Clinical Endoscopy

Akihisa Ohno

2 Articles

Puncture angle on an endoscopic ultrasound image is independently associated with unsuccessful guidewire manipulation of endoscopic ultrasound-guided hepaticogastrostomy: a retrospective study in Japan: Akihisa Ohno, Nao Fujimori, Toyoma Kaku, Kazuhide Matsumoto, Masatoshi Murakami, Katsuhito Teramatsu, Keijiro Ueda, Masayuki Hijioka, Akira Aso, Yoshihiro Ogawa; Clin Endosc 2024;57(5):656-665. Published online July 26, 2024; DOI: https://doi.org/10.5946/ce.2023.244

Graphical Abstract Abstract PDF Supplementary Material PubReader ePub: Background
/Aims: Although endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is performed globally, the procedure remains challenging. Guidewire manipulation is the most difficult step, and there are few reports on the factors associated with unsuccessful guidewire manipulation. This study aimed to assess the significance of the puncture angle on EUS images and identify the most effective guidewire rescue method for patients with unsuccessful guidewire manipulation.
Methods
We retrospectively enrolled 115 patients who underwent EUS-HGS between May 2016 and April 2022 at two centers. The puncture angle between the needle and the intrahepatic bile duct was measured through EUS movie records.
Results
Guidewire manipulation was unsuccessful in 28 patients. Receiver operating characteristic (ROC) curves identified an optimal puncture angle cutoff value of 85° (cutoff value, 85°; area under the ROC curve, 0.826; sensitivity, 85.7%; specificity, 81.6%). Multivariate analysis demonstrated that a puncture angle <85° was a significant risk factor for unsuccessful guidewire manipulation (odds ratio, 19.8; 95% confidence interval, 6.42–61.5; p<0.001). Among the 28 unsuccessful cases, 24 patients (85.7%) achieved successful guidewire manipulation using various rescue methods.
Conclusions
The puncture angle observed on EUS is crucial for guidewire manipulation. A puncture angle of <85° was associated with unsuccessful guidewire manipulation.

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The feasibility of percutaneous transhepatic gallbladder aspiration for acute cholecystitis after self-expandable metallic stent placement for malignant biliary obstruction: a 10-year retrospective analysis in a single center: Akihisa Ohno, Nao Fujimori, Toyoma Kaku, Masayuki Hijioka, Ken Kawabe, Naohiko Harada, Makoto Nakamuta, Takamasa Oono, Yoshihiro Ogawa; Clin Endosc 2022;55(6):784-792. Published online October 21, 2022; DOI: https://doi.org/10.5946/ce.2021.244

Abstract PDF PubReader ePub

Background
/Aims: Patients with acute cholecystitis (AC) after metallic stent (MS) placement for malignant biliary obstruction (MBO) have a high surgical risk. We performed percutaneous transhepatic gallbladder aspiration (PTGBA) as the first treatment for AC. We aimed to identify the risk factors for AC after MS placement and the poor response factors of PTGBA.
Methods
We enrolled 401 patients who underwent MS placement for MBO between April 2011 and March 2020. The incidence of AC was 10.7%. Of these 43 patients, 37 underwent PTGBA as the first treatment. The patients’ responses to PTGBA were divided into good and poor response groups.
Results
There were 20 patients in good response group and 17 patients in poor response group. Risk factors for cholecystitis after MS placement included cystic duct obstruction (p<0.001) and covered MS (p<0.001). Cystic duct obstruction (p=0.003) and uncovered MS (p=0.011) demonstrated significantly poor responses to PTGBA. Cystic duct obstruction is a risk factor for cholecystitis and poor response factor for PTGBA, whereas covered MS is a risk factor for cholecystitis and an uncovered MS is a poor response factor of PTGBA for cholecystitis.
Conclusions
The onset and poor response factors of AC after MS placement were different between covered and uncovered MS. PTGBA can be a viable option for AC after MS placement, especially in patients with covered MS.

Citations

Citations to this article as recorded by

Endeavors to prevent stent malfunction: new insights into the risk factors for recurrent biliary obstruction
Sung-Jo Bang
Clinical Endoscopy.2024; 57(1): 56. CrossRef
Endoscopic Ultrasound-Guided Naso-gallbladder Drainage Using a Dedicated Catheter for Acute Cholecystitis After Transpapillary Metal Stent Placement for Malignant Biliary Obstruction
Tadahisa Inoue, Rena Kitano, Mayu Ibusuki, Kazumasa Sakamoto, Satoshi Kimoto, Yuji Kobayashi, Yoshio Sumida, Yukiomi Nakade, Kiyoaki Ito, Masashi Yoneda
Digestive Diseases and Sciences.2023; 68(12): 4449. CrossRef
The writing on the wall: self-expandable stents for endoscopic ultrasound-guided hepaticogastrostomy?
Hyung Ku Chon, Shayan Irani, Tae Hyeon Kim
Clinical Endoscopy.2023; 56(6): 741. CrossRef
How should a therapeutic strategy be constructed for acute cholecystitis after self-expanding metal stent placement for malignant biliary obstruction?
Mamoru Takenaka, Masatoshi Kudo
Clinical Endoscopy.2022; 55(6): 757. CrossRef

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