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Original Article
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.

Citations

Citations to this article as recorded by  
  • Risk Factors for Cholecystitis After Self-expandable Metallic Stent Placement for Malignant Distal Biliary Obstruction
    Hashem Albunni, Azizullah Beran, Nwal Hadaki, Mark A. Gromski, Mohammad Al-Haddad
    Journal of Clinical Gastroenterology.2025;[Epub]     CrossRef
  • Risk Factors for Infection Following Particle Stent Placement in Obstructive Jaundice Patients: A Retrospective Analysis
    Gang Wang, Rui Qi
    Current Problems in Surgery.2025; : 101775.     CrossRef
  • Technical challenges and safety of prophylactic gallbladder stenting with metallic biliary stenting
    Masood Muhammad Karim, Om Parkash
    Clinical Endoscopy.2024; 57(6): 841.     CrossRef
  • 2,936 View
  • 296 Download
  • 1 Web of Science
  • 3 Crossref
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Systematic Review and Meta-analysis
Stricturing Crohn's disease: what is the role of endoscopic stenting? A systematic review
Giorgia Burrelli Scotti, Roberto Lorenzetti, Annalisa Aratari, Antonietta Lamazza, Enrico Fiori, Claudio Papi, Stefano Festa
Clin Endosc 2023;56(6):726-734.   Published online October 24, 2023
DOI: https://doi.org/10.5946/ce.2023.059
Graphical AbstractGraphical Abstract AbstractAbstract PDFPubReaderePub
Background
/Aims: Endoscopic stenting for stricturing Crohn's disease (CD) is an emerging treatment that achieves more persistent dilatation of the stricture over time than endoscopic balloon dilatation (EBD). We aimed to explore the efficacy and safety of stenting for the treatment of CD strictures.
Methods
A systematic electronic literature search was performed (PROSPERO; no. CRD42022308033). The primary outcomes were technical success, efficacy, complication rate, and the need for further interventions due to reobstruction. The outcomes of partially covered self-expanding metal stents (PCSEMS) with scheduled retrieval after seven days were also analyzed.
Results
Eleven eligible studies were included in the review. Overall, 173 patients with CD were included in this study. Mean percentage of technical success was 95% (range, 80%–100%), short-term efficacy was 100% in all studies, and long-term efficacy was 56% (range, 25%–90%). In patients with a scheduled PCSEMS retrieval, the long-term efficacy was 76% (range, 59%–90%), the mean complication rate was 35% (range, 15%–57%), and the major complication rate was 11% (range, 0%–29%).
Conclusions
Endoscopic stenting with scheduled PCSEMS retrieval may be considered a feasible second-line treatment for short CD strictures to postpone surgery. However, larger head-to-head prospective studies are needed to understand the role of stenting as an alternative or additional treatment to EBD in CD.

Citations

Citations to this article as recorded by  
  • Perioperative Considerations for the Surgical Treatment of Crohn’s Disease with Discussion on Surgical Antibiotics Practices and Impact on the Gut Microbiome
    Shelbi Olson, Lindsay Welton, Cyrus Jahansouz
    Antibiotics.2024; 13(4): 317.     CrossRef
  • 3,881 View
  • 199 Download
  • 1 Web of Science
  • 1 Crossref
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Review
Complications of endoscopic resection in the upper gastrointestinal tract
Takeshi Uozumi, Seiichiro Abe, Mai Ego Makiguchi, Satoru Nonaka, Haruhisa Suzuki, Shigetaka Yoshinaga, Yutaka Saito
Clin Endosc 2023;56(4):409-422.   Published online June 21, 2023
DOI: https://doi.org/10.5946/ce.2023.024
AbstractAbstract PDFPubReaderePub
Endoscopic resection (ER) is widely utilized as a minimally invasive treatment for upper gastrointestinal tumors; however, complications could occur during and after the procedure. Post-ER mucosal defect leads to delayed perforation and bleeding; therefore, endoscopic closure methods (endoscopic hand-suturing, the endoloop and endoclip closure method, and over-the-scope clip method) and tissue shielding methods (polyglycolic acid sheets and fibrin glue) are developed to prevent these complications. During duodenal ER, complete closure of the mucosal defect significantly reduces delayed bleeding and should be performed. An extensive mucosal defect that comprises three-quarters of the circumference in the esophagus, gastric antrum, or cardia is a significant risk factor for post-ER stricture. Steroid therapy is considered the first-line option for the prevention of esophageal stricture, but its efficacy for gastric stricture remains unclear. Methods for the prevention and management of ER-related complications in the esophagus, stomach, and duodenum differ according to the organ; therefore, endoscopists should be familiar with ways of preventing and managing organ-specific complications.

