Clinical Endoscopy

Original Article

Clinical outcomes of nonvariceal upper gastrointestinal bleeding in nonagenarians and octogenarians: a comparative nationwide analysis: Khaled Elfert, James Love, Esraa Elromisy, Fouad Jaber, Suresh Nayudu, Sammy Ho, Michel Kahaleh; Clin Endosc 2024;57(3):342-349. Published online February 7, 2024; DOI: https://doi.org/10.5946/ce.2023.130

Graphical Abstract Abstract PDF Supplementary Material PubReader ePub: Background
/Aims: Nonagenarians will purportedly account for 10% of the United States population by 2050. However, no studies have assessed the outcomes of nonvariceal upper gastrointestinal bleeding (NVUGIB) in this age group.
Methods
The National Inpatient Sample database between 2016 and 2020 was used to compare the clinical outcomes of NVUGIB in nonagenarians and octogenarians and evaluate predictors of mortality and the use of esophagogastroduodenoscopy (EGD).
Results
Nonagenarians had higher in-hospital mortality than that of octogenarians (4% vs. 3%, p<0.001). EGD utilization (30% vs. 48%, p<0.001) and blood transfusion (27% vs. 40%, p<0.001) was significantly lower in nonagenarians. Multivariate logistic regression analysis revealed that nonagenarians with NVUGIB had higher odds of mortality (odds ratio [OR], 1.5; 95% confidence interval [CI], 1.3–1.7) and lower odds of EGD utilization (OR, 0.86; 95% CI, 0.83–0.89) than those of octogenarians.
Conclusions
Nonagenarians admitted with NVUGIB have a higher mortality risk than that of octogenarians. EGD is used significantly in managing NVUGIB among nonagenarians; however, its utilization is comparatively lower than in octogenarians. More studies are needed to assess predictors of poor outcomes and the indications of EGD in this growing population.

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Review

Comparing palliative treatment options for cholangiocarcinoma: photodynamic therapy vs. radiofrequency ablation: Tayyaba Mohammad, Michel Kahaleh; Clin Endosc 2022;55(3):347-354. Published online May 17, 2022; DOI: https://doi.org/10.5946/ce.2021.274

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Referral to an endoscopist is often done once curative resection is no longer an option for cholangiocarcinoma management. In such cases, palliation has become the main objective of the treatment. Photodynamic therapy and radiofrequency ablation can be performed to achieve palliation, with both procedures associated with improved stent patency and survival. Despite the greatly increased cost and association with photosensitivity, photodynamic therapy allows transmission to the entire biliary tree. In contrast, radiofrequency ablation is cheaper and faster to apply but requires intraductal contact. This paper reviews both modalities and compares their efficacy and safety for bile duct cancer palliation.

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Current interventional options for palliative care for patients with advanced-stage cholangiocarcinoma
Maryam Makki, Malak Bentaleb, Mohammed Abdulrahman, Amal Abdulla Suhool, Salem Al Harthi, Marcelo AF Ribeiro Jr
World Journal of Clinical Oncology.2024; 15(3): 381. CrossRef
Endoskopisch gesteuerte Diagnostik und Therapie von Cholangiokarzinomen
Ulrike Denzer, Alexander Dechêne
Die Gastroenterologie.2023; 18(1): 16. CrossRef
Recent Updates on Local Ablative Therapy Combined with Chemotherapy for Extrahepatic Cholangiocarcinoma: Photodynamic Therapy and Radiofrequency Ablation
Tadahisa Inoue, Masashi Yoneda
Current Oncology.2023; 30(2): 2159. CrossRef
Role of radiofrequency ablation in advanced malignant hilar biliary obstruction
Mamoru Takenaka, Tae Hoon Lee
Clinical Endoscopy.2023; 56(2): 155. CrossRef
Impact of endobiliary radiofrequency ablation on survival of patients with unresectable cholangiocarcinoma: a narrative review
Elena Di Girolamo, Andrea Belli, Alessandro Ottaiano, Vincenza Granata, Valentina Borzillo, Luca Tarotto, Fabiana Tatangelo, Raffaele Palaia, Corrado Civiletti, Mauro Piccirillo, Valentina D’Angelo, Francesco Fiore, Pietro Marone, Guglielmo Nasti, Frances
Frontiers in Oncology.2023;[Epub] CrossRef
Thermal ablative therapies in the gastrointestinal tract
Hendrik Manner
Current Opinion in Gastroenterology.2023; 39(5): 370. CrossRef
Photodynamic Therapy: From the Basics to the Current Progress of N-Heterocyclic-Bearing Dyes as Effective Photosensitizers
Eurico Lima, Lucinda V. Reis
Molecules.2023; 28(13): 5092. CrossRef
Balloon‐assisted laser application for endoscopic treatment of biliary stricture
Seonghee Lim, Van Gia Truong, Seok Jeong, Jiho Lee, Byeong‐il Lee, Hyun Wook Kang
Lasers in Surgery and Medicine.2023; 55(10): 912. CrossRef
Emerging Systemic Therapies in Advanced Unresectable Biliary Tract Cancer: Review and Canadian Perspective
Vincent C. Tam, Ravi Ramjeesingh, Ronald Burkes, Eric M. Yoshida, Sarah Doucette, Howard J. Lim
Current Oncology.2022; 29(10): 7072. CrossRef

