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Review
Endoscopic biliary drainage for distal bile duct obstruction due to pancreatic cancer
Masahiro Itonaga, Masayuki Kitano
Received November 28, 2023  Accepted March 5, 2024  Published online September 26, 2024  
DOI: https://doi.org/10.5946/ce.2023.294    [Epub ahead of print]
AbstractAbstract PDFPubReaderePub
Approximately 60% of pancreatic cancers occur in the pancreatic head and may present as obstructive jaundice due to bile duct invasion. Obstructive jaundice often leads to poor general conditions and acute cholangitis, interfering with surgery and chemotherapy and requiring biliary drainage. The first choice of treatment for biliary drainage is the endoscopic transpapillary approach. In unresectable tumors, self-expandable metal stents (SEMSs) are most commonly used and are classified into uncovered and covered SEMSs. Recently, antireflux metal stents and large- or small-diameter SEMSs have become commercially available, and their usefulness has been reported. Plastic stents are infrequently used in patients with resectable biliary obstruction; however, owing to the recent trend in preoperative chemotherapy, SEMSs are frequently used because of the long time to recurrent biliary obstruction. Endoscopic ultrasound-guided biliary drainage (EUS-BD) is often performed in patients who are not eligible for the transpapillary approach, and favorable outcomes have been reported. Different EUS-BD techniques and specialized stents have been developed and can be safely used in high-volume centers. The indications for EUS-BD are expected to further expand in the future.
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Original Articles
Safety and efficacy of trans-afferent loop endoscopic ultrasound-guided pancreaticojejunostomy for post pancreaticoduodenectomy anastomotic stricture using the forward-viewing echoendoscope: a retrospective study from Japan
Ahmed Sadek, Kazuo Hara, Nozomi Okuno, Shin Haba, Takamichi Kuwahara, Toshitaka Fukui, Minako Urata, Takashi Kondo, Yoshitaro Yamamoto, Kenneth Tachi
Received April 12, 2024  Accepted May 31, 2024  Published online August 26, 2024  
DOI: https://doi.org/10.5946/ce.2024.089    [Epub ahead of print]
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Endoscopic ultrasound (EUS)-guided pancreatic duct drainage is a well-established procedure for managing pancreaticojejunostomy anastomotic strictures (PJAS) post-Whipple surgery. In this study, we examined the effectiveness and safety of EUS-guided pancreaticojejunostomy (EUS-PJS).
Methods
This retrospective, single-arm study was performed at Aichi Cancer Center Hospital on 10 patients who underwent EUS-guided pancreaticojejunostomy through the afferent jejunal loop using a forward-viewing echoendoscope when endoscopic retrograde pancreatography failed. Our primary endpoint was technical success rate, defined as successful stent insertion. The secondary endpoints were early and late adverse events.
Results
A total of 10 patients underwent EUS-PJS between February 2019 and October 2023. The technical success rate was 100%. The median procedure time was 23.5 minutes. No remarkable early or late adverse events related to the procedure, except for fever, occurred in two patients. The median follow-up duration was 9.5 months, and the median number of stent exchanges was two. A stent-free state was achieved in three patients.
Conclusions
EUS-PJS for PJAS management after pancreaticoduodenectomy appears to be an effective and safe procedure with the potential advantages of fewer reinterventions and the creation of a permanent drainage fistula.
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Hepatobiliary scintigraphy of bile excretion after endoscopic ultrasound-guided hepaticogastrostomy for malignant biliary obstruction: a retrospective study in Japan
Masanori Yamada, Kazuo Hara, Shin Haba, Takamichi Kuwahara, Nozomi Okuno, Yasuhiro Kuraishi, Takafumi Yanaidani, Sho Ishikawa, Tsukasa Yasuda, Toshitaka Fukui
Received November 16, 2023  Accepted February 22, 2024  Published online August 20, 2024  
DOI: https://doi.org/10.5946/ce.2023.291    [Epub ahead of print]
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Hepatobiliary scintigraphy (HBS) is used to evaluate bile excretion. This study aimed to evaluate biliary excretion during endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) using HBS.
Methods
We retrospectively evaluated 78 consecutive patients with malignant extrahepatic biliary obstruction, who underwent HBS after EUS-HGS between April 2015 and July 2022. The peak time and decay rate were scored with 0, 1, or 2 points based on thresholds of 20 and 35 minutes, and 10% and 50%, respectively. A total score of 4 or 3 was considered indicative of good bile excretion, whereas scores of 2, 1, or 0 indicated poor bile excretion.
Results
The good and poor bile excretion groups included 40 and 38 cases, respectively. The group with good bile excretion had a significantly longer time to recurrent biliary obstruction compared to the poor bile excretion group (not reached vs. 124 days, p=0.026). Multivariate analysis identified the site of obstruction as a significant factor influencing good bile excretion (odds ratio, 3.39; 95% confidence interval, 1.01–11.4, p=0.049), with superior bile excretion observed in cases involving upper biliary obstruction compared to middle or lower biliary obstruction.
Conclusions
In patients with malignant biliary obstruction who underwent HGS, the site of obstruction is significantly associated with stent patency.
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Review
Advances in self-expandable metal stents for endoscopic ultrasound-guided interventions
Dong Kee Jang, Dong Wook Lee, Seong-Hun Kim, Kwang Bum Cho, Sundeep Lakhtakia
Clin Endosc 2024;57(5):588-594.   Published online July 9, 2024
DOI: https://doi.org/10.5946/ce.2023.169
AbstractAbstract PDFPubReaderePub
Endoscopic ultrasound (EUS)-guided interventions have evolved rapidly in recent years, with dedicated metal stents playing a crucial role in this process. Specifically, the invention of biflanged short metal-covered stents, including lumen-apposing metal stents (LAMS), and modifications in a variety of tubular self-expandable metal stents (SEMS), have led to innovations in EUS-guided interventions. LAMS or non-LAMS stents are commonly used in the EUS-guided drainage of pancreatic fluid collections, especially in cases of walled-off necrosis. Additionally, LAMS is commonly considered for drainage of the EUS-guided gallbladder or dilated common bile duct and EUS-guided gastroenterostomy. Fully or partially covered tubular SEMS with several new designs are being considered for EUS-guided biliary drainage. This review focuses on advances in SEMS for EUS-guided interventions and discusses related research results.
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Original Articles
Safety and efficacy of endoscopic ultrasound-guided pancreatic duct drainage using a drill dilator: a retrospective study in Japan
Ahmed Sadek, Kazuo Hara, Nozomi Okuno, Shin Haba, Takamichi Kuwahara, Toshitaka Fukui, Minako Urata, Takashi Kondo, Yoshitaro Yamamoto, Kenneth Tachi
Clin Endosc 2024;57(5):666-674.   Published online June 5, 2024
DOI: https://doi.org/10.5946/ce.2023.272
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Dilation of the tract before stent deployment is a challenging step in endoscopic ultrasound-guided pancreatic duct drainage (EUS-PDD). In this study, we examined the effectiveness and safety of a novel spiral dilator, Tornus ES (Asahi Intec), for EUS-PDD.
Methods
This was a retrospective, single-arm, observational study at Aichi Cancer Center Hospital. The punctured tract was dilated using a Tornus ES dilator in all EUS-PDD cases. Our primary endpoint was the technical success rate of initial tract dilation. Technical success was defined as successful fistula dilation using a Tornus ES followed by successful stent insertion. Secondary endpoints were procedure times and early adverse events.
Results
A total of 12 patients were included between December 2021 and March 2023. EUS-PDD was performed in 11 patients for post-pancreaticoduodenectomy anastomotic strictures and one patient with pancreatitis with duodenal perforation. The technical success rates of stent insertion and fistula dilation using a Tornus ES dilator was 100%. The median procedure time was 24 minutes. No remarkable adverse events related to the procedure were observed, apart from fever, which occurred in 2 patients.
Conclusions
Tract dilation in EUS-PDD using a Tornus ES is effective and safe.