Citations

Citations to this article as recorded by  
  • The Current Landscape of Endoscopic Submucosal Training in the United States
    Mike T. Wei, Shai Friedland, Joo Ha Hwang
    Current Gastroenterology Reports.2025;[Epub]     CrossRef
  • Gastric polyps are not created equal: Know your enemy
    Fady Daniel
    World Journal of Gastroenterology.2025;[Epub]     CrossRef
  • Endoscopic Resection for Superficial Non-Ampullary Duodenal Epithelial Tumors
    Hye Kyung Jeon, Gwang Ha Kim
    Gut and Liver.2025; 19(1): 19.     CrossRef
  • Diagnosis and treatment of three synchronous early squamous cell carcinomas of the esophagus: case report
    A.A. Paratovskaya, M.Yu. Agapov, N.A. Belinskaya, T.F. Savostyanov, E.E. Topuzov
    Russian Journal of Evidence-Based Gastroenterology.2025; 14(1): 104.     CrossRef
  • International Digestive Endoscopy Network consensus on the management of antithrombotic agents in patients undergoing gastrointestinal endoscopy
    Seung Joo Kang, Chung Hyun Tae, Chang Seok Bang, Cheol Min Shin, Young-Hoon Jeong, Miyoung Choi, Joo Ha Hwang, Yutaka Saito, Philip Wai Yan Chiu, Rungsun Rerknimitr, Christopher Khor, Vu Van Khien, Kee Don Choi, Ki-Nam Shim, Geun Am Song, Oh Young Lee
    Clinical Endoscopy.2024; 57(2): 141.     CrossRef
  • Risk factors for intraoperative and delayed perforation related with gastric endoscopic submucosal dissection
    Takuya Mimura, Yoshinobu Yamamoto, Haruhisa Suzuki, Kohei Takizawa, Toshiaki Hirasawa, Yoji Takeuchi, Kenji Ishido, Shu Hoteya, Tomonori Yano, Shinji Tanaka, Norihiko Kudara, Masahiro Nakagawa, Yumi Mashimo, Masahiro Ishigooka, Kazutoshi Fukase, Taichi Sh
    Journal of Gastroenterology and Hepatology.2024; 39(7): 1358.     CrossRef
  • IDEN Consensus on Management of Antithrombotic Agents in Patients Undergoing Gastrointestinal Endoscopy
    Seung Joo Kang, Chung Hyun Tae, Chang Seok Bang, Cheol Min Shin, Young-Hoon Jeong, Miyoung Choi, Joo Ha Hwang, Yutaka Saito, Philip Wai Yan Chiu, Rungsun Rerknimitr, Christopher Khor, Vu Van Khien, Kee Don Choi, Ki-Nam Shim, Geun Am Song, Oh Young Lee
    The Korean Journal of Gastroenterology.2024; 83(6): 217.     CrossRef
  • International Digestive Endoscopy Network Consensus on the Management of Antithrombotic Agents in Patients Undergoing Gastrointestinal Endoscopy
    Seung Joo Kang, Chung Hyun Tae, Chang Seok Bang, Cheol Min Shin, Young-Hoon Jeong, Miyoung Choi, Joo Ha Hwang, Yutaka Saito, Philip Wai Yan Chiu, Rungsun Rerknimitr, Christopher Khor, Vu Van Khien, Kee Don Choi, Ki-Nam Shim, Geun Am Song, Oh Young Lee
    Gut and Liver.2024; 18(5): 764.     CrossRef
  • Endoscopic submucosal dissection for early gastric cancer: It is time to consider the quality of its outcomes
    Gwang Ha Kim
    World Journal of Gastroenterology.2023; 29(43): 5800.     CrossRef
  • 5,251 View
  • 216 Download
  • 7 Web of Science
  • 9 Crossref
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Original Article
Risk factors for recurrent stenosis after balloon dilation for benign hepaticojejunostomy anastomotic stricture
Takafumi Mie, Takashi Sasaki, Takeshi Okamoto, Tsuyoshi Takeda, Chinatsu Mori, Yuto Yamada, Takaaki Furukawa, Akiyoshi Kasuga, Masato Matsuyama, Masato Ozaka, Naoki Sasahira
Clin Endosc 2024;57(2):253-262.   Published online May 16, 2023
DOI: https://doi.org/10.5946/ce.2022.216
Graphical AbstractGraphical Abstract AbstractAbstract PDFPubReaderePub
Background
/Aims: Hepaticojejunostomy anastomotic stricture (HJAS) is a feared adverse event associated with hepatopancreatobiliary surgery. Although balloon dilation for benign HJAS during endoscopic retrograde cholangiopancreatography with balloon-assisted enteroscopy has been reported to be useful, the treatment strategy remains controversial. Therefore, we evaluated the outcomes and risk factors of recurrent stenosis after balloon dilation alone for benign HJAS.
Methods
We retrospectively analyzed consecutive patients who underwent balloon-assisted enteroscopy–endoscopic retrograde cholangiopancreatography for benign HJAS at our institution between July 2014 and December 2020.
Results
Forty-six patients were included, 16 of whom had recurrent HJAS after balloon dilation. The patency rates at 1 and 2 years after balloon dilation were 76.8% and 64.2%, respectively. Presence of a residual balloon notch during balloon dilation was an independent predictor of recurrence (hazard ratio, 2.80; 95% confidence interval, 1.01–7.78; p=0.048), whereas HJAS within postoperative 1 year tended to be associated with recurrence (hazard ratio, 2.43; 95% confidence interval, 0.85–6.89; p=0.096). The patency rates in patients without a residual balloon notch were 82.1% and 73.1% after 1 and 2 years, respectively.
Conclusions
Balloon dilation alone may be a viable option for patients with benign HJAS without residual balloon notches on fluoroscopy.
  • 3,259 View
  • 203 Download
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Case Report
Refractory benign biliary stricture due to chronic pancreatitis in two patients treated using endoscopic ultrasound-guided choledochoduodenostomy fistula creation: case reports
Sho Ishikawa, Nozomi Okuno, Kazuo Hara, Nobumasa Mizuno, Shin Haba, Takamichi Kuwahara, Yasuhiro Kuraishi, Takafumi Yanaidani
Clin Endosc 2024;57(1):122-127.   Published online May 16, 2023
DOI: https://doi.org/10.5946/ce.2022.149
AbstractAbstract PDFPubReaderePub
Benign biliary stricture (BBS) is a complication of chronic pancreatitis (CP). Despite endoscopic biliary stenting, some patients do not respond to treatment, and they experience recurrent cholangitis. We report two cases of CP with refractory BBS treated using endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) fistula creation. A 50-year-old woman and a 60-year-old man both presented with obstructive jaundice secondary to BBS due to alcoholic CP. They underwent repeated placement of a fully covered self-expandable metal stent for biliary strictures. However, the strictures persisted, causing repeated episodes of cholangitis. Therefore, an EUS-CDS was performed. The stents were eventually removed and the patients became stent-free. These fistulas have remained patent without cholangitis for more than 2.5 years. Fistula creation using EUS-CDS is an effective treatment option for BBS.

Citations

Citations to this article as recorded by  
  • Forward viewing liner echoendoscopy for therapeutic interventions
    Kazuo Hara, Nozomi Okuno, Shin Haba, Takamichi Kuwahara
    Clinical Endoscopy.2024; 57(2): 175.     CrossRef
  • Successful sequential management of traumatic choledochal leak and stenosis in children using ERCP: a case report and literature review
    Cuo Leng, Yu Zou, Zhoujian Yang, Xinhua Zhao
    Frontiers in Medicine.2024;[Epub]     CrossRef
  • 2,933 View
  • 188 Download
  • 2 Web of Science
  • 2 Crossref
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Review
Intraductal ultrasonography for biliary strictures
Young Koog Cheon
Clin Endosc 2023;56(2):164-168.   Published online February 17, 2023
DOI: https://doi.org/10.5946/ce.2022.184
AbstractAbstract PDFPubReaderePub
When diagnosing the nature of biliary strictures, it is sometimes difficult to perform non-invasive methods such as ultrasound, spiral computed imaging, magnetic resonance imaging, or endoscopic ultrasonography. Thus, treatment decisions are usually based on biopsy results. However, brush cytology or biopsy, which is widely used for biliary stenosis, has limitations owing to its low sensitivity and negative predictive value for malignancy. Currently, the most accurate method is bile duct tissue biopsy under direct cholangioscopy. On the other hand, intraductal ultrasonography administered under the guidance of a guidewire has the advantages of easy administration and being less invasive, allowing for adequate examination of the biliary tract and surrounding organs. This review discusses the usefulness and drawbacks of intraductal ultrasonography for biliary strictures.

