutaneous approach is impossible.
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Affiliation(s)
- Yuichi Takano
- Division of GastroenterologyDepartment of Internal MedicineShowa University Fujigaoka HospitalKanagawaJapan
| | - Naoki Tamai
- Division of GastroenterologyDepartment of Internal MedicineShowa University Fujigaoka HospitalKanagawaJapan
| | - Masataka Yamawaki
- Division of GastroenterologyDepartment of Internal MedicineShowa University Fujigaoka HospitalKanagawaJapan
| | - Jun Noda
- Division of GastroenterologyDepartment of Internal MedicineShowa University Fujigaoka HospitalKanagawaJapan
| | - Dai Matsubara
- Division of GastroenterologyDepartment of Internal MedicineShowa University Fujigaoka HospitalKanagawaJapan
| | - Tetsushi Azami
- Division of GastroenterologyDepartment of Internal MedicineShowa University Fujigaoka HospitalKanagawaJapan
| | - Fumitaka Niiya
- Division of GastroenterologyDepartment of Internal MedicineShowa University Fujigaoka HospitalKanagawaJapan
| | - Fumiya Nishimoto
- Division of GastroenterologyDepartment of Internal MedicineShowa University Fujigaoka HospitalKanagawaJapan
| | - Naotaka Maruoka
- Division of GastroenterologyDepartment of Internal MedicineShowa University Fujigaoka HospitalKanagawaJapan
| | - Tatsuya Yamagami
- Division of GastroenterologyDepartment of Internal MedicineShowa University Fujigaoka HospitalKanagawaJapan
| | - Masatsugu Nagahama
- Division of GastroenterologyDepartment of Internal MedicineShowa University Fujigaoka HospitalKanagawaJapan
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2
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Gadour E, Awad A, Hassan Z, Shrwani KJ, Miutescu B, Okasha HH. Diagnostic and therapeutic role of endoscopic ultrasound in liver diseases: A systematic review and meta-analysis. World J Gastroenterol 2024; 30:742-758. [PMID: 38515947 PMCID: PMC10950627 DOI: 10.3748/wjg.v30.i7.742] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 12/19/2023] [Accepted: 01/16/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND In hepatology, the clinical use of endoscopic ultrasound (EUS) has experienced a notable increase in recent times. These applications range from the diagnosis to the treatment of various liver diseases. Therefore, this systematic review summarizes the evidence for the diagnostic and therapeutic roles of EUS in liver diseases. AIM To examine and summarize the current available evidence of the possible roles of the EUS in making a suitable diagnosis in liver diseases as well as the therapeutic accuracy and efficacy. METHODS PubMed, Medline, Cochrane Library, Web of Science, and Google Scholar databases were extensively searched until October 2023. The methodological quality of the eligible articles was assessed using the Newcastle-Ottawa scale or Cochrane Risk of Bias tool. In addition, statistical analyses were performed using the Comprehensive Meta-Analysis software. RESULTS Overall, 45 articles on EUS were included (28 on diagnostic role and 17 on therapeutic role). Pooled analysis demonstrated that EUS diagnostic tests had an accuracy of 92.4% for focal liver lesions (FLL) and 96.6% for parenchymal liver diseases. EUS-guided liver biopsies with either fine needle aspiration or fine needle biopsy had low complication rates when sampling FLL and parenchymal liver diseases (3.1% and 8.7%, respectively). Analysis of data from four studies showed that EUS-guided liver abscess had high clinical (90.7%) and technical success (90.7%) without significant complications. Similarly, EUS-guided interventions for the treatment of gastric varices (GV) have high technical success (98%) and GV obliteration rate (84%) with few complications (15%) and rebleeding events (17%). CONCLUSION EUS in liver diseases is a promising technique with the potential to be considered a first-line therapeutic and diagnostic option in selected cases.
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Affiliation(s)
- Eyad Gadour
- Department of Gastroenterology and Hepatology, King Abdulaziz Hospital-National Guard, Ahsa 31982, Saudi Arabia
- Department of Internal Medicine, Faculty of Medicine, Zamzam University College, Khartoum 11113, Sudan
| | - Abeer Awad
- Department of Hepatogastroenterology, Kasar Alainy Hospital, Faculty of Medicine, Cairo University, Cairo 11451, Egypt
| | - Zeinab Hassan
- Department of Internal Medicine, Stockport Hospitals NHS Foundation Trust, Manchester SK2 7JE, United Kingdom
| | - Khalid Jebril Shrwani
- Public Health Authority, Saudi Center for Disease Prevention and Control, Jazan 45142, Saudi Arabia
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, School of Medicine and Life Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Bogdan Miutescu
- Department of Gastroenterology and Hepatology, Victor Babes University of Medicine and Pharmacy, Timisoara 300041, Romania
- Advanced Regional Research Center in Gastroenterology and Hepatology, Victor Babes University of Medicine and Pharmacy, Timisoara 30041, Romania
| | - Hussein Hassan Okasha
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kasr Al-Aini School of Medicine, Cairo University, Cairo 11562, Egypt
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Shah J, Jena A, Singh AK, Jearth V, Dutta U. Endoscopic Ultrasound (EUS)-guided Drainage of Caudate Lobe Abscess: A Single Center Experience. Surg Laparosc Endosc Percutan Tech 2023; 33:682-687. [PMID: 37725821 DOI: 10.1097/sle.0000000000001229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/17/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Liver abscess is usually treated with medical therapy. Few patients require drainage of the collection due to large size, certain high-risk location or rupture of the collection. Percutaneous drainage is most commonly used modality for the drainage of such collection. However, caudate lobe poses a unique difficulty in percutaneous drainage due to its deep location. METHODS We did a retrospective analysis of all patients with caudate lobe abscess who underwent endoscopic ultrasound (EUS)-guided drainage at our center. We reviewed their indications, technical and clinical success rates of the procedure from 2020 to 2023. We also performed systemic review of published literature till June 12, 2023 showing use of EUS-guided drainage of caudate lobe abscess. RESULTS Total of 8 patients (age: 37.33 ± 12.8 y; Males 62.5%) underwent EUS-guided drainage of caudate lobe collection at our center. Six patients underwent drainage using plastic stents, 1 patient underwent using metal stent, and 1 patient had aspiration of the abscess. Technical success was achieved in all patients. One patient succumbed to background illness and clinical success could be achieved in rest of the patients. In systemic review of literature on EUS-guided drainage of caudate lobe, a total of 10 studies (17 patients) were included. All patients achieved technical success. Majority studies reported use of plastic stents or naso-cystic drains whereas only 1 case reported use of metal stents. One procedure related complication (localized para-esophageal abscess) was reported requiring endoscopic intervention for management. CONCLUSION EUS-guided drainage of caudate lobe abscess is safe and effective. It should be used as a first-line intervention after a failed medical management.