Citations

Citations to this article as recorded by  
  • A novel spiral dilator for pancreatic duct drainage: catching two birds with one stone
    Han Taek Jeong, Jimin Han
    Clinical Endoscopy.2024; 57(5): 608.     CrossRef
  • 2,832 View
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Prophylactic endoscopic transpapillary gallbladder stenting to prevent acute cholecystitis induced after metallic stent placement for malignant biliary strictures: a retrospective study in Japan
Fumisato Kozakai, Yoshihide Kanno, Shinsuke Koshita, Takahisa Ogawa, Hiroaki Kusunose, Toshitaka Sakai, Keisuke Yonamine, Kazuaki Miyamoto, Haruka Okano, Yuto Matsuoka, Kento Hosokawa, Hidehito Sumiya, Kei Ito
Clin Endosc 2024;57(5):647-655.   Published online May 17, 2024
DOI: https://doi.org/10.5946/ce.2023.284
Graphical AbstractGraphical Abstract AbstractAbstract PDFPubReaderePub
Background
/Aims: Endoscopic biliary drainage using self-expandable metallic stents (SEMSs) for malignant biliary strictures occasionally induces acute cholecystitis (AC). This study evaluated the efficacy of prophylactic gallbladder stents (GBS) during SEMS placement.
Methods
Among 158 patients who underwent SEMS placement for malignant biliary strictures between January 2018 and March 2023, 30 patients who attempted to undergo prophylactic GBS placement before SEMS placement were included.
Results
Technical success was achieved in 21 cases (70.0%). The mean diameter of the cystic duct was more significant in the successful cases (6.5 mm vs. 3.7 mm, p<0.05). Adverse events occurred for 7 patients (23.3%: acute pancreatitis in 7; non-obstructive cholangitis in 1; perforation of the cystic duct in 1 with an overlap), all of which improved with conservative treatment. No patients developed AC when the GBS placement was successful, whereas 25 of the 128 patients (19.5%) without a prophylactic GBS developed AC during the median follow-up period of 357 days (p=0.043). In the multivariable analysis, GBS placement was a significant factor in preventing AC (hazard ratio, 0.61; 95% confidence interval, 0.37–0.99; p=0.045).
Conclusions
GBS may contribute to the prevention of AC after SEMS placement for malignant biliary strictures.
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Reviews
Drainage for fluid collections post pancreatic surgery and acute pancreatitis: similar but different?
Yousuke Nakai, Saburo Matsubara, Tsuyoshi Mukai, Tsuyoshi Hamada, Takashi Sasaki, Hirotoshi Ishiwatari, Susumu Hijioka, Hideyuki Shiomi, Mamoru Takenaka, Takuji Iwashita, Atsuhiro Masuda, Tomotaka Saito, Hiroyuki Isayama, Ichiro Yasuda, for the WONDERFUL study group in Japan
Received October 3, 2023  Accepted November 1, 2023  Published online May 17, 2024  
DOI: https://doi.org/10.5946/ce.2023.254    [Epub ahead of print]
AbstractAbstract PDFPubReaderePub
Postoperative pancreatic fistulas (POPFs) are common adverse events that occur after pancreatic surgery. Endoscopic ultrasonography (EUS)-guided drainage (EUS-D) is a first-line treatment, similar to that for pancreatic fluid collection (PFCs) after acute pancreatitis. However, some POPFs do not develop fluid collections depending on the presence or location of the surgical drain, whereas others develop fluid collections, such as postoperative fluid collections (POPFCs). Although POPFCs are similar to PFCs, the strategy and modality for POPF management need to be modified according to the presence of fluid collections, surgical drains, and surgical type. As discussed for PFCs, the indications, timing, and selection of interventions or stents for EUS-D have not been fully elucidated for POPFs. In this review, we discuss the management of POPFs and POPFCs in comparison with PFCs due to acute pancreatitis and summarize the topics that should be addressed in future studies.
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Forward viewing liner echoendoscopy for therapeutic interventions
Kazuo Hara, Nozomi Okuno, Shin Haba, Takamichi Kuwahara
Clin Endosc 2024;57(2):175-180.   Published online February 29, 2024
DOI: https://doi.org/10.5946/ce.2023.271
AbstractAbstract PDFPubReaderePub
Therapeutic endoscopic ultrasonography (EUS) procedures using the forward-viewing convex EUS (FV-EUS) have been reviewed based on the articles reported to date. The earliest reported procedure is the drainage of pancreatic pseudocysts using FV-EUS. However, the study on drainage of pancreatic pseudocysts focused on showing that drainage is possible with FV-EUS rather than leveraging its features. Subsequently, studies describing the characteristics of FV-EUS have been reported. By using FV-EUS in EUS-guided choledochoduodenostomy, double punctures in the gastrointestinal tract can be avoided. In postoperative modified anatomical cases, using the endoscopic function of FV-EUS, procedures such as bile duct drainage from anastomosis, pancreatic duct drainage from the afferent limb, and abscess drainage from the digestive tract have been reported. When a perpendicular puncture to the gastrointestinal tract is required or when there is a need to insert the endoscope deep into the gastrointestinal tract, FV-EUS is considered among the options.

Citations

Citations to this article as recorded by  
  • Failed endoscopic ultrasound‐guided gallbladder drainage across the duodenal covered metallic stent salvaged by using a forward‐viewing linear echoendoscope
    Tesshin Ban, Yoshimasa Kubota, Takashi Joh
    Digestive Endoscopy.2024;[Epub]     CrossRef
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Original Articles
The efficacy of a novel integrated outside biliary stent and nasobiliary drainage catheter system for acute cholangitis: a single center pilot study
Naosuke Kuraoka, Tetsuro Ujihara, Hiromi Kasahara, Yuto Suzuki, Shun Sakai, Satoru Hashimoto
Clin Endosc 2023;56(6):795-801.   Published online April 11, 2023
DOI: https://doi.org/10.5946/ce.2022.289
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Endoscopic biliary drainage is the gold standard treatment for cholangitis. The two methods of biliary drainage are endoscopic biliary stenting and nasobiliary drainage. A novel integrated outside biliary stent and nasobiliary drainage catheter system (UMIDAS NB stent; Olympus Medical Systems) was recently developed. In this study, we evaluated the efficacy of this stent in the treatment of cholangitis caused by common bile duct stones or distal bile duct strictures.
Methods
We conducted a retrospective pilot study by examining the medical records of patients who required endoscopic biliary drainage for cholangitis due to common bile duct stones or distal bile duct strictures, and who were treated with a UMIDAS NB stent, between December 2021 and July 2022.
Results
Records of 54 consecutive patients were reviewed. Technical and clinical success rates were 47/54 (87.0%) and 52/54 (96.3%), respectively. Adverse events were observed in 12 patients, with six patients experiencing pancreatitis as an adverse event, following endoscopic retrograde cholangiopancreatography (ERCP). Regarding late adverse events, five cases of biliary stent migration into the bile duct were observed. Disease-related death occurred in one patient.
Conclusions
The outside-type UMIDAS NB stent is an efficacious new method for biliary drainage and can be applied to many indications.
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Clinical outcomes of permanent stenting with endoscopic ultrasound gallbladder drainage
Eisuke Suzuki, Yuji Fujita, Kunihiro Hosono, Yuji Koyama, Seitaro Tsujino, Takuma Teratani, Atsushi Nakajima, Nobuyuki Matsuhashi
Clin Endosc 2023;56(5):650-657.   Published online April 5, 2023
DOI: https://doi.org/10.5946/ce.2022.190
Graphical AbstractGraphical Abstract AbstractAbstract PDFPubReaderePub
Background
/Aims: Endoscopic ultrasound gallbladder drainage (EUS-GBD) is gaining attention as a treatment method for cholecystitis. However, only a few studies have assessed the outcomes of permanent stenting with EUS-GBD. Therefore, we evaluated the clinical outcomes of permanent stenting using EUS-GBD.
Methods
This was a retrospective, single-center cohort study. The criteria for EUS-GBD at our institution are a high risk for surgery, inability to perform surgery owing to poor performance status, and inability to obtain consent for emergency surgery. EUS-GBD was performed using a 7-Fr double-pigtail plastic stent with a dilating device. The primary outcomes were the recurrence-free rate of cholecystitis and the late-stage complication-avoidance rate. Secondary outcomes were technical success, clinical success, and procedural adverse events.
Results
A total of 41 patients were included in the analysis. The median follow-up period was 168 (range, 10–1,238) days. The recurrence-free and late-stage complication-avoidance rates during the follow-up period were 95% (38 cases) and 90% (36 cases), respectively. There were only two cases of cholecystitis recurrence during the study period.
Conclusions
EUS-GBD using double-pigtail plastic stent was safe and effective with few complications, even in the long term, in patients with acute cholecystitis.

Citations

Citations to this article as recorded by  
  • Revolutionizing outcomes: endoscopic ultrasound-guided gallbladder drainage using innovative electrocautery enhanced-lumen apposing metal stents for high-risk surgical patients
    Hyung Ku Chon, Yun Chae Lee, Tae Hyeon Kim, Seung Ok Lee, Seong-Hun Kim
    Scientific Reports.2024;[Epub]     CrossRef
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  • 106 Download
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Case Report
Single-pigtail plastic stent made from endoscopic nasobiliary drainage tubes in endoscopic ultrasound-guided gallbladder drainage: a retrospective case series
Koichi Soga
Clin Endosc 2024;57(2):263-267.   Published online April 4, 2023
DOI: https://doi.org/10.5946/ce.2022.213
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Technical failure of endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is often attributed to device failure. To rectify this problem, we developed a single-pigtail plastic stent (SPPS) for EUS-GBD. We retrospectively reviewed the cases of four patients who underwent EUS-GBD for acute cholecystitis. To prepare the SPPS, a 7.5-Fr endoscopic nasobiliary drainage tube was cut to an appropriate length. The use of SPPS during EUS-GBD was successful from both technical and clinical standpoints. The SPPS spontaneously detached 57 days after the procedure in patient 4 and 412 days after the procedure in patient 1. Patient 1 developed cholecystitis after 426 days and was managed with antibiotics. The other three patients did not develop any complications after surgery. In conclusion, we designed a new SPPS dedicated to EUS-GBD and established its technical feasibility and clinical effectiveness.