Citations

Citations to this article as recorded by  
  • Diagnostic Approach to Biliary Strictures
    Daniyal Raza, Sahib Singh, Stefano Francesco Crinò, Ivo Boskoski, Cristiano Spada, Lorenzo Fuccio, Jayanta Samanta, Jahnvi Dhar, Marco Spadaccini, Paraskevas Gkolfakis, Marcello Fabio Maida, Jorge Machicado, Marcello Spampinato, Antonio Facciorusso
    Diagnostics.2025; 15(3): 325.     CrossRef
  • Artificial intelligence for automatic diagnosis and pleomorphic morphological characterization of malignant biliary strictures using digital cholangioscopy
    Miguel Mascarenhas, Maria João Almeida, Mariano González-Haba, Belén Agudo Castillo, Jessica Widmer, António Costa, Yousef Fazel, Tiago Ribeiro, Francisco Mendes, Miguel Martins, João Afonso, Pedro Cardoso, Joana Mota, Joana Fernandes, João Ferreira, Fili
    Scientific Reports.2025;[Epub]     CrossRef
  • Dual-frequency intraductal ultrasonography: a breakthrough in biliopancreatic imaging during endoscopic retrograde cholangiopancreatography
    Yao Lu, Xiaoyan Lv, Shun He
    Endoscopy.2025; 57(S 01): E355.     CrossRef
  • Case report: The diagnostic dilemma of indeterminate biliary strictures: report on two cases with a literature review
    Chunyan Meng, Jing Wang, Peipei Zhang, Bo Wang
    Frontiers in Oncology.2024;[Epub]     CrossRef
  • Clinical application of fly-thru in diagnosis of biliary obstructive diseases: feasibility, reproducibility, and diagnostic value
    Tongyi Huang, Zebang Yang, Xiaoli Wang, Jiaqian Yao, Lin Jiang, Xiaoyan Xie, Ming Xu, Xiaoer Zhang
    Abdominal Radiology.2024; 50(5): 2078.     CrossRef
  • 4,563 View
  • 184 Download
  • 5 Web of Science
  • 5 Crossref
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Systematic Review and Meta-Analysis
Hybrid argon plasma coagulation in Barrett’s esophagus: a systematic review and meta-analysis
Sagar N. Shah, Nabil El Hage Chehade, Amirali Tavangar, Alyssa Choi, Marc Monachese, Kenneth J. Chang, Jason B. Samarasena
Clin Endosc 2023;56(1):38-49.   Published online January 30, 2023
DOI: https://doi.org/10.5946/ce.2022.179
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Patients with Barrett’s esophagus are at increased risk of developing esophageal adenocarcinoma. Endoscopic therapies aim to eradicate dysplastic and metaplastic tissues. Hybrid argon plasma coagulation (hybrid-APC) utilizes submucosal fluid injection to create a protective cushion prior to ablation that shields the submucosa from injury. We performed a pooled meta-analysis to evaluate the safety and efficacy of hybrid-APC.
Methods
We conducted a systematic search of major electronic databases in April 2022. Studies that included patients with dysplastic and non-dysplastic Barrett’s esophagus undergoing treatment with hybrid-APC were eligible for inclusion. Outcome measures included complete remission of intestinal metaplasia (CR-IM), stricture formation, serious adverse events, and number of sessions necessary to achieve CR-IM.
Results
Overall pooled CR-IM rate for patients undergoing hybrid-APC was 90.8% (95% confidence interval [CI], 0.872–0.939; I2=0%). Pooled stricture rate was 2.0% (95% CI, 0.005–0.042; I2=0%). Overall serious adverse event rate was 2.7% (95% CI, 0.007–0.055; I2=0%).
Conclusions
Results of the current meta-analysis suggest that hybrid-APC is associated with high rates of CR-IM and a favorable safety profile. Interpretation of these results is limited by the inclusion of retrospective cohort and case series data. Randomized controlled trials that standardize treatment and outcome evaluation protocols are necessary to understand how this treatment option is comparable to the current standards of care.