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Original Articles

The Learning Curve for Peroral Endoscopic Myotomy in Latin America: A Slide to the Right?: Michel Kahaleh, Amy Tyberg, Supriya Suresh, Arnon Lambroza, Fernando Rodriguez Casas, Mario Rey, Jose Nieto, Guadalupe Ma Martínez, Felipe Zamarripa, Vitor Arantes, Maria G Porfilio, Monica Gaidhane, Pietro Familiari, Juan Carlos Carames, Romulo Vargas-Rubio, Raul Canadas, Albis Hani, Guillermo Munoz, Bismarck Castillo, Eduardo T Moura, Farias F Galileu, Hannah P Lukashok, Carlos Robles-Medranda, Eduardo G de Moura; Clin Endosc 2021;54(5):701-705. Published online June 3, 2021; DOI: https://doi.org/10.5946/ce.2020.290

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Background
/Aims: Peroral endoscopic myotomy (POEM) has been increasingly used for achalasia in Latin America, where Chagas disease is prevalent, and this makes POEM more challenging. The aim of this study was to determine the learning curve for POEM in Latin America.
Methods
Patients undergoing POEM in Latin America with a single operator were included from a prospective registry over 4 years. Non-linear regression and cumulative sum control chart (CUSUM) analyses were conducted for the learning curve.
Results
A total of 125 patients were included (52% male; mean age, 59 years), of which 80 had type II achalasia (64%), and 38 had Chagas disease (30%). The average pre-procedure and post-procedure Eckardt scores were 6.79 and 1.87, respectively. Technical success was achieved in 93.5% of patients, and clinical success was achieved in 88.8%. Adverse events occurred in 27 patients (22%) and included bleeding (4 patients), pneumothorax (4 patients), mucosal perforation (13 patients), mediastinitis (2 patients), and leakage (4 patients).
The CUSUM chart showed a median procedure time of 97 min (range, 45-196 min), which was achieved at the 61st procedure. Procedure duration progressively decreased, with the last 10 procedures under 50 min approaching a plateau (p-value <0.01).
Conclusions
Mastering POEM in Latin America requires approximately 61 procedures for both POEM efficiency and to accomplish the procedure within 97 minutes.

Citations

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Experiencia en miotomía endoscópica peroral en un centro de Bogotá, Colombia, entre 2018 y 2022
Tatiana P Barragan Briceño, Paola Stephany Gonzalez Ausique, Carlos Fernando Fuentes Díaz, Jesús Antonio Rodríguez Fajardo, Maria Camila Gomez Ayala
Revista colombiana de Gastroenterología.2024; 39(2): 146. CrossRef
Learning curve for esophageal peroral endoscopic myotomy: a systematic review and meta-analysis
Srinivas R. Puli, Mihir S. Wagh, David Forcione, Harishankar Gopakumar
Endoscopy.2023; 55(04): 355. CrossRef
Diagnosis and Management of Achalasia: Updates of the Last Two Years
Amir Mari, Fadi Abu Baker, Rinaldo Pellicano, Tawfik Khoury
Journal of Clinical Medicine.2021; 10(16): 3607. CrossRef
Issues to be Considered for Learning Curve for Peroral Endoscopic Myotomy
Hironari Shiwaku, Haruhiro Inoue
Clinical Endoscopy.2021; 54(5): 625. CrossRef

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Endoscopic Therapy for Pancreatic Fluid Collections: A Definitive Management Using a Dedicated Algorithm: Ming Ming Xu, Iman Andalib, Aleksey Novikov, Enad Dawod, Moamen Gabr, Monica Gaidhane, Amy Tyberg, Michel Kahaleh; Clin Endosc 2020;53(3):355-360. Published online December 3, 2019; DOI: https://doi.org/10.5946/ce.2019.113

