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Jearth V, Sundaram S, Kale A, Sachan A, Rana SS. Current paradigm of endoscopic ultrasound in biliary and pancreatic duct drainage: an update. Ann Gastroenterol 2024; 37:1-14. [PMID: 38223246 PMCID: PMC10785026 DOI: 10.20524/aog.2023.0854] [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] [Received: 08/21/2023] [Accepted: 10/19/2023] [Indexed: 01/16/2024] Open
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is the workhorse for biliary and pancreatic ductal interventions. Despite advances in both endoscopes and accessories for ERCP, it still has limitations in the presence of altered anatomy, luminal obstruction hindering access to the papilla, and proximal duct obstructions by tight stricture, calculi or intraductal growth. Endoscopic ultrasound-guided biliary drainage (EUS-BD) and EUS-guided pancreatic duct drainage (EUS-PDD) have expanded the rescue procedures after failed ERCP. This review discusses the techniques and results of various EUS-BD procedures, as well as EUS-PDD.
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Affiliation(s)
- Vaneet Jearth
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh (Vaneet Jearth, Anurag Sachan, Surinder Singh Rana)
| | - Sridhar Sundaram
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Mumbai, Maharashtra (Sridhar Sundaram, Aditya Kale), India
| | - Aditya Kale
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Mumbai, Maharashtra (Sridhar Sundaram, Aditya Kale), India
| | - Anurag Sachan
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh (Vaneet Jearth, Anurag Sachan, Surinder Singh Rana)
| | - Surinder Singh Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh (Vaneet Jearth, Anurag Sachan, Surinder Singh Rana)
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Mukai S, Itoi T. Preoperative endoscopic ultrasound-guided biliary drainage for primary drainage in obstructive jaundice. Expert Rev Gastroenterol Hepatol 2023; 17:1197-1204. [PMID: 38124621 DOI: 10.1080/17474124.2023.2293813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION Endoscopic transpapillary approach by endoscopic retrograde cholangiopancreatography (ERCP) is the established technique for preoperative biliary drainage (PBD). Recently, endoscopic ultrasound-guided biliary drainage (EUS-BD) has been reported to be a useful alternative technique after ERCP fail. However, the optimal strategy remain controversial. AREA COVERED This review summarizes the literature on EUS-BD techniques for PBD with a literature search using PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials database between 2000 and 2023 using keywords for 'preoperative biliary drainage' and all types of EUS-BD techniques. EXPERT OPINION As there is no consensus on the optimal EUS-BD technique for PBD, selection of the EUS-BD approach depends on the patient's condition, the biliary obstruction site, the anastomosis after surgical intervention, and the preference of the endoscopist. However, we consider that EUS-HGS using a dedicated plastic stent may have some advantages in the adverse impact of surgical procedure because the location where the fistula is created by EUS-HGS is away from the site of the surgical procedure. Although there remain many issues that require further investigation, EUS-BD can be a feasible and safe alternative method of PBD for malignant biliary obstruction after ERCP fail.
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Affiliation(s)
- Shuntaro Mukai
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
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Fugazza A, Andreozzi M, De Marco A, Da Rio L, Colombo M, Spadaccini M, Carrara S, Giacchetto M, Sharma M, Craviotto V, Busacca A, Ferrari C, Repici A. Endoscopy Ultrasound-Guided Biliary Drainage Using Lumen Apposing Metal Stent in Malignant Biliary Obstruction. Diagnostics (Basel) 2023; 13:2788. [PMID: 37685326 PMCID: PMC10487072 DOI: 10.3390/diagnostics13172788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/16/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
This narrative review provides an overview of the application of endoscopic ultrasound-guided biliary drainage (EUS-BD), including EUS-guided gallbladder drainage (EUS-GBD), for the treatment of malignant biliary obstruction. EUS-BD has demonstrated excellent technical and clinical success rates, with lower rates of adverse events when compared with percutaneous trans-hepatic biliary drainage (PTBD). EUS-BD is currently the preferred alternative technique for biliary drainage (BD) in patients with distal malignant biliary obstruction (DMBO) after failed endoscopic retrograde cholangiopancreatography (ERCP). Particularly, this review will focus on EUS-BD performed with the use of lumen apposing metal stent (LAMS). The introduction of these innovative devices, followed by the advent of electrocautery-enhanced LAMS (EC-LAMS), gave the procedure a great technical implementation and a widespread application.
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Affiliation(s)
- Alessandro Fugazza
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital–IRCSS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (A.F.); (M.A.); (A.D.M.); (L.D.R.); (M.C.); (M.S.); (S.C.); (M.G.); (V.C.); (A.B.)
| | - Marta Andreozzi
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital–IRCSS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (A.F.); (M.A.); (A.D.M.); (L.D.R.); (M.C.); (M.S.); (S.C.); (M.G.); (V.C.); (A.B.)
| | - Alessandro De Marco
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital–IRCSS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (A.F.); (M.A.); (A.D.M.); (L.D.R.); (M.C.); (M.S.); (S.C.); (M.G.); (V.C.); (A.B.)
| | - Leonardo Da Rio
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital–IRCSS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (A.F.); (M.A.); (A.D.M.); (L.D.R.); (M.C.); (M.S.); (S.C.); (M.G.); (V.C.); (A.B.)
| | - Matteo Colombo
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital–IRCSS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (A.F.); (M.A.); (A.D.M.); (L.D.R.); (M.C.); (M.S.); (S.C.); (M.G.); (V.C.); (A.B.)
| | - Marco Spadaccini
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital–IRCSS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (A.F.); (M.A.); (A.D.M.); (L.D.R.); (M.C.); (M.S.); (S.C.); (M.G.); (V.C.); (A.B.)
| | - Silvia Carrara
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital–IRCSS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (A.F.); (M.A.); (A.D.M.); (L.D.R.); (M.C.); (M.S.); (S.C.); (M.G.); (V.C.); (A.B.)
| | - Marco Giacchetto
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital–IRCSS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (A.F.); (M.A.); (A.D.M.); (L.D.R.); (M.C.); (M.S.); (S.C.); (M.G.); (V.C.); (A.B.)
| | - Mrigya Sharma
- G.M.E.R.S Medical College & Hospital, Gotri, Vadodara 390021, India
| | - Vincenzo Craviotto
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital–IRCSS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (A.F.); (M.A.); (A.D.M.); (L.D.R.); (M.C.); (M.S.); (S.C.); (M.G.); (V.C.); (A.B.)
| | - Anita Busacca
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital–IRCSS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (A.F.); (M.A.); (A.D.M.); (L.D.R.); (M.C.); (M.S.); (S.C.); (M.G.); (V.C.); (A.B.)
| | - Chiara Ferrari
- Division of Anaesthesiology, Humanitas Research Hospital–IRCCS, Via Manzoni 56, Rozzano, 20089 Milan, Italy;
| | - Alessandro Repici
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital–IRCSS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (A.F.); (M.A.); (A.D.M.); (L.D.R.); (M.C.); (M.S.); (S.C.); (M.G.); (V.C.); (A.B.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
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Rizzo GEM, Carrozza L, Quintini D, Ligresti D, Traina M, Tarantino I. A Systematic Review of Endoscopic Treatments for Concomitant Malignant Biliary Obstruction and Malignant Gastric Outlet Obstruction and the Outstanding Role of Endoscopic Ultrasound-Guided Therapies. Cancers (Basel) 2023; 15:cancers15092585. [PMID: 37174051 PMCID: PMC10177271 DOI: 10.3390/cancers15092585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/22/2023] [Accepted: 04/29/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND The treatments for cancer palliation in patients with concomitant malignant biliary obstruction (MBO) and gastric outlet obstruction (MGOO) are still under investigation due to the lack of evidence available in the medical literature. We performed a systematic search and critical review to investigate efficacy and safety among patients with MBO and MGOO undergoing both endoscopic ultrasound-guided biliary drainage (EUS-BD) and MGOO endoscopic treatment. METHODS A systematic literature search was performed in PubMed, MEDLINE, EMBASE, and the Cochrane Library. EUS-BD included both transduodenal and transgastric techniques. Treatment of MGOO included duodenal stenting or EUS-GEA (gastroenteroanastomosis). Outcomes of interest were technical success, clinical success, and rate of adverse events (AEs) in patients undergoing double treatment in the same session or within one week. RESULTS 11 studies were included in the systematic review for a total number of 337 patients, 150 of whom had concurrent MBO and MGOO treatment, fulfilling the time criteria. MGOO was treated by duodenal stenting (self-expandable metal stents) in 10 studies, and in one study by EUS-GEA. EUS-BD had a mean technical success of 96.4% (CI 95%, 92.18-98.99) and a mean clinical success of 84.96% (CI 95%, 67.99-96.26). The average frequency of AEs for EUS-BD was 28.73% (CI 95%, 9.12-48.33). Clinical success for duodenal stenting was 90% vs. 100% for EUS-GEA. CONCLUSIONS EUS-BD could become the preferred drainage in the case of double endoscopic treatment of concomitant MBO and MGOO in the near future, with the promising EUS-GEA becoming a valid option for MGOO treatment in these patients.