Citations

Citations to this article as recorded by  
  • High Quality Barrett’s Esophagus Examination & Endoscopic Eradication Therapy
    Shirin Dey, Kevin Shah, Srinadh Komanduri
    Gastrointestinal Endoscopy Clinics of North America.2025;[Epub]     CrossRef
  • Application of electrosurgery in gastrointestinal endoscopy
    Hongrui Wang, Jiuzhou Zhao, Yu Zhou
    Progress in Medical Devices.2024;[Epub]     CrossRef
  • Hybrid Argon Plasma Coagulation for Barrett’s Esophagus and for Colonic Mucosal Resection—A Systematic Review and Meta-Analysis
    Maria Manuela Estevinho, Rolando Pinho, João Carlos Silva, João Correia, Pedro Mesquita, Teresa Freitas
    Biomedicines.2023; 11(4): 1139.     CrossRef
  • Hybrid-APC treatment for gastric vascular ectasia of atypical location after failed radiofrequency ablation
    José Manuel Palma García, Raúl Honrubia López, Cristina Fernández de Castro, Carmen Comas Redondo
    Revista Española de Enfermedades Digestivas.2023;[Epub]     CrossRef
  • Thermal ablative therapies in the gastrointestinal tract
    Hendrik Manner
    Current Opinion in Gastroenterology.2023; 39(5): 370.     CrossRef
  • Endoscopic Management of Dysplastic Barrett’s Oesophagus and Early Oesophageal Adenocarcinoma
    Leonardo Henry Eusebi, Andrea Telese, Chiara Castellana, Rengin Melis Engin, Benjamin Norton, Apostolis Papaefthymiou, Rocco Maurizio Zagari, Rehan Haidry
    Cancers.2023; 15(19): 4776.     CrossRef
  • Critical Decision Making: Technical Aspects of Esophageal Ablation
    Felice Schnoll-Sussman
    Foregut: The Journal of the American Foregut Society.2023; 3(3): 314.     CrossRef
  • 4,423 View
  • 183 Download
  • 5 Web of Science
  • 7 Crossref
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Original Article
A prospective study of fully covered self-expandable metal stents for refractory benign pancreatic duct strictures
Bhavik Bharat Shah, Gajanan Ashokrao Rodge, Usha Goenka, Shivaraj Afzalpurkar, Mahesh Kumar Goenka
Clin Endosc 2022;55(6):793-800.   Published online April 4, 2022
DOI: https://doi.org/10.5946/ce.2021.211
AbstractAbstract PDFPubReaderePub
Background
/Aims: Fully covered self-expanding metal stents (FCSEMSs) are a relatively novel option for treating painful main pancreatic duct refractory strictures in patients with chronic pancreatitis. Herein, we aimed to assess the efficacy, feasibility, and safety of FCSEMSs in this patient group.
Methods
This prospective single-center study included patients who underwent endoscopic retrograde pancreatography with FCSEMS placement. The primary endpoints were the technical and clinical success rates. A reduction in visual analog scale pain score of >50% compared with that before stent placement was defined as clinical success. Secondary endpoints were resolution of pancreatic strictures on fluoroscopy during endoscopic retrograde pancreatography and the development of stent-related adverse events.
Results
Thirty-six patients were included in the analysis. The technical success rate was 100% (n=36) and the clinical success rate was 86.1% (n=31). There was a significant increase in stricture diameter from 1.7 mm to 3.5 mm (p<0.001) after stent removal. The mean visual analog scale pain score showed statistically significant improvement. At 19 months of follow-up, 55.6% of the patients were asymptomatic. Stent migration (16.7%), intolerable abdominal pain (8.3%), development of de novo strictures (8.3%), and mild pancreatitis (2.8%) were the most common adverse events.
Conclusions
FCSEMS placement showed good technical and clinical success rates for achieving pain relief in patients with refractory main pancreatic duct strictures.

Citations

Citations to this article as recorded by  
  • A review on pancreatic duct stents: materials and emerging trends
    Huijuan Fan, Nan Li, Xingguang Zhang, Wei Xu, Wencheng Zhang, Yangjuan Ding, Lingjian Li, Taotao Liu, Shihai Xia
    Biomedical Materials.2025; 20(3): 032004.     CrossRef
  • Citric Acid Loaded Hydrogel-Coated Stent for Dissolving Pancreatic Duct Calculi
    Jing Li, Yanwei Lv, Zheng Chen, Jiulong Zhao, Shige Wang
    Gels.2024; 10(2): 125.     CrossRef
  • Fully Covered Self-expandable Metallic Stents for Refractory Benign Pancreatic Duct Strictures: A Systematic Review and Meta-analysis
    Gajanan Rodge, Suprabhat Giri, Kailash Kolhe, Shivaraj Afzalpurkar, Sidharth Harindranath, Sridhar Sundaram, Aditya Kale
    Surgical Laparoscopy, Endoscopy & Percutaneous Techniques.2024; 34(5): 529.     CrossRef
  • Self-expanding metallic stent for refractory pancreatic duct stricture in chronic pancreatitis: A prospective follow-up study
    Praveer Rai, Pankaj Kumar, Ashok Kumar, Sana Asari, Kartik Agarwal, Mayank, Ravi V. Krishna Kishore, Prabhaker Mishra
    Indian Journal of Gastroenterology.2023;[Epub]     CrossRef
  • Quality of life after endoscopic procedures for chronic pancreatitis: A multicentre study
    Mikael Parhiala, Camilla Nøjgaard, Andreas Bartholdy, Anne Waage, Povilas Ignatavičius, Trond Engjom, Georg Dimcevski, Ingrid Kvåle Nordaas, Evangelos Kalaitzakis, Asbjørn M. Drewes, Amer Hadi, Søren S. Olesen, Jakob L. Poulsen, Johanna Laukkarinen
    United European Gastroenterology Journal.2023; 11(9): 884.     CrossRef
  • Pancreatic duct stents
    Jin Hui Yi, Zhao Shen Li, Liang Hao Hu
    Journal of Digestive Diseases.2022; 23(12): 675.     CrossRef
  • 3,996 View
  • 293 Download
  • 6 Web of Science
  • 6 Crossref
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Systematic Review and Meta-Analysises
Confocal Laser Endomicroscopy in the Diagnosis of Biliary and Pancreatic Disorders: A Systematic Analysis
Do Han Kim, Somashekar G. Krishna, Emmanuel Coronel, Paul T. Kröner, Herbert C. Wolfsen, Michael B. Wallace, Juan E. Corral
Clin Endosc 2022;55(2):197-207.   Published online November 29, 2021
DOI: https://doi.org/10.5946/ce.2021.079
AbstractAbstract PDFPubReaderePub
Background
/Aims: Endoscopic visualization of the microscopic anatomy can facilitate the real-time diagnosis of pancreatobiliary disorders and provide guidance for treatment. This study aimed to review the technique, image classification, and diagnostic performance of confocal laser endomicroscopy (CLE).
Methods
We conducted a systematic review of CLE in pancreatic and biliary ducts of humans, and have provided a narrative of the technique, image classification, diagnostic performance, ongoing research, and limitations.
Results
Probe-based CLE differentiates malignant from benign biliary strictures (sensitivity, ≥89%; specificity, ≥61%). Needlebased CLE differentiates mucinous from non-mucinous pancreatic cysts (sensitivity, 59%; specificity, ≥94%) and identifies dysplasia. Pancreatitis may develop in 2-7% of pancreatic cyst cases. Needle-based CLE has potential applications in adenocarcinoma, neuroendocrine tumors, and pancreatitis (chronic or autoimmune). Costs, catheter lifespan, endoscopist training, and interobserver variability are challenges for routine utilization.
Conclusions
CLE reveals microscopic pancreatobiliary system anatomy with adequate specificity and sensitivity. Reducing costs and simplifying image interpretation will promote utilization by advanced endoscopists.