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Background
/Aims: Endoscopic ultrasonography (EUS)-guided drainage is the preferred approach for infected or symptomatic pancreatic fluid collections (PFCs). Here, we developed an algorithm for the management of pancreatitis complicated by PFCs and report on its effcacy and safety.
Methods
Between September 2011 and October 2017, patients were prospectively managed according to the algorithm. PFCs were classified as poorly organized fluid collections (POFCs), pancreatic pseudocysts (PPs), or walled-off pancreatic necrosis (WOPN). Clinical success was defined as a decrease in PFC size by ≥50% of the maximal diameter or to ≤2 cm.
Results
A total of 108 patients (62% male; mean age, 53 years) were included: 13 had POFCs, 43 had PPs, and 52 had WOPN. Seventytwo patients (66%) required a pancreatic duct (PD) stent, whereas 65 (60%) received enteral feeding. A total of 103 (95%) patients achieved clinical success. Eight patients experienced complications including bleeding (n=6) and surgical intervention (n=2). Patients with enteral feeding were 3.4 times more likely to achieve resolution within 60 days (p=0.0421), whereas those with PD stenting was five times more likely to achieve resolution within 90 days (p=0.0069).
Conclusions
A high PFC resolution rate can be achieved when a dedicated algorithm encompassing EUS-guided drainage, PD stenting, and early enteral feeding is adopted.

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Liang Chen, Ting Li, Bin Wang, Yunxiao Cheng, Sicong Zhao, Yunxiao Lyu
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A. V. Fedorov, V. N. Ektov, M. A. Khodorkovskiy
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A.V. Fedorov, V.N. Ektov, M.A. Khodorkovsky
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World Journal of Gastroenterology.2020; 26(45): 7104. CrossRef

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Case Report

Reverse Endoscopic Ultrasound-Guided Gastrojejunostomy for the Treatment of Superior Mesenteric Artery Syndrome: A New Concept: Ming-ming Xu, Enad Dawod, Monica Gaidhane, Amy Tyberg, Michel Kahaleh; Clin Endosc 2020;53(1):94-96. Published online December 3, 2019; DOI: https://doi.org/10.5946/ce.2018.196

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Superior mesenteric artery syndrome (SMAS) causes compression and partial or complete obstruction of the duodenum, resulting in abdominal pain, nausea, vomiting, and weight loss. If conservative therapy fails, the patient is typically referred for enteral feeding or laparoscopic gastrojejunostomy.
The last few years have seen increasing use of endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ) for gastric obstruction indications. EUS-GJ involves the creation of a gastric bypass via an echoendoscope in cases in which the small intestine can be punctured under ultrasonographic visualization, resulting in an incision-free, efficient, and safe procedure.
In this case report, we present the first case of SMAS treated using a reverse EUS-GJ, and describe the steps and advantages of the procedure in this particular case.

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Brief Report

Case Series Review of the Safety and Efficacy of Endoscopic Ultrasound-Guided Splenic Mass Core Biopsy: Sammy Saab, Youssef Challita, David Holloman, Kelli Hathaway, Michel Kahaleh, Jose Nieto; Clin Endosc 2018;51(6):600-601. Published online October 4, 2018; DOI: https://doi.org/10.5946/ce.2017.174

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Review

Management of Benign and Malignant Pancreatic Duct Strictures: Enad Dawod, Michel Kahaleh; Clin Endosc 2018;51(2):156-160. Published online July 20, 2017; DOI: https://doi.org/10.5946/ce.2017.085

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The diagnosis and management of pancreatic strictures, whether malignant or benign, remain challenging. The last 2 decades have seen dramatic progress in terms of both advanced imaging and endoscopic therapy. While plastic stents remain the cornerstone of the treatment of benign strictures, the advent of fully covered metal stents has initiated a new wave of interest in calibrating the pancreatic duct with fewer sessions. In malignant disease, palliation remains the priority and further data are necessary before offering systematic pancreatic stenting.

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Focused Review Series: Expanding the Indication with Safety Issue of Endoscopic Ultrasound

Safety and Complications of Interventional Endoscopic Ultrasound: Monica Saumoy, Michel Kahaleh; Clin Endosc 2018;51(3):235-238. Published online July 19, 2017; DOI: https://doi.org/10.5946/ce.2017.081

Abstract PDF PubReader ePub

Endoscopic ultrasound (EUS) has become an essential tool for the diagnostic and therapeutic intervention of gastrointestinal diseases. Beyond the drainage of fluid collections, it enables decompression of inaccessible bile and pancreatic ducts, the gallbladder, and the creation of anastomosis within the gastrointestinal tract using fully lumen-apposing stents. This review explored the safety and efficacy of these novel procedures and discussed the training pathway that is necessary to perform them efficiently and safely.

