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Miwa H, Oishi R, Endo K, Tsuchiya H, Funaoka A, Suzuki Y, Maeda S. Antegrade metallic stent placement using a slim cholangioscope for malignant afferent loop obstruction. Endoscopy 2024; 56:E774-E775. [PMID: 39231522 PMCID: PMC11374441 DOI: 10.1055/a-2387-4238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/06/2024]
Affiliation(s)
- Haruo Miwa
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Ritsuko Oishi
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Kazuki Endo
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Hiromi Tsuchiya
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Akihiro Funaoka
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Yuichi Suzuki
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Shin Maeda
- Department of Gastroenterology, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
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Bronswijk M, Pérez-Cuadrado-Robles E, Van der Merwe S. Endoscopic ultrasound-guided gastrointestinal anastomosis: Current status and future perspectives. Dig Endosc 2023; 35:255-263. [PMID: 35726383 DOI: 10.1111/den.14381] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 06/16/2022] [Indexed: 01/24/2023]
Abstract
OBJECTIVES Both clinical experience and supporting data have improved drastically in the context of endoscopic ultrasound-guided gastrointestinal anastomosis (EUS-GIA). Where outcomes used to be questioned, focus has now moved towards performing comparative studies, optimizing technical approaches, improving patient selection, and developing well-defined treatment algorithms. METHODS The purpose of this review is to provide an overview of technical developments within EUS-GIA and to discuss the current status of EUS-GIA and future directions. RESULTS EUS-GIA techniques such as EUS-guided gastroenterostomy (EUS-GE), EUS-directed transgastric endoscopic retrograde cholangiopancreatography (ERCP) (EDGE) and EUS-guided treatment afferent loop syndrome have undergone further development, refining technical approaches, improving patient selection and subsequent outcomes. Retrospective evaluations of EUS-GE have shown similar safety when compared to enteral stenting, whilst attaining surgical range efficacy. Whereas, in patients with gastric bypass anatomy, EDGE seems less cumbersome and time consuming than enteroscopy-assisted ERCP, while preventing surgical morbidity associated with laparoscopy-assisted ERCP. Although less evidence is available on EUS-guided treatment of afferent loop syndrome, this technique has been associated with higher clinical success and fewer reinterventions and adverse events when compared to enteral stenting and percutaneous drainage, respectively. Several randomized studies are currently underway evaluating EUS-GE in malignant gastric outlet obstruction (GOO), whereas more prospective data are still required on EDGE and long-term fistula management. CONCLUSION EUS-GIA has become a crucial alternative to established techniques, overcoming technical limitations and subsequently improving patient outcomes. Although we should focus on prospective confirmation of these results in the context of GOO and EDGE, the current evidence already allows for a prominent role for EUS-GIA in our everyday practice.
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Affiliation(s)
- Michiel Bronswijk
- Department of Gastroenterology and Hepatology, Imelda Hospital, Bonheiden, Belgium.,Imelda GI Clinical Research Center, Bonheiden, Belgium.,Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | | | - Schalk Van der Merwe
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
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De Bie C, Bronswijk M, Vanella G, Pérez-Cuadrado-Robles E, van Malenstein H, Laleman W, Van der Merwe S. EUS-guided hepaticogastrostomy for patients with afferent loop syndrome: a comparison with EUS-guided gastroenterostomy or percutaneous drainage. Surg Endosc 2021; 36:2393-2400. [PMID: 33909126 DOI: 10.1007/s00464-021-08520-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 04/17/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Where palliative surgery or percutaneous drainage used to be the only option in patients with afferent loop syndrome, endoscopic management by EUS-guided gastroenterostomy has been gaining ground. However, EUS-guided hepaticogastrostomy might also provide sufficient biliary drainage. Our aim was to evaluate the feasibility of EUS-guided hepaticogastrostomy for the management of afferent loop syndrome and provide comparative data on the different approaches. METHODS The institutional databases were queried for all consecutive minimally invasive procedures for afferent loop syndrome. A retrospective, dual-centre analysis was performed, separately analysing EUS-guided hepaticogastrostomy, EUS-guided gastroenterostomy and percutaneous drainage. Efficacy, safety, need for re-intervention, hospital stay and overall survival were compared. RESULTS In total, 17 patients were included (mean age 59 years (± SD 10.5), 23.5% female). Six patients, which were ineligible for EUS-guided gastroenterostomy, were treated with EUS-guided hepaticogastrostomy. EUS-guided gastroenterostomy and percutaneous drainage were performed in 6 and 5 patients respectively. Clinical success was achieved in all EUS-treated patients, versus 80% in the percutaneous drainage group (p = 0.455). Furthermore, higher rates of bilirubin decrease were seen among patients undergoing EUS: > 25% bilirubin decrease in 10 vs. 1 patient(s) in the percutaneously drained group (p = 0.028), with > 50% and > 75% decrease identified only in the EUS group. Using the ASGE lexicon for adverse event grading, adverse events occurred only in patients treated with percutaneous drainage (60%, p = 0.015). And last, the median number of re-interventions was significantly lower in patients undergoing EUS (0 (IQR 0.0-1.0) vs. 1 (0.5-2.5), p = 0.045) when compared to percutaneous drainage. CONCLUSIONS In the management of afferent loop syndrome, EUS seems to outperform percutaneous drainage. Moreover, in our cohort, EUS-guided gastroenterostomy and hepaticogastrostomy provided similar outcomes, suggesting EUS-guided hepaticogastrostomy as the salvage procedure in situations where EUS-guided gastroenterostomy is not feasible or has failed.