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Affiliation(s)
- Jimil Shah
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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4
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Shahid H, Tyberg A, Sarkar A, Gaidhane M, Mahpour NY, Patel R, Flumignan VK, Vazquez-Sequeiros E, Martínez GM, Artifon EL, Kahaleh M. EUS-guided versus percutaneous liver abscess drainage: A multicenter collaborative study. Endosc Ultrasound 2023; 12:472-476. [PMID: 38948125 PMCID: PMC11213585 DOI: 10.1097/eus.0000000000000033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/02/2024] Open
Abstract
Background and Objectives Management of hepatic abscesses has traditionally been performed by image-guided percutaneous techniques. More recently, EUS drainage has been shown to be efficacious and safe. The aim of this study is to compare EUS-guided versus percutaneous catheter drainage (PCD) of hepatic abscesses. Methods Patients who underwent EUS-guided drainage or PCD of hepatic abscesses from January 2018 through November 2021 from 4 international academic centers were included in a dedicated registry. Demographics, clinical data preprocedure and postprocedure, abscess characteristics, procedural data, adverse events, and postprocedure care were collected. Results Seventy-four patients were included (mean age, 63.9 years; 45% male): EUS-guided (n = 30), PCD (n = 44). Preprocedure Charlson Comorbidity Index scores were 4.3 for the EUS group and 4.3 for the PCD group. The median abscess size was 8.45 × 6 cm (length × width) in the EUS group versus 7.3 × 5.5 cm in the PCD group. All of the abscesses in the EUS group were left-sided, whereas the PCD group contained both left- and right-sided abscesses (29 and 15, respectively). Technical success was 100% in both groups. Ten-millimeter-diameter stents were used in most cases in the EUS group, and 10F catheters were used in the PCD group. The duration to resolution of symptoms from the initial procedure was 10.9 days less in the EUS group compared with the PCD group (P < 0.00001). Hospital length of stay was shorter in the EUS group by 5.2 days (P = 0.000126). The EUS group had significantly fewer number of repeat sessions: mean of 2 versus 7.7 (P < 0.00001) and trended toward fewer number of procedure-related readmissions: 10% versus 34%. The PCD group had a significantly higher number of adverse events (n = 27 [61%]) when compared with the EUS group (n = 5 [17%]; P = 0.0001). Conclusions EUS-guided drainage is an efficacious and safe intervention for the management of hepatic abscesses. EUS-guided drainage allows for quicker resolution of symptoms, shorter length of hospital stay, fewer adverse events, and fewer procedural sessions needed when compared with the PCD technique. However, EUS-guided drainage may not be feasible in right-sided lesions.
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Affiliation(s)
- Haroon Shahid
- Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Amy Tyberg
- Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Avik Sarkar
- Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Monica Gaidhane
- Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Noah Y. Mahpour
- Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Roohi Patel
- Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, NJ
| | | | | | | | | | - Michel Kahaleh
- Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, NJ
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5
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Alqahtani SA, Ausloos F, Park JS, Jang S. The Role of Endoscopic Ultrasound in Hepatology. Gut Liver 2023; 17:204-216. [PMID: 36457262 PMCID: PMC10018300 DOI: 10.5009/gnl220071] [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: 02/22/2022] [Revised: 05/19/2022] [Accepted: 06/21/2022] [Indexed: 12/05/2022] Open
Abstract
Endoscopic ultrasound (EUS) has been an indispensable and widely used diagnostic tool in several medical fields, including gastroenterology, cardiology, and urology, due to its diverse therapeutic and diagnostic applications. Many studies show that it is effective and safe in patients with liver conditions where conventional endoscopy or cross-sectional imaging are inefficient or when surgical interventions pose high risks. In this article, we present a review of the current literature for the different diagnostic and therapeutic applications of EUS in liver diseases and their complications and discuss the potential future application of artificial intelligence analysis of EUS.
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Affiliation(s)
- Saleh A Alqahtani
- Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, MD, USA.,Liver Transplant Centre, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Floriane Ausloos
- Department of Gastroenterology and Hepatology, CHU Liège, Sart-Tilman, Liège, Belgium
| | - Ji Seok Park
- Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sunguk Jang
- Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA
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Okuno N, Hara K, Mizuno N, Haba S, Kuwahara T, Kuraishi Y, Yanaidani T, Ishikawa S, Yasuda T, Yamada M, Fukui T. Endoscopic ultrasound-guided drainage for an abscess cavity. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2022. [DOI: 10.18528/ijgii220051] [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: 11/06/2022] Open
Affiliation(s)
- Nozomi Okuno
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Kazuo Hara
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Nobumasa Mizuno
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Shin Haba
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Takamichi Kuwahara
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yasuhiro Kuraishi
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Takafumi Yanaidani
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Sho Ishikawa
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Tsukasa Yasuda
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Masanori Yamada
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Toshitaka Fukui
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
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Jearth V, Sundaram S, Rana SS. Diagnostic and interventional EUS in hepatology: An updated review. Endosc Ultrasound 2022; 11:355-370. [PMID: 36255023 PMCID: PMC9688142 DOI: 10.4103/eus-d-22-00027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
EUS has become an increasingly used diagnostic and therapeutic modality in the armamentarium of endoscopists. With ever-expanding indications, EUS is being used in patients with liver disease, for both diagnosis and therapy. EUS is playing an important role in providing additional important information to that provided by cross-sectional imaging modalities such as computerized tomography and magnetic resonance imaging. Domains of therapy that were largely restricted to interventional radiologists have become accessible to endosonologists. From liver biopsy and sampling of liver lesions to ablative therapy for liver lesions and vascular interventions for varices, there is increased use of EUS in patients with liver disease. In this review, we discuss the various diagnostic and therapeutic applications of EUS in patients with various liver diseases.
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Affiliation(s)
- Vaneet Jearth
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sridhar Sundaram
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Surinder Singh Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India,Address for correspondence Prof. Surinder Singh Rana, Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh - 160 012, India. E-mail:
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8
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Maulahela H, Fauzi A, Renaldi K, Srisantoso QP, Jasmine A. Current role of endoscopic ultrasound for gastrointestinal and abdominal tuberculosis. JGH Open 2022; 6:745-753. [PMID: 36406654 PMCID: PMC9667406 DOI: 10.1002/jgh3.12823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/10/2022] [Accepted: 09/15/2022] [Indexed: 11/26/2022]
Abstract
A high incidence of tuberculosis (TB), especially in endemic countries, makes this infectious disease a concern. Abdominal TB contributes to 10% of extrapulmonary TB. Due to nonspecific clinical, radiological, and endoscopic findings, diagnosing abdominal TB continues to be a challenge. Hence, a precise diagnosis is needed. The diagnosis of gastrointestinal disease using endoscopic ultrasound (EUS) is often performed due to its high resolution and ability to provide a real‐time visual representation of the gastrointestinal tract and extramural structures. EUS‐guided fine‐needle aspiration (FNA) and fine‐needle biopsy (FNB) have helped diagnose TB as they offer an adequate specimen for cytology or histopathological examination. This method is considered safer, more effective, and more efficient. The capacity of EUS to diagnose abdominal TB based on the affected organs was examined via a literature search. We reviewed the role of EUS in diagnosing esophageal, gastric, pancreatic, peripancreatic, hepatosplenic, peritoneal, and intestinal TB. Generally, EUS aids in diagnosing abdominal TB. In some organs, it is superior to other diagnostic modalities. However, further examinations, such as cytology or histopathology and microbial, are still needed. We also studied the roles of EUS‐FNA and EUS‐FNB. EUS‐FNA has shown a high diagnostic yield in esophageal (94.3–100%), pancreatic and peripancreatic (76.2%), and intestinal TB (84.1%). As minimally invasive methods, EUS‐FNA and EUS‐FNB can successfully provide sufficient samples. EUS is a functional diagnostic modality for abdominal TB. EUS‐FNA and EUS‐FNB provide sufficient samples safely and efficiently for further cytology, histopathology, and microbial examinations.