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Reviews

Necrotizing Pancreatitis: Current Management and Therapies: Christine Boumitri, Elizabeth Brown, Michel Kahaleh; Clin Endosc 2017;50(4):357-365. Published online May 16, 2017; DOI: https://doi.org/10.5946/ce.2016.152

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Acute necrotizing pancreatitis accounts for 10% of acute pancreatitis (AP) cases and is associated with a higher mortality and morbidity. Necrosis within the first 4 weeks of disease onset is defined as an acute necrotic collection (ANC), while walled off pancreatic necrosis (WOPN) develops after 4 weeks of disease onset. An infected or symptomatic WOPN requires drainage. The management of pancreatic necrosis has shifted away from open necrosectomy, as it is associated with a high morbidity, to less invasive techniques. In this review, we summarize the current management and therapies for acute necrotizing pancreatitis.

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Endoscopic Management of Anastomotic Strictures after Liver Transplantation: Dong Wook Lee, Hyeong Ho Jo, Juveria Abdullah, Michel Kahaleh; Clin Endosc 2016;49(5):457-461. Published online September 30, 2016; DOI: https://doi.org/10.5946/ce.2016.130

Abstract PDF PubReader ePub

Endoscopic treatment of biliary strictures involving plastic stent placement has been used widely. The use of self-expandable metal stents (SEMSs) has been described for anastomotic strictures following liver transplantation (LT). This review aimed to assess and compare the efficacy of plastic stents with SEMS in LT patients. Information was retrieved regarding technical success, stricture resolution, the number of endoscopic retrograde cholangiography procedures, follow-up, immediate, and late complications. Eight studies involving plastic stents had a stricture resolution rate of 84.5%, with the rates ranging from 63% to 100%. These rates are comparable with the stricture resolution rate of 75% determined from six studies that involved 236 patients who received metal stents and the rates ranged from 53% to 81%. The observed success rate for metal stents used to manage post-LT anastomotic biliary strictures was below the reported rate for multiple plastic stents. Hence, the currently available metal stents should not be offered for the management of post-LT anastomotic biliary strictures.

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Clinical Endoscopy.2016; 49(6): 502. CrossRef

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A Review of Probe-Based Confocal Laser Endomicroscopy for Pancreaticobiliary Disease: Kunal Karia, Michel Kahaleh; Clin Endosc 2016;49(5):462-466. Published online September 19, 2016; DOI: https://doi.org/10.5946/ce.2016.086

Abstract PDF PubReader ePub

Confocal laser endomicroscopy (CLE) is a novel in vivo imaging technique that can provide real-time optical biopsies in the evaluation of pancreaticobiliary strictures and pancreatic cystic lesions (PCLs), both of which are plagued by low sensitivities of routine evaluation techniques. Compared to pathology alone, CLE is associated with a higher sensitivity and accuracy for the evaluation of indeterminate pancreaticobiliary strictures. CLE has the ability to determine the malignant potential of PCLs. As such, CLE can increase the diagnostic yield of endoscopic retrograde cholangiopancreatography and endoscopic ultrasound, reducing the need for repeat procedures. It has been shown to be safe, with an adverse event rate of ≤1%. Published literature regarding its cost-effectiveness is needed.

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Original Articles

Endoscopic Ultrasound (EUS)-Directed Transgastric Endoscopic Retrograde Cholangiopancreatography or EUS: Mid-Term Analysis of an Emerging Procedure: Amy Tyberg, Jose Nieto, Sanjay Salgado, Kristen Weaver, Prashant Kedia, Reem Z. Sharaiha, Monica Gaidhane, Michel Kahaleh; Clin Endosc 2017;50(2):185-190. Published online September 19, 2016; DOI: https://doi.org/10.5946/ce.2016.030