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Affiliation(s)
- Giacomo Emanuele Maria Rizzo
- Endoscopy Unit, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT Palermo, 90127 Palermo, Italy
- Ph.D. Program, Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, 90133 Palermo, Italy
| | - Lucio Carrozza
- Endoscopy Unit, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT Palermo, 90127 Palermo, Italy
| | - Dario Quintini
- Endoscopy Unit, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT Palermo, 90127 Palermo, Italy
| | - Dario Ligresti
- Endoscopy Unit, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT Palermo, 90127 Palermo, Italy
| | - Mario Traina
- Endoscopy Unit, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT Palermo, 90127 Palermo, Italy
| | - Ilaria Tarantino
- Endoscopy Unit, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT Palermo, 90127 Palermo, Italy
- Ilaria Tarantino, Chief of Endoscopy Ultrasound Service, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT Palermo, 90127 Palermo, Italy
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Paduano D, Facciorusso A, De Marco A, Ofosu A, Auriemma F, Calabrese F, Tarantino I, Franchellucci G, Lisotti A, Fusaroli P, Repici A, Mangiavillano B. Endoscopic Ultrasound Guided Biliary Drainage in Malignant Distal Biliary Obstruction. Cancers (Basel) 2023; 15:cancers15020490. [PMID: 36672438 PMCID: PMC9856645 DOI: 10.3390/cancers15020490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 01/08/2023] [Accepted: 01/09/2023] [Indexed: 01/15/2023] Open
Abstract
Malignant biliary obstruction (MBO) is a challenging medical problem that often negatively impacts the patient's quality of life (QoL), postoperative complications, and survival rates. Endoscopic approaches to biliary drainage are generally performed by ERCP or, in selected cases, with a percutaneous transhepatic biliary drainage (PTBD). Recent advances in therapeutic endoscopic ultrasound (EUS) allow drainage where previous methods have failed. EUS has evolved from a purely diagnostic technique to one that allows a therapeutic approach in the event of ERCP failure in distal MBO. Moreover, the introduction of dedicated accessories and prostheses for EUS-guided transmural biliary drainage (EUS-BD) made these procedures more successful with regard to technical success, clinical outcomes and reduction of adverse events (AEs). Finally, lumen-apposing metal stents (LAMS) have improved the therapeutic role of the EUS. Subsequently, the electrocautery enhanced tip of the LAMS (EC-LAMS) allows a direct access of the delivery system to the target lumen, thereby simplifying and reducing the EUS-BD procedure time. EUS-BD using LAMS and EC-LAMS has proven effective and safe with a low rate of AEs. This review aims to evaluate biliary drainage techniques in malignant obstruction, focusing on the role of EUS biliary drainage by LAMS.
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Affiliation(s)
- Danilo Paduano
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, 21053 Castellanza, Italy
- Correspondence: (D.P.); (B.M.); Tel.: +39-0331-476205 (D.P.)
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia, 71122 Foggia, Italy
- Gastroenterology and Digestive Endoscopy Unit, Department of Medicine, The Pancreas Institute, University Hospital of Verona, 37100 Verona, Italy
| | - Alessandro De Marco
- Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, 20089 Rozzano, Italy
| | - Andrew Ofosu
- Division of Gastroenterology and Hepatology, University of Cincinnati, Cincinnati, OH 45201, USA
| | - Francesco Auriemma
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, 21053 Castellanza, Italy
| | - Federica Calabrese
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, 21053 Castellanza, Italy
| | - Ilaria Tarantino
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT, 90100 Palermo, Italy
| | | | - Andrea Lisotti
- Gastroenterology Unit, Hospital of Imola, University of Bologna, 40121 Bologna, Italy
| | - Pietro Fusaroli
- Gastroenterology Unit, Hospital of Imola, University of Bologna, 40121 Bologna, Italy
| | - Alessandro Repici
- Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, 20089 Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, 20089 Rozzano, Italy
| | - Benedetto Mangiavillano
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, 21053 Castellanza, Italy
- Department of Biomedical Sciences, Humanitas University, 20089 Rozzano, Italy
- Correspondence: (D.P.); (B.M.); Tel.: +39-0331-476205 (D.P.)
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Ogura T, Itoi T. Technical tips and recent development of endoscopic ultrasound-guided choledochoduodenostomy. DEN OPEN 2021; 1:e8. [PMID: 35310149 PMCID: PMC8828248 DOI: 10.1002/deo2.8] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/01/2021] [Accepted: 03/02/2021] [Indexed: 12/11/2022]
Abstract
Various efforts to improve technical success rates and decrease adverse event rates have also been described in endoscopic ultrasound (EUS)-guided choledochoduodenostomy (CDS). In particular, lumen-apposing metal stents (LAMS) may open novel opportunities in EUS-biliary drainage (BD). To date, various studies have been reported with EUS-CDS using LAMS, so we should clarify the benefits and limitations of recent EUS-CDS based on developments in both techniques and devices. In this review, we provide technical tips and describe recent developments in EUS-CDS, along with a review of the recent literature (between 2015 and 2020). The overall technical success rate is 95.0% (939/988), and the overall clinical success rate is 97.0% (820/845). The most frequent adverse event is cholangitis or cholecystitis (24.5%, 27/110). According to previous review, pneumoperitoneum (28%, 9/34) or peritonitis associated with bile leak (23.5%, 8/34) was most commonly observed. This difference might be based on improvements in dilation devices or the use of covered metal stents. Several randomized controlled trials comparing EUS-CDS and endoscopic retrograde cholangiopancreatography (ERCP) for malignant biliary obstruction have recently been reported. To summarize, overall technical success rates for ERCP and EUS-CDS were 92.7% (101/109) and 91.1% (72/79), respectively (p = 0.788). Overall clinical success rates for ERCP and EUS-CDS were 94.1% (96/102) and 93.6% (72/78), respectively (p = 0.765). Further high-quality evidence is needed to establish EUS-CDS as a primary drainage technique.
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Affiliation(s)
- Takeshi Ogura
- 2nd Department of Internal Medicine Osaka Medical College Osaka Japan
| | - Takao Itoi
- Depaertment of Gastroenterology and Hepatology Tokyo Medical University Tokyo Japan
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Matsumoto S, Hara K, Mizuno N, Kuwahara T, Okuno N, Obata M, Kurita Y, Koda H, Tajika M, Tanaka T, Hirayama Y, Onishi S, Toriyama K, Niwa Y. Risk factor analysis for adverse events and stent dysfunction of endoscopic ultrasound-guided choledochoduodenostomy. Dig Endosc 2020; 32:957-966. [PMID: 31883405 DOI: 10.1111/den.13620] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 12/22/2019] [Accepted: 12/25/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIMS Although the technique of endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) is becoming standardized, its safety issues have not been sufficiently investigated. Therefore, we aimed to identify factors associated with adverse events and stent patency in EUS-CDS. METHODS Consecutive patients who underwent EUS-CDS between September 2003 and July 2017 were included. Technical/clinical success, adverse events and stent dysfunctions were analyzed retrospectively. RESULTS A total of 151 patients underwent EUS-CDS. In nine patients, procedures were discontinued before puncture. Technical and clinical success rates were 96.5% (137/142) and 98.5% (135/137), respectively. The adverse event rate was 20.4% (29/142). As a risk factor for peritonitis, plastic stents (PS) showed a significantly high odds ratio (OR) compared with covered self-expandable metal stents (CSEMS; OR, 4.31; P = 0.030). CSEMS cases showed a significantly longer patency period than PS cases (329 vs 89 days; HR, 0.35; P < 0.001). As a risk factor for early stent dysfunction (within 14 days), stent direction to the oral side showed a significantly high OR (OR, 43.47; P < 0.001). In cases with oblique-viewing EUS, double penetration of the duodenum occurred at significantly higher frequency than in cases with forward-viewing EUS (7.0 vs 0.0%; P = 0.024). CONCLUSIONS Plastic stents and stent direction to the oral side were risk factors for peritonitis and early stent dysfunction, respectively. Using covered self-expandable metal stents and changing stent direction to the anal side seemed appropriate to prevent peritonitis and early stent dysfunction.
