1
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Behrens S, Sutton TL, Patel R, Schwantes IR, O'Grady J, Johnson A, Grossberg A, Lopez C, Gilbert E, Mayo S, Sheppard BC. Neoadjuvant therapy does not impact the biliary microbiome in patients with pancreatic cancer. J Surg Oncol 2023; 128:271-279. [PMID: 37095724 DOI: 10.1002/jso.27281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 03/07/2023] [Accepted: 03/20/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND Pancreatic adenocarcinoma (PDAC) often impinges on the biliary tree and obstruction necessitates stent placement increasing the risk of surgical site infections (SSIs). We sought to explore the impact of neoadjuvant therapy on the biliary microbiome and SSI risk in patients undergoing resection. METHODS A retrospective analysis was performed on 346 patients with PDAC who underwent resection at our institution from 2008 to 2021. Univariate and multivariate methods were utilized for analysis. RESULTS Biliary stenting rates were similar between groups but resulted in increased bile culture positivity (97% vs. 15%, p < 0.001). Culture positivity did not differ between upfront resection or neoadjuvant chemotherapy (NAC) (77% vs. 80%, p = 0.60). NAC-alone versus neoadjuvant chemoradiotherapy did not impact biliary positivity (80% vs. 79%, p = 0.91), nor did 5-fluorouracil versus gemcitabine-based regimens (73% vs. 85%, p = 0.19). While biliary stenting increased incisional SSI risk (odds ratios [OR]: 3.87, p = 0.001), NAC did not (OR: 0.83, p = 0.54). Upfront resection, NAC, and chemoradiotherapy were not associated with biliary organism-specific changes or antibiotic resistance patterns. CONCLUSIONS Biliary stenting is the greatest predictor for positive biliary cultures and SSIs in resected PDAC patients. Neither NAC nor radiotherapy impact bile culture positivity, speciation, rates, or antibiotic resistance patterns, and perioperative antibiotic prophylaxis should not differ.
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Affiliation(s)
- Shay Behrens
- Department of Surgery, Oregon Heath & Science University (OHSU), Portland, Oregon, USA
| | - Thomas L Sutton
- Department of Surgery, Oregon Heath & Science University (OHSU), Portland, Oregon, USA
| | - Ranish Patel
- Department of Surgery, Oregon Heath & Science University (OHSU), Portland, Oregon, USA
| | - Issac R Schwantes
- Department of Surgery, Oregon Heath & Science University (OHSU), Portland, Oregon, USA
| | | | - Alicia Johnson
- Department of Surgery, Oregon Heath & Science University (OHSU), Portland, Oregon, USA
| | - Aaron Grossberg
- Department of Surgery, Oregon Heath & Science University (OHSU), Portland, Oregon, USA
| | - Charles Lopez
- Division of Hematology Oncology, Knight Cancer Institute, Oregon Health & Science University (OHSU), Portland, OR, USA
| | - Erin Gilbert
- Department of Surgery, Oregon Heath & Science University (OHSU), Portland, Oregon, USA
| | - Skye Mayo
- Department of Surgery, Oregon Heath & Science University (OHSU), Portland, Oregon, USA
- Department of Surgery, Division of Surgical Oncology, OHSU, Portland, Oregon, USA
| | - Brett C Sheppard
- Department of Surgery, Oregon Heath & Science University (OHSU), Portland, Oregon, USA
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Çelik M, Yilmaz H, Kılıç MC, Soykan M, Akbudak İH, Ozban M, Yılmaz M. Efficacy and safety of endoscopic retrograde cholangiopancreatography with endoscopic sphincterotomy and biliary stenting in post-operative bile leaks. ULUS TRAVMA ACIL CER 2023; 29:904-908. [PMID: 37563904 PMCID: PMC10560794 DOI: 10.14744/tjtes.2023.49963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 07/04/2023] [Accepted: 07/16/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND We evaluated the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP), sphincterotomy, balloon biliary tract scanning, and plastic stenting in diagnosing and treating bile duct leakage after laparoscopic cholecystectomy and hydatid cyst surgery in this study. METHODS The study evaluated patients who underwent ERCP, sphincterotomy, and stenting for post-operative bile leakage. The patients were grouped under 4 groups (cystic duct stump, sac bed, hydatid cyst, and choledochal) according to the bile leakage de-tected in the ERCP procedure. The success of the procedure after the ERCP was evaluated by drain extraction time, whether early complications such as bleeding, pancreatitis, and perforation developed due to the ERCP procedure and the presence of obstructive pathology in ERCP. RESULTS Clinical improvement was observed in 65/73 (89%) patients who underwent successful ERCP procedures, and their drains could be removed. The mean drain removal time was 32.69±23.32 days. After laparoscopic cholecystectomy, bile leakage was most frequently from the cystic duct stump. There was no difference between the groups in procedural success rates. Drain removal time was shorter in the patient group with leakage from the cystic duct compared to the other three groups (P<0.05). After the ERCP procedure, 5/73 (6.9%) patients had minor ERCP complications, which improved with medical treatment. No major ERCP complication was observed. In addition, 25/73 patients (34.2%) had obstructive pathology such as biliary stone and hydatid membrane. CONCLUSION In patients with biliary leak due to laparoscopic cholecystectomy and hydatid cyst surgery, ERCP, sphincterotomy, balloon scanning, and plastic stenting are both highly effective and reliable options. They should be considered as the first-choice treat-ment approach in this patient group.
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Affiliation(s)
- Mustafa Çelik
- Department of Gastroenterology, Pamukkale University Training and Research Hospital, Denizli-Türkiye
| | - Halil Yilmaz
- Department of Gastroenterology, Denizli State Hospital, Denizli-Türkiye
| | - Mahmut Can Kılıç
- Department of Gastroenterology, Pamukkale University Training and Research Hospital, Denizli-Türkiye
| | - Melek Soykan
- Department of Gastroenterology, Pamukkale University Training and Research Hospital, Denizli-Türkiye
| | - İlknur Hatice Akbudak
- Department of Anesthesiology and Reanimation, Pamukkale University Training and Research Hospital, Denizli-Türkiye
| | - Murat Ozban
- Department of General Surgery, Pamukkale University Training and Research Hospital, Denizli-Türkiye
| | - Mustafa Yılmaz
- Department of Gastroenterology, Pamukkale University Training and Research Hospital, Denizli-Türkiye
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3
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Yang J, Shu C, Shang X, Xu H, Wei N. Prognostic Value of Systemic Immune-Inflammation Index-Based Nomogram in Patients with Extrahepatic Cholangiocarcinoma Treated by Percutaneous Transhepatic Biliary Stenting Combined with 125I Seed Intracavitary Irradiation. Int J Gen Med 2023; 16:2081-2094. [PMID: 37275332 PMCID: PMC10237196 DOI: 10.2147/ijgm.s411577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/15/2023] [Indexed: 06/07/2023] Open
Abstract
Purpose This study aimed to investigate the prognostic value of systemic immune-inflammation index (SII) in patients with extrahepatic cholangiocarcinoma (EHCC) treated by percutaneous transhepatic biliary stenting (PTBS) combined with 125I seed intracavitary irradiation and further develop a predictive model related to SII. Methods A total of 145 patients with EHCC who received PTBS combined with 125I seed implantation were retrospectively analyzed. The optimal cut-off value of SII was identified by receiver operating characteristic (ROC) curve analysis. Kaplan-Meier curves and Cox regression were applied to estimate the prognostic value of SII and identify other significant factors of overall survival (OS). Additionally, a novel nomogram was constructed. The concordance index (C-index), calibration plots and decision curve analysis were used to evaluate the performance of the nomogram model. Results The optimal cut-off value for preoperative SII of 890.2 stratified the patients into High-SII (H-SII) and Low-SII (L-SII) groups. Univariate and multivariate analyses demonstrated that SII was an independent factor for OS. We also found that better therapeutic effect could be obtained with combined postoperative chemotherapy (P < 0.001). Moreover, we revealed that elevated preoperative CA19-9 (P = 0.038) and TBIL level (P = 0.024) were reason for poor prognosis of EHCC. A well-discriminated and calibrated nomogram was developed to predict the 1-year and 2-year OS of EHCC (C-index: 0.709). Conclusion The SII may be a feasible and convenient prognosis predictor for EHCC. The comprehensive nomogram based on SII presented in this study is a promising model for predicting OS in EHCC patients after PTBS combined with 125I seed intracavitary irradiation.