Citations

Citations to this article as recorded by  
  • Endoscopic ultrasound-guided retrieval of a migrated plastic stent from a pelvic abscess
    Koichi Soga, Yuto Suzuki, Fuki Hayakawa, Takeshi Fujiwara, Yo Fujimoto, Ikuhiro Kobori, Masaya Tamano
    Endoscopy.2024; 56(S 01): E870.     CrossRef
  • Usefulness of inserting a modified single‐pigtail plastic stent into a metallic stent in endoscopic ultrasound-guided gallbladder drainage
    Koichi Soga
    Endoscopy.2023; 55(S 01): E1081.     CrossRef
  • 3,198 View
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Original Articles
Role of interventional endoscopic ultrasound in a developing country
Hasan Maulahela, Nagita Gianty Annisa, Achmad Fauzi, Kaka Renaldi, Murdani Abdullah, Marcellus Simadibrata, Dadang Makmun, Ari Fahrial Syam
Clin Endosc 2023;56(1):100-106.   Published online January 17, 2023
DOI: https://doi.org/10.5946/ce.2022.058
AbstractAbstract PDFPubReaderePub
Background
/Aims: Endoscopic ultrasound (EUS) has become an essential diagnostic and therapeutic tool. EUS was introduced in 2013 in Indonesia and is considered relatively new. This study aimed to describe the current role of interventional EUS at our hospital as a part of the Indonesian tertiary health center experience.
Methods
This retrospective study included all patients who underwent interventional EUS (n=94) at our center between January 2015 and December 2020. Patient characteristics, technical success, clinical success, and adverse events associated with each type of interventional EUS procedure were evaluated.
Results
Altogether, 94 interventional EUS procedures were performed at our center between 2015 and 2020 including 75 cases of EUS-guided biliary drainage (EUS-BD), 14 cases of EUS-guided pancreatic fluid drainage, and five cases of EUS-guided celiac plexus neurolysis. The technical and clinical success rates of EUS-BD were 98.6% and 52%, respectively. The technical success rate was 100% for both EUS-guided pancreatic fluid drainage and EUS-guided celiac plexus neurolysis. The adverse event rates were 10.6% and 7.1% for EUS-BD and EUS-guided pancreatic fluid drainage, respectively.
Conclusions
EUS is an effective and safe tool for the treatment of gastrointestinal and biliary diseases. It has a low rate of adverse events, even in developing countries.

Citations

Citations to this article as recorded by  
  • EUS-guided interventional therapies for pancreatic diseases
    Rongmin Xu, Kai Zhang, Nan Ge, Siyu Sun
    Frontiers in Medicine.2024;[Epub]     CrossRef
  • 2,648 View
  • 167 Download
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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
AbstractAbstract PDFPubReaderePub
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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Endoscopic internal drainage with double pigtail stents for upper gastrointestinal anastomotic leaks: suitable for all cases?
Bin Chet Toh, Jingli Chong, Baldwin PM Yeung, Chin Hong Lim, Eugene KW Lim, Weng Hoong Chan, Jeremy TH Tan
Clin Endosc 2022;55(3):401-407.   Published online January 6, 2022
DOI: https://doi.org/10.5946/ce.2021.197
AbstractAbstract PDFPubReaderePub
Background
/Aims: Surgeons and endoscopists have started to use endoscopically inserted double pigtail stents (DPTs) in the management of upper gastrointestinal (UGI) leaks, including UGI anastomotic leaks. We investigated our own experiences in this patient population.
Methods
From March 2017 to June 2020, 12 patients had endoscopic internal drainage of a radiologically proven anastomotic leak after UGI surgery in two tertiary UGI centers. The primary outcome measure was the time to removal of the DPTs after anastomotic healing. The secondary outcome measure was early oral feeding after DPT insertion.
Results
Eight of the 12 patients (67%) required only one DPT, whereas four (33%) required two DPTs. The median duration of drainage was 42 days. Two patients required surgery due to inadequate control of sepsis. Of the remaining 10 patients, nine did not require a change in DPT before anastomotic healing. Nine patients were allowed oral fluids within the 1st week and a soft diet in the 2nd week. One patient was allowed clear oral feeds on the 8th day after DPT insertion.
Conclusions
Endoscopic internal drainage is becoming an established minimally invasive technique for controlling anastomotic leak after UGI surgery. It allows for early oral nutritional feeding and minimizes discomfort from conventional external drainage.

Citations

Citations to this article as recorded by  
  • Endoscopic Intervention for Anastomotic Leakage After Gastrectomy
    Ji Yoon Kim, Hyunsoo Chung
    Journal of Gastric Cancer.2024; 24(1): 108.     CrossRef
  • Endoscopic Management of Post-Sleeve Gastrectomy Complications
    Muaaz Masood, Donald E. Low, Shanley B. Deal, Richard A. Kozarek
    Journal of Clinical Medicine.2024; 13(7): 2011.     CrossRef
  • Endoscopic Internal Drainage Achieving Successful Closure of Iatrogenic Pharyngoesophageal Fistula
    Ahmad Rimawi, Yahia Al-Turk, Abdul Monem Swied
    ACG Case Reports Journal.2023; 10(10): e01191.     CrossRef
  • 3,827 View
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  • 4 Web of Science
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Case Report
Endoscopic Ultrasound-Guided Transgastric Puncture and Drainage of an Adrenal Abscess in an Immunosuppressed Patient
Carlos Andrés Regino, Jean Paul Gómez, Gabriel Mosquera-Klinger
Clin Endosc 2022;55(2):302-304.   Published online November 16, 2021
DOI: https://doi.org/10.5946/ce.2021.090
AbstractAbstract PDFPubReaderePub
Adrenal gland infection is a clinical entity of great importance, but it is a largely unrecognized pathology. Immunosuppressed individuals are at a higher risk of presentation. Herein, we describe a young female patient, recently diagnosed with HIV, who presented with severe sepsis due to methicillin-resistant Staphylococcus aureus, associated with a left adrenal abscess. She was initially treated with antibiotics; however, due to the persistence of the systemic inflammatory response and bacteremia, endoscopic ultrasound-guided drainage was performed. This procedure was successful in resolving the clinical situation. Endoscopic ultrasound-guided adrenal gland drainage can be a safe, efficacious, and minimally invasive option for managing antibiotic-refractory adrenal abscesses in immunosuppressed patients.
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Review
Clinical Practice Guidelines for the Endoscopic Management of Peripancreatic Fluid Collections
Chi Hyuk Oh, Jun Kyu Lee, Tae Jun Song, Jin-Seok Park, Jae Min Lee, Jun Hyuk Son, Dong Kee Jang, Miyoung Choi, Jeong-Sik Byeon, In Seok Lee, Soo Teik Lee, Ho Soon Choi, Ho Gak Kim, Hoon Jai Chun, Chan Guk Park, Joo Young Cho
Clin Endosc 2021;54(4):505-521.   Published online July 27, 2021
DOI: https://doi.org/10.5946/ce.2021.185
AbstractAbstract PDFPubReaderePub
Endoscopic ultrasonography-guided intervention has gradually become a standard treatment for peripancreatic fluid collections (PFCs). However, it is difficult to popularize the procedure in Korea because of restrictions on insurance claims regarding the use of endoscopic accessories, as well as the lack of standardized Korean clinical practice guidelines. The Korean Society of Gastrointestinal Endoscopy (KSGE) appointed a Task Force to develope medical guidelines by referring to the manual for clinical practice guidelines development prepared by the National Evidence-Based Healthcare Collaborating Agency. Previous studies on PFCs were searched, and certain studies were selected with the help of experts. Then, a set of key questions was selected, and treatment guidelines were systematically reviewed. Answers to these questions and recommendations were selected via peer review. This guideline discusses endoscopic management of PFCs and makes recommendations on Indications for the procedure, pre-procedural preparations, optimal approach for drainage, procedural considerations (e.g., types of stent, advantages and disadvantages of plastic and metal stents, and accessories), adverse events of endoscopic intervention, and procedural quality issues. This guideline was reviewed by external experts and suggests best practices recommended based on the evidence available at the time of preparation. This will be revised as necessary to address advances and changes in technology and evidence obtained in clinical practice and future studies.