Citations

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  • Updates in Diagnosis and Endoscopic Management of Cholangiocarcinoma
    Roxana-Luiza Caragut, Madalina Ilie, Teodor Cabel, Deniz Günșahin, Afrodita Panaitescu, Christopher Pavel, Oana Mihaela Plotogea, Ecaterina Mihaela Rînja, Gabriel Constantinescu, Vasile Sandru
    Diagnostics.2024; 14(5): 490.     CrossRef
  • Endoscopic Ultrasound-Guided Needle-Based Confocal Endomicroscopy as a Diagnostic Imaging Biomarker for Intraductal Papillary Mucinous Neoplasms
    Shreyas Krishna, Ahmed Abdelbaki, Phil A. Hart, Jorge D. Machicado
    Cancers.2024; 16(6): 1238.     CrossRef
  • Exploring Intestinal Permeability: Concept, Diagnosis, Connection to Bowel Disease, and Iron Deficiency
    Olesja Basina, Aleksejs Derovs, Jeļena Derova, Sandra Lejniece
    Proceedings of the Latvian Academy of Sciences. Section B. Natural, Exact, and Applied Sciences..2024; 78(4): 244.     CrossRef
  • American Society for Gastrointestinal Endoscopy guideline on the role of endoscopy in the diagnosis of malignancy in biliary strictures of undetermined etiology: summary and recommendations
    Larissa L. Fujii-Lau, Nirav C. Thosani, Mohammad Al-Haddad, Jared Acoba, Curtis J. Wray, Rodrick Zvavanjanja, Stuart K. Amateau, James L. Buxbaum, Audrey H. Calderwood, Jean M. Chalhoub, Nayantara Coelho-Prabhu, Madhav Desai, Sherif E. Elhanafi, Douglas S
    Gastrointestinal Endoscopy.2023; 98(5): 685.     CrossRef
  • In Vivo Click Chemistry Enables Multiplexed Intravital Microscopy
    Jina Ko, Kilean Lucas, Rainer Kohler, Elias A. Halabi, Martin Wilkovitsch, Jonathan C. T. Carlson, Ralph Weissleder
    Advanced Science.2022;[Epub]     CrossRef
  • Endoscopic ultrasound-guided tissue acquisition: Needle types, technical issues, and sample handling
    Woo Hyun Paik
    International Journal of Gastrointestinal Intervention.2022; 11(3): 96.     CrossRef
  • 5,641 View
  • 259 Download
  • 5 Web of Science
  • 6 Crossref
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Stent versus Balloon Dilation for the Treatment of Dominant Strictures in Primary Sclerosing Cholangitis: A Systematic Review and Meta-Analysis
Marina Tucci Gammaro Baldavira Ferreira, Igor Braga Ribeiro, Diogo Turiani Hourneaux de Moura, Thomas R. McCarty, Alberto Machado da Ponte Neto, Galileu Ferreira Ayala Farias, Antônio Afonso de Miranda Neto, Pedro Victor Aniz Gomes de Oliveira, Wanderley Marques Bernardo, Eduardo Guimarães Hourneaux de Moura
Clin Endosc 2021;54(6):833-842.   Published online July 1, 2021
DOI: https://doi.org/10.5946/ce.2021.052
AbstractAbstract PDFPubReaderePub
Background
/Aims: The endoscopic management of primary sclerosing cholangitis (PSC)-associated dominant strictures remains challenging. This systematic review and meta-analysis aimed to compare balloon dilation and stent placement in the treatment of dominant strictures among PSC patients.
Methods
Literature searches on MEDLINE, EMBASE, Cochrane CENTRAL and Lilacs/Bireme were performed for studies published until December 2020. Measured outcomes included clinical efficacy, stricture recurrence, cumulative recurrencefree rate, transplant rate, 5-year survival rate, and adverse events (i.e., pancreatitis, cholangitis, bleeding, perforation and death).
Results
A total of 5 studies (n=467) were included. Based on pooled analyses, there were no differences in clinical efficacy (risk difference [RD], -0.13; 95% confidence interval [CI], -0.58 to 0.33; I2=93%) or transplant rates (RD, -0.09; 95% CI, -0.19 to 0.01; I2=0%); however, the risk of occurrence of adverse events was lower with balloon dilatation than with stent placement (RD,-0.34; 95% CI, -0.45 to -0.23; I2=61%). Among the types of adverse events reported, only the rates of cholangitis/bacteremia were significantly lower in balloon dilation patients (RD, -0.19; 95% CI, -0.25 to -0.13; I2=51%).
Conclusions
Compared to balloon dilation, stent placement for dominant strictures in PSC appeared to have higher complication rates without significant differences in efficacy.

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Focused Review Series: Endoscopic Management for Biliary Stricture after Liver Transplantations
Magnetic Compression Anastomosis for the Treatment of Post-Transplant Biliary Stricture
Sung Ill Jang, Jae Hee Cho, Dong Ki Lee
Clin Endosc 2020;53(3):266-275.   Published online May 29, 2020
DOI: https://doi.org/10.5946/ce.2020.095
AbstractAbstract PDFPubReaderePub
A number of different conditions can lead to a bile duct stricture. These strictures are particularly common after biliary operations, including living-donor liver transplantation. Endoscopic and percutaneous methods have high success rates in treating benign biliary strictures. However, these conventional methods are difficult to manage when a guidewire cannot be passed through areas of severe stenosis or complete obstruction. Magnetic compression anastomosis has emerged as an alternative nonsurgical treatment method to avoid the mortality and morbidity risks of reoperation. The feasibility and safety of magnetic compression anastomosis have been reported in several experimental and clinical studies in patients with biliobiliary and bilioenteric strictures. Magnetic compression anastomosis is a minimally traumatic and highly effective procedure, and represents a new paradigm for benign biliary strictures that are difficult to treat with conventional methods.

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Unilateral Versus Bilateral Biliary Drainage for Post-Transplant Anastomotic Stricture
Jin Ho Choi, Woo Hyun Paik
Clin Endosc 2020;53(3):255-260.   Published online May 22, 2020
DOI: https://doi.org/10.5946/ce.2020.079
AbstractAbstract PDFPubReaderePub
Living donor liver transplantation is the most common type of liver transplantation in Asia. Post-transplant biliary stricture is frequent in living donor liver transplantation, and endoscopic management is considered to be the treatment of choice. However, endoscopic management is still challenging in patients who undergo right lobe living donor liver transplantation because of the anatomical alteration. In this article, we reviewed the recently updated results for proper endoscopic biliary drainage in post-living donor liver transplantation anatomical biliary stricture and compared unilateral and bilateral drainage.