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Affiliation(s)
- Jing Yang
- Department of Interventional Radiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221006, People’s Republic of China
| | - Chengsen Shu
- Department of Interventional Radiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221006, People’s Republic of China
| | - Xianfu Shang
- Department of Interventional Radiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221006, People’s Republic of China
| | - Hao Xu
- Department of Interventional Radiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221006, People’s Republic of China
| | - Ning Wei
- Department of Interventional Radiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221006, People’s Republic of China
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Marx M, Caillol F, Autret A, Ratone JP, Zemmour C, Boher JM, Pesenti C, Bories E, Barthet M, Napoléon B, Giovannini M. EUS-guided hepaticogastrostomy in patients with obstructive jaundice after failed or impossible endoscopic retrograde drainage: A multicenter, randomized phase II Study. Endosc Ultrasound 2022; 11:495-502. [PMID: 36537387 PMCID: PMC9921974 DOI: 10.4103/eus-d-21-00108] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
Background and Objectives Over the last two decades, EUS-guided hepaticogastrostomy (EUS-HGS) has emerged as a therapeutic alternative for patients with biliary obstruction and failed ERCP. Percutaneous transhepatic biliary drainage (PTBD) as the gold standard is associated with relevant morbidity and need for re-intervention. The aim of our work was to evaluate in a phase II study the safety and efficacy profile of EUS-HGS. A PTBD arm was considered a control group. Patients and Methods We conducted a prospective, randomized, noncomparative phase II study in three French tertiary centers involving patients with benign or malignant obstructive jaundice after failure of ERCP. Patients were randomized to either PTBD or EUS-HGS. Results Fifty-six patients (mean age 64 years) have been included between 2011 and 2015. Twenty-one underwent PTBD and thirty-five were drained using EUS-HGS. An interim analysis after the inclusion of 41 patients revealed an unexpected high 30-day morbidity rate for PTBD (13 out of 21 patients), justifying to stop randomization and inclusion in this control arm in 2013. The primary objective was reached with 10 out of the 35 EUS-HGS patients (28.6%) having observed complications (90%-level bilateral exact binomial confidence interval [CI] [16.4%-43.6%], left-sided exact binomial test to the objectified 50% unacceptable rate P = 0.0083). Both methods achieved comparable technical success rate (TSR) and clinical success rate (CSR) (TSR: PTBD 100% vs. EUS-HGS 94.3%, P = 0.28; CSR: PTBD 66.7% vs. EUS-HGS 80%, P = 0.35). Long-term follow-up showed EUS-HGS patients being at lower risk for re-intervention (relative risk = 0.47, 95% CI [0.27-0.83]). Conclusion In cases of ERCP failure, EUS-HGS is a valuable alternative for biliary drainage with a high TSR and CSR. PTBD is associated with an unacceptable 30-day morbidity rate, whereas EUS-HGS seems to have a decent safety profile, suggesting that it may be the treatment of choice in appropriately selected patients.
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Affiliation(s)
- Mariola Marx
- Division of Gastroenterology, Paoli-Calmettes Institute, Marseille, France,Address for correspondence Dr. Mariola Marx, Division of Gastroenterology, Paoli-Calmettes Institute, Marseille, France. E-mail:
| | - Fabrice Caillol
- Division of Gastroenterology, Paoli-Calmettes Institute, Marseille, France
| | - Aurélie Autret
- Division of Biostatistics, Paoli-Calmettes Institute, Marseille, France
| | | | | | - Jean Marie Boher
- Division of Biostatistics, Paoli-Calmettes Institute, Marseille, France
| | - Christian Pesenti
- Division of Gastroenterology, Paoli-Calmettes Institute, Marseille, France
| | - Erwan Bories
- Division of Gastroenterology, Paoli-Calmettes Institute, Marseille, France
| | - Marc Barthet
- Division of Gastroenterology and Hepatology, Hôpital Nord, Marseille, France
| | - Bertrand Napoléon
- Division of Gastroenterology and Hepatology, Hôpital Jean Mermoz, Lyon, France
| | - Marc Giovannini
- Division of Gastroenterology, Paoli-Calmettes Institute, Marseille, France
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5
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Constantinescu A, Plotogea OM, Stan-Ilie M, Ciurea T, Gheonea DI, Ungureanu BS, Bălan G, Rinja E, Panic N, Şandru V, Constantinescu G. Impact of biliary stenting in endoscopic ultrasound-guided tissue acquisition among patients with pancreatic cancer. J Clin Ultrasound 2022; 50:844-849. [PMID: 35254661 DOI: 10.1002/jcu.23186] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 01/18/2022] [Accepted: 01/21/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Pancreatic malignancies represent highly fatal diseases with poor prognosis and constantly increasing incidence despite modern diagnostic and therapeutic options. Both endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) are regarded as mainstays in pancreatic cancer management. The present study aims to evaluate whether accuracy EUS with fine-needle aspiration or biopsy (FNA or FNB) in pancreatic cancer diagnosis is influenced by prior biliary stenting or by technical or anatomical features (stent type, number of needle passes, common bile duct or Wirsung's diameter, topographical characteristics and diameter of the pancreatic tumor). MATERIALS AND METHODS This retrospective study includes 243 patients with pancreatic cancer who underwent ERCP and EUS with fine-needle aspiration or biopsy (FNA or FNB). RESULTS AND DISCUSSION Out of the total number of patients, 68 were stented prior to EUS. We found that the EUS-FNA diagnostic yield is not influenced either by the presence of biliary stent, nor by the type of stent (plastic or metallic). Moreover, the mean needle passes required were similar for both stented patients and not stented ones. CONCLUSIONS Ultimately, given our results, we can state that EUS-FNA/FNB can be safely and accurately performed in the presence of biliary stents.
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Affiliation(s)
- Alexandru Constantinescu
- Department of Gastroenterology, Clinical Emergency Hospital of Bucharest, Bucharest, Romania
- University of Medicine and Pharmacy, Craiova, Romania
| | - Oana-Mihaela Plotogea
- Department of Gastroenterology, Clinical Emergency Hospital of Bucharest, Bucharest, Romania
- Department 5, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Mădălina Stan-Ilie
- Department of Gastroenterology, Clinical Emergency Hospital of Bucharest, Bucharest, Romania
- Department 5, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Tudorel Ciurea
- Department of Gastroenterology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Dan Ionut Gheonea
- Department of Gastroenterology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Bogdan Silviu Ungureanu
- Department of Gastroenterology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Gheorghe Bălan
- University of Medicine and Pharmacy "Grigore T. Popa" Iasi, Iasi, Romania
| | - Ecaterina Rinja
- Department of Gastroenterology, Clinical Emergency Hospital of Bucharest, Bucharest, Romania
| | - Nikola Panic
- Dr. Dragisa Misovic-Dedinje University Clinic, Belgrade, Serbia
| | - Vasile Şandru
- Department of Gastroenterology, Clinical Emergency Hospital of Bucharest, Bucharest, Romania
- University of Medicine and Pharmacy, Craiova, Romania
| | - Gabriel Constantinescu
- Department of Gastroenterology, Clinical Emergency Hospital of Bucharest, Bucharest, Romania
- Department 5, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
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Klein F, Wellhöner F, Plumeier I, Kahl S, Chhatwal P, Vital M, Voigtländer T, Pieper DH, Manns MP, Lenzen H, Solbach P, Heidrich B. The biliary microbiome in ischaemic-type biliary lesions can be shaped by stenting but is resilient to antibiotic treatment. Liver Int 2022; 42:1070-1083. [PMID: 35152539 DOI: 10.1111/liv.15194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 02/02/2022] [Accepted: 02/07/2022] [Indexed: 02/13/2023]
Abstract
This study aims to characterize the biliary microbiome as neglected factor in patients with ischaemic-type biliary lesions (ITBL) after liver transplantation. Therefore, the V1-V2 region of the 16S rRNA gene was sequenced in 175 bile samples. Samples from patients with anastomotic strictures (AS) served as controls. Multivariate analysis and in silico metagenomics were applied cross-sectionally and longitudinally. The microbial community differed significantly between ITBL and AS in terms of alpha and beta diversity. Both, antibiotic treatment and stenting were associated independently with differences in the microbial community structure. In contrast to AS, in ITBL stenting was associated with pronounced differences in the biliary microbiome, whereas no differences associated with antibiotic treatment could be observed in ITBL contrasting the pronounced differences found in AS. Bacterial pathways involved in the production of antibacterial metabolites were increased in ITBL with antibiotic treatment. After liver transplantation, the biliary tract harbours a complex microbial community with significant differences between ITBL and AS. Fundamental changes in the microbial community in ITBL can be achieved with biliary stenting. However, the effect of antibiotic treatment in ITBL was minimal. Therefore, antibiotics should be administered wisely in order to reduce emerging resistance of the biliary microbiome towards external antibiotics.