Citations

Citations to this article as recorded by  
  • Pancreatic Pseudocyst after Fully Covered Self-expandable Metallic Stent Placement
    Mitsuhito Koizumi, Sho Ishikawa, Kaori Marui, Masahito Kokubu, Yusuke Okujima, Yuki Numata, Yoshiki Imamura, Teru Kumagi, Yoichi Hiasa
    Internal Medicine.2024; 63(21): 2943.     CrossRef
  • Neutrophil Gelatinase-Associated Lipocalin for the Differentiation of Mucinous Pancreatic Cystic Lesions
    Miruna Patricia Olar, Maria Iacobescu, Sorana D. Bolboacă, Cristina Pojoga, Ofelia Moșteanu, Radu Seicean, Ioana Rusu, Oana Banc, Cristina Adela Iuga, Andrada Seicean
    International Journal of Molecular Sciences.2024; 25(6): 3224.     CrossRef
  • Comparative outcome of single versus two double-pigtail stents for endoscopic drainage of pancreatic fluid collections with minimal necrosis: a retrospective analysis
    S Giri, S Bhrugumalla, S Gangadhar, S Angadi
    Acta Gastro Enterologica Belgica.2024; 87(1): 1.     CrossRef
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    Judy Daboul, Shiab Mussad, Anna Cecilia Amaral, Waleed K. Hussain, Peter J. Lee, Samuel Han
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  • Single double pigtail plastic stent (DPT) is equally effective to two double pigtail plastic stents for endoscopic ultrasonography-guided drainage of "symptomatic peripancreatic fluid collection with 30 % or less necrotic debris"
    Hemanta Kumar Nayak, Shubham Gupta, Manas Kumar Panigrahi, Abhijeet Rai, Saswati Kar, Mansi Chaudhary, Ajay Ghosh, Taraprasad Tripathy, Bramhadatta Pattnaik, Subash Chandra Samal
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    Dong Kee Jang, Dong Wook Lee, Seong-Hun Kim, Kwang Bum Cho, Sundeep Lakhtakia
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    Hyung Ku Chon, Seong-Hun Kim
    International Journal of Gastrointestinal Intervention.2023; 12(1): 7.     CrossRef
  • A preferable modality for the differentiation of peripancreatic fluid collections: Endoscopic ultrasound
    Ning Xu, Longsong Li, Danqi Zhao, Zixin Wang, Xueting Wang, Runzi Wang, Yanbo Zeng, Lei Zhang, Ning Zhong, Ying Lv, Enqiang Linghu, Ningli Chai
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  • Disconnected pancreatic duct syndrome in acute pancreatitis
    A.V. Fedorov, V.N. Ektov, M.A. Khodorkovsky
    Khirurgiya. Zhurnal im. N.I. Pirogova.2022; (8): 83.     CrossRef
  • Single balloon enteroscopy-guided endoscopic retrograde pancreatography for the treatment of a symptomatic pancreatic pseudocyst complicated by pancreaticojejunostomy stricture: A case report
    Eunae Cho, Chang-Hwan Park, Seo Yeon Cho
    Medicine.2022; 101(43): e31293.     CrossRef
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Original Article
Endoscopic Transpapillary Gallbladder Drainage for Acute Cholecystitis using Two Gallbladder Stents (Dual Gallbladder Stenting)
Zain A Sobani, Sergio A. Sánchez-Luna, Tarun Rustagi
Clin Endosc 2021;54(6):899-902.   Published online May 31, 2021
DOI: https://doi.org/10.5946/ce.2021.023
AbstractAbstract PDFPubReaderePub
Background
/Aims: Endoscopic transpapillary gallbladder drainage (ETPGBD) is gaining popularity for the management of acute cholecystitis (AC) in high-risk patients. However, the stents placed during the procedure are not immune to obstruction. Here we describe a novel technique of stenting with two transpapillary stents and evaluate its technical feasibility, safety, and efficacy in AC.
Methods
A retrospective analysis of all patients undergoing ETPGBD using dual stents for AC at our institution between November 1, 2017 and August 31, 2020 was conducted. We abstracted patient data to evaluate technical and clinical success, adverse events, and long-term outcomes. Two stents were placed either during the index procedure or during an interval procedure performed 4–6 weeks after the index procedure.
Results
A total of 21 patients underwent ETPGBD with dual stenting (57.14% male, mean age: 62.14±17.21 years). The median interval between the placement of the first and the second stents was 37 days (range: 0–226 days). Technical and clinical success rates were 100%, with a recurrence rate of 4.76% (n=1) and adverse event rate of 9.52% (n=2) during a mean follow-up period of 471.74±345.64 days (median: 341 days, range: 55–1084 days).
Conclusions
ETPGBD with dual gallbladder stenting is a safe and effective technique for long-term gallbladder drainage in non-surgical candidates. Larger controlled studies are needed to validate our findings for the widespread implementation of this technique.

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    Edoardo Troncone, Rosa Amendola, Alessandro Moscardelli, Elena De Cristofaro, Pasquale De Vico, Omero Alessandro Paoluzi, Giovanni Monteleone, Manuel Perez-Miranda, Giovanna Del Vecchio Blanco
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    Jad P. AbiMansour, Ryan J. Law, Andrew C. Storm, Vinay Chandrasekhara
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    Dorotea Bozic, Zarko Ardalic, Antonio Mestrovic, Josipa Bilandzic Ivisic, Damir Alicic, Ivan Zaja, Tomislav Ivanovic, Ivona Bozic, Zeljko Puljiz, Andre Bratanic
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    Tadahisa Inoue, Michihiro Yoshida, Yuta Suzuki, Rena Kitano, Fumihiro Okumura, Itaru Naitoh
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    Jad AbiMansour, Ryan Law
    Clinical Endoscopy.2021; 54(6): 783.     CrossRef
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Focused Review Series: Recent Updates on the Role of EUS in Pancreatobiliary Disease
What You Need to Know Before Performing Endoscopic Ultrasound-guided Hepaticogastrostomy
Tanyaporn Chantarojanasiri, Thawee Ratanachu-Ek, Nonthalee Pausawasdi
Clin Endosc 2021;54(3):301-308.   Published online May 28, 2021
DOI: https://doi.org/10.5946/ce.2021.103
AbstractAbstract PDFPubReaderePub
Endoscopic retrograde cholangiopancreatography (ERCP) is the primary treatment modality for bile duct obstruction. When ERCP is unsuccessful, percutaneous transhepatic biliary drainage can be an alternative method. Endoscopic ultrasound-guided biliary drainage (EUS-BD) has emerged as a treatment option for biliary obstruction, especially after ERCP failure. EUS-BD offers transluminal intrahepatic and extrahepatic drainage through a transgastric and transduodenal approach. EUS-guided hepaticogastrostomy (EUS-HGS) is an excellent choice for patients with hilar strictures or those with a surgically altered anatomy. The optimal steps in EUS-HGS are case selection, bile duct visualization, puncture-site selection, wire insertion and manipulation, tract dilation, and stent placement. Caution should be taken at each step to prevent complications. Dedicated devices for EUS-HGS have been developed to improve the technical success rate and reduce complications. This technical review focuses on the essential practical points at each step of EUS-HGS.

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    Shin Kato, Mariko Tsukamoto, Taichi Murai, Yuta Koike
    Revista Española de Enfermedades Digestivas.2024;[Epub]     CrossRef
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    Philipp Thies, Markus Dollhopf
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    Tsukasa Yasuda, Kazuo Hara, Nobumasa Mizuno, Shin Haba, Takamichi Kuwahara, Nozomi Okuno, Yasuhiro Kuraishi, Takafumi Yanaidani, Sho Ishikawa, Masanori Yamada, Toshitaka Fukui
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    Takafumi Mie, Takashi Sasaki, Takeshi Okamoto, Tsuyoshi Takeda, Chinatsu Mori, Yuto Yamada, Takaaki Furukawa, Akiyoshi Kasuga, Masato Matsuyama, Masato Ozaka, Naoki Sasahira
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  • Is Endoscopic Ultrasound-Guided Hepaticogastrostomy Safe and Effective after Failed Endoscopic Retrograde Cholangiopancreatography?—A Systematic Review and Meta-Analysis
    Saqr Alsakarneh, Mahmoud Y. Madi, Dushyant Singh Dahiya, Fouad Jaber, Yassine Kilani, Mohamed Ahmed, Azizullah Beran, Mohamed Abdallah, Omar Al Ta’ani, Anika Mittal, Laith Numan, Hemant Goyal, Mohammad Bilal, Wissam Kiwan
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    Kambiz Kadkhodayan, Shayan Irani
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    Koichiro Mandai, Shiho Nakamura
    Cureus.2024;[Epub]     CrossRef
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    Partha Pal, Sundeep Lakhtakia
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    Junichi Nakamura, Takeshi Ogura, Saori Ueno, Atsushi Okuda, Nobu Nishioka, Yuki Uba, Mitsuki Tomita, Kimi Bessho, Nobuhiro Hattori, Hiroki Nishikawa
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    Saburo Matsubara, Keito Nakagawa, Kentaro Suda, Takeshi Otsuka, Masashi Oka, Sumiko Nagoshi
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Focused Review Series: Endoscopic Management of Postoperative Gastrointestinal Complication: What’s New?
Endoscopic Management of Staple Line Leak after Bariatric Surgery: Surgeon’s Perspective
Yoona Chung, Dae Geun Park, Yong Jin Kim
Clin Endosc 2021;54(6):805-809.   Published online May 12, 2021
DOI: https://doi.org/10.5946/ce.2020.298
AbstractAbstract PDFPubReaderePub
Laparoscopic sleeve gastrectomy (LSG) has become a standalone primary procedure as a bariatric metabolic surgery since the early 2000s. The overall complication rate of LSG is reported to range from 2% to 15%. Staple line leakage (SLL) remains a major adverse event and occurs in approximately 1–6% of patients. Choosing the optimal treatment modality is a complex process. Clinicians must understand that nutritional support and drainage of fluid collection are essential for initial management. Conservative endoscopic management and sufficient drainage can resolve approximately 70% of SLLs. Endoscopic management of bariatric complications has been rapidly evolving in recent years and can be considered in all patients who are hemodynamically stable. We will review the available endoscopic management techniques, including stent placement (self-expanding stents and bariatric-specific stents), clipping, tissue sealant application, and internal drainage (double-pigtail stents [DPS] placement, endoscopic vacuum therapy, and septotomy). Stent placement remains the mainstream treatment for SLLs. However, healing with stents requires multiple sessions/stents and a long course of recovery. Endoscopic internal drainage is gaining popularity and has the potential to be a superior method. The importance of early intervention and combined endoscopic methods should be recognized.