Abstract PDF PubReader ePub

Background
/Aims: Performing endoscopic retrograde cholangiopancreatography (ERCP) in patients who have undergone Rouxen-Y gastric bypass (RYGB) is challenging. Standard ERCP and enteroscopy-assisted ERCP are associated with limited success rates. Laparoscopy- or laparotomy-assisted ERCP yields improved efficacy rates, but with higher complication rates and costs. We present the first multicenter experience regarding the efficacy and safety of endoscopic ultrasound (EUS)-directed transgastric ERCP (EDGE) or EUS.
Methods
All patients who underwent EDGE at two academic centers were included. Clinical success was defined as successful ERCP and/or EUS through the use of lumen-apposing metal stents (LAMS). Adverse events related to EDGE were separated from ERCP- or EUS-related complications and were defined as bleeding, stent migration, perforation, and infection.
Results
Sixteen patients were included in the study. Technical success was 100%. Clinical success was 90% (n=10); five patients were awaiting maturation of the fistula tract prior to ERCP or EUS, and one patient had an aborted ERCP due to perforation. One perforation occurred, which was managed endoscopically. Three patients experienced stent dislodgement; all stents were successfully repositioned or bridged with a second stent. Ten patients (62.5%) had their LAMS removed. The average weight change from LAMS insertion to removal was negative 2.85 kg.
Conclusions
EDGE is an effective, minimally invasive, single-team solution to the difficulties associated with ERCP in patients with RYGB.

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Endoscopic Gallbladder Drainage for Acute Cholecystitis: Jessica Widmer, Paloma Alvarez, Reem Z. Sharaiha, Sonia Gossain, Prashant Kedia, Savreet Sarkaria, Amrita Sethi, Brian G. Turner, Jennifer Millman, Michael Lieberman, Govind Nandakumar, Hiren Umrania, Monica Gaidhane, Michel Kahaleh; Clin Endosc 2015;48(5):411-420. Published online September 30, 2015; DOI: https://doi.org/10.5946/ce.2015.48.5.411

Abstract PDF PubReader ePub

Background/Aims

Surgery is the mainstay of treatment for cholecystitis. However, gallbladder stenting (GBS) has shown promise in debilitated or high-risk patients. Endoscopic transpapillary GBS and endoscopic ultrasound-guided GBS (EUS-GBS) have been proposed as safe and effective modalities for gallbladder drainage.

Methods

Data from patients with cholecystitis were prospectively collected from August 2004 to May 2013 from two United States academic university hospitals and analyzed retrospectively. The following treatment algorithm was adopted. Endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and cystic duct stenting was initially attempted. If deemed feasible by the endoscopist, EUS-GBS was then pursued.

Results

During the study period, 139 patients underwent endoscopic gallbladder drainage. Among these, drainage was performed in 94 and 45 cases for benign and malignant indications, respectively. Successful endoscopic gallbladder drainage was defined as decompression of the gallbladder without incidence of cholecystitis, and was achieved with ERCP and cystic duct stenting in 117 of 128 cases (91%). Successful endoscopic gallbladder drainage was also achieved with EUS-guided gallbladder drainage using transmural stent placement in 11 of 11 cases (100%). Complications occurred in 11 cases (8%).

Conclusions

Endoscopic gallbladder drainage techniques are safe and efficacious methods for gallbladder decompression in non-surgical patients with comorbidities.

Citations

Citations to this article as recorded by

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Review

Peroral Endoscopic Myotomy: Establishing a New Program: Nikhil A. Kumta, Shivani Mehta, Prashant Kedia, Kristen Weaver, Reem Z. Sharaiha, Norio Fukami, Hitomi Minami, Fernando Casas, Monica Gaidhane, Arnon Lambroza, Michel Kahaleh; Clin Endosc 2014;47(5):389-397. Published online September 30, 2014; DOI: https://doi.org/10.5946/ce.2014.47.5.389

Abstract PDF PubReader ePub

Achalasia is an esophageal motility disorder characterized by incomplete relaxation of the lower esophageal sphincter (LES) and aperistalsis of the esophageal body. Treatment of achalasia is aimed at decreasing the resting pressure in the LES. Peroral endoscopic myotomy (POEM), derived from natural orifice transluminal endoscopic surgery (NOTES) and advances in endoscopic submucosal dissection (ESD), presents a novel, minimally invasive, and curative endoscopic treatment for achalasia. POEM involves an esophageal mucosal incision followed by creation of a submucosal tunnel crossing the esophagogastric junction and myotomy before closure of the mucosal incision. Although the procedure is technically demanding and requires a certain degree of skill and competency, treatment success is high (90%) with low complication rates. Since the first described POEM in humans in 2010, it has been used increasingly at centers worldwide. This article reviews available published clinical studies demonstrating POEM efficacy and safety in order to present a proposal on how to establish a dedicated POEM program and reach base proficiency for the procedure.