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Affiliation(s)
- Charlotte De Bie
- Department of Gastroenterology and Hepatology, University Hospitals Gasthuisberg, University of Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Michiel Bronswijk
- Department of Gastroenterology and Hepatology, University Hospitals Gasthuisberg, University of Leuven, Herestraat 49, 3000, Leuven, Belgium.
- Department of Gastroenterology and Hepatology, Imelda Hospital, Bonheiden, Belgium.
| | - Giuseppe Vanella
- Department of Gastroenterology and Hepatology, University Hospitals Gasthuisberg, University of Leuven, Herestraat 49, 3000, Leuven, Belgium
- Pancreatobiliary Endoscopy and EUS Division, IRCSS San Raffaele Scientific Institute, Milan, Italy
| | | | - Hannah van Malenstein
- Department of Gastroenterology and Hepatology, University Hospitals Gasthuisberg, University of Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Wim Laleman
- Department of Gastroenterology and Hepatology, University Hospitals Gasthuisberg, University of Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Schalk Van der Merwe
- Department of Gastroenterology and Hepatology, University Hospitals Gasthuisberg, University of Leuven, Herestraat 49, 3000, Leuven, Belgium
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Coro O, Caillol F, Poincloux L, Bories E, Pesenti C, Ratone JP, Giovannini M. Hepaticogastrostomy under EUS guidance for a patient with a history of bypass surgery with a new stent design (with video). Endosc Ultrasound 2019; 8:66-68. [PMID: 30168478 PMCID: PMC6400087 DOI: 10.4103/eus.eus_15_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Omar Coro
- Department of Endoscopy, Paoli Calmettes Institute, Marseille, France
| | - Fabrice Caillol
- Department of Endoscopy, Paoli Calmettes Institute, Marseille, France
| | | | - Erwan Bories
- Department of Endoscopy, Paoli Calmettes Institute, Marseille, France
| | - Christian Pesenti
- Department of Endoscopy, Paoli Calmettes Institute, Marseille, France
| | | | - Marc Giovannini
- Department of Endoscopy, Paoli Calmettes Institute, Marseille, France
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Sasaki T, Yamada I, Matsuyama M, Sasahira N. Enteral stent placement for malignant afferent loop obstruction by the through-the-scope technique using a short-type single-balloon enteroscope. Endosc Int Open 2018; 6:E806-E811. [PMID: 29977998 PMCID: PMC6032631 DOI: 10.1055/a-0605-3508] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 04/03/2018] [Indexed: 12/18/2022] Open
Abstract
Background and study aims A short-type single-balloon enteroscope with a 3.2-mm working channel makes it possible to insert an enteral stent by the through-the-scope technique in patients with malignant afferent loop obstruction. Here, we report five cases of malignant afferent loop obstruction treated with endoscopic enteral stenting. We also propose a new classification for three types of malignant afferent loop obstruction. Type 1: The obstruction site is located distal to the papilla or the bilioenteric anastomosis. Type 2: The obstruction site is located at the papilla or the bilioenteric anastomosis. Type 3: The obstruction site is located between the bilioenteric and pancreaticoenteric anastomosis. The patients with type 1 and 3 were simply treated by inserting an enteral stent endoscopically. The patient with type 2 was treated with an endoscopic enteral stent for malignant afferent loop obstruction and with percutaneous transhepatic biliary stenting for malignant biliary obstruction. Although double stenting for type 2 remains a difficult endoscopic procedure, the endoscopic approach has become the standard approach for malignant afferent loop obstruction.