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Affiliation(s)
- Shimpei Matsumoto
- Departments of, Department of, Gastroenterology, Aichi Cancer Center Hospital, Aichi, Japan.,Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kazuo Hara
- Departments of, Department of, Gastroenterology, Aichi Cancer Center Hospital, Aichi, Japan
| | - Nobumasa Mizuno
- Departments of, Department of, Gastroenterology, Aichi Cancer Center Hospital, Aichi, Japan
| | - Takamichi Kuwahara
- Departments of, Department of, Gastroenterology, Aichi Cancer Center Hospital, Aichi, Japan
| | - Nozomi Okuno
- Departments of, Department of, Gastroenterology, Aichi Cancer Center Hospital, Aichi, Japan
| | - Masahiro Obata
- Departments of, Department of, Gastroenterology, Aichi Cancer Center Hospital, Aichi, Japan.,Department of Gastroenterology, Kumamoto City Hospital, Kumamoto, Japan
| | - Yusuke Kurita
- Departments of, Department of, Gastroenterology, Aichi Cancer Center Hospital, Aichi, Japan.,Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Kanagawa, Japan
| | - Hiroki Koda
- Departments of, Department of, Gastroenterology, Aichi Cancer Center Hospital, Aichi, Japan
| | - Masahiro Tajika
- Department of, Endoscopy, Aichi Cancer Center Hospital, Aichi, Japan
| | - Tsutomu Tanaka
- Department of, Endoscopy, Aichi Cancer Center Hospital, Aichi, Japan
| | - Yutaka Hirayama
- Department of, Endoscopy, Aichi Cancer Center Hospital, Aichi, Japan
| | - Sachiyo Onishi
- Department of, Endoscopy, Aichi Cancer Center Hospital, Aichi, Japan
| | - Kazuhiro Toriyama
- Department of, Endoscopy, Aichi Cancer Center Hospital, Aichi, Japan
| | - Yasumasa Niwa
- Department of, Endoscopy, Aichi Cancer Center Hospital, Aichi, Japan
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Ogura T, Nishioka N, Yamada M, Yamada T, Higuchi K. Comparison Study between Double Bare Covered and Fully Covered Metal Stent during Endoscopic Ultrasound-Guided Choledochoduodenostomy (with Video). Dig Dis 2020; 39:165-170. [PMID: 32731245 DOI: 10.1159/000510560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 07/29/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) is a common technique for biliary drainage. However, EUS-CDS is associated with adverse events such as cystic duct obstruction, stent dislocation, and stent kinking caused by powerful axial force. A novel double-bare, covered self-expandable metal stent (DBSEMS) has recently become available in Japan. This pilot study evaluated the clinical outcomes of EUS-CDS using DBSEMS. METHOD We retrospectively enrolled patients with malignant lower bile duct obstruction who underwent EUS-CDS due to failed endoscopic retrograde cholangiopancreatography (ERCP). EUS-CDS procedures performed between April 2017 and March 2018 used a conventional fully covered self-expandable metal stent (FCSEMS), and those performed between April 2018 and April 2019 used DBSEMS. In all stents, the diameter was 10 mm and length was 6 cm. RESULTS A total of 22 patients underwent EUS-CDS, performed using conventional FCSEMS (n = 12) and DBSEMS (n = 10). Four complications occurred with FCSEMS: cholangitis due to kinking (n = 3) and stent dislocation (n = 1). With DBSEMS, there were no instances of kinking, and reflux cholangitis that developed in 1 patient due to duodenal obstruction was resolved by duodenal stenting. Elapsed time to recurrent biliary obstruction was longer with DBSEMS than FCSEMS (200 vs. 99 days), although the difference was not significant (p = 0.06). CONCLUSION BSEMS can help prevent cholangitis due to stent kinking after EUS-CDS, thus increasing stent patency.
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Affiliation(s)
- Takeshi Ogura
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan,
| | - Nobu Nishioka
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Masanori Yamada
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Tadahiro Yamada
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Kazuhide Higuchi
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
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Pinto-Carta R, Solano J, Cabrera LF, Sanchez A, Moreno L, Pedraza M. Endoscopic ultrasound (EUS) guided choledocoduodenostomy in a patient with irresecable pancreas cancer and biliar obstruction using a luminal apposing metal stent (LAMS). Int J Surg Case Rep 2020; 74:23-26. [PMID: 32771936 PMCID: PMC7415624 DOI: 10.1016/j.ijscr.2020.07.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 07/04/2020] [Accepted: 07/06/2020] [Indexed: 12/13/2022] Open
Abstract
The endoscopic retrograde cholangiopancreatography (ERCP) is the election treatment of biliary obstruction. EUS-guided biliary drainage (EUS-BD) has emerged as an alternative to PTBD with a high technical and clinical success rate, low risk of complications and a better quality of life for the patient. Case presentation we present the first case in Colombia of EUS-guided biliary drainage using luminal apposing metal stent (LAMS) in a patient with unresectable pancreatic adenocarcinoma with biliary obstruction in who ERCP was failed due to neoplastic invasion of the Vater papilla. Discussion Transhepatic biliary drainage has been the most common procedure for treatment of malignant biliary obstruction in cases which ERCP fails due to tumor infiltration of the duodenum or the Vater papilla. During the last decade the development of endoscopic ultrasound (EUS) has implied an alternative for biliary drainage in cases of failed ERCP, demonstrating advantages over Trans hepatic biliary drainage Conclusion Considering that EUS-CD is a safe procedure, with a high rate of technical and clinical success, low risk of complications.
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Affiliation(s)
- Renzo Pinto-Carta
- Department of Gastroenterology and Digestive Endoscopy, Santa Fe Foundation University Hospital of Bogotá, Bogotá, Colombia.
| | - Jaime Solano
- Department of Gastroenterology and Digestive Endoscopy, Santa Fe Foundation University Hospital of Bogotá, Bogotá, Colombia; Department of Surgery, Jose Felix Patiño, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Luis Felipe Cabrera
- Department of Surgery, Jose Felix Patiño, Fundación Santa Fe de Bogotá, Bogotá, Colombia; Department of General Surgery, University El Bosque, Bogotá, Colombia; Department of Medicine, Universidad Los Andes, Bogotá, Colombia.
| | - Alvaro Sanchez
- Department of General Surgery, University El Bosque, Bogotá, Colombia
| | - Luisa Moreno
- Department of Internal Medicine, University El Bosque, Bogotá, Colombia
| | - Mauricio Pedraza
- Department of General Surgery, University El Bosque, Bogotá, Colombia.
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Current Status of Needles in the Optimization of Endoscopic Ultrasound-Guided Procedures. Diagnostics (Basel) 2020; 10:diagnostics10070463. [PMID: 32650628 PMCID: PMC7400280 DOI: 10.3390/diagnostics10070463] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 07/05/2020] [Accepted: 07/07/2020] [Indexed: 12/12/2022] Open
Abstract
Endoscopic ultrasound (EUS) is among the most important tools for the evaluation of gastrointestinal tumors and affected areas around the gastrointestinal tract. It enables the acquisition of material from abnormal lesions via the gastrointestinal wall for tissue confirmation via endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). EUS-FNA has played a vital role in oncological care and has become the standard method for tissue sampling. The choice of needle type is an important factor determining tissue acquisition and has been evaluated by many researchers. New needles are introduced into the market almost every year, and opinions vary regarding proper needle selection. While there are diverse opinions but no definitive recommendations about the use of one particular device, fine-needle biopsy needles may provide detailed information on a tissue’s architecture based on greater sample yields. This permits additional analyses, including genetic sequencing and phenotyping, thereby enabling the provision of more personalized treatment plans. Furthermore, other EUS-guided procedures have been developed, including interventional EUS and through-the-needle devices. Given the continued attempts to improve the diagnostic ability and therapeutic techniques, we review in detail the available types of puncture needles to provide guidance on the selection of the appropriate needle types.