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Affiliation(s)
- Friederike Klein
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,German Center for Infection Research (DZIF), Hannover/Braunschweig, Germany.,Microbial Interactions and Processes Research Group, Helmholtz Center for Infection Research, Braunschweig, Germany
| | - Freya Wellhöner
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Iris Plumeier
- Microbial Interactions and Processes Research Group, Helmholtz Center for Infection Research, Braunschweig, Germany
| | - Silke Kahl
- Microbial Interactions and Processes Research Group, Helmholtz Center for Infection Research, Braunschweig, Germany
| | - Patrick Chhatwal
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany
| | - Marius Vital
- Microbial Interactions and Processes Research Group, Helmholtz Center for Infection Research, Braunschweig, Germany
| | - Torsten Voigtländer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Dietmar H Pieper
- Microbial Interactions and Processes Research Group, Helmholtz Center for Infection Research, Braunschweig, Germany
| | - Michael P Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Henrike Lenzen
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,Integrated Research and Treatment Center Transplantation (IFB-Tx), Hannover Medical School, Hanover, Germany
| | - Philipp Solbach
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,German Center for Infection Research (DZIF), Hannover/Braunschweig, Germany.,Integrated Research and Treatment Center Transplantation (IFB-Tx), Hannover Medical School, Hanover, Germany
| | - Benjamin Heidrich
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,German Center for Infection Research (DZIF), Hannover/Braunschweig, Germany.,Cluster of Excellence RESIST (EXC 2155), Hannover Medical School, Hannover, Germany
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7
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Nakahara K, Komatsu T, Matsumoto N. Successful biliary stenting after portal vein cannulation during endoscopic retrograde cholangiopancreatography. J Hepatobiliary Pancreat Sci 2022; 29:e61-e62. [PMID: 35150471 DOI: 10.1002/jhbp.1124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/16/2021] [Accepted: 01/10/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Kazunari Nakahara
- Department of Gastroenterology and Hepatology, St. Marianna University, School of Medicine, 2-16-1 Sugao Miyamae-ku, Kawasaki, 216-8511, Japan
| | - Takumi Komatsu
- Department of Gastroenterology and Hepatology, St. Marianna University, School of Medicine, Yokohama City Seibu Hospital, 1197-1, Yasashicho Asahi-ku, Yokohama, 241-0811, Japan
| | - Nobuyuki Matsumoto
- Department of Gastroenterology and Hepatology, St. Marianna University, School of Medicine, Yokohama City Seibu Hospital, 1197-1, Yasashicho Asahi-ku, Yokohama, 241-0811, Japan
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8
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Shevchenko EG, Al-Kanani JS, Yarosh AL, Soloshenko AV, Karpachev AA, Olejnik NV, Bratishcheva NN, Khalchenko AA. [Endoscopically non-removable stones of the common bile duct]. Khirurgiia (Mosk) 2022:56-60. [PMID: 36469469 DOI: 10.17116/hirurgia202212156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of long-term biliary stenting in the treatment of endoscopically intractable common bile duct stones. MATERIAL AND METHODS The study enrolled 247 patients with endoscopically non-removable bile duct calculi («difficult» choledocholithiasis) divided into two comparable groups. The main group included 129 patients who underwent biliary stenting with original stents with a nanocarbon inert coating (RF patent No. 84226), including those with inclusion of silver nanoclusters (RF patent No. 129397). The control group included 118 patients who underwent all methods of surgical treatment of choledocholithiasis, while biliary stents with original nanocarbon silver-containing inert coating were excluded. The vast majority of patients were women of advanced age (mean 66.8±4.7 and 66.3±5.6, max 89 and 90, min 32 and 37 years, respectively). RESULTS In the control group, all patients underwent endoscopic transpapillary interventions as soon as possible. We could not extract common bile duct stones via endoscopic approach in 56.8% of cases. These patients underwent open or laparoscopic choledocholithotomy with lithoextraction. Complications occurred in 28.5% of cases. Mortality rate was 4.2%. Standard stenting of common bile duct was performed in 28.8% of cases. At the same time, stent dysfunction followed by relapse of obstructive jaundice occurred in 27.1% of patients within 3-3.5 months. Of these, 16 patients (13.5%) underwent stent removal and lithoextraction. Re-stenting was performed in 18 patients (15.3%). Moreover, shock wave lithotripsy with subsequent removal of common bile duct calculi was performed in 8 (6.8%) of these patients the next day. In the main group, original biliary plastic stents with nanocarbon silver-containing inert coating were implanted in all patients. Under permanent therapy with ursodeoxycholic acid drugs, we observed significant shrinkage of calculi to 11.8±1.8 mm and decrease in their density. This made it possible to carry out successful extraction of calculi in 81 patients (62.8%) after 6±0.3 months. Shock wave lithotripsy was performed in 36 (27.9%) cases. This procedure was successful and allowed final lithoextraction in 28 patients (21.7%). Re-stenting was performed in 15 (11.6%) cases, laparotomy - in 5 (3.9%) patients. Mortality rate was 0.78%. CONCLUSION Our data allow us to discuss high efficiency of long-term bile duct stenting with plastic stents with nanocarbon silver-containing inert coating in complex treatment of choledocholithiasis. This approach ensures acceptable incidence of undesirable complications and mortality. This situation undoubtedly dictates the need for further larger prospective studies.
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Affiliation(s)
| | | | - A L Yarosh
- Belgorod National Research University, Belgorod, Russia
| | | | - A A Karpachev
- Belgorod National Research University, Belgorod, Russia
| | - N V Olejnik
- Belgorod National Research University, Belgorod, Russia
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9
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Franko J, Chamberlain DM, James AB, Collins A, Tee MC, Le VH, Frankova D. Rising Incidence of Peri-Operative Bactibilia among Patients Undergoing Complex Biliopancreatic Surgery. Surg Infect (Larchmt) 2021; 23:47-52. [PMID: 34619058 DOI: 10.1089/sur.2021.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Biliary instrumentation is associated with bactibilia and post-operative infection. Bactibilia incidence over time remains unknown. Patients and Methods: Consecutive patients with bilioenteric anastomosis surgery and available surveillance intra-operative bile duct cultures were evaluated for post-operative infection. The study period (2008-2019) was divided into quartiles to examine time-based trends. Results: Among 101 cases, 60 intra-operative bile duct cultures had no growth and 41 patients had documented at least one culture-positive isolate in their bile. Frequency of patients with culture-positive intra-operative bile increased over the study period (period 1, 1/28, 3.6% vs. period 2, 7/21, 33.3% vs. period 3, 15/26, 57.7% vs. period 4, 18/26, 69.2%; p < 0.001). Culture-positive post-operative infection (17/101; 16.8%) was not associated with intra-operative bile duct culture (p = 0.552), however, the same micro-organism isolate was identified on post-operative infection and intra-operative culture of bile duct bile among six of 17 patients (35.3%). Conclusions: We found an increasing incidence of bactibilia and post-operative culture-positive infections over the last decade. One-third of patients with a positive intra-operative bile duct culture experienced post-operative infection with the same organism, yet a clear link between bile colonization and post-operative infection was not established.