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    In Rae Cho, Sang Hyub Lee, Joongyu Kang, Junyeol Kim, Tae Seung Lee, Myeong Hwan Lee, Min Woo Lee, Jin Ho Choi, Woo Hyun Paik, Ji Kon Ryu, Yong-Tae Kim, Suk Kyun Hong, YoungRok Choi, Nam-Joon Yi, Kwang-Woong Lee, Kyung-Suk Suh
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Case Report
Esophageal Stricture Caused by the Ingestion of Undissolved Picosulfate Powder
Daehyun Kim, Byungha Cho, Jong Wook Choi, Ki Bae Kim, Seon Mee Park
Clin Endosc 2021;54(1):122-126.   Published online March 16, 2020
DOI: https://doi.org/10.5946/ce.2019.206
AbstractAbstract PDFPubReaderePub
Picosulfate solution is widely used as a small volume bowel cleansing agent and is considered to be effective and relatively safe. A case of a 75-year-old woman ingested picosulfate powder and drank a small volume of water, subsequently experienced severe burning pain in the chest. Endoscopy was performed and showed a submucosal hemorrhage and exudative ulcers at the mid to lower esophagus. At 2 weeks, her symptoms improved with conservative treatment. However, liquid food dysphagia developed 11 weeks after ingestion. A follow-up endoscopy revealed multiple esophageal strictures, which were treated with a fully covered metal stent and esophageal balloon dilation. Consequently, the esophageal strictures improved after one year. As this case demonstrates, detailed information about picosulfate powder ingestion after dissolving it in more than 200 mL of water should be presented to patients to avoid esophageal injury.

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  • Citric acid/magnesium oxide/sodium picosulfate

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Original Article
Inside Plastic Stents versus Metal Stents for Treating Unresectable Malignant Perihilar Biliary Obstructions: A Retrospective Comparative Study
Yoshihide Kanno, Shinsuke Koshita, Takahisa Ogawa, Hiroaki Kusunose, Kaori Masu, Toshitaka Sakai, Keisuke Yonamine, Kazuaki Miyamoto, Toji Murabayashi, Fumisato Kozakai, Jun Horaguchi, Yutaka Noda, Kei Ito
Clin Endosc 2020;53(6):735-742.   Published online March 4, 2020
DOI: https://doi.org/10.5946/ce.2020.003
AbstractAbstract PDFPubReaderePub
Background
/Aims: The aim of this study was to evaluate outcomes of inside plastic stents (iPSs) versus those of metal stents (MSs) for treating unresectable perihilar malignant obstructions.
Methods
For all patients who underwent endoscopic suprapapillary placement of iPS(s) or MS(s) as the first permanent biliary drainage for unresectable malignant perihilar obstructions between January 2014 and August 2019, clinical outcomes using iPSs (n=20) and MSs (n=85), including clinical efficacy, adverse events, and time to recurrence of biliary obstruction (RBO), were retrospectively evaluated.
Results
There were no differences in clinical effectiveness (95% for the iPS group vs. 92% for the MS group, p=1.00). Procedure-related adverse events, including pancreatitis, acute cholangitis, acute cholecystitis, and death, were observed for 8% of the MS group, although no patient in the iPS group developed such adverse events. The median time to RBO was 561 days (95% confidence interval, 0–1,186 days) for iPSs and 209 days (127–291 days) for MSs, showing a significant difference (p=0.008).
Conclusions
Time to RBO after iPS placement was significantly longer than that after MS placement. IPSs, which are removable, unlike MSs, were an acceptable option.

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Reviews
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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The Role of Peroral Cholangioscopy in Evaluating Indeterminate Biliary Strictures
Nasim Parsa, Mouen A. Khashab
Clin Endosc 2019;52(6):556-564.   Published online July 16, 2019
DOI: https://doi.org/10.5946/ce.2019.011
AbstractAbstract PDFPubReaderePub
Biliary strictures are considered indeterminate when the initial radiologic evaluation and endoscopic retrograde cholangiopancreatography with brush cytology and/or forceps biopsy do not reveal diagnostic findings. Evaluation of these strictures is challenging and often requires a multidisciplinary approach and multiple procedures. Peroral cholangioscopy allows direct visualization of these lesions and targeted tissue acquisition using miniature biopsy forceps. In the past decade, there have been significant improvements in the field of cholangioscopy. These advances have allowed higher-quality image acquisition, easy setup, operation by a single operator, easy maneuverability, and excellent targeted tissue sampling performance. However, the interpretation of cholangioscopic visual findings remains challenging. In this review, we discuss the role of peroral cholangioscopy in the evaluation of indeterminate biliary strictures.

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Original Articles
Endoscopic Ultrasonography-Guided Gallbladder Drainage as a Treatment Option for Acute Cholecystitis after Metal Stent Placement in Malignant Biliary Strictures
Fumisato Kozakai, Yoshihide Kanno, Kei Ito, Shinsuke Koshita, Takahisa Ogawa, Hiroaki Kusunose, Kaori Masu, Toshitaka Sakai, Toji Murabayashi, Keisuke Yonamine, Yujiro Kawakami, Yuki Fujii, Kazuaki Miyamoto, Yutaka Noda
Clin Endosc 2019;52(3):262-268.   Published online March 15, 2019
DOI: https://doi.org/10.5946/ce.2018.183
AbstractAbstract PDFPubReaderePub
Background
/Aims: It is often difficult to manage acute cholecystitis after metal stent (MS) placement in unresectable malignant biliary strictures. The aim of this study was to evaluate the feasibility of endoscopic ultrasonography-guided gallbladder drainage (EUS-GBD) for acute cholecystitis.
Methods
The clinical outcomes of 10 patients who underwent EUS-GBD for acute cholecystitis after MS placement between January 2011 and August 2018 were retrospectively evaluated. The procedural outcomes of percutaneous transhepatic gallbladder drainage (PTGBD) with tube placement (n=11 cases) and aspiration (PTGBA) (n=27 cases) during the study period were evaluated as a reference.
Results
The technical success and clinical effectiveness rates of EUS-GBD were 90% (9/10) and 89% (8/9), respectively. Severe bile leakage that required surgical treatment occurred in one case. Acute cholecystitis recurred after stent dislocation in 38% (3/8) of the cases. Both PTGBD and PTGBA were technically successful in all cases without severe adverse events and clinically effective in 91% and 63% of the cases, respectively.
Conclusions
EUS-GBD after MS placement was a feasible option for treating acute cholecystitis. However, it was a rescue technique following the established percutaneous intervention in the current setting because of the immature technical methodology, including dedicated devices, which need further development.