Citations

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  • Endoscopic therapies for bariatric surgery complications
    Abdelrahman Yakout, Enrique F. Elli, Vivek Kumbhari, Nader Bakheet
    Current Opinion in Gastroenterology.2024; 40(6): 449.     CrossRef
  • Endoscopic Management of Post-Sleeve Gastrectomy Complications
    Muaaz Masood, Donald E. Low, Shanley B. Deal, Richard A. Kozarek
    Journal of Clinical Medicine.2024; 13(7): 2011.     CrossRef
  • Metabolic and Bariatric Surgeon Criteria—An International Experts’ Consensus
    Mohammad Kermansaravi, Sonja Chiappetta, Scott A. Shikora, Mario Musella, Lilian Kow, Edo Aarts, Syed Imran Abbas, Ahmad Aly, Ali Aminian, Luigi Angrisani, Syed Tanseer Asghar, Ahmad Bashir, Estuardo Behrens, Helmuth Billy, Camilo Boza, Wendy A. Brown, Da
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  • New Endoscopic Devices and Techniques for the Management of Post-Sleeve Gastrectomy Fistula and Gastric Band Migration
    Carlo Felix Maria Jung, Cecilia Binda, Luigi Tuccillo, Matteo Secco, Giulia Gibiino, Elisa Liverani, Chiara Petraroli, Chiara Coluccio, Carlo Fabbri
    Journal of Clinical Medicine.2024; 13(16): 4877.     CrossRef
  • Esophagojejunostomy or Fistulojejunostomy Are Safe Salvage Operations for Bariatric Surgery Leaks
    Steven G. Leeds, Kacie R. Kerlee, Lucas Fair, Daniel Tran, Daniel G. Davis, Gerald O. Ogola, Marc A. Ward
    Foregut: The Journal of the American Foregut Society.2023; 3(2): 157.     CrossRef
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    Lucas Fair, Marc Ward, Meghana Vankina, Rashmeen Rana, Titus McGowan, Gerald Ogola, Bola Aladegbami, Steven Leeds
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    Muaaz Masood, Donald Low, Shanley B. Deal, Richard A. Kozarek
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    Georgios-Ioannis Verras, Francesk Mulita, Charalampos Lampropoulos, Dimitrios Kehagias, Oliver Curwen, Andreas Antzoulas, Ioannis Panagiotopoulos, Vasileios Leivaditis, Ioannis Kehagias
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  • Role of Endoscopic Internal Drainage in Treating Gastro-Bronchial and Gastro-Colic Fistula After Sleeve Gastrectomy
    Alessandra D’Alessandro, Giovanni Galasso, Francesco Paolo Zito, Cristiano Giardiello, Fabrizio Cereatti, Roberto Arienzo, Filippo Pacini, Jean-Marc Chevallier, Gianfranco Donatelli
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    Ahmed Elnabil-Mortada, Haitham M. Elmaleh, Roger Ackroyd, Rabbah A. Khaled
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    Hamidreza Goudarzi, Jacob R. Obney, Mahsa Hemmatizadeh, Taha Anbara
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Case Report
A Gastrobronchial Fistula Secondary to Endoscopic Internal Drainage of a Post-Sleeve Gastrectomy Fluid Collection
Paraskevas Gkolfakis, Marc-André Bureau, Marianna Arvanitakis, Jacques Devière, Daniel Blero
Clin Endosc 2022;55(1):141-145.   Published online April 16, 2021
DOI: https://doi.org/10.5946/ce.2021.033
AbstractAbstract PDFPubReaderePub
A 44-year-old woman underwent sleeve gastrectomy, which was complicated by a leak. She was treated with two sessions of endoscopic internal drainage using plastic double-pigtail stents. Her clinical evolution was favorable, but four months after the initial stent placement, she became symptomatic, and a gastrobronchial fistula with the proximal end of the stents invading the diaphragm was diagnosed. She was treated with antibiotics, plastic stents were removed, and a partially covered metallic esophageal stent was placed. Eleven weeks later, the esophageal stent was removed with no evidence of fistula. Inappropriate stent size, position, stenting duration, and persistence of low-grade inflammation could explain the patient’s symptoms and provide a mechanism for gradual muscle rupture and fistula formation. Although endoscopic internal drainage is usually safe and effective for the management of post-laparoscopic sleeve gastrectomy leaks, close clinical and radiological follow-up is mandatory.

Citations

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  • Management of leakage and fistulas after bariatric surgery
    Stephen A. Firkins, Roberto Simons-Linares
    Best Practice & Research Clinical Gastroenterology.2024; 70: 101926.     CrossRef
  • Role of Endoscopic Internal Drainage in Treating Gastro-Bronchial and Gastro-Colic Fistula After Sleeve Gastrectomy
    Alessandra D’Alessandro, Giovanni Galasso, Francesco Paolo Zito, Cristiano Giardiello, Fabrizio Cereatti, Roberto Arienzo, Filippo Pacini, Jean-Marc Chevallier, Gianfranco Donatelli
    Obesity Surgery.2022; 32(2): 342.     CrossRef
  • 4,222 View
  • 158 Download
  • 1 Web of Science
  • 2 Crossref
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Original Article
RWON Study: The Real-World Walled-off Necrosis Study
Ankush Pawar, Ujjwal Sonika, Manish Kumar, Sundeep Saluja, Siddharth Srivastava
Clin Endosc 2021;54(6):909-915.   Published online February 23, 2021
DOI: https://doi.org/10.5946/ce.2020.175
AbstractAbstract PDFPubReaderePub
Background
/Aims: The management of walled-off necrosis (WON) has undergone a paradigm shift from surgical to nonsurgical modalities. Real-world data on the management of symptomatic WON are scarce.
Methods
Prospectively collected data of symptomatic WON cases were retrospectively evaluated. The treatment modalities used were medical management alone, percutaneous catheter drainage (PCD) or endoscopic drainage (ED), or a combination of PCD and ED. We compared clinical outcome among these modalities.
Results
A total of 264 patients were evaluated. The most common indications for drainage were pain and fever. Of the patients, 28% was treated with medical therapy alone, 31% with ED, 37% with PCD, and 4% with a combined approach. Technical success and clinical success were achieved in 93% and 91% of patients in the endoscopic arm and in 90% and 81% patients in the PCD arm, respectively (p=0.0004 for clinical success). Lower rates of complications (7% vs. 22%, p=0.005), readmission (20% vs. 34%, p=0.04), and mortality (4% vs. 19%, p=0.0012), and shorter hospital stay (13 days vs. 19 days, p=0.0018) were observed in the endoscopic group than in the PCD group.
Conclusions
ED of WON is better than PCD and is associated with lower mortality, fewer complications, and shorter hospitalization.