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Affiliation(s)
- Hasan Maulahela
- Division of Gastroenterology, Pancreatobiliary, and Digestive Endoscopy, Internal Medicine Department Faculty of Medicine Universitas Indonesia‐Cipto Mangunkusumo National Central General Hospital Jakarta Indonesia
| | - Achmad Fauzi
- Division of Gastroenterology, Pancreatobiliary, and Digestive Endoscopy, Internal Medicine Department Faculty of Medicine Universitas Indonesia‐Cipto Mangunkusumo National Central General Hospital Jakarta Indonesia
| | - Kaka Renaldi
- Division of Gastroenterology, Pancreatobiliary, and Digestive Endoscopy, Internal Medicine Department Faculty of Medicine Universitas Indonesia‐Cipto Mangunkusumo National Central General Hospital Jakarta Indonesia
| | | | - Amirah Jasmine
- Faculty of Medicine University of Indonesia Jakarta Indonesia
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Zanwar S, Agrawal A. Endosonography-Guided Caudate Lobe Liver Abscess Drainage: A Case and Review of Methods. JOURNAL OF DIGESTIVE ENDOSCOPY 2022. [DOI: 10.1055/s-0042-1747912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
AbstractThere are only 11 cases of caudate lobe liver abscess drainage described in the published literature. We present a case of liver abscess drainage done by endosonography (EUS) and review of various EUS-guided liver abscess drainage techniques and endoprostheses. Here we have aimed at reviewing the data for paving the way for the development of a consensus for liver abscess drainage.
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Affiliation(s)
- Shankar Zanwar
- Department of Gastroenterology, Care Hospitals, Nagpur, India
| | - Amit Agrawal
- Department of Gastroenterology, Disha Clinics, Nagpur, India
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10
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Shionoya K, Koizumi K, Masuda S, Suno Y, Kawachi J, Kimura K, Makazu M, Kubota J, Nishino T, Sumida C, Tasaki J, Ichita C, Sasaki A, Hadano H, Kako M. Liver cyst with biliary communication treated with endoscopic ultrasound-guided drainage: A case report. Medicine (Baltimore) 2022; 101:e29007. [PMID: 35356909 PMCID: PMC10684242 DOI: 10.1097/md.0000000000029007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 02/16/2022] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Simple liver cysts are common, and usually benign and asymptomatic, requiring little to no treatment. Liver cysts with biliary communication, however, are rare and require effective treatment to avoid recurrence. PATIENT CONCERNS A 70-year-old woman with breast cancer visited our hospital for treatment. Physical examination revealed abdominal distension and bilateral lower leg edema. DIAGNOSIS Abdominal contrast-enhanced computed tomography revealed a giant liver cyst, inducing inferior vena cava compression that was causing her edema. INTERVENTIONS Percutaneous transhepatic cyst drainage was performed. Since the bilirubin level in the drained fluid was high, the patient was diagnosed with a liver cyst with biliary communication. After the procedure, her symptoms improved and the cyst decreased in size. However, the drainage volume did not decrease after approximately 2 weeks. Sclerotherapy with minocycline was ineffective. Thus, endoscopic retrograde cholangiopancreatography was performed, and an endoscopic nasobiliary drainage tube was inserted. The percutaneous drainage tube was clamped, and the cyst showed increase in size. Therefore, endoscopic ultrasound-guided cyst drainage, which is less invasive than surgery, was performed. OUTCOMES The cyst tended to decrease in size even after the percutaneous drainage tube had been removed. At 3years follow-up, the cyst has almost disappeared. LESSONS Endoscopic ultrasound-guided drainage can treat liver cyst with biliary communication.
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Affiliation(s)
| | - Kazuya Koizumi
- Correspondence: Kazuya Koizumi, Shonan Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura-shi, Kanagawa 247-8533, Japan (e-mail: ).
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11
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Jing X, Liu S, Tian Z, Jiang Y, Mao T, Ding X. Endoscopic ultrasound-guided drainage to abdominal abscess: A systematic review and meta-analysis. J Minim Access Surg 2022; 18:489-496. [PMID: 35915535 PMCID: PMC9632695 DOI: 10.4103/jmas.jmas_349_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Ultrasound (US)- or computed tomography-guided drainage for abdominal abscess is currently the first-line options for drainage, but both options have disadvantages. Patients without adequate windows for drainage mostly undergo surgical drainage. However, surgical drainage is invasive and expensive. Endoscopic US (EUS)-guided drainage is a minimally invasive alternative for abdominal abscess, but there is less consensus on its efficacy, safety and complications. This meta-analysis aims to evaluate EUS-guided drainage for abdominal abscess. Materials and Methods: We retrieved relevant papers on EUS-guided drainage for abdominal abscess from the PubMed, Cochrane Library, Web of Science and EMBASE databases. Each paper was reviewed, and data were extracted. We used R software version 3.6.3 to perform the meta-analysis. Fixed effects models were used for merging data. Results: A total of 11 papers met the inclusion criteria, with a total sample population of 264 patients. The meta-analysis showed that the pooled clinical success rate was 90% (95% confidence interval [CI], 0.85–0.95), the technical success rate was 99% (95% CI, 0.97–1.00) and the recurrence rate was 1% (95% CI, 0.00–0.03). Three studies reported the complications, including perforation, bleeding and stent migration; none of the other eight studies reported complications. There were no significant differences between subgroups. There was no publication bias in either the clinical or the technical success rates. Conclusions: This meta-analysis showed that EUS-guided drainage for abdominal abscess was effective and safe, with an excellent technical success rate. In addition, EUS-guided drainage could be used for abscesses with complex anatomy. Nevertheless, complications and stent type should be considered.
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12
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EUS-guided drainage of liver abscesses: Video demonstration of two novel endoscopic techniques (with video). Endosc Ultrasound 2022. [DOI: 10.4103/eus-d-21-00162] [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: 08/30/2023] Open
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13
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Dhar J, Samanta J. Role of endoscopic ultrasound in the field of hepatology: Recent advances and future trends. World J Hepatol 2021; 13:1459-1483. [PMID: 34904024 PMCID: PMC8637671 DOI: 10.4254/wjh.v13.i11.1459] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 07/19/2021] [Accepted: 09/03/2021] [Indexed: 02/06/2023] Open
Abstract
The role of endoscopic ultrasound (EUS) as a diagnostic and therapeutic modality for the management of various gastrointestinal diseases has been expanding. The imaging or intervention for various liver diseases has primarily been the domain of radiologists. With the advances in EUS, the domain of endosonologists is rapidly expanding in the field of hepatology. The ability to combine endoscopy and sonography in one hybrid device is a unique property of EUS, together with the ability to bring its probe/transducer near the liver, the area of interest. Its excellent spatial resolution and ability to provide real-time images coupled with several enhancement techniques, such as contrast-enhanced (CE) EUS, have facilitated the growth of EUS. The concept of “Endo-hepatology” encompasses the wide range of diagnostic and therapeutic procedures that are now gradually becoming feasible for managing various liver diseases. Diagnostic advancements can enable a wide array of techniques from elastography and liver biopsy for liver parenchymal diseases, to CE-EUS for focal liver lesions to portal pressure measurements for managing various liver conditions. Similarly, therapeutic advancements range from EUS-guided eradication of varices, drainage of bilomas and abscesses to various EUS-guided modalities of liver tumor management. We provide a comprehensive review of all the different diagnostic and therapeutic EUS modalities available for the management of various liver diseases. A synopsis of all the technical details involving each procedure and the available data has been tabulated, and the future trends in this area have been highlighted.
