Clinical Endoscopy

Dhaval Choksi

2 Articles

Outcomes of Dilation of Recalcitrant Pancreatic Strictures Using a Wire-Guided Cystotome: Sridhar Sundaram, Dhaval Choksi, Aditya Kale, Suprabhat Giri, Biswaranjan Patra, Shobna Bhatia, Akash Shukla; Clin Endosc 2021;54(6):903-908. Published online March 4, 2021; DOI: https://doi.org/10.5946/ce.2020.297

Background
/Aims: Pancreatic strictures in chronic pancreatitis are treated using endoscopic retrograde cholangiopancreatography (ERCP) with plastic stent placement. The management of recalcitrant strictures remains a challenge, with the use of a Soehendra stent retriever or a needle knife described in case reports. Here, we discuss our experience with dilation of dominant pancreatic strictures with a 6-Fr cystotome.
Methods
A retrospective review of an endoscopy database was performed to search for patients with pancreatic strictures recalcitrant to conventional methods of dilation in which a cystotome was used. Technical success was defined as the successful dilation of the stricture with plastic stent placement. Functional success was defined as substantial pain relief or resolution of pancreatic fistulae.
Results
Ten patients (mean age, 30.8 years) underwent dilation of a dominant pancreatic stricture secondary to chronic pancreatitis, with a 6-Fr cystotome. Seven patients presented with pain. Three patients had pancreatic fistulae (two had pancreatic ascites and one had a pancreaticopleural fistula). The median stricture length was 10 mm (range, 5–25 mm). The head of the pancreas was the most common location of the stricture (60%). Technical and functional success was achieved in all patients. One patient had self-limiting bleeding, whereas another patient developed mild post-ERCP pancreatitis.
Conclusions
The use of a 6-Fr cystotome (diathermy catheter) can be an alternative method for dilation of recalcitrant pancreatic strictures after the failure of conventional modalities.

Citations

Citations to this article as recorded by

Fully Covered Self-expandable Metallic Stents for Refractory Benign Pancreatic Duct Strictures: A Systematic Review and Meta-analysis
Gajanan Rodge, Suprabhat Giri, Kailash Kolhe, Shivaraj Afzalpurkar, Sidharth Harindranath, Sridhar Sundaram, Aditya Kale
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques.2024; 34(5): 529. CrossRef
Treatment of Difficult Pancreatic Duct Strictures Using a Cystotome: A Single-Center Experience
Jonghyun Lee, Dong Uk Kim, Sung Yong Han
The Korean Journal of Pancreas and Biliary Tract.2023; 28(4): 108. CrossRef
Approach to management of pancreatic strictures: the gastroenterologist’s perspective
Vaneet Jearth, Suprabhat Giri, Sridhar Sundaram
Clinical Journal of Gastroenterology.2021; 14(6): 1587. CrossRef

3,875 View
99 Download
2 Web of Science
3 Crossref

Endoscopic Ultrasonography Can Prevent Unnecessary Diagnostic Endoscopic Retrograde Cholangiopancreatography Even in Patients with High Likelihood of Choledocholithiasis and Inconclusive Ultrasonography: Results of a Prospective Study: Ruchir Patel, Meghraj Ingle, Dhaval Choksi, Prateik Poddar, Vikas Pandey, Prabha Sawant; Clin Endosc 2017;50(6):592-597. Published online August 9, 2017; DOI: https://doi.org/10.5946/ce.2017.010

Abstract PDF PubReader ePub

Background
/Aims: Endoscopic retrograde cholangiopancreatography (ERCP) is the initial therapy recommended for patients with high likelihood of choledocholithiasis. To determine whether endoscopic ultrasonography (EUS) can prevent diagnostic ERCPs in patients with high probability of choledocholithiasis and inconclusive ultrasonography (US).
Methods
All patients with high likelihood of choledocholithiasis and negative US underwent EUS. ERCP was performed for the patients who showed a definite stone/sludge on EUS. Patients without choledocholithiasis were followed up for 3 months. The primary outcome was avoidance of diagnostic ERCP.
Results
We included 78 patients (51 women; 27 men). Of these, 25 and 7 (total 41%) were diagnosed with choledocholithiasis and sludge, respectively; stone/sludge was removed in 96.9% of the patients. EUS ruled out choledocholithiasis in 38 patients (48.7%). Two of them were found to have choledocholithiasis on follow-up. The sensitivity, specificity, positive and negative predictive value of EUS for detecting choledocholithiasis were 93.9%, 97.3%, 96.9%, and 94.7%, respectively. Unnecessary ERCP was avoided in 57.7% of the patients by using the EUS-first approach.
Conclusions
EUS is a highly accurate and safe procedure. EUS can replace ERCP as the initial investigation in patients with a high probability of choledocholithiasis. It avoids unnecessary ERCP; hence, decreasing related costs and complications.