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  • Endoscopic ultrasound drainage of pancreatic fluid collections: do we know enough about the best approach?
    Andrada Seicean, Cristina Pojoga, Voicu Rednic, Claudia Hagiu, Radu Seicean
    Therapeutic Advances in Gastroenterology.2023;[Epub]     CrossRef
  • Treatment of Walled-off Necrosis – Outcomes are Best When Endoscopy and Percutaneous Interventions are Complimentary, Not Exclusive
    Ji Young Bang, Shyam Varadarajulu
    Clinical Endoscopy.2021; 54(6): 785.     CrossRef
  • 4,289 View
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Case Report
Minimally Invasive Approach Using Digital Single-Operator Peroral Cholangioscopy-Guided Electrohydraulic Lithotripsy and Endoscopic Nasogallbladder Drainage for the Management of High-Grade Mirizzi Syndrome
Hyung Ku Chon, Chan Park, Tae Hyeon Kim
Clin Endosc 2021;54(6):930-934.   Published online February 18, 2021
DOI: https://doi.org/10.5946/ce.2021.015
AbstractAbstract PDFPubReaderePub
Mirizzi syndrome is a rare complication of gallbladder disease that can be difficult to treat. In particular, endoscopic treatment often fails because of the inability to access or to capture the impacted cystic duct stone. We report a case of Mirizzi syndrome grade III that was successfully managed by digital single-operator peroral cholangioscopy-guided electrohydraulic lithotripsy with endoscopic nasogallbladder drainage and interval laparoscopic cholecystectomy. Based on our experience, digital single-operator peroral cholangioscopy-guided electrohydraulic lithotripsy with endoscopic nasogallbladder drainage is a feasible minimally invasive approach for the management of high-grade Mirizzi syndrome.

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  • Difficult Biliary Stones: A Comprehensive Review of New and Old Lithotripsy Techniques
    Edoardo Troncone, Michelangela Mossa, Pasquale De Vico, Giovanni Monteleone, Giovanna Del Vecchio Blanco
    Medicina.2022; 58(1): 120.     CrossRef
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    Rishi Pawa, Robert Dorrell, Swati Pawa
    Endoscopy International Open.2022; 10(01): E135.     CrossRef
  • Mirizzi Syndrome Type IV Successfully Treated with Peroral Single-operator Cholangioscopy-guided Electrohydraulic Lithotripsy: A Case Report with Literature Review
    Hirokazu Kawai, Toshifumi Sato, Masaaki Natsui, Kotaro Watanabe, Ryosuke Inoue, Mayuki Kimura, Kazumi Yoko, Syun-ya Sasaki, Masashi Watanabe, Taku Ohashi, Akihiro Tsukahara, Norio Tanaka, Yoshihisa Tsukada
    Internal Medicine.2022; 61(23): 3513.     CrossRef
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    F. M. Pavuk
    Klinicheskaia khirurgiia.2021; 88(1-2): 69.     CrossRef
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    Min Jae Yang, Do Hyun Park
    Clinical Endoscopy.2021; 54(5): 777.     CrossRef
  • 3,635 View
  • 107 Download
  • 4 Web of Science
  • 5 Crossref
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Original Article
Outcomes of Endoscopic Ultrasound-Guided Biliary Drainage in Patients Undergoing Antithrombotic Therapy
Nozomi Okuno, Kazuo Hara, Nobumasa Mizuno, Shin Haba, Takamichi Kuwahara, Hiroki Koda, Masahiro Tajika, Tsutomu Tanaka, Sachiyo Onishi, Keisaku Yamada, Akira Miyano, Daiki Fumihara, Moaz Elshair
Clin Endosc 2021;54(4):596-602.   Published online February 17, 2021
DOI: https://doi.org/10.5946/ce.2020.194
AbstractAbstract PDFPubReaderePub
Background
/Aims: The Japan Gastroenterological Endoscopy Society (JGES) has published guidelines for gastroenterological endoscopy in patients undergoing antithrombotic treatment. These guidelines classify endoscopic ultrasound-guided biliary drainage (EUS-BD) as a high-risk procedure. Nevertheless, the bleeding risk of EUS-BD in patients undergoing antithrombotic therapy is uncertain. Therefore, this study aimed to assess the bleeding risk in patients undergoing antithrombotic therapy.
Methods
This single-center retrospective study included 220 consecutive patients who underwent EUS-BD between January 2013 and December 2018. We managed the withdrawal and continuation of antithrombotic agents according to the JGES guidelines. We compared the bleeding event rates among patients who received and those who did not receive antithrombotic agents.
Results
A total of 18 patients (8.1%) received antithrombotic agents and 202 patients (91.8%) did not. Three patients experienced bleeding events, with an overall bleeding event rate of 1.3% (3/220): one patient was in the antithrombotic group (5.5%) and two patients were in the non-antithrombotic group (0.9%) (p=0.10). All cases were moderate. The sole thromboembolic event (0.4%) was a cerebral infarction in a patient in the non-antithrombotic group.
Conclusions
The rate of EUS-BD-related bleeding events was low. Even in patients receiving antithrombotic therapy, the bleeding event rates were not significantly different from those in patients not receiving antithrombotic therapy.

Citations

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Focused Review Series: Endoscopic Ultrasound-Guided Therapeutic Intervention: Focus on Technique and Practical Tips
Endoscopic Ultrasound-Guided Pancreatic Duct Drainage: Techniques and Literature Review of Transmural Stenting
Akira Imoto, Takeshi Ogura, Kazuhide Higuchi
Clin Endosc 2020;53(5):525-534.   Published online September 24, 2020
DOI: https://doi.org/10.5946/ce.2020.173
AbstractAbstract PDFPubReaderePub
Endoscopic ultrasound-guided pancreatic duct drainage (EUS-PD) has emerged as an option in patients with failure of retrograde access to the pancreatic duct (PD) because of difficulty in cannulation or surgically altered anatomy. This article provides a comprehensive review of the techniques and outcomes of EUS-PD, especially EUS-guided pancreatic transmural stenting. The clinical data derived from a total of 401 patients were reviewed in which the overall technical and clinical success rates were 339/401 (85%, range 63%–100%) and 328/372 (88%, range 76%–100%), respectively. Short-term adverse events occurred in 25% (102/401) of the cases, which included abdominal pain (n=45), acute pancreatitis (n=17), bleeding (n=10), and issues associated with pancreatic juice leakage such as perigastric or peripancreatic fluid collection (n=9). In conclusion, although EUS-PD remains a challenging procedure with a high risk of adverse events such as pancreatic juice leakage, perforation, and severe acute pancreatitis, the procedure seems to be a promising alternative for PD drainage in patients with altered anatomy or unsuccessful endoscopic retrograde pancreatography.

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Reviews
Practical Approaches for High-Risk Surgical Patients with Acute Cholecystitis: The Percutaneous Approach versus Endoscopic Alternatives
Rungsun Rerknimitr, Khanh Cong Pham
Clin Endosc 2020;53(6):678-685.   Published online January 9, 2020
DOI: https://doi.org/10.5946/ce.2019.186
AbstractAbstract PDFPubReaderePub
In high-risk surgical patients with acute cholecystitis who are not candidates for early laparoscopic cholecystectomy, gallbladder (GB) drainage is an alternative treatment option. Percutaneous transhepatic gallbladder drainage (PTGBD) is a recommended first line intervention because of its high efficacy and feasibility in most centers. However, with the advent of endoscopic accessories and technology, endoscopic GB drainage has been chosen as a more favorable choice by endoscopists. Endoscopic transpapillary gallbladder drainage (ETGBD) can be performed under either fluoroscopic or peroral cholangioscopic guidance via endoscopic retrograde cholangiopancreatography by the transpapillary placement of a long double-pigtail stent. In a patient with common bile duct stones, this procedure is accompanied with stone removal. ETGBD is especially useful for acute cholecystitis patients who are contraindicated for PTGBD or those with severe coagulopathy, thrombocytopenia, and abnormal anatomy. Moreover, the advantage of ETGBD is its preservation of the external GB structure. Thereby it would not disturb the future cholecystectomy. Recently, endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) using plastic, fully covered metallic, or lumen-apposing metal stents transmurally has emerged as a modality for GB drainage with higher technical and clinical success rates. EUS-GBD can provide a more permanent GB drainage than PTGBD and ETGBD.