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Kuraoka N, Hara K, Okuno N, Kuwahara T, Mizuno N, Shimizu Y, Niwa Y, Terai S. Outcomes of EUS-guided choledochoduodenostomy as primary drainage for distal biliary obstruction with covered self-expandable metallic stents. Endosc Int Open 2020; 8:E861-E868. [PMID: 32617390 PMCID: PMC7297614 DOI: 10.1055/a-1161-8488] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 02/25/2020] [Indexed: 12/16/2022] Open
Abstract
Background and study aims Endoscopic ultrasonography-guided choledochoduodenostomy (EUS-CDS) is an alternative therapy for percutaneous transhepatic biliary drainage. Outcomes of EUS-CDS for distal biliary tract obstruction with a covered self-expandable metallic stent (SEMS) as a primary drainage technique are unclear because there are few relevant reports. This study aimed to determine outcomes in patients undergoing EUS-CDS using SEMS as the primary drainage technique for malignant distal biliary duct obstruction. Patients and methods This retrospective study was conducted at Aichi Cancer Center Hospital, from January 2010 to July 2018, using data from our database. Results EUS-CDS was performed as a primary drainage technique for 92 patients. The technical success rate was 92.8 %, and the clinical success rate was 91.6 %. The overall incidence of adverse events was 15.7 %. The median stent patency time for the EUS-CDS was 396 days. Nineteen patients required re-intervention because of cholangitis or jaundice. Conclusion EUS-CDS as a primary drainage technique using SEMS has high technical and clinical success rates. It should be considered an effective drainage method with respect to long-term stent patency, low re-intervention rates, and absence of severe complications.
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Affiliation(s)
- Naosuke Kuraoka
- Department of Gastroenterology, Aichi Cancer Center Hospital,Department of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University
| | - Kazuo Hara
- Department of Gastroenterology, Aichi Cancer Center Hospital
| | - Nozomi Okuno
- Department of Gastroenterology, Aichi Cancer Center Hospital
| | | | - Nobumasa Mizuno
- Department of Gastroenterology, Aichi Cancer Center Hospital
| | - Yasuhiro Shimizu
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital
| | - Yasumasa Niwa
- Department of Endoscopy, Aichi Cancer Center Hospital
| | - Shuji Terai
- Department of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University
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12
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Narula VK, Fung EC, Overby DW, Richardson W, Stefanidis D. Clinical spotlight review for the management of choledocholithiasis. Surg Endosc 2020; 34:1482-1491. [DOI: 10.1007/s00464-020-07462-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 02/13/2020] [Indexed: 02/07/2023]
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13
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Tyberg A, Mishra A, Cheung M, Kedia P, Gaidhane M, Craig C, Tarnasky PR, Ardengh JC, Kahaleh M. Learning curve for EUS-guided biliary drainage: What have we learned? Endosc Ultrasound 2020; 9:392-396. [PMID: 32687074 PMCID: PMC7811715 DOI: 10.4103/eus.eus_42_20] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background and Objective: EUS-guided-biliary drainage (EUS-BD) is an efficacious and safe option for patients who fail ERCP. EUS-BD is a technically challenging procedure. The aim of this study was to define the learning curve for EUS-BD. Methods: Consecutive patients undergoing EUS-BD by a single operator were included for a prospective registry over 6 years. Demographics, procedural information, adverse events, and follow-up data were collected. Nonlinear regression and CUSUM analyses were conducted for the learning curve. Technical success was defined as successful stent placement. Clinical success was defined as resolution of jaundice and/or at least a 30% reduction in the pretreatment bilirubin level within a week after placement or normalization of bilirubin within 30 days. Results: Seventy-two patients were included in the study (53% male, mean age 67 years). Technical success was achieved in 69 patients (96%). Clinical success was achieved in 59/69 patients (86%). Seven patients (10%) had adverse events including bleeding (n = 6) and liver abscess (n = 1). The median procedural time was 59 min (range 36–138 min). This was achieved at the 32nd procedure. Procedural durations were further reduced to 50 min and below after the 50th procedure in a nonlinear pattern. This suggests that procedural durations approach a potential plateau after 100 cases. Conclusion: Endoscopists experienced in EUS-BD are expected to achieve a reduction in procedural time over successive cases, with efficiency reached at 59 min and a learning rate of 32 cases. Continued improvement is demonstrated with additional experience, with mastery suggested after approximately 100 cases.
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Affiliation(s)
- Amy Tyberg
- Division of Gastroenterology, Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
| | - Avantika Mishra
- Division of Gastroenterology, Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
| | - Maggie Cheung
- Division of Gastroenterology, Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
| | | | - Monica Gaidhane
- Division of Gastroenterology, Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
| | | | | | | | - Michel Kahaleh
- Division of Gastroenterology, Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
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14
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Zhang HC, Tamil M, Kukreja K, Singhal S. Review of Simultaneous Double Stenting Using Endoscopic Ultrasound-Guided Biliary Drainage Techniques in Combined Gastric Outlet and Biliary Obstructions. Clin Endosc 2019; 53:167-175. [PMID: 31405265 PMCID: PMC7137573 DOI: 10.5946/ce.2019.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 05/24/2019] [Indexed: 12/16/2022] Open
Abstract
Concomitant malignant gastric outlet obstruction and biliary obstruction may occur in patients with advanced cancers affecting these anatomical regions. This scenario presents a unique challenge to the endoscopist in selecting an optimal management approach. We sought to determine the efficacy and safety of endoscopic techniques for treating simultaneous gastric outlet and biliary obstruction (GOBO) with endoscopic ultrasound (EUS) guidance for biliary drainage. An extensive literature search for peer-reviewed published cases yielded 6 unique case series that either focused on or included the use of EUS-guided biliary drainage (EUS-BD) with simultaneous gastroduodenal stenting. In our composite analysis, a total of 51 patients underwent simultaneous biliary drainage through EUS, with an overall reported technical success rate of 100% for both duodenal stenting and biliary drainage. EUS-guided choledochoduodenostomy or EUS-guided hepaticogastrostomy was employed as the initial technique. In 34 cases in which clinical success was ascribed, 100% derived clinical benefit. The common adverse effects of double stenting included cholangitis, stent migration, bleeding, food impaction, and pancreatitis. We conclude that simultaneous double stenting with EUS-BD and gastroduodenal stenting for GOBO is associated with high success rates. It is a feasible and practical alternative to percutaneous biliary drainage or surgery for palliation in patients with associated advanced malignancies.
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Affiliation(s)
- Hao Chi Zhang
- Division of Gastroenterology, Hepatology and Nutrition, University of Texas Health Science Center at Houston, Houston, TX, USA.,Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Monica Tamil
- Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Keshav Kukreja
- Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA
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15
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Chang JI, Dong E, Kwok KK. Endoscopic ultrasound-guided transmural gallbladder drainage in malignant obstruction using a novel lumen-apposing stent: a case series (with video). Endosc Int Open 2019; 7:E655-E661. [PMID: 31058208 PMCID: PMC6497498 DOI: 10.1055/a-0826-4309] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 10/26/2018] [Indexed: 02/07/2023] Open
Abstract
Background and aims Current endoscopic methods of biliary decompression in malignant pancreatic neoplasms are often limited by anatomical and technical challenges. In this case series, we report our experience with endoscopic ultrasound (EUS)-guided placement of an electrocautery-enhanced, lumen-apposing self-expandable metallic stent (LAMS) via transmural gallbladder drainage. Methods This is a retrospective case series of nine patients (five male, mean age 63.1 years) who underwent EUS-guided LAMS placement for malignant, obstructive jaundice in the pancreatic head. All nine cases were performed by an experienced interventional endoscopist at a single, tertiary medical center. We review the technical and clinical success rates as well as the incidence of procedural adverse events across the nine patients. Results LAMS placement was technically successful in all cases and there were no procedural adverse events. Seven of nine (77.78 %) patients showed clinical and laboratory improvement immediately following the procedure. One case required re-intervention with interventional radiology guided biliary drain placement. The mean fluoroscopy time was 1.02 minutes. Conclusions EUS-guided LAMS placement for transmural gallbladder drainage in malignant obstruction appears to be a safe and effective technique, allowing patients to proceed to surgery, chemotherapy, or hospice care.