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POEM in Latin America
Michel Kahaleh, Ming-ming Xu, Felipe Zamarripa, Guadalupe Martínez, Vitor N. Arantes, Fernando Casas Rodriguez, Bismarck Castillo, Iman Andalib, Amy Tyberg, Arnon Lambroza, Monica Saumoy, Juan C. Carames, Alberto Baptista, Carlos Robles-Medranda, Hanna Lu
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An Update on Current Management Strategies for Achalasia and Future Perspectives
Ioana Smith, Michel Kahaleh
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Treatment of Achalasia with Per-Oral Endoscopic Myotomy: Analysis of 50 Consecutive Patients
Erica D. Kane, David J. Desilets, Donna Wilson, Marc Leduc, Vikram Budhraja, John R. Romanelli
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Robert Bechara, Haruhiro Inoue
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Optical coherence tomography (OCT) prior to peroral endoscopic myotomy (POEM) reduces procedural time and bleeding: a multicenter international collaborative study
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Special Issue Articles of IDEN 2013

Technical Advances in Endoscopic Ultrasound (EUS)-Guided Tissue Acquisition for Pancreatic Cancers: How Can We Get the Best Results with EUS-Guided Fine Needle Aspiration?: Prashant Kedia, Monica Gaidhane, Michel Kahaleh; Clin Endosc 2013;46(5):552-562. Published online September 30, 2013; DOI: https://doi.org/10.5946/ce.2013.46.5.552

Abstract PDF PubReader ePub

Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is one of the least invasive and most effective modality in diagnosing pancreatic adenocarcinoma in solid pancreatic lesions, with a higher diagnostic accuracy than cystic tumors. EUS-FNA has been shown to detect tumors less than 3 mm, due to high spatial resolution allowing the detection of very small lesions and vascular invasion, particularly in the pancreatic head and neck, which may not be detected on transverse computed tomography. Furthermore, this minimally invasive procedure is often ideal in the endoscopic procurement of tissue in patients with unresectable tumors. While EUS-FNA has been increasingly used as a diagnostic tool, most studies have collectively looked at all primary pancreatic solid lesions, including lymphomas and pancreatic neuroendocrine neoplasms, whereas very few studies have examined the diagnostic utility of EUS-FNA of pancreatic ductal carcinoma only. As with any novel and advanced endoscopic procedure that may incorporate several practices and approaches, endoscopists have adopted diverse techniques to improve the tissue procurement practice and increase diagnostic accuracy. In this article, we present a review of literature to date and discuss currently practiced EUS-FNA technique, including indications, technical details, equipment, patient selection, and diagnostic accuracy.

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EUS-guided fine-needle biopsy sampling of solid pancreatic tumors with 3 versus 12 to-and-fro movements: a multicenter prospective randomized controlled study
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Endoscopic ultrasound-guided tissue acquisition: Needle types, technical issues, and sample handling
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EUS‐guided hydrogel microparticle injection in a cadaveric model
Seong‐Hun Kim, Kai Ding, Avani Rao, Jin He, Manoop S. Bhutani, Joseph M. Herman, Amol Narang, Eun Ji Shin
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Optimal Techniques for EUS-Guided Fine-Needle Aspiration of Pancreatic Solid Masses at Facilities without On-Site Cytopathology: Results from Two Prospective Randomised Trials
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Journal of Clinical Medicine.2021; 10(20): 4662. CrossRef
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High-resolution endoscopic ultrasound imaging and the number of needle passages are significant factors predicting high yield of endoscopic ultrasound-guided fine needle aspiration for pancreatic solid masses without an on-site cytopathologist
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9,381 View
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26 Crossref

Endoscopic Guided Biliary Drainage: How Can We Achieve Efficient Biliary Drainage?: Prashant Kedia, Monica Gaidhane, Michel Kahaleh; Clin Endosc 2013;46(5):543-551. Published online September 30, 2013; DOI: https://doi.org/10.5946/ce.2013.46.5.543

Abstract PDF PubReader ePub

Currently, endoscopic retrograde cholangiopancreatography (ERCP) is the preferred procedure for biliary drainage for various pancreatico-biliary disorders. ERCP is successful in 90% of the cases, but is unsuccessful in cases with altered anatomy or with tumors obstructing access to the duodenum. Due to the morbidity and mortality associated with surgical or percutaneous approaches in unsuccessful ERCP cases, biliary endoscopists have been using endoscopic ultrasound-guided biliary drainage (EUS-BD) more frequently within the last decade in different countries. As with any novel advanced endoscopic procedure that incorporates various approaches, advanced endoscopists all over the world have innovated and adopted diverse EUS-BD techniques. Indications for EUS-BD include failed conventional ERCP, altered anatomy, tumor preventing access into the biliary tree and contraindication to percutaneous access (i.e., ascites, etc.). EUS-BD utilizing EUS-guided rendezvous technique is conducted by creating a tract from either the stomach or the duodenum into the bile duct. Although EUS-BD has rapidly been gaining attraction and popularity in the endoscopic world, the indications and methods have yet to be standardized. There are several access routes and techniques that are employed by advanced endoscopists throughout the world for BD. This article reviews the indications and currently practiced EUS-BD techniques, including indications, technical details (intrahepatic or extrahepatic approach), equipment, patient selection, complications, and overall advantages and limitations.