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Affiliation(s)
- Jahnvi Dhar
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Jayanta Samanta
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
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14
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Pavic T, Mikolasevic I, Kralj D, Blazevic N, Skrtic A, Budimir I, Lerotic I, Hrabar D. Role of Endoscopic Ultrasound in Liver Disease: Where Do We Stand? Diagnostics (Basel) 2021; 11:2021. [PMID: 34829368 PMCID: PMC8618190 DOI: 10.3390/diagnostics11112021] [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] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/25/2021] [Accepted: 10/29/2021] [Indexed: 12/13/2022] Open
Abstract
As the burden of liver disease in the general populace steadily increases, so does the need for both advanced diagnostic and treatment options. Endoscopic ultrasound is a reliable diagnostic and therapeutic method that has an established role, foremost in pancreatobiliary pathology. This paper aims to summarize the growing role of endoscopic ultrasound in hepatology based on the search of the current literature. A number of applications of endoscopic ultrasound are reviewed, including both noninvasive methods and tissue acquisition in focal and diffuse liver disease, portal hypertension measurement, detection and management of gastric and esophageal varices, treatment of focal liver lesions and staging of pancreatobiliary malignancies, treatment of cystic and solid liver lesions, as well as liver abscess drainage. Both hepatologists and endoscopists should be aware of the evolving role of endoscopic ultrasound in liver disease. The inherent invasive nature of endoscopic examination limits its use to a targeted population identified using noninvasive methods. Endoscopic ultrasound is one the most versatile methods in gastroenterology, allowing immediate access with detection, sampling, and treatment of digestive tract pathology. Further expansion of its use in hepatology is immanent.
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Affiliation(s)
- Tajana Pavic
- Department of Gastroenterology and Hepatology, University Hospital Center Sestre Milosrdnice, 10000 Zagreb, Croatia; (D.K.); (N.B.); (I.B.); (I.L.); (D.H.)
| | - Ivana Mikolasevic
- Department of Gastroenterology, University Hospital Center Rijeka, 51000 Rijeka, Croatia;
| | - Dominik Kralj
- Department of Gastroenterology and Hepatology, University Hospital Center Sestre Milosrdnice, 10000 Zagreb, Croatia; (D.K.); (N.B.); (I.B.); (I.L.); (D.H.)
| | - Nina Blazevic
- Department of Gastroenterology and Hepatology, University Hospital Center Sestre Milosrdnice, 10000 Zagreb, Croatia; (D.K.); (N.B.); (I.B.); (I.L.); (D.H.)
| | - Anita Skrtic
- Department of Pathology, Merkur University Hospital, 10000 Zagreb, Croatia;
| | - Ivan Budimir
- Department of Gastroenterology and Hepatology, University Hospital Center Sestre Milosrdnice, 10000 Zagreb, Croatia; (D.K.); (N.B.); (I.B.); (I.L.); (D.H.)
| | - Ivan Lerotic
- Department of Gastroenterology and Hepatology, University Hospital Center Sestre Milosrdnice, 10000 Zagreb, Croatia; (D.K.); (N.B.); (I.B.); (I.L.); (D.H.)
| | - Davor Hrabar
- Department of Gastroenterology and Hepatology, University Hospital Center Sestre Milosrdnice, 10000 Zagreb, Croatia; (D.K.); (N.B.); (I.B.); (I.L.); (D.H.)
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Endoscopic ultrasound-guided drainage of a fungal liver abscess using a lumen-apposing metal stent: case report and literature review. ACTA ACUST UNITED AC 2021; 59:93-98. [PMID: 33170145 DOI: 10.2478/rjim-2020-0035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Indexed: 11/20/2022]
Abstract
Liver abscesses are rare entities for which percutaneous drainage is traditionally employed. The technique is simple, but associated with a significant rate of side effects and patient discomfort. We herein report a case of fungal left liver lobe abscess that was successfully treated by using EUS-guided drainage, with insertion of a large caliber lumen-apposing metal stent. The literature review we performed on the topic seems to favor, at least for abscess in the left and/or caudate liver lobes, EUS as compared to percutaneous drainage.
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16
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Chandra S, Chandra U. Endoscopic ultrasound-guided transgastric drainage of radiologically inaccessible left lobe liver abscess involving segment 4, caudate lobe, and left lateral segments using a modified technique. Endosc Int Open 2021; 9:E35-E40. [PMID: 33403234 PMCID: PMC7775807 DOI: 10.1055/a-1293-7746] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 09/30/2020] [Indexed: 01/19/2023] Open
Abstract
Liver abscess requiring drainage is conventionally managed by interventional radiology-guided percutaneous drainage (PCD). Radiologically inaccessible abscesses are managed with laparoscopic or open surgery, which carries high rates of morbidity and mortality. EUS-guided transluminal liver abscess drainage is minimally invasive and can be an alternative approach for caudate lobe, segment 4, and left lateral segment abscesses. We report on three consecutive patients with radiologically inaccessible left lobe liver abscess involving the caudate lobe, segment 4, and lateral segment in whom EUS-guided transluminal drainage using a modified technique was successful.
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Affiliation(s)
- Sharad Chandra
- Department of Gastroenterology, Meghraj Memorial Hospital, Jhansi, Uttar Pradesh, India
| | - Urvashi Chandra
- Department of Gastroenterology, Meghraj Memorial Hospital, Jhansi, Uttar Pradesh, India
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17
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Hashimoto R, Chang KJ. Endoscopic ultrasound guided hepatic interventions. Dig Endosc 2021; 33:54-65. [PMID: 32145117 DOI: 10.1111/den.13661] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 03/03/2020] [Indexed: 02/08/2023]
Abstract
Intervention for liver disease has predominantly been performed through the percutaneous approach. However, as endoscopic ultrasound (EUS) applications have expanded, there have emerged various EUS-guided interventions for liver disease, a space we call "Endo-Hepatology". EUS-guided liver biopsy can be considered the "forerunner" of Endo-Hepatology and has become a clinical option for patients requiring histologic diagnosis and staging of their liver disease. EUS also enables direct access to the portal vein. Subsequently, many procedures are being explored, such as angiography, measurement of the portosystemic pressure gradient, portal vein sampling to detect cancer cell or DNA, and EUS-guided transhepatic intrahepatic portosystemic shunt creation. Since the transducer is close to the liver, especially the left and caudate lobes, EUS can be used as a rescue when the percutaneous approach is not favorable and EUS-guided treatments of liver tumor, cyst and abscess have been reported. This review summarizes the available studies of EUS-guided intervention in the liver.