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Affiliation(s)
- Jonathan I. Chang
- Division of Gastroenterology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Elizabeth Dong
- Division of Gastroenterology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Karl K. Kwok
- Division of Gastroenterology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA,Corresponding author Karl K. Kwok, MD 1526 North Edgemont Street7th FloorLos AngelesCA 90027USA+1-323-783-7056
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16
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Ogura T, Higuchi K. Endoscopic ultrasound-guided gallbladder drainage: Current status and future prospects. Dig Endosc 2019; 31 Suppl 1:55-64. [PMID: 30994239 DOI: 10.1111/den.13334] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 12/22/2018] [Indexed: 12/23/2022]
Abstract
Early surgical treatment using the laparoscopic approach is generally accepted as the treatment of choice for acute cholecystitis (AC) according to Tokyo Guidelines 2018 (TG2018). If the patient is a poor candidate for surgery because of the presence of advanced malignancy or severe organ failure, this treatment may be too invasive. In such cases, gallbladder drainage is considered an alternative treatment method to surgery. Several drainage methods have been established, such as percutaneous transhepatic gallbladder drainage (PTGBD) or endoscopic transpapillary gallbladder drainage (ETGBD) under endoscopic retrograde cholangiopancreatography (ERCP), including endoscopic naso-gallbladder drainage (ENGBD) and endoscopic gallbladder stenting (EGBS). PTGBD is a well-established procedure that is relatively easily carried out by general clinicians. And ETGBD has been developed as an alternative drainage method. The procedure also calls for guidewire passage across the cystic duct. Therefore, in AC cases who are contraindicated for surgery, PTGBD should be considered before ETGBD, and ETGBD may be considered only in high-volume institutes where expert hands are available, as described in the TG2018. However, there are several limitations to these procedures. Recently, endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is increasingly being done as an alternative method to PTGBD and ETGBD. In this review, the current status and problems of EUS-GBD are reviewed, including technical review and clinical data of previous papers, current indication, long-term outcome, and comparison data with PTGBD or ETGBD, and their future prospects are discussed.
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Affiliation(s)
- Takeshi Ogura
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Kazuhide Higuchi
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
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17
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Ogura T, Okuda A, Miyano A, Imanishi M, Nishioka N, Yamada M, Yamda T, Kamiyama R, Masuda D, Higuchi K. EUS-guided versus percutaneous biliary access in patients with obstructive jaundice due to gastric cancer. Dig Liver Dis 2019; 51:247-252. [PMID: 30327252 DOI: 10.1016/j.dld.2018.09.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 09/12/2018] [Accepted: 09/16/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Gastric cancer is sometimes complicated by obstructive jaundice. However, ERCP may be challenging in patients who have advanced gastric cancer, or recurrent gastric cancer after surgical resection that is complicated by obstructive jaundice. In such cases, percutaneous transhepatic biliary drainage (PTBD) is considered. Recently, EUS-guided biliary drainage (EUS-BD) has been developed. We conducted a retrospective study to compare the efficacy of EUS-BD and PTBD in patients with obstructive jaundice due to gastric cancer. METHODS Patients with gastric cancer complicated with obstructive jaundice who were contraindicated for standard ERCP were enrolled. RESULTS A total of 47 consecutive patients were enrolled during the study period. The technical success rates of PTBD and EUS-BD were 88.9% (16/18) and 96.7% (29/30), respectively (P = 0.64). The stent patency period, including patient death was equivalent between the two groups (EUS-BD vs. PTBD: 188.4 days vs. 200.9 days, P = 0.974). Time to stent dysfunction in the EUS-BD group (391.1 days) was not significantly different as compared to that in the PTBD group (398.1 days) (P = 0.78). Adverse events were relatively severe in the PTBD group. CONCLUSIONS Given the relative severity of adverse events in the PTBD group, EUS-BD might be the procedure of choice for gastric cancer patients with contraindications by inability to perform ERCP.
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Affiliation(s)
- Takeshi Ogura
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan.
| | - Atsushi Okuda
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Akira Miyano
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Miyuki Imanishi
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Nobu Nishioka
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Masanori Yamada
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Tadahiro Yamda
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Rieko Kamiyama
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Daisuke Masuda
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Kazuhide Higuchi
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
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18
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EUS-Guided Antegrade Biliary Stenting Using a Novel Fully Covered Metal Stent (with Video). J Gastrointest Surg 2019; 23:192-198. [PMID: 30128830 DOI: 10.1007/s11605-018-3914-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 08/01/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Recently, endoscopic ultrasound (EUS)-guided hepaticogastrostomy (HGS) combined with antegrade stenting (AS) has been reported to be associated with longer stent patency and reduced procedure-related adverse events. In EUS-AS, an uncovered metal stent is usually selected to prevent stent misplacement or dislocation. However, because patient survival has improved with advances in chemotherapy, longer stent patency may be required. AIM The technical feasibility and safety of EUS-guided transhepatic biliary drainage combined with EUS-AS using a novel covered metal stent were evaluated. METHODS Patients with malignant biliary obstruction leading to obstructive jaundice, in whom standard ERCP had failed or was contraindicated, were enrolled in this study between July 2015 and October 2017. As the control group, patients undergoing EUS-AS using an uncovered metal stent were enrolled between October 2014 and June 2015. RESULTS A total of 39 patients were enrolled in this study. Among them, EUS-AS using a covered metal stent was performed in 17 patients and using an uncovered metal stent in the remaining 22 patients. Median stent patency including stent dysfunction and patient death was longer in the covered metal stent group (153 days) compared with that of the uncovered metal stent group (108 days) although there were no significant differences (P = 0.06). In only cases with stent dysfunction was median stent patency of the covered metal stent group significantly longer than that of the uncovered metal stent group (not available vs 150 days, P = 0.02). CONCLUSIONS In conclusion, EUS-guided transluminal biliary drainage combined with EUS-AS using a covered metal stent may be feasible and safe, although the indications for this procedure should be carefully considered.
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Okuda A, Ogura T, Imanishi M, Miyano A, Nishioka N, Higuchi K. Clinical Impact of Recombinant Soluble Thrombomodulin for Disseminated Intravascular Coagulation Associated with Severe Acute Cholangitis. Gut Liver 2018; 12:471-477. [PMID: 29699063 PMCID: PMC6027841 DOI: 10.5009/gnl17489] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 12/13/2017] [Accepted: 12/14/2017] [Indexed: 12/21/2022] Open
Abstract
Background/Aims Recently, recombinant human soluble thrombomodulin (rTM) has been developed as a new drug for disseminated intravascular coagulation (DIC). This study aims to evaluate the clinical benefit of rTM in patients with sepsis-induced DIC caused by acute cholangitis who underwent biliary drainage. Methods Patients were divided into two groups: the rTM therapy group and the non-rTM therapy group. The primary outcome was the DIC resolution rate at 7 days, and the secondary outcome was 28-day mortality rate. Results Thirty-five patients were treated by rTM, and 36 patients were treated without rTM for DIC. The rate of resolution of DIC at day 7 was significantly higher in the rTM group than in the non-rTM group (82.9% vs 55.6%, p=0.0012). Compared with the non-rTM group, the 28-day survival rate of the r-TM group was significantly higher (rTM vs non-rTM, 91.4% vs 69.4%, p=0.014). According to multivariate analysis, non-rTM (hazard ratio [HR], 2.681) and CRP (HR, 2.370) were factors related to decreased survival. Conclusions rTM treatment may have a positive impact on improving DIC and survival rates in patients with severe acute cholangitis.