Citations

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Application of endoscopic ultrasound-guided hepaticogastrostomy combined with antegrade stenting in patients with malignant biliary obstruction after failed ERCP
Yin Zhang, Xiaohong Wang, Kewen Sun, Jianping Chen, Yue Zhang, Longqing Shi, Zhining Fan, Li Liu, Bingfang Chen, Yanbo Ding
Surgical Endoscopy.2022; 36(8): 5930. CrossRef
Clinical value of preferred endoscopic ultrasound-guided antegrade surgery in the treatment of extrahepatic bile duct malignant obstruction
Xuan Zhao, Lihong Shi, Jinchen Wang, Siming Guo, Sumin Zhu
Clinics.2022; 77: 100017. CrossRef
What You Need to Know Before Performing Endoscopic Ultrasound-guided Hepaticogastrostomy
Tanyaporn Chantarojanasiri, Thawee Ratanachu-Ek, Nonthalee Pausawasdi
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Endoscopic Ultrasound-Guided Biliary Drainage
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Gian Eugenio Tontini, Guido Manfredi, Stefania Orlando, Helmut Neumann, Maurizio Vecchi, Elisabetta Buscarini, Luca Elli
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B. L. Duberman, D. V. Mizgirev, A. M. Epshtein, V. N. Pozdeev, A. V. Tarabukin
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María Victoria Alvarez-Sánchez, O.B. Luna, I. Oria, K. Marchut, F. Fumex, G. Singier, A. Salgado, B. Napoléon
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Jin Myung Park, Chang Don Kang, Minjong Lee, Sung Chul Park, Sung Joon Lee, Yong Hwan Jeon, Seong Whi Cho
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Mihai Rimbaş, Alberto Larghi
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Kaixuan Wang, Jianwei Zhu, Ling Xing, Yunfeng Wang, Zhendong Jin, Zhaoshen Li
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Endoscopic ultrasound-guided biliary drainage versus percutaneous transhepatic biliary drainage: predictors of successful outcome in patients who fail endoscopic retrograde cholangiopancreatography
Reem Z. Sharaiha, Nikhil A. Kumta, Amit P. Desai, Ersilia M. DeFilippis, Moamen Gabr, Alex M. Sarkisian, Sanjay Salgado, Jennifer Millman, Andrea Benvenuto, Michelle Cohen, Amy Tyberg, Monica Gaidhane, Michel Kahaleh
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Jintao Guo, Siyu Sun, Xiang Liu, Sheng Wang, Nan Ge, Guoxin Wang
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Xiang‐qian Zhao, Jia‐hong Dong, Kai Jiang, Xiao‐qiang Huang, Wen‐zhi Zhang
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Pancreatic Fluid Collection Drainage by Endoscopic Ultrasound: An Update: Shashideep Singhal, Stephen R. Rotman, Monica Gaidhane, Michel Kahaleh; Clin Endosc 2013;46(5):506-514. Published online September 30, 2013; DOI: https://doi.org/10.5946/ce.2013.46.5.506

Abstract PDF PubReader ePub

Endoscopic management of symptomatic pancreatic fluid collections (PFCs) is now considered to be first line therapy. Expanded use of endoscopic ultrasound (EUS) techniques has resulted in increased applicability, safety, and efficacy of endoscopic transluminal PFC drainage. Steps include EUS-guided trangastric or transduodenal fistula creation into the PFC followed by stent placement or nasocystic drain deployment in order to decompress the collection. With the remarkable improvement in the available accessories and stents and development of exchange free access device; EUS drainage techniques have become simpler and less time consuming. The use of self-expandable metal stents with modifications to drain PFC has helped in overcoming some previously encountered challenges. PFCs considered suitable for endoscopic drainage include collection present for greater than 4 weeks, possessing a well-formed wall, position accessible endoscopically and located within 1 cm of the duodenal or gastric walls. Indications for EUS-guided drainage have been increasing which include unusual location of the collection, small window of entry, nonbulging collections, coagulopathy, intervening varices, failed conventional transmural drainage, indeterminate adherence of PFC to the luminal wall or suspicion of malignancy. In this article, we present a review of literature to date and discuss the recent developments in EUS-guided PFC drainage.