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Affiliation(s)
- Rintaro Hashimoto
- H. H. Chao Comprehensive Digestive Center, University of California Irvine Medical Center, Orange, USA
| | - Kenneth J Chang
- H. H. Chao Comprehensive Digestive Center, University of California Irvine Medical Center, Orange, USA
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Chin YK, Asokkumar R. Endoscopic ultrasound-guided drainage of difficult-to-access liver abscesses. SAGE Open Med 2020; 8:2050312120921273. [PMID: 32435490 PMCID: PMC7222655 DOI: 10.1177/2050312120921273] [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: 10/03/2019] [Accepted: 04/02/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Antibiotic therapy and percutaneous drainage have been the first-line treatments for liver abscesses. However, percutaneous drainage of abscesses may be challenging in difficult-to-access locations such as the caudate lobe. The aim of this review was to determine the indications, technical feasibility and efficacy of endoscopic ultrasound-guided drainage of difficult-to-access liver abscesses. METHODS A literature review of original articles, abstracts, case series and case reports describing endoscopic ultrasound-guided liver abscess drainage was performed. The indications, techniques and complications associated with endoscopic ultrasound-guided drainage were reviewed. RESULTS A total of 15 studies were identified. The main indications were failed antibiotic therapy and difficulty in gaining percutaneous access. The technique involved identification and puncturing of an abscess under endoscopic ultrasound guidance followed by placement of a prosthesis via a guide wire. The technique was 97.5% successful with no major complications reported. CONCLUSION Endoscopic ultrasound-guided drainage was feasible and safe and allowed complete drainage of liver abscesses not accessible by percutaneous drainage.
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Affiliation(s)
- Yung Ka Chin
- Department of Gastroenterology and Hepatology, Academia, Singapore General Hospital, Singapore
| | - Ravishankar Asokkumar
- Department of Gastroenterology and Hepatology, Academia, Singapore General Hospital, Singapore
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Campos S, Poley JW, van Driel L, Bruno MJ. The role of EUS in diagnosis and treatment of liver disorders. Endosc Int Open 2019; 7:E1262-E1275. [PMID: 31579708 PMCID: PMC6773586 DOI: 10.1055/a-0958-2183] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 01/07/2019] [Indexed: 02/06/2023] Open
Abstract
Background and aim Transabdominal ultrasound (US), computed tomographic scanning (CT) and magnetic resonance imaging (MRI) are established diagnostic tools for liver diseases. Percutaneous transhepatic cholangiography is used to perform hepatic interventional procedures including biopsy, biliary drainage procedures, and radiofrequency ablation. Despite their widespread use, these techniques have limitations. Endoscopic ultrasound (EUS), a tool that has proven useful for evaluating the mediastinum, esophagus, stomach, pancreas, and biliary tract, has an expanding role in the field of hepatology complementing the traditional investigational modalities. This review aimed to assess the current scientific evidence regarding diagnostic and therapeutic applications of EUS for hepatic diseases.
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Affiliation(s)
- Sara Campos
- Department of Gastroenterology, Hospital Garcia da Orta, Portugal
- Department of Gastroenterology and Hepatology, Erasmus MC, The Netherlands
| | - Jan-Werner Poley
- Department of Gastroenterology and Hepatology, Erasmus MC, The Netherlands
| | - Lydi van Driel
- Department of Gastroenterology and Hepatology, Erasmus MC, The Netherlands
| | - Marco J. Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC, The Netherlands
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Carbajo AY, Brunie Vegas FJ, García-Alonso FJ, Cimavilla M, Torres Yuste R, Gil-Simón P, de la Serna-Higuera C, Fernández Pérez GC, Pérez-Miranda M. Retrospective cohort study comparing endoscopic ultrasound-guided and percutaneous drainage of upper abdominal abscesses. Dig Endosc 2019; 31:431-438. [PMID: 30629764 DOI: 10.1111/den.13342] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 01/07/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM Endoscopic ultrasonography (EUS)-guided drainage (EUS-D) has become the standard treatment for peripancreatic fluid collections. Its use in other intra-abdominal abscesses has been reported, although there is limited evidence. METHODS We carried out a single-center retrospective cohort study comparing percutaneous drainage (PCD) and EUS-D of upper abdominal abscesses between January 2012 and June 2017. Pancreatic fluid collections and liver transplant recipients were excluded. Primary endpoints were technical and clinical success rates. RESULTS We included 18 EUS-D (nine hepatic and nine intraperitoneal abscesses) and 62 PCD. There were no differences regarding age, gender and etiology. Size was larger in the PCD group (80 vs 65.5 mm, P = 0.04) and perivesicular location was more frequent in the PCD group (24.2% vs 11.1%, P = 0.003). In the EUS-D group, metal stents were deployed in 16 (88.9%) subjects (eight lumen-apposing metal stents and eight self-expandable metal stents), coaxial double-pigtail plastic stents in six (33.3%) and lavage/debridement was carried out in five (27.8%). There were no significant differences in technical success (EUS-D: 88.9%, PCD: 96.8%, P = 0.22) or clinical success (EUS-D: 88.9%, PCD: 82.3%, P = 0.50), with no relapses in the EUS-D group and 10 (16.1%) in the PCD group (P = 0.11). There were four (22.2%) adverse events in the EUS-D group, none of them severe, and 13 (21%) in the PCD group (P = 0.91). CONCLUSIONS EUS-D is an alternative to PCD in the treatment of upper abdominal abscesses, reaching similar success, relapse and adverse events rates.
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Affiliation(s)
- Ana Yaiza Carbajo
- Department of Gastroenterology, Hospital Universitario Río Hortega, Valladolid, Spain
| | | | | | - Marta Cimavilla
- Department of Gastroenterology, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Raúl Torres Yuste
- Department of Gastroenterology, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Paula Gil-Simón
- Department of Gastroenterology, Hospital Universitario Río Hortega, Valladolid, Spain
| | | | | | - Manuel Pérez-Miranda
- Department of Gastroenterology, Hospital Universitario Río Hortega, Valladolid, Spain
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Liang X, Huang X, Yang Q, He J. Calcified peripancreatic lymph nodes in pancreatic and hepatic tuberculosis mimicking pancreatic malignancy: A case report and review of literature. Medicine (Baltimore) 2018; 97:e12255. [PMID: 30200160 PMCID: PMC6133400 DOI: 10.1097/md.0000000000012255] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 08/14/2018] [Indexed: 12/17/2022] Open
Abstract
RATIONALE Tuberculosis remains a serious menace to the health of people. Isolated hepatic tuberculosis is rare and pancreatic tuberculosis is extremely rare. The preoperative diagnosis of pancreatic tuberculosis remains a great challenge. PATIENT CONCERNS A 58-year-old Asian woman was referred to our hospital for evaluation of low back pain for 4 years and abdominal pain for 1 month. DIAGNOSES Computed tomography (CT) of the abdomen showed a hypodense mass in the pancreatic head and neck with abundant calcifications, a hypodense lesion in the liver without calcification, peripancreatic lymphadenopathy, calcifications in some lymph nodes. CT-guided fine needle aspiration biopsy of the hepatic lesion was carried out and the cytological examination revealed hepatic tuberculosis. INTERVENTIONS The patient was treated with antituberculous therapy for 1 year. OUTCOMES Low back pain and abdominal pain disappeared 3 months after initial treatment and after 2 year of follow-up, the patient was asymptomatic. LESSONS Our data hint that calcifications in both pancreatic lesions and peripancreatic lymph nodes may suggest pancreatic tuberculosis rather than pancreatic malignancy.