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Factors Associated with Malignant Biliary Strictures in Patients with Atypical or Suspicious Cells on Brush Cytology
Ji Young Park, Tae Joo Jeon
Clin Endosc 2019;52(2):168-174.   Published online January 9, 2019
DOI: https://doi.org/10.5946/ce.2018.105
AbstractAbstract PDFPubReaderePub
Background
/Aims: Pathological diagnosis of biliary strictures with atypical or suspicious cells on endoscopic retrograde brush cytology and indeterminate strictures on imaging is challenging. The aim of this study was to identify markers for malignant strictures in such cases.
Methods
We retrospectively analyzed data collected from 146 consecutive patients with indeterminate biliary strictures on imaging who underwent endoscopic retrograde brush cytology from 2007 to 2013. Factors associated with malignant strictures in patients with atypical or suspicious cells on brush cytology were identified.
Results
Among the 67 patients with a malignant disease (48 cholangiocarcinoma, 6 gallbladder cancer, 5 pancreatic cancer, 5 ampulla of Vater cancer, and 3 other types), 36 (53.7%) had atypical or suspicious cells on brush cytology. Among these, the factors that independently correlated with malignant strictures were stricture length (odds ratio [OR], 5.259; 95% confidence interval [CI], 1.802– 15.294) and elevated carbohydrate antigen 19-9 (CA19-9) (OR, 3.492; 95% CI, 1.242–9.815), carcinoembryonic antigen (CEA) (OR, 4.909; 95% CI, 1.694–14.224), alkaline phosphatase (ALP) (OR, 3.362; 95% CI, 1.207–9.361), and gamma-glutamyl transpeptidase (rGT) (OR, 4.318; 95% CI, 1.512–12.262).
Conclusions
Elevated levels of CA19-9, CEA, ALP, and rGT and stricture length are associated with malignant strictures in patients with indeterminate biliary strictures on imaging and atypical or suspicious cells on brush cytology.

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Focused Review Series: Current Status of Endoscopy in the Management of Inflammatory Bowel Disease
Endoscopic Balloon Dilation for Crohn’s Disease-Associated Strictures
Thomas Klag, Jan Wehkamp, Martin Goetz
Clin Endosc 2017;50(5):429-436.   Published online September 29, 2017
DOI: https://doi.org/10.5946/ce.2017.147
AbstractAbstract PDFPubReaderePub
Management of intestinal strictures associated with Crohn’s disease (CD) is clinically challenging despite advanced medical therapy directed toward mucosal healing to positively influence the natural course of CD-associated complications. Although medical therapy is available for inflammatory strictures, therapy of fibrostenotic strictures is the domain of surgery and endoscopy. Endoscopic balloon dilation (EBD) has been recognized as a well-established first-line procedure in terms of safety and efficacy. Although surgery is a valuable treatment modality for the management of CD-related strictures, EBD can help prevent multiple surgical interventions, which might in the long-term lead to a risk of short bowel syndrome. In this review we discuss requirements, techniques, safety, short- and long-term outcomes, as well as combinations of this procedure with surgical and medical treatment in CD-associated intestinal strictures.

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Original Article
Health-Care Utilization and Complications of Endoscopic Esophageal Dilation in a National Population
Abhinav Goyal, Kshitij Chatterjee, Sujani Yadlapati, Shailender Singh
Clin Endosc 2017;50(4):366-371.   Published online March 17, 2017
DOI: https://doi.org/10.5946/ce.2016.155
AbstractAbstract PDFPubReaderePub
Background
/Aims: Esophageal stricture is usually managed with outpatient endoscopic dilation. However, patients with food impaction or failure to thrive undergo inpatient dilation. Esophageal perforation is the most feared complication, and its risk in inpatient setting is unknown.
Methods
We used National Inpatient Sample (NIS) database for 2007–2013. International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) codes were used to identify patients with esophageal strictures. Logistic regression was used to assess association between hospital/patient characteristics and utilization of esophageal dilation.
Results
There were 591,187 hospitalizations involving esophageal stricture; 4.2% were malignant. Endoscopic dilation was performed in 28.7% cases. Dilation was more frequently utilized (odds ratio [OR], 1.36; p<0.001), had higher in-hospital mortality (3.1% vs. 1.4%, p<0.001), and resulted in longer hospital stays (5 days vs. 4 days, p=0.01), among cases of malignant strictures. Esophageal perforation was more common in the malignant group (0.9% vs. 0.5%, p=0.007). Patients with malignant compared to benign strictures undergoing dilation were more likely to require percutaneous endoscopic gastrostomy or jejunostomy (PEG/J) tube (14.1% vs. 4.5%, p<0.001). Palliative care services were utilized more frequently in malignant stricture cases not treated with dilation compared to those that were dilated.
Conclusions
Inpatient endoscopic dilation was utilized in 29% cases of esophageal stricture. Esophageal perforation, although infrequent, is more common in malignant strictures.

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Review
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
AbstractAbstract PDFPubReaderePub
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 Article
The Clinical Usefulness of Simultaneous Placement of Double Endoscopic Nasobiliary Biliary Drainage
Hong Jun Kim, Sung Koo Lee, Choong Heon Ryu, Do Hyun Park, Sang Soo Lee, Dong Wan Seo, Myung-Hwan Kim
Clin Endosc 2015;48(6):542-548.   Published online November 30, 2015
DOI: https://doi.org/10.5946/ce.2015.48.6.542
AbstractAbstract PDFPubReaderePub
Background
/Aims: To evaluate the technical feasibility and clinical efficacy of double endoscopic nasobiliary drainage (ENBD) as a new method of draining multiple bile duct obstructions.
Methods
A total of 38 patients who underwent double ENBD between January 2004 and February 2010 at the Asan Medical Center were retrospectively analyzed. We evaluated indications, laboratory results, and the clinical course.
Results
Of the 38 patients who underwent double ENBD, 20 (52.6%) had Klatskin tumors, 12 (31.6%) had hepatocellular carcinoma, 3 (7.9%) had strictures at the anastomotic site following liver transplantation, and 3 (7.9%) had acute cholecystitis combined with cholangitis. Double ENBD was performed to relieve multiple biliary obstruction in 21 patients (55.1%), drain contrast agent filled during endoscopic retrograde cholangiopancreatography in 4 (10.5%), obtain cholangiography in 4 (10.5%), drain hemobilia in 3 (7.9%), relieve Mirizzi syndrome with cholangitis in 3 (7.9%), and relieve jaundice in 3 (7.9%).
Conclusions
Double ENBD may be useful in patients with multiple biliary obstructions.