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    Federico Coccolini, Eugenio Cucinotta, Andrea Mingoli, Mauro Zago, Gaia Altieri, Alan Biloslavo, Roberto Caronna, Ismail Cengeli, Enrico Cicuttin, Roberto Cirocchi, Luigi Cobuccio, Gianluca Costa, Valerio Cozza, Camilla Cremonini, Giovanni Del Vecchio, Gi
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  • Single-Session Endoscopic Ultrasound–Directed Transgastric Endoscopic Retrograde Cholangiopancreatography and Simultaneous Endoscopic Ultrasound–Guided Transmural Gallbladder Drainage in Choledocholithiasis and Acute Cholecystitis After Unsuccessful Lapar
    Azhar Hussain, Vishnu Charan Suresh Kumar, Hafiz Muzaffar Akbar Khan
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    Markus Zachäus, Michael Bartels, Andreas Flade, Andreas Schubert-Hartmann, Regina Lamberts, Alireza Sepehri-Shamloo, Ulrich Paul Halm
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    Wiriyaporn Ridtitid, Thanawat Luangsukrerk, Panida Piyachaturawat, Nicha Teeratorn, Phonthep Angsuwatcharakon, Pradermchai Kongkam, Rungsun Rerknimitr
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    Hayato Kurihara, Francesca M. Bunino, Alessandro Fugazza, Enrico Marrano, Giulia Mauri, Martina Ceolin, Ezio Lanza, Matteo Colombo, Antonio Facciorusso, Alessandro Repici, Andrea Anderloni
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    Takumi Habu, Akihiro Sako, Kotaro Nishida, Koichi Komatsu, Keiichi Arakawa, Takehito Maruyama, Shigeo Aoki, Hideyuki Mishima, Yuichi Matsui
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    Clement Chun Ho Wu, Christopher Jen Lock Khor
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Current Status in the Treatment of Acute Cholecystitis Patients Receiving Antithrombotic Therapy: Is Endoscopic Drainage Feasible?- A Systematic Review
Ryota Sagami, Kenji Hayasaka, Hidefumi Nishikiori, Hideaki Harada, Yuji Amano
Clin Endosc 2020;53(2):176-188.   Published online January 9, 2020
DOI: https://doi.org/10.5946/ce.2019.177
AbstractAbstract PDFPubReaderePub
The bleeding complication risk of surgery or percutaneous transhepatic gallbladder drainage (PTGBD) may increase in patients with acute cholecystitis receiving antithrombotic therapy (ATT). Endoscopic gallbladder drainage (EGBD) may be recommended for such patients. English articles published between 1991 and 2018 in peer-reviewed journals that discuss cholecystectomy, PTGBD, and EGBD in patients with ATT or coagulopathy were reviewed to assess the safety of the procedures, especially in terms of the bleeding complication. There were 8 studies on cholecystectomy, 3 on PTGBD, and 1 on endoscopic transpapillary gallbladder drainage (ETGBD) in patients receiving ATT. With respect to EGBD, 28 studies on ETGBD (including 1 study already mentioned above) and 26 studies on endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) were also analyzed. The overall bleeding complication rate in patients with ATT who underwent cholecystectomy was significantly higher than that in patients without ATT (6.5% [23/354] vs. 1.2% [26/2,224], p<0.001). However, the bleeding risk of cholecystectomy and PTGBD in patients receiving ATT was controversial. The overall technical success, clinical success, and bleeding complication rates of ETGBD vs. EUS-GBD were 84% vs. 96% (p<0.001), 92% vs. 97% (p<0.001), and 0.65% vs. 2.1% (p=0.005), respectively. One patient treated with ETGBD experienced bleeding complication among 191 patients with bleeding tendency. ETGBD may be an ideal drainage procedure for patients receiving ATT from the viewpoint of bleeding, although EUS-GBD is also efficacious.

Citations

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  • Acute cholecystitis management in high-risk, critically ill, and unfit-for-surgery patients: the Italian Society of Emergency Surgery and Trauma (SICUT) guidelines
    Federico Coccolini, Eugenio Cucinotta, Andrea Mingoli, Mauro Zago, Gaia Altieri, Alan Biloslavo, Roberto Caronna, Ismail Cengeli, Enrico Cicuttin, Roberto Cirocchi, Luigi Cobuccio, Gianluca Costa, Valerio Cozza, Camilla Cremonini, Giovanni Del Vecchio, Gi
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  • Elective Cholecystectomy After Endoscopic Gallbladder Stenting for Acute Cholecystitis: A Propensity Score Matching Analysis
    Shinjiro Kobayashi, Kazunari Nakahara, Saori Umezawa, Keisuke Ida, Atsuhito Tsuchihashi, Satoshi Koizumi, Junya Sato, Keisuke Tateishi, Takehito Otsubo
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    Markus Zachäus, Michael Bartels, Andreas Flade, Andreas Schubert-Hartmann, Regina Lamberts, Alireza Sepehri-Shamloo, Ulrich Paul Halm
    Zentralblatt für Chirurgie - Zeitschrift für Allgemeine, Viszeral-, Thorax- und Gefäßchirurgie.2023; 148(02): 140.     CrossRef
  • Postoperative bleeding after percutaneous transhepatic gallbladder drainage and aspiration in patients receiving antithrombotic therapy
    Takayuki Iwamoto, Takahiro Suda, Takanori Inoue, Yasutoshi Nozaki, Rui Mizumoto, Yuki Arimoto, Takashi Ohta, Shinjiro Yamaguchi, Yoshiki Ito, Hideki Hagiwara, Rizaldy Taslim Pinzon
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  • Strategy Comparison of Endoscopic Ultrasound-Guided Gallbladder Drainage to Percutaneous Transhepatic Gallbladder Drainage, Following Failed Emergent Endoscopic Transpapillary Gallbladder Drainage
    Ryota Sagami, Kazuhiro Mizukami, Takao Sato, Hidefumi Nishikiori, Kazunari Murakami
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    Anri Kaneta, Hirotaka Sasada, Takuma Matsumoto, Tsuyoshi Sakai, Shuichi Sato, Takashi Hara
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    Christoph F. Dietrich, Barbara Braden, Christian Jenssen
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    Miloš Buhavac, Ali Elsaadi, Sharmila Dissanaike
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Endoscopic Ultrasound-Guided Pancreatic Transmural Stenting and Transmural Intervention
Takeshi Ogura, Hideko Ohama, Kazuhide Higuchi
Clin Endosc 2020;53(4):429-435.   Published online November 27, 2019
DOI: https://doi.org/10.5946/ce.2019.130
AbstractAbstract PDFPubReaderePub
Endoscopic ultrasound (EUS)-guided pancreatic access is an emergent method that can be divided into the two main techniques of EUS-guided rendezvous and pancreatic transmural stenting (PTS). While many reports have described EUS-guided procedures, the indications, technical tips, clinical effects, and safety of EUS-guided pancreatic duct drainage (EUS-PD) remain controversial. This review describes the current status of and problems associated with EUS-PD, particularly PTS. We reviewed clinical data derived from a total of 334 patients. Rates of technical and clinical success ranged from 63% to 100% and 76% to 100%, respectively. In contrast, the rate of procedure-related adverse events was high at 26.7% (89/334). The most frequent adverse events comprised abdominal pain (n=38), acute pancreatitis (n=15), bleeding (n=9), and issues associated with pancreatic juice leakage such as perigastric fluid, pancreatic fluid collection, or pancreatic juice leaks (n=8). In conclusion, indications for EUS-PTS are limited, as is the evidence of its viability, due to the scarcity of expert operators. Despite improvements made to various devices, EUS-PTS remains technically challenging. Therefore, a long-term, large-scale, multicenter study is required to establish this technique as a viable alternative drainage method.

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    Jayanta Samanta, Abhirup Chatterjee, Jahnvi Dhar, Zaheer Nabi, Michiel Bronswijk, Manik Aggarwal, Antonio Facciorusso, Paraskevas Gkolfakis, Takeshi Ogura, Schalk Van der Merwe, Sundeep Lakhtakia
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  • A novel fluoroscopic system improves visibility of devices during endoscopic ultrasound-guided pancreatic duct drainage
    Takeshi Ogura, Yuki Uba, Nobuhiro Hattori, Kimi Bessho, Hiroki Nishikawa
    Endoscopy.2024; 56(S 01): E831.     CrossRef
  • A novel spiral dilator for pancreatic duct drainage: catching two birds with one stone
    Han Taek Jeong, Jimin Han
    Clinical Endoscopy.2024; 57(5): 608.     CrossRef
  • Best Practices in Pancreatico-biliary Stenting and EUS-guided Drainage
    Renato Medas, Joel Ferreira-Silva, Mohit Girotra, Monique Barakat, James H. Tabibian, Eduardo Rodrigues-Pinto
    Journal of Clinical Gastroenterology.2023; 57(6): 553.     CrossRef
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    Akinori Suzuki, Shigeto Ishii, Toshio Fujisawa, Hiroaki Saito, Yusuke Takasaki, Sho Takahashi, Wataru Yamagata, Kazushige Ochiai, Ko Tomishima, Hiroyuki Isayama
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Original Article
A New Technique of Endoscopic Transpapillary Gallbladder Drainage Combined with Intraductal Ultrasonography for the Treatment of Acute Cholecystitis
Ryota Sagami, Kenji Hayasaka, Tetsuro Ujihara, Ryotaro Nakahara, Daisuke Murakami, Tomoyuki Iwaki, Satoshi Suehiro, Yasushi Katsuyama, Hideaki Harada, Yuji Amano
Clin Endosc 2020;53(2):221-229.   Published online November 5, 2019
DOI: https://doi.org/10.5946/ce.2019.099
AbstractAbstract PDFPubReaderePub
Background
/Aims: Endoscopic transpapillary gallbladder drainage (ETGBD) is useful for the treatment of acute cholecystitis; however, the technique is difficult to perform. When intraductal ultrasonography (IDUS) is combined with ETGBD, the orifice of the cystic duct in the common bile duct may be more easily detected in the cannulation procedure. The aim of this study was to evaluate the efficacy of ETGBD with IDUS compared with that of ETGBD alone.
Methods
A total of 100 consecutive patients with acute cholecystitis requiring ETGBD were retrospectively recruited. The first 50 consecutive patients were treated using ETGBD without IDUS, and the next 50 patients were treated using ETGBD with IDUS. Through propensity score matching analysis, we compared the clinical outcomes between the groups. The primary outcome was the technical success rate.
Results
The technical success rate of ETGBD with IDUS was significantly higher than that of ETGBD without IDUS (92.0% vs. 76.0%, p=0.044). There was no significant difference in procedure length between the two groups (74.0 min vs. 66.7 min, p=0.310). The complication rate of ETGBD with IDUS was significantly higher than that of ETGBD without IDUS (6.0% vs. 0%, p<0.001); however, only one case showed an IDUS technique-related complication (pancreatitis).
Conclusions
The assistance of IDUS may be useful in ETGBD.