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Affiliation(s)
- Xi Liang
- Department of Radiotherapy, Hebei Provincial Hospital of Chinese Medicine, Hebei University of Chinese Medicine, Shijiazhuang
| | - Xuequan Huang
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing
| | - Qian Yang
- Department of Gastroenterology, Hebei Provincial Hospital of Chinese Medicine, Hebei University of Chinese Medicine, Shijiazhuang, China
| | - Jianming He
- Department of Radiotherapy, Hebei Provincial Hospital of Chinese Medicine, Hebei University of Chinese Medicine, Shijiazhuang
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Saraireh HA, Bilal M, Singh S. Role of endoscopic ultrasound in liver disease: Where do we stand in 2017? World J Hepatol 2017; 9:1013-1021. [PMID: 28932347 PMCID: PMC5583533 DOI: 10.4254/wjh.v9.i24.1013] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 06/11/2017] [Accepted: 07/24/2017] [Indexed: 02/06/2023] Open
Abstract
Endoscopic ultrasound (EUS) was first introduced into medical practice in 1980s as a diagnostic imaging modality for pancreatic pathology. EUS has the unique advantage of combining ultrasound and endoscopy to obtain detailed information of the gastrointestinal tract. Over the past decade, the use of EUS in liver diseases has been increasing. EUS, which was initially used as a diagnostic tool, is now having increasing therapeutic role as well. We provide a review of the application of EUS in the diagnostic and therapeutic aspects of liver disease. We also look at the evolving future research on the role of EUS in liver diseases.
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Affiliation(s)
- Hamzeh A Saraireh
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77555, United States
| | - Mohammad Bilal
- Division of Gastroenterology and Hepatology, University of Texas Medical Branch, Galveston, TX 77555, United States
| | - Shailendra Singh
- Division of Gastroenterology, Hepatology and Nutrition, Allegheny General Hospital, Pittsburgh, PA 15212, United States
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Tonozuka R, Itoi T, Tsuchiya T, Sofuni A, Ishii K, Ikeuchi N, Umeda J, Tanaka R, Mukai S, Gotoda T, Moriyasu F. EUS-guided drainage of hepatic abscess and infected biloma using short and long metal stents (with videos). Gastrointest Endosc 2016; 81:1463-9. [PMID: 25843615 DOI: 10.1016/j.gie.2015.01.023] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 01/02/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND Currently, few reports exist on EUS-guided hepatic abscess drainage (EUS-HAD) and EUS-guided biloma drainage (EUS-BLD) using a metal stent. OBJECTIVE We evaluated the technical success rate and efficacy of EUS-HAD and EUS-BLD for patients with hepatic abscess (HA) and infected biloma. DESIGN Retrospective case series. SETTING Single tertiary referral medical center. PATIENTS We evaluated 7 HA and 6 infected biloma patients who were treated between August 2013 and August 2014 at Tokyo Medical University Hospital. INTERVENTIONS EUS-HAD or EUS-BLD using a short (length, 2 or 3 cm) or long (length, 6 or 8 cm) self-expandable fully covered metal stent. MAIN OUTCOME MEASUREMENTS Technical success, clinical success, and adverse event. RESULTS The overall technical success rate was 100% in both EUS-HAD and EUS-BLD. The clinical success rates of EUS-HAD and EUS-BLD at the first session were 71.4% and 83.3%, respectively. Direct endoscopic necrosectomy was required in 1 case each of HA and infected biloma. The final clinical success rate was 100%. There were no procedure-related adverse events or cases of recurrence during the follow-up period (median, 83.5 days; range, 24-396 days). LIMITATIONS Small sample size and no control group. CONCLUSIONS EUS-HAD and EUS-BLD using a metal stent can be performed safely and effectively for HA and infected biloma.
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Affiliation(s)
- Ryosuke Tonozuka
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Takayoshi Tsuchiya
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Atsushi Sofuni
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Kentaro Ishii
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Nobuhito Ikeuchi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Junko Umeda
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Reina Tanaka
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Shuntaro Mukai
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Takuji Gotoda
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Fuminori Moriyasu
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
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Prachayakul V, Aswakul P. Endoscopic ultrasound-guided interventions in special situations. World J Gastrointest Endosc 2016; 8:104-112. [PMID: 26839650 PMCID: PMC4724027 DOI: 10.4253/wjge.v8.i2.104] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Revised: 09/07/2015] [Accepted: 12/02/2015] [Indexed: 02/05/2023] Open
Abstract
Endoscopic ultrasound (EUS) was introduced in 1982 and has since become a popular advanced procedure for diagnosis and therapeutic intervention. Initially, EUS was most commonly used for the diagnosis of pancreatobiliary diseases and tissue acquisition. EUS was first used for guided cholangiography in 1996, followed by EUS-guided biliary drainage in 2001. Advancements in equipment and endoscopic accessories have led to an expansion of EUS-guided procedures, which now include EUS-guided drainage of intra-abdominal abscesses or collections, intra-vascular treatment of refractory variceal and nonvariceal bleeding, transmural pancreatic drainage, common bile duct stone clearance, enteral feeding tube placement and entero-enteric anastomosis. Patients with surgically altered upper gastrointestinal anatomies have greatly benefited from EUS also. This systematic review describes and discusses EUS procedures performed in uncommon diseases and conditions, as well as applications on more vulnerable patients such as young children and pregnant women. In these cases, routine approaches do not always apply, and thus may require the use of innovative and unconventional techniques. Increased knowledge of such special applications will help increase the success rates of these procedures and provide a foundation for additional advances and utilizations of the technique.
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25
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Nakaji S, Hirata N. Evaluation of the viability of hepatocellular carcinoma in the caudate lobe using contrast-enhanced endoscopic ultrasonography after transarterial chemoembolization. Endosc Ultrasound 2016; 5:390-392. [PMID: 28000631 PMCID: PMC5206828 DOI: 10.4103/2303-9027.190924] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
A 71-year-old female was diagnosed with hepatocellular carcinoma (HCC). The tumor measured 65 mm in diameter and was located in the caudate lobe. Transarterial chemoembolization (TACE) was performed repeatedly; however, a follow-up dynamic computed tomography (CT) scan showed that the tumor remained viable. Thus, TACE was performed using drug-eluting beads that had been preloaded with epirubicin. Contrast-enhanced endoscopic ultrasonography (CE-EUS) was conducted for evaluating the treatment effects. First, we detected the internal part of the tumor. Then, a perflubutane suspension was injected intravenously. Next, CE-EUS was performed for the external ventral part of the tumor in the same manner. The perflubutane flowed into the tumor and spread into both its internal and external ventral regions. Thus, we considered that the tumor was still viable and planned to carry out TACE again. CE-EUS could be a useful tool for evaluating the treatment effects of TACE on HCC deep inside the liver.