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Affiliation(s)
- Atsushi Okuda
- Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Japan
| | - Takeshi Ogura
- Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Japan
| | - Miyuki Imanishi
- Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Japan
| | - Akira Miyano
- Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Japan
| | - Nobu Nishioka
- Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Japan
| | - Kazuhide Higuchi
- Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Japan
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Abstract
Endoscopic ultrasound (EUS)-guided biliary drainage is an emerging technique that combines the advantages of the endoscopic and percutaneous approaches, without the inconveniences and discomfort of an indwelling external catheter. There has been growing interest and experience in EUS-biliary drainage. Several different EUS-guided techniques have been developed to access the obstructed biliary tree from either the stomach or duodenum, according to the location of the stricture, the anatomy of the patient, and the experience of the endoscopist.
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Affiliation(s)
- Brian R Boulay
- Division of Gastroenterology and Hepatology, University of Illinois Hospital and Health Sciences System, 840 S Wood Street, M/C 716, Chicago, IL 60612, USA.
| | - Simon K Lo
- Pancreatic and Biliary Disease Program, Digestive Diseases, Cedars Sinai Medical Center, 8700 Beverly Boulevard, South Tower, Suite 7511, Los Angeles, CA 90048, USA
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21
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Ribeiro H, Azevedo R, Caldeira A, Sousa R, Pereira E, Banhudo A. Endoscopic Ultrasound-Guided Choledochoduodenostomy as Palliative Treatment: A Challenging Case Report. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2018; 25:146-150. [PMID: 29761151 PMCID: PMC5939861 DOI: 10.1159/000481175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 09/01/2017] [Indexed: 06/08/2023]
Abstract
We report the case of an 88-year-old female with obstructive jaundice due to a periampullary tumor. The patient developed acute cholangitis and consequent clinical deterioration, so it was decided to perform palliative biliary drainage. Due to duodenal tumor invasion, it was not possible to perform endoscopic retrograde cholangiopancreatography. A different approach was attempted and it was decided to carry out an endoscopic ultrasound-guided choledochoduodenostomy. This procedure was performed with a linear echoendoscope, and using a duodenal bulbar approach, a fistula was created between the bulb and the common bile duct. A self-expandable fully covered metal biliary stent was placed in the common bile duct under endoscopic and fluoroscopic guidance, allowing biliary drainage. The patient presented clinical improvement. However, 3 weeks after being discharged, she was readmitted to our department with hematemesis associated with the migration of the biliary stent to the duodenal bulb. Endoscopic hemostasis was performed but the patient had multiple bleeding relapses that were controlled through arterial embolization. Despite the migration of the biliary stent, the fistula between the duodenum and the common bile duct remained patent, allowing a successful palliation of the obstructive jaundice. Therefore, despite the occurred complication, we admitted a technical and clinical success of the endoscopic ultrasound-guided choledochoduodenostomy. This is an emerging technique and a valuable alternative for palliative biliary drainage in cases of malignant distal obstruction. This clinical report supports this finding, reporting technical aspects of the procedure, associated complications and their management as well as the clinical outcomes.
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Affiliation(s)
- Helena Ribeiro
- *Dr. Helena Sofia Brito Ribeiro, Gastroenterology Department, Hospital Amato Lusitano, Avenida Pedro Álvares Cabral, PT-6000-085 Castelo Branco (Portugal), E-Mail
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22
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Minaga K, Kitano M. Recent advances in endoscopic ultrasound-guided biliary drainage. Dig Endosc 2018; 30:38-47. [PMID: 28656640 DOI: 10.1111/den.12910] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 06/22/2017] [Indexed: 12/12/2022]
Abstract
Endoscopic ultrasound-guided biliary drainage (EUS-BD) is increasingly used as an alternative in patients with biliary obstruction who fail standard endoscopic retrograde cholangiopancreatography (ERCP). The two major endoscopic approach routes for EUS-BD are the transgastric intrahepatic and the transduodenal extrahepatic approaches. Biliary drainage can be achieved by three different methods, transluminal biliary stenting, transpapillary rendezvous technique, and antegrade biliary stenting. Choice of approach route and drainage method depends on individual anatomy, underlying disease, and location of the biliary stricture. Recent meta-analyses have revealed that cumulative technical success and adverse event rates were 90-94% and 16-23%, respectively. Development of new dedicated devices for EUS-BD would help refine the technical aspects and minimize the possibility of complications, making it a more promising procedure.
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Affiliation(s)
- Kosuke Minaga
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Masayuki Kitano
- Second Department of Internal Medicine, Wakayama Medical University School of Medicine, Wakayama, Japan
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23
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Rai P, Lokesh CR, Goel A, Aggarwal R. Endoscopic ultrasound-guided choledochoduodenostomy using partially-covered self-expandable metal stent in patients with malignant distal biliary obstruction and unsuccessful ERCP. Endosc Int Open 2018; 6:E67-E72. [PMID: 29344562 PMCID: PMC5770273 DOI: 10.1055/s-0043-120664] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 08/31/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) is an alternative to percutaneous transhepatic biliary drainage (PTBD) for patients with malignant distal biliary obstruction in whom ERCP has failed. We studied technical success, clinical success, stent patency rate and occurrence of adverse events in patients undergoing EUS-CDS with partially-covered self-expanding metal stent (PCSEMS). PATIENTS AND METHODS Medical records of consecutive patients with unresectable malignant distal biliary obstruction requiring biliary drainage who underwent EUS-CDS because of failure of attempt at ERCP were reviewed. EUS-CDS was done using 6-cm, PCSEMS (Wallflex, Boston Scientific). Technical success, clinical success (more than 50 % reduction in total bilirubin at 2 weeks post-procedure), stent patency rate and adverse events (AEs) were assessed. Patients were followed up for 3 months post-procedure. RESULTS Between January 2015 and December 2016, 30 patients underwent EUS-CDS, including 20 (67 %) with failed biliary cannulation and 10 (33 %) with duodenal stenosis. Technical success was achieved in 28 patients, all of whom also had clinical success. Median total serum bilirubin decreased from 20 mg/dL to 5 mg/dL at 2 weeks post-procedure. Three patients (10 %) had adverse events (bile leak, hemobilia, stent block in one patient each; no stent migration); none of these adverse events was major and all were managed successfully. There were no procedure-related deaths. Five patients died of disease progression in the 3-month period post-procedure, and the 3-month dysfunction-free stent patency rate was 83 %. CONCLUSION EUS-CDS with a PCSEMS has a high technical and clinical success. Adverse events were infrequent, minor and could be managed easily.