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  • The Success Rate Is Lower but Completion Rate of Laparoscopic Cholecystectomy Is higher in Endoscopic Transpapillary Gallbladder Drainage than Percutaneous Gallbladder Drainage for Acute Cholecystitis
    Toshiro Masuda, Hiroshi Takamori, Ken-ichi Ogata, Katsuhiro Ogawa, Kenji Shimizu, Ryuichi Karashima, Hidetoshi Nitta, Katsutaka Matsumoto, Tetsuya Okino, Hideo Baba
    Surgical Laparoscopy, Endoscopy & Percutaneous Techniques.2024; 34(4): 413.     CrossRef
  • The Endoscopic Retrograde Cholangiopancreatography and Endoscopic Ultrasound Connection: Unity Is Strength, or the Endoscopic Ultrasonography Retrograde Cholangiopancreatography Concept
    Claudio Giovanni De Angelis, Eleonora Dall’Amico, Maria Teresa Staiano, Marcantonio Gesualdo, Mauro Bruno, Silvia Gaia, Marco Sacco, Federica Fimiano, Anna Mauriello, Simone Dibitetto, Chiara Canalis, Rosa Claudia Stasio, Alessandro Caneglias, Federica Me
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  • Strategy Comparison of Endoscopic Ultrasound-Guided Gallbladder Drainage to Percutaneous Transhepatic Gallbladder Drainage, Following Failed Emergent Endoscopic Transpapillary Gallbladder Drainage
    Ryota Sagami, Kazuhiro Mizukami, Takao Sato, Hidefumi Nishikiori, Kazunari Murakami
    Journal of Clinical Medicine.2023; 12(22): 7034.     CrossRef
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    Soichiro Kawahara, Takeshi Tomoda, Hironari Kato, Toru Ueki, Yutaka Akimoto, Ryo Harada, Tomohiro Toji, Hiroyuki Okada
    Digestion.2022; 103(2): 116.     CrossRef
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    Shallu Garg, Usha Dutta, Sreedhara B. Chaluvashetty, Kimavat Hemanth Kumar, Naveen Kalra, Daisy Sahni, Anjali Aggarwal
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    Rishabh Gulati, Tarun Rustagi
    Journal of Hepato-Biliary-Pancreatic Sciences.2021;[Epub]     CrossRef
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    Zain A. Sobani, Christina Ling, Tarun Rustagi
    Digestive Diseases and Sciences.2021; 66(5): 1425.     CrossRef
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    Manuela Götzberger, Natascha Nüssler, Barbara Braden, Christoph F. Dietrich, Thomas Müller
    Zeitschrift für Gastroenterologie.2021; 59(09): 983.     CrossRef
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Case Report
A Rare Fatal Bile Peritonitis after Malposition of Endoscopic Ultrasound-Guided 5-Fr Naso-Gallbladder Drainage
Tae Hyung Kim, Hyun Jin Bae, Seung Goun Hong
Clin Endosc 2020;53(1):97-100.   Published online September 3, 2019
DOI: https://doi.org/10.5946/ce.2019.032
AbstractAbstract PDFPubReaderePub
Endoscopic ultrasound (EUS)-guided gallbladder (GB) drainage has recently emerged as a more feasible treatment than percutaneous transhepatic GB drainage for acute cholecystitis. In EUS-guided cholecystostomies in patients with distended GBs without pericholecystic inflammation or prominent wall thickening, a needle puncture with tract dilatation is often difficult. Guidewires may slip during the insertion of thin and flexible drainage catheters, which can also cause the body portion of the catheter to be unexpectedly situated and prolonged between the GB and intestines because the non-inflamed distended GB is fluctuant. Upon fluoroscopic examination during the procedure, the position of the abnormally coiled catheter may appear to be correct in patients with a distended stomach. We experienced such an adverse event with fatal bile peritonitis in a patient with GB distension suggestive of malignant bile duct stricture. Fatal bile peritonitis then occurred. Therefore, the endoscopist should confirm the indications for cholecystostomy and determine whether a distended GB is a secondary change or acute cholecystitis.

Citations

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    Kazunari Nakahara, Junya Sato, Ryo Morita, Yosuke Michikawa, Keigo Suetani, Yosuke Igarashi, Akihiro Sekine, Shinjiro Kobayashi, Takehito Otsubo, Fumio Itoh
    Digestive Endoscopy.2022; 34(1): 207.     CrossRef
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  • 95 Download
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Original Article
Risk Factors for Pancreatitis and Cholecystitis after Endoscopic Biliary Stenting in Patients with Malignant Extrahepatic Bile Duct Obstruction
Ga Hee Kim, Si Kyong Ryoo, Jae Keun Park, Joo Kyung Park, Kwang Hyuck Lee, Kyu Taek Lee, Jong Kyun Lee
Clin Endosc 2019;52(6):598-605.   Published online May 28, 2019
DOI: https://doi.org/10.5946/ce.2018.177
AbstractAbstract PDFPubReaderePub
Background
/Aims: For the treatment of malignant biliary obstruction, endoscopic retrograde biliary drainage (ERBD) has been widely accepted as a standard procedure. However, post-ERBD complications can affect the lives of patients. The purpose of this study was to identify the predictive factors for these complications, including the patient’s status, cancer status, and stent type.
Methods
This was a retrospective analysis conducted in a single tertiary hospital from January 2007 to July 2017. The following variables were evaluated: sex, age, body mass index, cancer type, history of pancreatitis, gallbladder stone, previous biliary stenting, precut papillotomy, stent type, contrast injection into the pancreatic duct or gallbladder, cystic duct invasion by the tumor, and occlusion of the cystic duct orifice by a metal stent.
Results
Multivariate analysis showed that contrast injection into the pancreatic duct was a risk factor for pancreatitis. Patients with a history of bile drainage showed a lower risk of pancreatitis. For cholecystitis, the analysis revealed contrast injection into the gallbladder and cystic duct invasion by the tumor as important predictive factors. Metal stents showed a greater risk of post-procedure pancreatitis than plastic stents, but did not affect the incidence of cholecystitis.
Conclusions
Considering that contrast injection is the most important factor for both complications, a careful approach by the physician is essential in preventing the occurrence of any complications. Further, choosing the type of stent is an important factor for patients at a risk of post-procedure pancreatitis.

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    DEN Open.2025;[Epub]     CrossRef
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    Endoscopy International Open.2024; 12(06): E772.     CrossRef
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    Jing Song, Jun Deng, Feng Wen, Piero Chirletti
    Gastroenterology Research and Practice.2023; 2023: 1.     CrossRef
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    Nga T. Nguyen, Hasan A. Khan, Kian Abdul-Baki, Woongsoon Choi, Neel K. Shroff, Zahra Akhtar, Peeyush Bhargava
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    Mamoru Takenaka, Masatoshi Kudo
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    Masahiro Umemura, Eri Shimura, Yusuke Asai, Atsushi Tsuji, Masafumi Nishino, Yurimi Takahashi, Yuzo Sasada, Yasuhiko Saida, Kazuhito Kawata, Ken Sugimoto, Takanori Yamada
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    Masafumi Watanabe, Kosuke Okuwaki, Jun Woo, Mitsuhiro Kida, Hiroshi Imaizumi, Tomohisa Iwai, Hiroshi Yamauchi, Toru Kaneko, Rikiya Hasegawa, Takahiro Kurosu, Naoki Minato, Hiroki Haradome, Wasaburo Koizumi
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    Ming‐Xing Xia, Yi‐Feng Zhou, Ming Zhang, Wei Wang, Jun Wu, Tian‐Tian Wang, Xiao‐Feng Zhang, Bing Hu
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    Clinical Endoscopy.2019; 52(6): 525.     CrossRef
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