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Affiliation(s)
- So Nakaji
- Department of Gastroenterology, Kameda Medical Center, Kamogawa City, Chiba, Japan
| | - Nobuto Hirata
- Department of Gastroenterology, Kameda Medical Center, Kamogawa City, Chiba, Japan
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Ogura T, Masuda D, Saori O, Wataru T, Sano T, Okuda A, Miyano A, Kitano M, Abdel-Aal UM, Takeuchi T, Fukunishi S, Higuchi K. Clinical Outcome of Endoscopic Ultrasound-Guided Liver Abscess Drainage Using Self-Expandable Covered Metallic Stent (with Video). Dig Dis Sci 2016; 61:303-8. [PMID: 26254774 DOI: 10.1007/s10620-015-3841-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 08/01/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Percutaneous drainage (PCD) is now the first-line drainage method for liver abscess because of its minimal invasiveness and high technical success rate. However, this procedure has several disadvantages, such as extra-drainage and self-tube removal. Recently, EUS-guided liver abscess drainage (EUS-AD) has been developed. However, only a few reports of EUS-AD have been reported. In addition, the clinical benefits of PCD and EUS-AD have not been reported. AIMS In the present study, the safety and feasibility of EUS-AD using fully covered SEMS (FCSEMS) and the clinical outcomes of EUS-AD and PCD were examined retrospectively. METHODS Twenty-seven consecutive patients who underwent PCD or EUS-AD between April 2012 and April 2015 were included in this study. EUS-AD was performed using FCSEMS. In addition, to prevent stent migration, 7-Fr pig tail plastic stent was placed within FCSEMS. RESULTS Technical success was achieved in all patients of both groups. Clinical success was 100 % in the EUS-AD group although it was 89 % in PCD group (P = 034). Three adverse events were seen in the PCD group (self-tube removal n = 1, tube migration n = 2), but no adverse events were seen in the EUS-AD group. The median hospital stay was significantly shorter in the EUS-AD group than in the PCD group (21 vs 41 days, P = 0.03). CONCLUSION Because of the short hospital stay, the high clinical success rate, and the low adverse event rate compared to PCD, EUS-AD has potential as a first-line treatment for liver abscess.
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Affiliation(s)
- Takeshi Ogura
- 2nd Department of Internal Medicine, Osaka Medical College, 1-1 Daigakuchou, Takatsukishi, Osaka, 464-8681, Japan.
| | - Daisuke Masuda
- 2nd Department of Internal Medicine, Osaka Medical College, 1-1 Daigakuchou, Takatsukishi, Osaka, 464-8681, Japan
| | - Onda Saori
- 2nd Department of Internal Medicine, Osaka Medical College, 1-1 Daigakuchou, Takatsukishi, Osaka, 464-8681, Japan
| | - Takagi Wataru
- 2nd Department of Internal Medicine, Osaka Medical College, 1-1 Daigakuchou, Takatsukishi, Osaka, 464-8681, Japan
| | - Tatsushi Sano
- 2nd Department of Internal Medicine, Osaka Medical College, 1-1 Daigakuchou, Takatsukishi, Osaka, 464-8681, Japan
| | - Atsushi Okuda
- 2nd Department of Internal Medicine, Osaka Medical College, 1-1 Daigakuchou, Takatsukishi, Osaka, 464-8681, Japan
| | - Akira Miyano
- 2nd Department of Internal Medicine, Osaka Medical College, 1-1 Daigakuchou, Takatsukishi, Osaka, 464-8681, Japan
| | - Masayuki Kitano
- Department of Gastroenterology and Hepatology, Kinki University Faculty of Medicine, Osaka-sayama, Japan
| | - Usama M Abdel-Aal
- Division of Gastroenterology, Department of Internal Medicine, Sohag University, Sohag, Egypt
| | - Toshihisa Takeuchi
- 2nd Department of Internal Medicine, Osaka Medical College, 1-1 Daigakuchou, Takatsukishi, Osaka, 464-8681, Japan
| | - Shinya Fukunishi
- 2nd Department of Internal Medicine, Osaka Medical College, 1-1 Daigakuchou, Takatsukishi, Osaka, 464-8681, Japan
| | - Kazuhide Higuchi
- 2nd Department of Internal Medicine, Osaka Medical College, 1-1 Daigakuchou, Takatsukishi, Osaka, 464-8681, Japan
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Endoscopic ultrasonography-guided drainage of infected intracystic papillary adenocarcinoma of the liver. Clin J Gastroenterol 2015; 8:335-9. [PMID: 26412329 DOI: 10.1007/s12328-015-0607-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 09/03/2015] [Indexed: 01/03/2023]
Abstract
We describe a case of effective use of endoscopic ultrasonography (EUS)-guided drainage of an infected intracystic papillary adenocarcinoma (ICPA) of the liver. The patient was an 84-year-old woman who was admitted with complaints of continuous epigastric pain and a slight fever. Laboratory data revealed severe inflammation. Computed tomography scanning showed a 110-mm cystic lesion with enhanced papillary tumors in the medial segment of the liver associated with a cyst in the right lobe and subcapsular cyst of the liver. Streptococcus species were detected in the culture of cystic fluid, and a diagnosis of infected ICPA was suspected. Although the patient was medicated by antibiotics, the fever did not resolve. EUS-guided transgastric drainage was performed for the abscess of the medial segment of the liver. Fourteen days after the endoscopic procedure, the plastic drainage tube was replaced with a metal stent. Inserting an endoscope into the liver cyst through the metal stent permitted observation and biopsy of an intracystic tumor, and the diagnosis of ICPA was confirmed. The patient was discharged with the internal metal stent still in place.
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Chantarojanasiri T, Aswakul P, Prachayakul V. Uncommon complications of therapeutic endoscopic ultrasonography: What, why, and how to prevent. World J Gastrointest Endosc 2015; 7:960-968. [PMID: 26265989 PMCID: PMC4530329 DOI: 10.4253/wjge.v7.i10.960] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 05/04/2015] [Accepted: 07/08/2015] [Indexed: 02/05/2023] Open
Abstract
There is an increasing role for endoscopic ultrasound (EUS)-guided interventions in the treatment of many conditions. Although it has been shown that these types of interventions are effective and safe, they continue to be considered only as alternative treatments in some situations. This is in part due to the occurrence of complications with these techniques, which can occur even when performed by experienced endosonographers. Although common complications have been described for many procedures, it is also crucial to be aware of uncommon complications. This review describes rare complications that have been reported with several EUS-guided interventions. EUS-guided biliary drainage is accepted as an alternative treatment for malignant biliary obstruction. Most of the uncommon complications related to this procedure involve stent malfunction, such as the migration or malposition of stents. Rare complications of EUS-guided pancreatic pseudocyst drainage can result from air embolism and infection. Finally, a range of uncommon complications has been reported for EUS-guided celiac plexus neurolysis, involving neural and vascular injuries that can be fatal. The goal of this review is to identify possible complications and promote an understanding of how they occur in order to increase general awareness of these adverse events with the hope that they can be avoided in the future.