Citations

Citations to this article as recorded by

Rendimiento diagnóstico de la endosonografía biliopancreática en pacientes con riesgo intermedio de coledocolitiasis
Lázaro Antonio Arango Molano, Andrés Sánchez Gil, Claudia Patricia Diaz Tovar, Andrés Valencia Uribe, Christian Germán Ospina Pérez, Pedro Eduardo Cuervo Pico, Rodrigo Alberto Jiménez Gómez
Revista de Gastroenterología del Perú.2024; 44(1): 8. CrossRef
The additional value of the combined use of EUS and ERCP for the evaluation of unclear biliary strictures
Eszter Bényei, Antonio Molinaro, Per Hedenström, Riadh Sadik
Scandinavian Journal of Gastroenterology.2024; 59(8): 980. CrossRef
Low Detection Rates of Bile Duct Stones During Endoscopic Treatment for Highly Suspected Bile Duct Stones with No Imaging Evidence of Stones
Hirokazu Saito, Hajime Iwasaki, Hisashi Itoshima, Yoshihiro Kadono, Takashi Shono, Kentaro Kamikawa, Atsushi Urata, Jiro Nasu, Masayoshi Uehara, Ikuo Matsushita, Tatsuyuki Kakuma, Shuji Tada
Digestive Diseases and Sciences.2023; 68(5): 2061. CrossRef
Diagnostic accuracy of endoscopic ultrasound in evaluation of patients with obstructive jaundice: single-center experience
Shereen Abou Bakr, Hagar Elessawy, Sameh Ghaly, Muhammed Abo Elezz, Ahmed Farahat, Mariam Salah Zaghloul
Egyptian Liver Journal.2022;[Epub] CrossRef
Endoscopic ultrasound avoids adverse events in high probability choledocholithiasis patients with a negative computed tomography
Meng-Ying Lin, Chun-Te Lee, Ming-Tsung Hsieh, Ming-Ching Ou, Yao-Shen Wang, Meng-Chieh Lee, Wei-Lun Chang, Bor-Shyang Sheu
BMC Gastroenterology.2022;[Epub] CrossRef
Role of endoscopic ultrasound in evaluation of patients with missed common bile duct stones
Mohamed Eissa, Hussein Hassan Okasha, Mohamed Abbasy, Ahmed Kamal Khamis, Abeer Abdellatef, Mohamed Akl Rady
World Journal of Gastrointestinal Endoscopy.2022; 14(9): 564. CrossRef
Az endoszkópos ultrahangvizsgálat diagnosztikus érzékenysége epeúti kövesség gyanúja esetén
Bánk Keczer, Zsolt Dubravcsik, Attila †Szepes, László Madácsy, Attila Szijártó, István Hritz
Orvosi Hetilap.2022; 163(10): 400. CrossRef
Evolution in the Practice of Pediatric Endoscopy and Sedation
Conrad B. Cox, Trevor Laborda, J. Matthew Kynes, Girish Hiremath
Frontiers in Pediatrics.2021;[Epub] CrossRef
The Relationship between Choledocholithiasis and Liver Enzymes in Elderly Patients
Almohamad Almahmud Tamim, Alexey Klimov
Journal Of Biochemical Technology.2021; 12(2): 67. CrossRef
Aspects of diagnosis and treatment of oligosymptomatic choledocholithiasis in patients with acute calculous cholecystitis
V.I. Kolomiytsev, O.M. Terletskiy, O.V. Lukavetskiy
Acta Medica Leopoliensia.2020; 26(2-3): 49. CrossRef
Adenomyoma of the distal common bile duct demonstrated by endoscopic ultrasound: A case report and review of the literature
Li-Ming Xu, Duan-Min Hu, Wen Tang, Shao-Hua Wei, Wei Chen, Guang-Qiang Chen
World Journal of Clinical Cases.2019; 7(21): 3598. CrossRef
Adenomyoma of the distal common bile duct demonstrated by endoscopic ultrasound: A case report and review of the literature
Li-Ming Xu, Duan-Min Hu, Wen Tang, Shao-Hua Wei, Wei Chen, Guang-Qiang Chen
World Journal of Clinical Cases.2019; 7(21): 3615. CrossRef
Can Endoscopic Ultrasonography Prevent Unnecessary Endoscopic Retrograde Cholangiopancreatography in Patients with High and Intermediate Likelihood of Choledocholithiasis?
Eui Joo Kim, Jae Hee Cho
Clinical Endoscopy.2017; 50(6): 518. CrossRef

6,618 View
222 Download
12 Web of Science
13 Crossref

Author index