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Affiliation(s)
- Jan Franko
- MercyOne Medical Center, Des Moines, Iowa, USA
| | | | | | | | - May C Tee
- MercyOne Medical Center, Des Moines, Iowa, USA
| | - Viet H Le
- MercyOne Medical Center, Des Moines, Iowa, USA
| | - Daniela Frankova
- MercyOne Medical Center, Des Moines, Iowa, USA.,Des Moines University, Des Moines, Iowa, USA
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10
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Nakamura S, Ishii Y, Serikawa M, Tsuboi T, Kawamura R, Tsushima K, Hirano T, Mori T, Uemura K, Chayama K. Utility of the inside stent as a preoperative biliary drainage method for patients with malignant perihilar biliary stricture. J Hepatobiliary Pancreat Sci 2021; 28:864-873. [PMID: 33993640 DOI: 10.1002/jhbp.990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 04/15/2021] [Accepted: 05/04/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND/PURPOSE Appropriate preoperative biliary drainage (PBD) is extremely important in patients with operable malignant perihilar biliary strictures. The aim of this study was to clarify the utility of inside stents in PBD. METHODS Eighty-one patients with malignant perihilar biliary stricture who underwent endoscopic nasobiliary drainage (ENBD) as the first PBD method were enrolled. Biliary stenting was performed in 61 patients during the study course (41 patients-inside stent implanted in the bile duct; 20 patients-conventional stent placed across the papilla of Vater). Twenty patients continued ENBD until surgery. Treatment outcomes were compared among the three groups. RESULTS The re-intervention rate was significantly lower in the inside stent group than in the conventional stent group and ENBD group (9.8% vs 40% and 35%, P = .013 and .030, respectively), and the time to re-intervention was also significantly longer (log-rank: P = .004 and .041, respectively). Of the five patients in the inside stent group who underwent neoadjuvant chemotherapy, only one required re-intervention. There was no significant difference in the incidence of postoperative complications among the three groups. CONCLUSIONS The inside stent may be a useful PBD method for patients with malignant perihilar biliary stricture.
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Affiliation(s)
- Shinya Nakamura
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yasutaka Ishii
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Masahiro Serikawa
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tomofumi Tsuboi
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Ryota Kawamura
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Ken Tsushima
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tetsuro Hirano
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takeshi Mori
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kenichiro Uemura
- Department of Surgery, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kazuaki Chayama
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
- Research Center for Hepatology and Gastroenterology, Hiroshima University, Hiroshima, Japan
- RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
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11
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Kin T, Ishii K, Okabe Y, Itoi T, Katanuma A. Feasibility of biliary stenting to distal malignant biliary obstruction using a novel designed metal stent with duckbill-shaped anti-reflux valve. Dig Endosc 2021; 33:648-655. [PMID: 32875614 DOI: 10.1111/den.13827] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/06/2020] [Accepted: 08/19/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Anti-reflux metal stent (ARMS) has been used to prevent recurrent biliary obstruction (RBO) due to sludge formation or food impaction. However, the most suitable ARMS remains to be identified. This study aimed to evaluate the feasibility, safety, and efficacy of biliary drainage using duckbill-shaped ARMS (D-ARMS). METHODS This was a multicenter, retrospective observational study conducted at three Japanese tertiary institutions. Patients with distal malignant biliary obstruction who underwent biliary stenting using D-ARMS were eligible to participate. Technical success, functional success, adverse event (AE), and time to RBO (TRBO) were evaluated. RESULTS Thirty patients underwent biliary stenting using D-ARMS from December 2018 to October 2019. The technical success rate and functional success rate were 93% and 87%, respectively. However, nonvisibility of the markers at the tip of the metal stent or spontaneous extension was occasionally observed, making biliary stenting using D-ARMS difficult. Early AE occurred in 10% of the patients including cholangitis and pancreatitis. During the median postprocedural observation time of 5.1 months (range, 0.8-22.8), RBO occurred in 33% and the median TRBO was 261 days. As for reintervention, D-ARMS could be extracted in 67% of the patients with RBO. However, the stent was torn off on removal in half of the patients. CONCLUSIONS Although some modifications are still needed, D-ARMS was feasible and safe for biliary drainage, and sufficient TRBO was achieved. Subsequent multi-institutional studies involving a larger number of patients and a longer follow-up period are warranted to validate the present results.
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Affiliation(s)
- Toshifumi Kin
- Center for Gastroenterology, Teine-Keijinkai Hospital, Hokkaido, Japan
| | - Kentaro Ishii
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Yoshinobu Okabe
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Fukuoka, Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Akio Katanuma
- Center for Gastroenterology, Teine-Keijinkai Hospital, Hokkaido, Japan
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12
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Köseoğlu H, Solakoğlu T, Başaran M, Özer Sarı S, Tahtacı M, Yaman S, Selvi E, Ersoy O. Risk factors for post-ERCP pancreatitis: it depends on the ERCP indication. Acta Gastroenterol Belg 2020; 83:598-602. [PMID: 33321017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND AIMS Endoscopic retrograde cholangiopancreatography (ERCP) is an invasive modality, and has a high risk of causing post-ERCP pancreatitis (PEP). Risk factors of PEP have been investigated and conflicting results are present for most risk factors. The aim of this study was to evaluate the risk factors for PEP and to determine whether the risk factors differ due to the ERCP indication. PATIENTS AND METHODS A retrospective study was conducted which included 666 patients with 968 ERCP procedures. Some risk factors were evaluated for PEP, and they were also evaluated separately for patients with bile duct stones and patients who underwent ERCP for other reasons than bile duct stones. RESULTS In patients with bile duct stones detected on ERCP ; female gender, lower diameter of the common bile duct, placing a biliary plastic stent and not having a cholecystectomy history were risk factors for PEP, whereas in patients without bile duct stones the only risk factor for PEP was not having a prior endoscopic sphincterotomy. CONCLUSIONS Our study revealed that PEP risk factors depend on the indication of ERCP. To the best of our knowledge our study is the first study defining cholecystectomy as a protective factor for PEP in patients with bile duct stones and endoscopic sphincterotomy history as a protective factor for PEP in patients without bile duct stones. Our study also showed that female gender, lower diameter of the common bile duct and placing a plastic biliary stent were risk factors for PEP in patients with bile duct stones.
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Affiliation(s)
- H Köseoğlu
- Department of Gastroenterology, Ankara Atatürk Education and Research Hospital, Ankara, Turkey
| | - T Solakoğlu
- Department of Gastroenterology, Ankara Atatürk Education and Research Hospital, Ankara, Turkey
| | - M Başaran
- Department of Gastroenterology, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - S Özer Sarı
- Department of Gastroenterology, Ankara Atatürk Education and Research Hospital, Ankara, Turkey
| | - M Tahtacı
- Department of Gastroenterology, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - S Yaman
- Department of Internal Medicine, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - E Selvi
- Department of Gastroenterology, Ankara Atatürk Education and Research Hospital, Ankara, Turkey
| | - O Ersoy
- Department of Gastroenterology, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
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13
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Abstract
Prolonged indwelling of endoscopically placed biliary plastic stents may lead to complications. We conducted a retrospective analysis of patients who underwent endoscopic retrograde cholangio-pancreaticography (ERCP) at our centre in 2017 and were noted to have retained biliary plastic stents ( > 3 months after an index ERCP). A total of 127 patients had previously placed biliary plastic stents, out of which 45 (35.4%) were retained. The median age of the latter was 52 years (range = 22-79 years) with 27 (60%) patients being men. The median duration of the retained stents was 144 days (range = 94-3292 days). The majority of the patients were asymptomatic. However, 9 (20%) patients had cholangitis, 2 (4.4%) had choledocholithiasis, 2 (4.4%) had cholangitic abscess and 1 (2.2%) developed septicaemia. Fortunately, all these complications could be managed medically and endoscopically. Retention of biliary plastic stents is a problem often overlooked and underestimated in clinical practice. Various measures need to be instituted to create awareness of this entity to prevent undesirable outcomes.