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Koizumi K, Masuda S, Uojima H, Ichita C, Tokoro S, Sasaki A, Egashira H, Kimbara T, Kako M. Endoscopic ultrasound-guided drainage of an amoebic liver abscess extending into the hepatic subcapsular space. Clin J Gastroenterol 2015. [PMID: 26204883 DOI: 10.1007/s12328-015-0585-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Here, we report a case of an amoebic liver abscess (ALA) successfully treated with endoscopic ultrasound (EUS)-guided liver abscess drainage (EUS-LAD). A 37-year-old male with a liver abscess was referred to our hospital due to disease progression despite receiving antibiotic therapy. Computed tomography showed an intrahepatic abscess extending into the hepatic subcapsular space. The abscess could not be punctured through the hepatic parenchyma percutaneously due to the presence of hepatic subcapsular lesions. Hence, EUS-LAD was performed via the transhepatic approach through the stomach. A 5-Fr pigtail-type nasocystic tube was inserted into the abscess through the hepatic parenchyma, with no procedure-related complications. The contents of the abscess had the appearance of anchovy paste which made us suspect an amoebic abscess; therefore, we started antibiotic therapy with metronidazole. Afterwards, serum anti-amoebic antibodies were found to be positive and the diagnosis of ALA was confirmed. Two weeks later, the size of the abscess decreased, and the patient's clinical symptoms disappeared. Hence, the tube was removed. There were no signs of recurrence during the follow-up period. The use of EUS-LAD for pyogenic or tuberculous abscesses has been reported previously. EUS-LAD for an ALA, similar to that for other liver abscesses, is an effective alternative to percutaneous transhepatic abscess drainage or surgical treatment.
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Affiliation(s)
- Kazuya Koizumi
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan,
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Taguchi H, Tamai T, Numata M, Maeda H, Ohshige A, Iwaya H, Hashimoto S, Kanmura S, Funakawa K, Fujita H, Ido A, Tsubouchi H. Endoscopic ultrasonography-guided transmural drainage of an infected hepatic cyst due to Edwardsiella tarda: a case report. Clin J Gastroenterol 2014; 7:422-8. [PMID: 26184023 DOI: 10.1007/s12328-014-0520-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 07/07/2014] [Indexed: 12/16/2022]
Abstract
Infected hepatic cysts are very rare compared to simple liver cysts and abscesses. We treated a 77-year-old man with an infected hepatic cyst in the lateral segment caused by Edwardsiella tarda, which has not been previously reported as a pathogenic organism associated with infected hepatic cysts. Percutaneous drainage was temporarily effective, but infection recurred after the drainage tube was removed. We then inserted two drainage tubes into the cyst using an endoscopic ultrasonography (EUS)-guided technique, which was developed from EUS-guided fine needle aspiration (EUS-FNA). The internal drainage tube was a 7 Fr double pigtail stent, and the external tube was a 6 Fr nasobiliary drainage tube. Lavage through the external drainage tube was carried out for one week. The external drainage tube was discontinued when the patient's condition improved significantly. Sixteen days after tube insertion, he was discharged with the internal tube draining the hepatic cyst into the stomach. Fifteen months after EUS-guided drainage, CT examination showed no recurrence of the hepatic cyst. EUS-guided drainage is an effective treatment for infected hepatic cysts.
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Affiliation(s)
- Hiroki Taguchi
- Department of Digestive and Life-style Related Diseases, Human and Environmental Sciences, Health Research, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
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Fabbri C, Luigiano C, Lisotti A, Cennamo V, Virgilio C, Caletti G, Fusaroli P. Endoscopic ultrasound-guided treatments: are we getting evidence based--a systematic review. World J Gastroenterol 2014; 20:8424-48. [PMID: 25024600 PMCID: PMC4093695 DOI: 10.3748/wjg.v20.i26.8424] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 01/30/2014] [Accepted: 03/12/2014] [Indexed: 02/07/2023] Open
Abstract
The continued need to develop less invasive alternatives to surgical and radiologic interventions has driven the development of endoscopic ultrasound (EUS)-guided treatments. These include EUS-guided drainage of pancreatic fluid collections, EUS-guided necrosectomy, EUS-guided cholangiography and biliary drainage, EUS-guided pancreatography and pancreatic duct drainage, EUS-guided gallbladder drainage, EUS-guided drainage of abdominal and pelvic fluid collections, EUS-guided celiac plexus block and celiac plexus neurolysis, EUS-guided pancreatic cyst ablation, EUS-guided vascular interventions, EUS-guided delivery of antitumoral agents and EUS-guided fiducial placement and brachytherapy. However these procedures are technically challenging and require expertise in both EUS and interventional endoscopy, such as endoscopic retrograde cholangiopancreatography and gastrointestinal stenting. We undertook a systematic review to record the entire body of literature accumulated over the past 2 decades on EUS-guided interventions with the objective of performing a critical appraisal of published articles, based on the classification of studies according to levels of evidence, in order to assess the scientific progress made in this field.
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Singhal S, Changela K, Lane D, Anand S, Duddempudi S. Endoscopic ultrasound-guided hepatic and perihepatic abscess drainage: an evolving technique. Therap Adv Gastroenterol 2014; 7:93-8. [PMID: 24587822 PMCID: PMC3903087 DOI: 10.1177/1756283x13506178] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Interventional radiology-guided percutaneous drainage of liver abscesses with concomitant use of antibiotics has been the conventional approach for the treatment of liver abscesses. Hepatic abscesses refractory or not amenable to percutaneous drainage have been treated with surgical drainage, either via laparoscopic or open laparotomy techniques. The aim of this review was to evaluate the technical feasibility and efficacy of endoscopic ultrasound (EUS)-guided drainage of liver abscesses. A literature review was performed to identify the studies describing the technique. In this review article we have summarized case series or reports describing EUS-guided liver abscess drainage. The indications, techniques, endoprostheses, limitations and complications reported are discussed. A total of seven cases have been described so far in the literature which included patients with failed conventional treatment modalities. The EUS-guided drainage technique involves puncturing the abscess using endosonography to gain access, passing a guidewire followed by tract dilation and placement of an endoprosthesis for drainage. Studies have reported 100% technical and clinical success rates in selected cases. No complications were reported. EUS-guided drainage of liver abscesses can be a safe and effective alternative approach in the management of liver abscesses in selected patients.
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Affiliation(s)
- Shashideep Singhal
- Division of Digestive and Liver Diseases, Columbia University Medical Center, 5141 Broadway, New York, NY 10034, USA
| | - Kinesh Changela
- Division of Gastroenterology, Department of Medicine, The Brooklyn Hospital Center, Brooklyn, New York, USA
| | - Devin Lane
- Division of Gastroenterology, Department of Medicine, The Brooklyn Hospital Center, Brooklyn, New York, USA
| | - Sury Anand
- Division of Gastroenterology, Department of Medicine, The Brooklyn Hospital Center, Brooklyn, New York, USA
| | - Sushil Duddempudi
- Division of Gastroenterology, Department of Medicine, The Brooklyn Hospital Center, Brooklyn, New York, USA
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Prasad GA, Varadarajulu S. Endoscopic ultrasound-guided abscess drainage. Gastrointest Endosc Clin N Am 2012; 22:281-90, ix. [PMID: 22632950 DOI: 10.1016/j.giec.2012.04.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Abdominal and pelvic abscesses have traditionally been drained by percutaneous techniques or surgery. While surgical drainage is associated with considerable morbidity and mortality, percutaneous techniques are associated with the need for multiple interventions, increased length of hospital stay, and an indwelling external catheter for prolonged periods. Endoscopic ultrasound (EUS) is a minimally invasive but highly effective technique that enables internal drainage of the abscess. Although data are limited, evidence supporting its clinical efficacy is increasing rapidly. This article summarizes the current status of EUS-guided approach for drainage of gastrointestinal abscess collections.
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Affiliation(s)
- Ganapathy A Prasad
- Division of Gastroenterology-Hepatology, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905-0002, USA
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