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Cureus.2024;[Epub] CrossRef
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Journal of Clinical Gastroenterology.2023; 57(2): 218. CrossRef
EUS-guided transluminal drainage using lumen-apposing metal stents with or without coaxial plastic stents for treatment of walled-off necrotizing pancreatitis: a prospective bicentric randomized controlled trial
Petr Vanek, Premysl Falt, Petr Vitek, Vincent Zoundjiekpon, Monika Horinkova, Jana Zapletalova, Martin Lovecek, Ondrej Urban
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Original Article

Photodynamic Therapy in Unresectable Cholangiocarcinoma: Not for the Uncommitted: Jayant P. Talreja, Marisa DeGaetani, Kristi Ellen, Timothy Schmitt, Monica Gaidhane, Michel Kahaleh; Clin Endosc 2013;46(4):390-394. Published online July 31, 2013; DOI: https://doi.org/10.5946/ce.2013.46.4.390

Abstract PDF PubReader ePub

Background/Aims

Photodynamic therapy (PDT) in unresectable cholangiocarcinoma has been associated with improved survival. We report a single tertiary care center experience over the past 6 years.

Methods

Fifty-five patients with unresectable cholangiocarcinoma received PDT between 2004 and 2010. Plastic stents were placed after PDT to prevent cholangitis.

Results

Twenty-seven patients (49%) showed Bismuth type IV, 22 (41%) showed Bismuth type III, and six (10%) showed Bismuth type I and II. Twenty patients (37%) received chemotherapy and radiation therapy, five (9%) received chemotherapy only; and one (2%) received radiation therapy only. Mean number of PDT sessions was 1.9±1.5 sessions (range, 1 to 9). Mean survival duration was 293±266 days (median, 190; range, 25 to 1,332). PDT related complications included three (5%) facial burn, three (5%) photosensitivity, and two (3%) rash. Kaplan-Meier analysis comparing the survival means of patients who received PDT and chemotherapy/radiation therapy (median survival 257 days; 95% confidence interval [CI], 166 to 528) versus who received PDT only (median survival 183 days; 95% CI, 129 to 224) showed no significant difference (log-rank p=0.20).

Conclusions

PDT has a measurable impact on survival in unresectable cholangiocarcinoma but requires aggressive stenting posttherapy.

Citations

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Special Issue Articleses of IDEN 2012

Spyglass Direct Visualization System: Michel Kahaleh; Clin Endosc 2012;45(3):316-318. Published online August 22, 2012; DOI: https://doi.org/10.5946/ce.2012.45.3.316

Abstract PDF PubReader ePub

Although endoscopic retrograde cholangiopancreatography is considered the gold standard to manage biliary disorders, it has its own limitations. The single-operator cholangioscopy (SOC) system (Spyglass) may offer an interesting compromise for most advanced biliary endoscopists, in terms of size (10 Fr diameter) and complexity of use. SOC is a great step toward intraductal visualization and therapy but the best is yet to come.

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Endoscopic Necrosectomy for Walled-Off Pancreatic Necrosis: Michel Kahaleh; Clin Endosc 2012;45(3):313-315. Published online August 22, 2012; DOI: https://doi.org/10.5946/ce.2012.45.3.313

Abstract PDF PubReader ePub

Approximately 20% of patients with acute pancreatitis develop pancreatic necrosis with significant mortality. Surgical debridement is the traditional management of necrotizing pancreatitis, but it is associated with significant morbidity and mortality. Endoscopic necrosectomy using repeats session of debridement and stent insertion has been more frequently used within the last decade and half. This technique continues to evolve as we attempt to optimize the post-procedural outcomes.

Citations

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Prevention and Management of Post-Endoscopic Retrograde Cholangiopancreatography Complications: Michel Kahaleh, Martin Freeman; Clin Endosc 2012;45(3):305-312. Published online August 22, 2012; DOI: https://doi.org/10.5946/ce.2012.45.3.305

Abstract PDF PubReader ePub

Endoscopic retrograde cholangiopancreatography (ERCP) is associated with a spectrum of complications such as pancreatitis, hemorrhage, perforation, and cardiopulmonary events. These complications can range from mild to severe resulting in extended hospitalization, requiring surgical intervention, and leading to permanent disability or even death. Complications of ERCP have been better understood in the past decade, with adoption of standardized consensus-based definitions of complications and introduction of new recommendations to minimize risks of ERCP. Adequate selection of patients undergoing ERCP, skilled operators using novel techniques and prompt identification and treatment are key to successful prevention and management.

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