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Affiliation(s)
- Rajeeb Jaleel
- Assistant Professor, Department of Gastroenterology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ebby G Simon
- Professor, Department of Gastroenterology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Piyush Gupta
- Endoscopy Fellow, Department of Gastroenterology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Itish Patnaik
- Assistant Professor, Department of Gastroenterology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Deepu David
- Associate Professor, Department of Gastroenterology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sudipta D Chowdhury
- Professor, Department of Gastroenterology, Christian Medical College, Vellore, Tamil Nadu, India
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14
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Katanuma A, Hayashi T, Kin T, Toyonaga H, Honta S, Chikugo K, Ueki H, Ishii T, Takahashi K. Interventional endoscopic ultrasonography in patients with surgically altered anatomy: Techniques and literature review. Dig Endosc 2020; 32:263-274. [PMID: 31643105 DOI: 10.1111/den.13567] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 10/21/2019] [Indexed: 12/11/2022]
Abstract
There are various reconstruction techniques that are used after upper gastrointestinal surgery. In recent years, opportunities for endoscopic diagnosis and treatment have been increasing in patients undergoing gastrointestinal surgery. With the advent of interventional endoscopic ultrasound (IV-EUS), various procedures have been developed mainly for patients in whom endoscopic retrograde cholangiopancreatography is difficult to carry out. Indications for such procedures are expanding. IV-EUS for surgically altered anatomy (SAA) includes EUS-guided fine-needle aspiration, biliary interventions (e.g. biliary drainage, treatment of bile duct stricture, removal of bile duct stones, and the rendezvous technique), and pancreatic interventions (e.g. rendezvous technique after Whipple surgery). In addition, there have been reports of various EUS-related procedures using a forward-viewing curved linear-array echoendoscope that are carried out for postoperative intestinal tract reconstruction. Although interventional EUS is a useful therapeutic procedure for SAA, there are still no dedicated devices, and standardization of the procedure is warranted.
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Affiliation(s)
- Akio Katanuma
- Center for Gastroenterology, Teine-Keijinkai Hospital, Hokkaido, Japan
| | - Tusyoshi Hayashi
- Center for Gastroenterology, Teine-Keijinkai Hospital, Hokkaido, Japan
| | - Toshifumi Kin
- Center for Gastroenterology, Teine-Keijinkai Hospital, Hokkaido, Japan
| | - Haruka Toyonaga
- Center for Gastroenterology, Teine-Keijinkai Hospital, Hokkaido, Japan
| | - Shunsuke Honta
- Center for Gastroenterology, Teine-Keijinkai Hospital, Hokkaido, Japan
| | - Kouki Chikugo
- Center for Gastroenterology, Teine-Keijinkai Hospital, Hokkaido, Japan
| | - Hidetaro Ueki
- Center for Gastroenterology, Teine-Keijinkai Hospital, Hokkaido, Japan
| | - Tastuya Ishii
- Center for Gastroenterology, Teine-Keijinkai Hospital, Hokkaido, Japan
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15
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Satoh T, Matsubayashi H, Ishiwatari H, Fujie S, Kaneko J, Sato J, Ito S, Kishida Y, Imai K, Hotta K, Yoshida M, Kawata N, Takizawa K, Kakushima N, Sawada A, Ono H. Rupture of Pseudoaneurysm after Biliary Metallic Stent Placement. Intern Med 2019; 58:1453-1457. [PMID: 30626807 PMCID: PMC6548938 DOI: 10.2169/internalmedicine.1862-18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Rupture of a pseudoaneurysm (PA) has been reported as a rare but serious adverse event associated with endoscopic biliary stenting. We herein report 2 cases of severe biliary bleeding from a PA that developed 10-14 days after placement of a self-expandable metallic stent (SEMS) for biliary malignancy. The first patient was successfully embolized with endovascular coiling. However, the second patient had wide-spreading cholangiocarcinoma and, despite being treated once by full coiling, developed a second rupture of PA two months after starting systemic chemotherapy. Clinicians should be aware of the possibility of PA and carefully follow stented patients after endovascular treatment.
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Affiliation(s)
| | | | | | - Shinya Fujie
- Division of Endoscopy, Shizuoka Cancer Center, Japan
| | | | - Junya Sato
- Division of Endoscopy, Shizuoka Cancer Center, Japan
| | - Sayo Ito
- Division of Endoscopy, Shizuoka Cancer Center, Japan
| | | | | | - Kinichi Hotta
- Division of Endoscopy, Shizuoka Cancer Center, Japan
| | - Masao Yoshida
- Division of Endoscopy, Shizuoka Cancer Center, Japan
| | - Noboru Kawata
- Division of Endoscopy, Shizuoka Cancer Center, Japan
| | | | | | | | - Hiroyuki Ono
- Division of Endoscopy, Shizuoka Cancer Center, Japan
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16
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Riaz A, Pinkard JP, Salem R, Lewandowski RJ. Percutaneous management of malignant biliary disease. J Surg Oncol 2019; 120:45-56. [PMID: 30977913 DOI: 10.1002/jso.25471] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 03/24/2019] [Indexed: 12/11/2022]
Abstract
Percutaneous biliary interventions have established their role in the management of benign and malignant biliary disease. There are limited data comparing procedures performed by gastroenterologists and interventional radiologists in managing malignant biliary obstruction. Endoscopic procedures performed by gastroenterologists are not completely benign with reported complications ranging from 2% to 15%. It is important that gastroenterologists and interventional radiologists collaborate to form algorithms for management of malignant biliary obstruction which provide safe and efficacious care to these patients.
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Affiliation(s)
- Ahsun Riaz
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, Illinois
| | - John P Pinkard
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, Illinois
| | - Riad Salem
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, Illinois.,Department of Surgery, Division of Transplant Surgery, Northwestern University, Chicago, Illinois.,Department of Medicine, Division of Hepatology, Northwestern University, Chicago, Illinois
| | - Robert J Lewandowski
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, Illinois.,Department of Medicine, Division of Hepatology, Northwestern University, Chicago, Illinois
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17
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Klimczak T, Kaczka K, Klimczak J, Tyczkowska-Sieroń E, Tyczkowska A. "Primary bacterial culture of bile and pancreatic juice in tumor related jaundice (TROJ) - is ascending cholangitis always our fault?". Scand J Gastroenterol 2018; 53:1569-1574. [PMID: 30621478 DOI: 10.1080/00365521.2018.1542454] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION TROJ (tumor-related obstructive jaundice) is one of the most common indications for endoscopic retrograde choleopancreatography (ERCP) with endoscopic biliary stenting. Despite the effectiveness of this procedure, especially in palliative patients, it is not without flaws. Ascending bacterial cholangitis, a common stenting complication, occurs in about 0.5-1.7% of cases. The authors' intention was to investigate whether this complication occurs solely due to the procedure or whether it is a result of an underlying bacterial infection in the dilated, obstructed bile and pancreatic ducts. METHODS Sixteen patients with painless obstructive jaundice related to a tumor located in or in the proximity of the bile duct were enrolled for this study. Prior to endoscopic palliative stenting we harvested bile and pancreatic fluid and the proceeded with the initial procedure. RESULTS In 14 cases (87.5%) we managed to restore the patency of the bile duct endoscopically. Additionaly, we observed that in 13 cases (81.25%) bacteria were present in the bile and/or pancreatic fluid. The most common pathogen was Streptococcus mitis - present in 7 cases (43.75%). The most effective antibiotics for discovered S. mitis strains were cefuroxime and vancomycin. CONCLUSION Primal bacterial pathogenes may be present in obstructed bile and pancreatic ducts prior to endoscopic intervention. The connection between Streptocccus mitis and TROJ needs further investigation.