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Affiliation(s)
- Praveer Rai
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India,Corresponding author Dr Praveer Rai, Additional Professor Department of GastroenterologySanjay Gandhi Postgraduate Institute of Medical SciencesLucknow 226014India
| | - CR Lokesh
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Amit Goel
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Rakesh Aggarwal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Ogura T, Onda S, Takagi W, Takeuchi T, Fukunishi S, Higuchi K. Endoscopic ultrasound-guided choledochoduodenostomy for obstructive jaundice with venous collaterals around the bile duct wall (with video). Endosc Ultrasound 2017; 6:140-141. [PMID: 28440241 PMCID: PMC5418968 DOI: 10.4103/2303-9027.204811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Takeshi Ogura
- 2nd Department of Internal Medicine, Osaka Medical College, Takatsukishi, Osaka, Japan
| | - Saori Onda
- 2nd Department of Internal Medicine, Osaka Medical College, Takatsukishi, Osaka, Japan
| | - Wataru Takagi
- 2nd Department of Internal Medicine, Osaka Medical College, Takatsukishi, Osaka, Japan
| | - Toshihisa Takeuchi
- 2nd Department of Internal Medicine, Osaka Medical College, Takatsukishi, Osaka, Japan
| | - Shinya Fukunishi
- 2nd Department of Internal Medicine, Osaka Medical College, Takatsukishi, Osaka, Japan
| | - Kazuhide Higuchi
- 2nd Department of Internal Medicine, Osaka Medical College, Takatsukishi, Osaka, Japan
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Ramchandani M, Pal P, Reddy DN. Endoscopic management of acute cholangitis as a result of common bile duct stones. Dig Endosc 2017; 29 Suppl 2:78-87. [PMID: 28425658 DOI: 10.1111/den.12848] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 02/14/2017] [Indexed: 02/08/2023]
Abstract
Acute cholangitis is infectious disease of the biliary system and potentially can cause significant morbidity and mortality. With advances in intensive care, antibiotic therapy advances and endoscopic and other modalities of biliary drainage, mortality rates have significantly come down of late. Although most cases respond to antibiotics alone, definitive therapy is required later in most of the patients. Increased biliary pressure leads to biliovenous reflux of bacteria and purulent bile into the circulation leading to systemic inflammation and sepsis with subsequent organ dysfunction. Biliary decompression increases antibiotic penetration in bile. Therefore, patients with high-risk factors and organ dysfunction require early and urgent biliary drainage, respectively, as they are unlikely to respond with antibiotics alone. Biliary decompression is best achieved by endoscopic retrograde cholangiopancreatography (ERCP) compared to percutaneous and surgical decompression. ERCP can be technically difficult and sometimes unsuccessful especially in patients with altered anatomy and upper gastrointestinal obstruction. Earlier percutaneous transhepatic biliary drainage (PTBD) and surgery were the only viable options in those patients. PTBD requires a dilated biliary system, is more invasive and cannot achieve ductal clearance in cholangitis as a result of choledocholithiasis, whereas surgery is associated with high morbidity and mortality. Advances in therapeutic endoscopy such as balloon enteroscopy-guided biliary drainage or endoscopic ultrasound guided-biliary drainage have added new dimensions to endoscopic management of acute cholangitis as a result of choledocholithiasis obviating the need for more invasive procedures.
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Affiliation(s)
- Mohan Ramchandani
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Partha Pal
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - D Nageshwar Reddy
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
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Amano M, Ogura T, Onda S, Takagi W, Sano T, Okuda A, Miyano A, Masuda D, Higuchi K. Prospective clinical study of endoscopic ultrasound-guided biliary drainage using novel balloon catheter (with video). J Gastroenterol Hepatol 2017; 32:716-720. [PMID: 27420770 DOI: 10.1111/jgh.13489] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/04/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM On endoscopic ultrasound (EUS)-guided biliary drainage, fistula dilation may be accompanied by leakage of bile juice, potentially along with bacteria or air, so this procedure should be kept as simple and short as possible. To date, various techniques to dilate the fistula have been reported. This prospective, single-center, single-arm study evaluated the technical feasibility and safety of EUS-guided biliary drainage using novel balloon catheters. METHODS Tip of novel balloon catheters is only 3 Fr and tapered, and the catheters also show favorable push ability. First, biliary tract was punctured using 19-G fine needle aspiration needle. Next, we immediately inserted the novel balloon catheter, and the biliary tract and intestinal wall were dilated. Then, we performed metallic stent placement without any dilation fistula. RESULTS A total of 20 patients were prospectively enrolled in this study. Technical success rate was 100%. Eleven patients underwent EUS-guided choledochoduodenostomy, and nine patients underwent EUS-guided hepaticogastrostomy. Median procedure time was only 11 min (range, 8-16 min) for EUS-guided choledochoduodenostomy and 14 min (range, 11-18 min) for EUS-guided hepaticogastrostomy. Adverse events were seen in 15% (3/20; self-limited abdominal pain n = 2, peritonitis n = 1). CONCLUSIONS Although additional cases and a randomized controlled comparison with another dilation technique such as the graded dilation or cystotome dilation technique are needed, our technique may be helpful for EUS-guided biliary drainage.
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Affiliation(s)
- Mio Amano
- Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Takeshi Ogura
- Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Saori Onda
- Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Wataru Takagi
- Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Tastsushi Sano
- Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Astushi Okuda
- Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Akira Miyano
- Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Daisuke Masuda
- Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Kazuhide Higuchi
- Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan
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Ogura T, Onda S, Takagi W, Sano T, Okuda A, Masuda D, Yamamoto K, Miyano A, Kitano M, Takeuchi T, Fukunishi S, Higuchi K. Clinical utility of endoscopic ultrasound-guided biliary drainage as a rescue of re-intervention procedure for high-grade hilar stricture. J Gastroenterol Hepatol 2017; 32:163-168. [PMID: 27161286 DOI: 10.1111/jgh.13437] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/01/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Re-intervention after stent placement for malignant hepatic hilum obstruction (HBO) is challenging. endoscopic ultrasound-guided biliary drainage (EUS-BD) has been developed as an alternative method for failed endoscopic retrograde cholangiopancreatography (ERCP). In this retrospective study, the clinical utility of EUS-BD as a rescue drainage technique for HBO patients who failed re-intervention under ERCP guidance was evaluated. METHODS Between April 2012 and August 2015, patients with HBO were enrolled. Patients' characteristics, kinds of metallic stents, configuration of stent placement, overall survival, stent patency, and results of re-intervention were reviewed, along with the re-intervention technical success rate. RESULTS The biliary stricture type was Bismuth type IV in 59% (23/39) and types IIIa and b in 20.5% (8/39) each. Biliary metallic stent placement was bilateral in 38.5% (15/39), and unilateral in 61.5% (24/39). Primary stent dysfunction was observed in 71.8% (28/39) of cases. Planned re-intervention under ERCP guidance was attempted in 26 patients. The technical success rate was 62% (16/26). For the 10 patients who failed re-intervention under ERCP guidance, EUS-BD was planned. The technical success rate was 100% (10/10). The procedure time was 25.8 min. Adverse events were not seen in any patients. Stent patency after re-intervention was not significantly different between ERCP (165 days) guidance and EUS-BD (152 days) guidance (P = 0.463) CONCLUSIONS: In conclusion, EUS-BD as a re-intervention method for metallic stent obstruction was safe and feasible. If ERCP was failed, EUS-BD may be one of option as re-intervention method for high-grade hilar stricture.
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Affiliation(s)
- Takeshi Ogura
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Saori Onda
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Wataru Takagi
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Tatsushi Sano
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Atsushi Okuda
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Daisuke Masuda
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | | | - Akira Miyano
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Masayuki Kitano
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Toshihisa Takeuchi
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Shinya Fukunishi
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Kazuhide Higuchi
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
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Almadi MA, Pausawasdi N, Ratanchuek T, Teoh AYB, Ho KY, Dhir V. Endoscopic ultrasound-guided biliary drainage. GASTROINTESTINAL INTERVENTION 2016. [DOI: 10.18528/gii150019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Majid A. Almadi
- Division of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Nonthalee Pausawasdi
- Department of Internal Medicine, Faculty of Medicine, Siriraj Hospital, Bangkok, Thailand
| | | | - Anthony Yuen Bun Teoh
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Khek Yu Ho
- Department of Medicine, National University Health System, Singapore
| | - Vinay Dhir
- Baldota Institute of Digestive Sciences, Global Hospitals, Mumbai, India
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Ogura T, Takagi W, Kurisu Y, Higuchi K. Technical tips for peroral transluminal cholangioscopy using novel single-operator cholangioscope (with videos). JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2016; 23:E25-E29. [PMID: 27531563 DOI: 10.1002/jhbp.380] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 07/19/2016] [Indexed: 12/16/2022]
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is the gold-standard modality for diagnosis and therapy of bilio-pancreatic disease. In particular, peroral cholangiography (POCS) is a useful modality not only for diagnosing biliary disease, but also for therapeutic procedures such as electrohydraulic lithotripsy. The SPY-DS single-operator cholangioscope has recently become available, and offers favorable visualization, a wide view, suction function and a larger accessory working channel. However, if the duodenoscope cannot be advanced into the ampulla of Vater for reasons such as surgical anatomy, POCS cannot be performed. On the other hand, percutaneous transhepatic cholangiodrainage (PTCD) has been developed as an alternative endoscopic ultrasound-guided approach to the biliary tract. Peroral transluminal cholangioscopy (PTLC) using SPY-DS is a novel approach. Because transluminal interventional procedures under endoscopic ultrasound guidance have recently been developed, our technique may have clinical impact for selected cases.