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Affiliation(s)
- Takashi Sasaki
- Department of Gastroenterology, Cancer Institute Hospital of Japanese Foundation of Cancer Research, Koto-ku, Japan,Corresponding author Takashi Sasaki, MD, PhD Department of GastroenterologyCancer Institute Hospital of Japanese Foundation of Cancer Research3-8-31 Ariake, Koto, Tokyo 135-8550, Japan+81-3-3520-0141
| | - Ikuhiro Yamada
- Department of Gastroenterology, Cancer Institute Hospital of Japanese Foundation of Cancer Research, Koto-ku, Japan
| | - Masato Matsuyama
- Department of Gastroenterology, Cancer Institute Hospital of Japanese Foundation of Cancer Research, Koto-ku, Japan
| | - Naoki Sasahira
- Department of Gastroenterology, Cancer Institute Hospital of Japanese Foundation of Cancer Research, Koto-ku, Japan
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Jinno N, Naitoh I, Nagura Y, Fujioka K, Mizuno Y, Momose J, Ooyama M, Hayashi K, Miyaki T, Nakamura M, Joh T. Percutaneous Transhepatic Self-expanding Metallic Stent Placement for the Treatment of Malignant Afferent Loop Obstruction. Intern Med 2018; 57:333-337. [PMID: 29093418 PMCID: PMC5827311 DOI: 10.2169/internalmedicine.9382-17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
We report the case of a 71-year-old man with afferent loop obstruction (ALO) after Roux-en-Y reconstruction due to gastric cancer. Computed tomography showed a distended afferent loop and a dilatated bile duct. We could not reach the stricture site in the afferent loop using a gastroscope. We performed percutaneous transhepatic biliary drainage (PTBD) and placed a self-expanding metallic stent (SEMS) in the duodenal stricture through the PTBD route. Although an endoscopic approach is preferable, when PTBD can be performed, percutaneous transhepatic SEMS placement might be an alternative option for treating ALO in cases in which it is not possible to reach the site of stenosis with an endoscope.
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Affiliation(s)
- Naruomi Jinno
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Japan
- Department of Gastroenterology, Toyokawa Municipal Hospital, Japan
| | - Itaru Naitoh
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Yoshihito Nagura
- Department of Gastroenterology, Toyokawa Municipal Hospital, Japan
| | | | - Yusuke Mizuno
- Department of Gastroenterology, Nagoya Daini Red Cross Hospital, Japan
| | - Junko Momose
- Department of Gastroenterology, Toyokawa Municipal Hospital, Japan
| | - Makoto Ooyama
- Department of Gastroenterology, Toyokawa Municipal Hospital, Japan
| | - Kazuki Hayashi
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Tomokatsu Miyaki
- Department of Gastroenterology, Toyokawa Municipal Hospital, Japan
| | - Makoto Nakamura
- Department of Gastroenterology, Toyokawa Municipal Hospital, Japan
| | - Takashi Joh
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Japan
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Benallal DC, Hoibian S, Caillol F, Bories E, Presenti C, Ratone JP, Giovannini M. EUS-guided gastroenterostomy for afferent loop syndrome treatment stent. Endosc Ultrasound 2018; 7:418-419. [PMID: 30004036 PMCID: PMC6289015 DOI: 10.4103/eus.eus_41_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
| | - Solene Hoibian
- Division of Gastroenterology, Paoli-Calmettes Institute, Marseille, France
| | - Fabrice Caillol
- Division of Gastroenterology, Paoli-Calmettes Institute, Marseille, France
| | - Erwan Bories
- Division of Gastroenterology, Paoli-Calmettes Institute, Marseille, France
| | - Christian Presenti
- Division of Gastroenterology, Paoli-Calmettes Institute, Marseille, France
| | | | - Marc Giovannini
- Division of Gastroenterology, Paoli-Calmettes Institute, Marseille, France
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