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Affiliation(s)
- Tomasz Klimczak
- a Department of General and Oncological Surgery , Łódź Medical University, Central Clinical Hospital in Łódź , Łódź , Poland.,b Department of Gastroenterological Oncological and General Surgery , Łódź Medical University 1st Clinical Hospital in Łódź , Łódź , Poland
| | - Krzysztof Kaczka
- a Department of General and Oncological Surgery , Łódź Medical University, Central Clinical Hospital in Łódź , Łódź , Poland
| | - Jerzy Klimczak
- b Department of Gastroenterological Oncological and General Surgery , Łódź Medical University 1st Clinical Hospital in Łódź , Łódź , Poland
| | - Ewa Tyczkowska-Sieroń
- c Microbiology Unit , Łódź Medical University 1st Clinical Hospital in Łódź , Łódź , Poland
| | - Anna Tyczkowska
- c Microbiology Unit , Łódź Medical University 1st Clinical Hospital in Łódź , Łódź , Poland
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18
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Johnson AM, Spaete JP, Jowell PS, Kamal AH, Fisher DA. Top Ten Tips Palliative Care Clinicians Should Know About Interventional Symptom Management Options When Caring for Patients with Gastrointestinal Malignancies. J Palliat Med 2018; 21:1339-1343. [PMID: 29905501 DOI: 10.1089/jpm.2018.0251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Patients diagnosed with advanced stages of gastrointestinal (GI) malignancies are often quite symptomatic, with symptoms primarily related to anatomic sites of obstruction. Endoscopic approaches to the palliation of GI malignancies have begun to overtake surgical approaches as first line in interventional management. We brought together a team of interventional gastroenterologists and palliative care experts to collate practical pearls for the types of endoscopic interventions used for symptom management in patients with GI malignancies. In this article, we use a "Top 10" format to highlight issues that may help palliative care physicians recognize common presentations of advanced GI malignancies, address interventional approaches to improve symptom burden, and improve the quality of shared decision making and goals-of-care discussions.
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Affiliation(s)
- Alyson M Johnson
- 1 Division of Gastroenterology, Department of Medicine, Duke University , Durham, North Carolina
| | - Joshua P Spaete
- 1 Division of Gastroenterology, Department of Medicine, Duke University , Durham, North Carolina
| | - Paul S Jowell
- 1 Division of Gastroenterology, Department of Medicine, Duke University , Durham, North Carolina
| | - Arif H Kamal
- 2 Duke Cancer Institute , Duke Fuqua School of Business, Durham, North Carolina
| | - Deborah A Fisher
- 1 Division of Gastroenterology, Department of Medicine, Duke University , Durham, North Carolina
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19
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Linzay C, Seth A, Suryawala K, Sheth A, Boktor M, Bienvenu J, Rahim R, Sangster GP, Jordan PA. The Aftermath of a Hepatic Artery Aneurysm-A Rare Etiology of Biliary Obstruction! Clin Med Insights Gastroenterol 2017. [PMID: 28634431 PMCID: PMC5467703 DOI: 10.1177/1179552217711430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Hepatic artery aneurysms (HAAs) constitute 14% to 20% of visceral artery aneurysms. Most HAAs are asymptomatic. Although rare, obstructive jaundice due to external bile duct compression or rupture of the HAA into the biliary tree with occlusion of the lumen from blood clots has been reported. CASE PRESENTATION A 56-year-old white man presented to an outside hospital with symptoms of obstructive jaundice, including abdominal pain and yellowing of the skin. Imaging showed a large HAA. Patient was transferred to our hospital where an endoscopic retrograde cholangiopancreatography with biliary stenting was performed. This was followed by coil embolization of the HAA with improvement in symptoms and liver chemistries. CONCLUSIONS Most clinicians agree that management of HAA is highly variable and depends on clinical presentation and anatomic location. Biliary stenting provides temporary relief for patients with obstructive jaundice. Definitive options include open aneurysmal repair versus endovascular therapy. Hepatic artery aneurysms represent a significant risk for hemorrhage and therefore must be addressed promptly once discovered.
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Affiliation(s)
- Catherine Linzay
- Divisions of Gastroenterology and Hepatology, School of Medicine, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, USA
| | - Abhishek Seth
- Divisions of Gastroenterology and Hepatology, School of Medicine, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, USA
| | - Kunal Suryawala
- Divisions of Gastroenterology and Hepatology, School of Medicine, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, USA
| | - Ankur Sheth
- Divisions of Gastroenterology and Hepatology, School of Medicine, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, USA
| | - Moheb Boktor
- Divisions of Gastroenterology and Hepatology, School of Medicine, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, USA
| | - John Bienvenu
- Divisions of Gastroenterology and Hepatology, School of Medicine, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, USA
| | - Robby Rahim
- Department of Radiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, USA
| | - Guillermo P Sangster
- Department of Radiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, USA
| | - Paul A Jordan
- Divisions of Gastroenterology and Hepatology, School of Medicine, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, USA
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20
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Sendino O, Fernández-Simon A, Law R, Abu Dayyeh B, Leise M, Chavez-Rivera K, Cordova H, Colmenero J, Crespo G, Rodriguez de Miguel C, Fondevila C, Llach J, Navasa M, Baron T, Cárdenas A. Endoscopic management of bile leaks after liver transplantation: An analysis of two high-volume transplant centers. United European Gastroenterol J 2017; 6:89-96. [PMID: 29435318 DOI: 10.1177/2050640617712869] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 05/06/2017] [Indexed: 12/28/2022] Open
Abstract
Background Bile leak after liver transplantation (LT) is commonly treated with endoscopic retrograde cholangiopancreatography (ERCP); however, there are limited data regarding the optimal treatment strategy. Objective We aimed to examine the role of ERCP in LT recipients with bile leaks at two large institutions. Methods We reviewed all ERCPs performed in LT recipients with bile leak and duct-to-duct biliary anastomosis at two high-volume transplant centers. Results Eighty patients were included. Forty-seven (59%) patients underwent ERCP with plastic stent placement (with or without sphincterotomy) and 33 patients (41%) underwent sphincterotomy alone. Complete resolution was obtained in 94% of the stent group vs. 58% of the sphincterotomy group (p < 0.01). There was no difference in three-month survival among both groups. Percutaneous transhepatic therapy and surgery were required in 4% and 6% in the stent group vs. 12% and 42% in the sphincterotomy group, respectively (p = 0.22 and p < 0.001). The only predictive factor of bile leak resolution was stent placement. Conclusion ERCP with plastic stent placement is highly successful and more effective than sphincterotomy alone for post-LT bile leak treatment. These results indicate that ERCP and plastic stent placement should be considered the standard of care for the treatment of bile leaks in LT.