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Affiliation(s)
- Takeshi Ogura
- Second Department of Internal Medicine, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.
| | - Wataru Takagi
- Second Department of Internal Medicine, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Yoshitaka Kurisu
- Department of Pathology, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Kazuhide Higuchi
- Second Department of Internal Medicine, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
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30
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Minaga K, Kitano M, Imai H, Yamao K, Kamata K, Miyata T, Omoto S, Kadosaka K, Yoshikawa T, Kudo M. Urgent endoscopic ultrasound-guided choledochoduodenostomy for acute obstructive suppurative cholangitis-induced sepsis. World J Gastroenterol 2016; 22:4264-4269. [PMID: 27122677 PMCID: PMC4837444 DOI: 10.3748/wjg.v22.i16.4264] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 01/07/2016] [Accepted: 01/30/2016] [Indexed: 02/06/2023] Open
Abstract
Acute obstructive suppurative cholangitis (AOSC) due to biliary lithiasis is a life-threatening condition that requires urgent biliary decompression. Although endoscopic retrograde cholangiopancreatography (ERCP) with stent placement is the current gold standard for biliary decompression, it can sometimes be difficult because of failed biliary cannulation. In this retrospective case series, we describe three cases of successful biliary drainage with recovery from septic shock after urgent endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) was performed for AOSC due to biliary lithiasis. In all three cases, technical success in inserting the stents was achieved and the patients completely recovered from AOSC with sepsis in a few days after EUS-CDS. There were no procedure-related complications. When initial ERCP fails, EUS-CDS can be an effective life-saving endoscopic biliary decompression procedure that shortens the procedure time and prevents post-ERCP pancreatitis, particularly in patients with AOSC-induced sepsis.
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Ogura T, Higuchi K. Technical tips for endoscopic ultrasound-guided hepaticogastrostomy. World J Gastroenterol 2016; 22:3945-3951. [PMID: 27099437 PMCID: PMC4823244 DOI: 10.3748/wjg.v22.i15.3945] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 01/29/2016] [Accepted: 03/02/2016] [Indexed: 02/06/2023] Open
Abstract
Interventional procedures using endoscopic ultrasound (EUS) have recently been developed. For biliary drainage, EUS-guided trans-luminal drainage has been reported. In this procedure, the transduodenal approach for extrahepatic bile ducts is called EUS-guided choledochoduodenostomy, and the transgastric approach for intrahepatic bile ducts is called EUS-guided hepaticogastrostomy (EUS-HGS). These procedures have several effects, such as internal drainage and avoiding post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis, and they are indicated for an inaccessible ampulla of Vater due to duodenal obstruction or surgical anatomy. EUS-HGS has particularly wide indications and clinical impact as an alternative biliary drainage method. In this procedure, it is necessary to dilate the fistula, and several devices and approaches have been reported. Stent selection is also important. In previous reports, the overall technical success rate was 82% (221/270), the clinical success rate was 97% (218/225), and the overall adverse event rate for EUS-HGS was 23% (62/270). Adverse events of EUS-biliary drainage are still high compared with ERCP or PTCD. EUS-HGS should continue to be performed by experienced endoscopists who can use various strategies when adverse events occur.
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32
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Hara K, Yamao K, Mizuno N, Hijioka S, Imaoka H, Tajika M, Tanaka T, Ishihara M, Okuno N, Hieda N, Yoshida T, Niwa Y. Endoscopic ultrasonography-guided biliary drainage: Who, when, which, and how? World J Gastroenterol 2016; 22:1297-1303. [PMID: 26811666 PMCID: PMC4716039 DOI: 10.3748/wjg.v22.i3.1297] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Revised: 09/28/2015] [Accepted: 11/13/2015] [Indexed: 02/06/2023] Open
Abstract
Both endoscopic ultrasonography (EUS)-guided choledochoduodenostomy (EUS-CDS) and EUS-guided hepaticogastrostomy (EUS-HGS) are relatively well established as alternatives to percutaneous transhepatic biliary drainage (PTBD). Both EUS-CDS and EUS-HGS have high technical and clinical success rates (more than 90%) in high-volume centers. Complications for both procedures remain high at 10%-30%. Procedures performed by endoscopists who have done fewer than 20 cases sometimes result in severe or fatal complications. When learning EUS-guided biliary drainage (EUS-BD), we recommend a mentor’s supervision during at least the first 20 cases. For inoperable malignant lower biliary obstruction, a skillful endoscopist should perform EUS-BD before EUS-guided rendezvous technique (EUS-RV) and PTBD. We should be select EUS-BD for patients having altered anatomy from malignant tumors before balloon-enteroscope-assisted endoscopic retrograde cholangiopancreatography, EUS-RV, and PTBD. If both EUS-CDS and EUS-HGS are available, we should select EUS-CDS, according to published data. EUS-BD will potentially become a first-line biliary drainage procedure in the near future.
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Takagi W, Ogura T, Sano T, Onda S, Okuda A, Masuda D, Imoto A, Takeuchi T, Fukunishi S, Higuchi K. EUS-guided cholecystoduodenostomy for acute cholecystitis with an anti-stent migration and anti-food impaction system; a pilot study. Therap Adv Gastroenterol 2016; 9:19-25. [PMID: 26770264 PMCID: PMC4699274 DOI: 10.1177/1756283x15609285] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Recently, endoscopic ultrasound-guided gall bladder drainage (EUS-GBD) has been reported using a self-expandable metallic stent. To prevent stent migration and food flowing into the common bile duct through the cystic duct, we perform a novel EUS-guided cholecystoduodenostomy. The aim of our study was to evaluate the safety and feasibility of EUS-guided cholecystoduodenostomy with an anti-stent migration and anti-food impaction system. METHODS A total of 16 consecutive patients who underwent EUS-guided cholecystoduodenostomy for acute cholecystitis were included in this study. RESULTS Technical and clinical success was obtained in all patients. The median procedure time was 26.9 min (range 19-42 min). Median follow-up time was 181.5 days (range 18-604 days), and in this time, recurrence of acute cholecystitis was not seen in all patients. Adverse events such as stent migration and cholangitis were not seen in any patients, although pneumoperitoneum was seen in one patient. CONCLUSION Our technique may be favorable and effective for the prevention of adverse events on EUS-GBD.
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Affiliation(s)
- Wataru Takagi
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | | | - Tatsushi Sano
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Saori Onda
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Atsushi Okuda
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Daisuke Masuda
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Akira Imoto
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Toshihisa Takeuchi
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Shinya Fukunishi
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Kazuhide Higuchi
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
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Guedes HG, Lopes RI, Oliveira JFD, Artifon ELDA. Reality named endoscopic ultrasound biliary drainage. World J Gastrointest Endosc 2015; 7:1181-1185. [PMID: 26504507 PMCID: PMC4613807 DOI: 10.4253/wjge.v7.i15.1181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 09/01/2015] [Accepted: 09/18/2015] [Indexed: 02/05/2023] Open
Abstract
Endoscopic ultrasound (EUS) is used for diagnosis and evaluation of many diseases of the gastrointestinal (GI) tract. In the past, it was used to guide a cholangiography, but nowadays it emerges as a powerful therapeutic tool in biliary drainage. The aims of this review are: outline the rationale for endoscopic ultrasound-guided biliary drainage (EGBD); detail the procedural technique; evaluate the clinical outcomes and limitations of the method; and provide recommendations for the practicing clinician. In cases of failed endoscopic retrograde cholangiopancreatography (ERCP), patients are usually referred for either percutaneous transhepatic biliary drainage (PTBD) or surgical bypass. Both these procedures have high rates of undesirable complications. EGBD is an attractive alternative to PTBD or surgery when ERCP fails. EGBD can be performed at two locations: transhepatic or extrahepatic, and the stent can be inserted in an antegrade or retrograde fashion. The drainage route can be transluminal, duodenal or transpapillary, which, again, can be antegrade or retrograde [rendezvous (EUS-RV)]. Complications of all techniques combined include pneumoperitoneum, bleeding, bile leak/peritonitis and cholangitis. We recommend EGBD when bile duct access is not possible because of failed cannulation, altered upper GI tract anatomy, gastric outlet obstruction, a distorted ampulla or a periampullary diverticulum, as a minimally invasive alternative to surgery or radiology.
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