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Affiliation(s)
- Oriol Sendino
- GI/Endoscopy Unit, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, and University of Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi-Sunyer (IDIBAPS), Ciber de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - Alejandro Fernández-Simon
- GI/Endoscopy Unit, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, and University of Barcelona, Spain.,GI Unit, Hospital Sant Joan Despí Moises Broggi, Barcelona, Spain
| | - Ryan Law
- Department of Medicine and Division of Gastroenterology, University of Michigan, MI, USA
| | - Barham Abu Dayyeh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Michael Leise
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Karina Chavez-Rivera
- GI/Endoscopy Unit, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, and University of Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi-Sunyer (IDIBAPS), Ciber de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - Henry Cordova
- GI/Endoscopy Unit, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, and University of Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi-Sunyer (IDIBAPS), Ciber de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - Jordi Colmenero
- Institut d'Investigacions Biomèdiques August Pi-Sunyer (IDIBAPS), Ciber de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.,Liver Unit, Institut de Malalties Digestives i Metabòliques, Hospital Clínic and University of Barcelona, Spain
| | - Gonzalo Crespo
- Institut d'Investigacions Biomèdiques August Pi-Sunyer (IDIBAPS), Ciber de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.,Liver Unit, Institut de Malalties Digestives i Metabòliques, Hospital Clínic and University of Barcelona, Spain
| | - Cristina Rodriguez de Miguel
- GI/Endoscopy Unit, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, and University of Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi-Sunyer (IDIBAPS), Ciber de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - Constantino Fondevila
- Institut d'Investigacions Biomèdiques August Pi-Sunyer (IDIBAPS), Ciber de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.,General and Digestive Surgery, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, and University of Barcelona, Spain
| | - Josep Llach
- GI/Endoscopy Unit, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, and University of Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi-Sunyer (IDIBAPS), Ciber de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - Miquel Navasa
- Institut d'Investigacions Biomèdiques August Pi-Sunyer (IDIBAPS), Ciber de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.,Liver Unit, Institut de Malalties Digestives i Metabòliques, Hospital Clínic and University of Barcelona, Spain
| | - Todd Baron
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, USA
| | - Andrés Cárdenas
- GI/Endoscopy Unit, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, and University of Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi-Sunyer (IDIBAPS), Ciber de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.,Liver Unit, Institut de Malalties Digestives i Metabòliques, Hospital Clínic and University of Barcelona, Spain
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21
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Gupta N, Goyal P, Bansal I, Li S, Kumar Y, Baijal SS. Modified palliative biliary stenting in situs inversus totalis patient with carcinoma gallbladder: feasibility and technical details. Transl Gastroenterol Hepatol 2017; 2:27. [PMID: 28447062 DOI: 10.21037/tgh.2017.03.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 02/23/2017] [Indexed: 01/16/2023] Open
Abstract
Knowledge of the anatomical variants is essential for all invasive hepatobiliary procedures such as endoscopy, surgery and radiologic interventions. Modification in standard therapeutic interventions may be required based on variant anatomy. We report a technical modification in a 75-year-old female with known situs inversus (SI) totalis with carcinoma gallbladder. Present case highlights the finer technical details of the modified percutaneous transhepatic biliary drainage (PTBD) procedure and biliary stenting in a SI patient with carcinoma gallbladder causing malignant biliary obstruction.
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Affiliation(s)
- Nishant Gupta
- Department of Radiology, St Vincent's Medical Center, Bridgeport, CT, USA
| | - Pradeep Goyal
- Department of Radiology, St Vincent's Medical Center, Bridgeport, CT, USA
| | - Itisha Bansal
- Department of Anesthesiology, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Shuo Li
- Department of Radiology, Yale New Haven Health, New Haven, CT, USA
| | - Yogesh Kumar
- Department of Radiology, Yale New Haven Health, New Haven, CT, USA
| | - Sanjay S Baijal
- Department of Interventional Radiology, Medanta, The Medicity, Gurgaon, Haryana, India
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22
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Ahmed O, Mathevosian S, Arslan B. Biliary Interventions: Tools and Techniques of the Trade, Access, Cholangiography, Biopsy, Cholangioscopy, Cholangioplasty, Stenting, Stone Extraction, and Brachytherapy. Semin Intervent Radiol 2016; 33:283-290. [PMID: 27904247 DOI: 10.1055/s-0036-1592327] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Therapeutic access to the biliary system is generally limited to endoscopic or percutaneous approaches. A variety of percutaneous transhepatic biliary interventions are applicable for the diagnosis and treatment of biliary system pathologies, the majority of which may be performed in conjunction with one another. The backbone of nearly all of these interventions is percutaneous transhepatic cholangiography for opacification of the biliary tree, after which any number of therapeutic or diagnostic modalities may be pursued. We describe an overview of the instrumentation and technical approaches for several fundamental interventional procedures, including percutaneous transhepatic cholangiography and internal/external biliary drainage, endobiliary biopsy techniques, cholangioscopy, cholangioplasty and biliary stenting, biliary stone extraction, and intraluminal brachytherapy.
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Affiliation(s)
- Osman Ahmed
- Division of Interventional Radiology, Department of Radiology, Rush University Medical Center, Chicago, Illinois
| | - Sipan Mathevosian
- Chicago Medical School, Rosalind Franklin University, North Chicago, Illinois
| | - Bulent Arslan
- Division of Interventional Radiology, Department of Radiology, Rush University Medical Center, Chicago, Illinois
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23
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Villa NA, Harrison ME. Management of Biliary Strictures After Liver Transplantation. Gastroenterol Hepatol (N Y) 2015; 11:316-328. [PMID: 27482175 PMCID: PMC4962682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Strictures of the bile duct are a well-recognized complication of liver transplant and account for more than 50% of all biliary complications after deceased donor liver transplant and living donor liver transplant. Biliary strictures that develop after transplant are classified as anastomotic strictures or nonanastomotic strictures, depending on their location in the bile duct. The incidence, etiology, natural history, and response to therapy of the 2 types vary greatly, so their distinction is clinically important. The imaging modality of choice for the diagnosis of biliary strictures is magnetic resonance cholangiopancreatography because of its high rate of diagnostic accuracy and limited risk of complications. Biliary strictures that develop after liver transplant may be managed with endoscopic retrograde cholangiography (ERC), percutaneous transhepatic cholangiography (PTC), or surgical revision, including retransplant. The initial treatment of choice for these strictures is ERC with progressive balloon dilation and the placement of increasing numbers of plastic stents. PTC and surgery are generally reserved for failures of endoscopic therapy or for anatomic variants that are not suitable for ERC. In this article, we discuss the classification of biliary strictures, their diagnosis, and the therapeutic strategies that can be used to manage these common complications of liver transplant.
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Affiliation(s)
- Nicolas A Villa
- Dr Villa is an advanced endoscopy fellow and Dr Harrison is a professor in the Division of Gastroenterology and Hepatology at the Mayo Clinic in Scottsdale, Arizona
| | - M Edwyn Harrison
- Dr Villa is an advanced endoscopy fellow and Dr Harrison is a professor in the Division of Gastroenterology and Hepatology at the Mayo Clinic in Scottsdale, Arizona
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24
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Itoi T, Itokawa F, Sofuni A, Kurihara T, Ishii K, Tsuji S, Ikeuchi N, Umeda J, Tanaka R, Tonozuka R, Moriyasu F. Endoscopic ultrasound-guided double stenting for biliary and duodenal obstruction. Endosc Ultrasound 2014; 1:36-40. [PMID: 24949333 PMCID: PMC4062199 DOI: 10.7178/eus.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Revised: 03/25/2012] [Accepted: 04/09/2012] [Indexed: 12/19/2022] Open
Abstract
Endoscopic biliary stenting for malignant biliary obstruction is currently the gold standard for biliary drainage. Biliary cancer treatment is crucial. Cases of gastric outlet obstruction that includes the duodenum because of cancer invasion and biliary obstruction are seldom observed. The required treatment for such cases is simple biliary stenting and a different treatment for duodenal obstruction. Hence, double stenting for bile duct and duodenal obstruction has drawn attention. In the present review, we state different treatment strategies for malignant duodenal obstruction and then describe double stenting in biliary obstruction that also includes non-biliary cancer malignant lesions and duodenal obstruction.
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Affiliation(s)
- Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Fumihide Itokawa
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Atsushi Sofuni
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Toshio Kurihara
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Kentaro Ishii
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Shujiro Tsuji
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Nobuhito Ikeuchi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Junko Umeda
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Rena Tanaka
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Ryosuke Tonozuka
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Fuminori Moriyasu
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
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25
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Aslan F, Arabul M, Celik M, Alper E, Unsal B. The effect of biliary stenting on difficult common bile duct stones. Prz Gastroenterol. 2014;9:109-115. [PMID: 25061492 PMCID: PMC4108754 DOI: 10.5114/pg.2014.42507] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Revised: 10/20/2013] [Accepted: 12/30/2013] [Indexed: 12/31/2022]
Abstract
Introduction If common bile duct (CBD) stones (choledocholithiasis) are left untreated, they may cause increases in morbidity and mortality due to several conditions. Aim In this study, using transient biliary stenting following the failure of an initial endoscopic retrograde cholangiopancreatography (ERCP) session, we aimed to show the effects of making the CBD stones smaller and easier to remove in the following session. Material and methods In 156 of 1300 (12%) patients with CBD stones, who underwent balloon screening and/or basket lithotripsy following ERCP and CBD cannulation, it was not possible to remove the stones in the first session. Of these 156 patients, 64 (4.9%) were further followed and tested following transient biliary stenting. Results In the last ERCP following biliary stenting, the maximum stone sizes and stone indices were decreased in 54 (83%) patients and stone fragmentation was observed in 46 (72%) patients. Complete and incomplete removal was obtained in 40 (62.5%) and 24 (37.5%) patients, respectively. Conclusions Biliary stenting, fragmentation and the reduction in the size of difficult common bile duct stones caused by the first session of ERCP may increase the chance of success in the next session of ERCP.
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26
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Bapaye A, Dubale N, Aher A. Comparison of endosonography-guided vs. percutaneous biliary stenting when papilla is inaccessible for ERCP. United European Gastroenterol J 2013; 1:285-93. [PMID: 24917973 PMCID: PMC4040793 DOI: 10.1177/2050640613490928] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 04/28/2013] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Endoscopic retrograde cholangiopancreatography (ERCP) and biliary stenting fails in 5-10% patients of malignant biliary obstruction because papilla is inaccessible. Percutaneous transhepatic biliary drainage (PTBD) is an accepted alternative. Endosonography-guided biliary drainage (EUS-BD) has been described recently. AIM To compare success rates and complications of EUS-BD and PTBD internal stenting. METHODS This retrospective study included failed ERCP in inoperable malignant biliary obstruction due to inaccessible papilla undergoing PTBD or EUS-BD. Percutaneous transhepatic cholangiography guided/EUS-guided rendezvous procedures were excluded. When PTBD internal stenting failed, external drainage was performed. EUS-BD was performed using either intra- or extrahepatic approach, and stents were placed by transmural (choledocho-duodenostomy or hepatico-gastrostomy) or antegrade approach. Self-expandable metallic stents or plastic stents were placed in both groups. Success of internal stenting and complications were compared using t-test and chi-squared test. RESULTS Retrospective review of 6 years of records (2005-2011) revealed 50 patients meeting the required criteria. EUS-BD was attempted in 25 and PTBD in 26 patients (one crossover from EUS-BD to PTBD). Internal stenting was technically and clinically successful in 23/25 (92%) EUS-BD vs. 12/26 (46%) PTBD (p < 0.05). External catheter drainage was performed in remaining 14 PTBD patients. Complications occurred in 5/25 (20%) EUS-BD (one major, four minor) and in 12/26 (46%) PTBD (four major, eight minor; p < 0.05). Late stent occlusion occurred in one EUS-BD and three PTBD. CONCLUSIONS In this retrospective study comparing success and complications of EUS-BD and PTBD in patients with inoperable malignant biliary obstruction and inaccessible papilla, EUS-BD was found superior to PTBD for both comparators.
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Affiliation(s)
- Amol Bapaye
- Deenanath Mangeshkar Hospital and Research Center, Pune, India
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27
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Dy SM, Harman SM, Braun UK, Howie LJ, Harris PF, Jayes RL. To stent or not to stent: an evidence-based approach to palliative procedures at the end of life. J Pain Symptom Manage 2012; 43:795-801. [PMID: 22464354 PMCID: PMC4696003 DOI: 10.1016/j.jpainsymman.2011.12.269] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Revised: 12/16/2011] [Accepted: 12/31/2011] [Indexed: 11/26/2022]
Abstract
Patients near the end of life often undergo invasive procedures, such as biliary stenting for obstructive jaundice, with the intent of relieving symptoms. We describe a case in which the medical team and a patient and family are considering a second palliative biliary stent despite the patient's limited life expectancy. We review available evidence to inform the decision, focusing on the specific question of whether the benefits of palliative biliary stents in patients with advanced cancer outweigh the risks. We then apply the evidence to the issue of how the primary and/or palliative care team and the interventionist communicate with patients and their families about the risks and benefits of palliative procedures. Review of the evidence found several prospective case series without control groups that measured patient-centered outcomes. Studies had high attrition rates, results for improvements in symptoms and quality of life were mixed, and rates of complications and short-term mortality were high. In conclusion, the limited evidence does not support that the benefits of palliative biliary stents in this population outweigh the risks. We propose that primary care teams consider and discuss the larger picture of the goals of care with patients and families when considering offering these procedures, as well as benefits and potential harms, and consider involving palliative care services early, before consultation with an interventionist.
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Affiliation(s)
- Sydney M Dy
- Department of Health Policy and Management, Johns Hopkins University, Baltimore, MD, USA.
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28
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Aljiffry M, Renfrew PD, Walsh MJ, Laryea M, Molinari M. Analytical review of diagnosis and treatment strategies for dominant bile duct strictures in patients with primary sclerosing cholangitis. HPB (Oxford) 2011; 13:79-90. [PMID: 21241424 PMCID: PMC3044341 DOI: 10.1111/j.1477-2574.2010.00268.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The diagnosis and treatment of indeterminate dominant strictures (DS) in patients with primary sclerosing cholangitis (PSC) is challenging and the literature on the subject is scarce. OBJECTIVES This review aims to appraise and synthesize the evidence published in the English-language medical literature on this topic. METHODS Scientific papers published from 1950 until week 4 of July 2010 were extracted from MEDLINE, Ovid Medline In-Process, the Cochrane Database of Systematic Reviews, the Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects, EMBASE, PubMed and the National Library of Medicine Gateway. RESULTS Strategies for the optimal management of DS in PSC patients are supported only by level II and III evidence. Intraductal endoscopic ultrasound appears to be the most sensitive (64%) and specific (95%) diagnostic test for the evaluation of DS in PSC. Endoscopic and percutaneous dilatations achieve 1- and 3-year palliation in 80% and 60% of patients, respectively. Although dilatation and stenting are the most common palliative interventions in DS, no randomized trials on the optimal duration of treatment have been conducted. CONCLUSIONS In benign DS, endoscopic dilatation with short-term stenting seems to be effective and safe and does not increase the risks for malignant transformation or complications after liver transplantation. Surgical bile duct resection and/or bilioenteric bypass are indicated only in patients with preserved liver function.
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Affiliation(s)
- Murad Aljiffry
- Section of Hepatopancreaticobiliary and Transplant Surgery, McGill University Health CentreMontreal, Canada,Department of Surgery, College of Medicine, King Abdul Aziz UniversityJeddah, Saudi Arabia
| | - Paul D Renfrew
- Department of Surgery, Dalhousie University, Queen Elizabeth II Health Science CenterHalifax, NS, Canada
| | - Mark J Walsh
- Department of Surgery, Dalhousie University, Queen Elizabeth II Health Science CenterHalifax, NS, Canada
| | - Marie Laryea
- Department of Surgery, Dalhousie University, Queen Elizabeth II Health Science CenterHalifax, NS, Canada
| | - Michele Molinari
- Department of Surgery, Dalhousie University, Queen Elizabeth II Health Science CenterHalifax, NS, Canada
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