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Focused Review Series: Advanced Endoscopic Treatment For Pancreaticobiliary Diseases
Preoperative Drainage for Malignant Biliary Strictures: Is It Time for Self-Expanding Metallic Stents?
Jason Roque, Shiaw-Hooi Ho, Khean-Lee Goh
Clin Endosc 2015;48(1):8-14.   Published online January 31, 2015
DOI: https://doi.org/10.5946/ce.2015.48.1.8
AbstractAbstract PDFPubReaderePub

Palliation of jaundice improves the general health of the patient and, therefore, surgical outcomes. Because of the complexity and location of strictures, especially proximally, drainage has been accompanied by increased morbidity due to sepsis. Another concern is the provocation of an inflammatory and fibrotic reaction around the area of stent placement. Preoperative biliary drainage with self-expanding metallic stent (SEMS) insertion can be achieved via a percutaneous method or through endoscopic retrograde cholangiopancreatography. A recently published multicenter randomized Dutch study has shown increased morbidity with preoperative biliary drainage. A Cochrane meta-analysis has also shown a significantly increased complication rate with preoperative drainage. However, few of these studies have used a SEMS, which allows better biliary drainage. No randomized controlled trials have compared preoperative deployment of SEMS versus conventional plastic stents. The outcomes of biliary drainage also depend on the location of the obstruction, namely the difficulty with proximal compared to distal strictures. Pathophysiologically, palliation of jaundice will benefit all patients awaiting surgery. However, preoperative drainage often results in increased morbidity because of procedure-related sepsis. The use of SEMS may change the outcome of preoperative biliary drainage dramatically.

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Reviews
Stricture Occurring after Endoscopic Submucosal Dissection for Esophageal and Gastric Tumors
Gwang Ha Kim, Sam Ryong Jee, Jae Young Jang, Sung Kwan Shin, Kee Don Choi, Jun Haeng Lee, Sang Gyun Kim, Jae Kyu Sung, Suck Chei Choi, Seong Woo Jeon, Byung Ik Jang, Kyu Chan Huh, Dong Kyung Chang, Sung-Ae Jung, Bora Keum, Jin Woong Cho, Il Ju Choi, Hwoon-Yong Jung, Korean ESD Study Group
Clin Endosc 2014;47(6):516-522.   Published online November 30, 2014
DOI: https://doi.org/10.5946/ce.2014.47.6.516
AbstractAbstract PDFPubReaderePub

Endoscopic submucosal dissection (ESD) is a widely accepted treatment for early gastric and esophageal cancer. Compared to endoscopic mucosal resection, ESD has the advantage of enabling en bloc removal of tumors regardless of their size. However, ESD can result in a large artificial ulcer, which may lead to a considerable deformity. Circumferential mucosal defects of more than three-fourths the esophageal circumference, long longitudinal mucosal defects (>30 mm), and lesions in the upper esophagus are significant risk factors for the development of post-ESD strictures of the esophagus. In the stomach, a circumferential mucosal defects more than three-fourths in extent and longitudinal mucosal defects >5 cm are risk factors of post-ESD stricture. If scheduled early, regular endoscopic balloon dilation is effective in controlling and preventing post-ESD stricture. Moreover, intralesional steroid injections or oral steroids can achieve remission of dysphagia or reduce the need for repeated endoscopic balloon dilation. However, further study is needed to improve the prevention of stricture formation.

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Plastic and Biodegradable Stents for Complex and Refractory Benign Esophageal Strictures
Young Hee Ham, Gwang Ha Kim
Clin Endosc 2014;47(4):295-300.   Published online July 28, 2014
DOI: https://doi.org/10.5946/ce.2014.47.4.295
AbstractAbstract PDFPubReaderePub

Endoscopic stent placement is a well-accepted and effective alternative treatment modality for complex and refractory esophageal strictures. Among the currently available types of stents, the partially covered self-expanding metal stent (SEMS) has a firm anchoring effect, preventing stent migration and ensuring effective covering of a narrowed segment. However, hyperplastic tissue reaction driven by the uncovered mesh may prevent easy and safe stent removal. As an alternative, a fully covered SEMS decreases the recurrence of dysphagia caused by hyperplastic tissue ingrowth; however, it has a high migration rate. Likewise, although a self-expanding plastic stent (SEPS) reduces reactive hyperplasia, the long-term outcome is disappointing because of the high rate of stent migration. A biodegradable stent has the main benefit of not requiring stent removal in comparison with SEMS and SEPS. However, it still has a somewhat high rate of hyperplastic reaction, and the long-term outcome does not satisfy expectations. Up to now, the question of which type of stent should be recommended for the effective treatment of complex and refractory benign strictures has no clear answer. Therefore, the selection of stent type for endoscopic treatment should be individualized, taking into consideration the endoscopist's experience as well as patient and stricture characteristics.

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Special Issue Article of IDEN 2013
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
AbstractAbstract PDFPubReaderePub

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.

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    Kaixuan Wang, Jianwei Zhu, Ling Xing, Yunfeng Wang, Zhendong Jin, Zhaoshen Li
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    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
    Surgical Endoscopy.2016; 30(12): 5500.     CrossRef
  • Endoscopic Ultrasound-Guided Biliary Drainage Using a Fully Covered Metallic Stent after Failed Endoscopic Retrograde Cholangiopancreatography
    Jintao Guo, Siyu Sun, Xiang Liu, Sheng Wang, Nan Ge, Guoxin Wang
    Gastroenterology Research and Practice.2016; 2016: 1.     CrossRef
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    Damian Mullan, Raman Uberoi
    International Journal of Gastrointestinal Intervention.2016; 5(2): 129.     CrossRef
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    Nayantara Coelho-Prabhu, John A. Martin
    Gastrointestinal Endoscopy Clinics of North America.2016; 26(4): 739.     CrossRef
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    Xiang‐qian Zhao, Jia‐hong Dong, Kai Jiang, Xiao‐qiang Huang, Wen‐zhi Zhang
    Digestive Endoscopy.2015; 27(1): 137.     CrossRef
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    Fan-Sheng Meng
    World Journal of Gastroenterology.2015; 21(46): 12996.     CrossRef
  • Endoscopic ultrasonography guided drainage: Summary of consortium meeting, May 21, 2012, San Diego, California
    Michel Kahaleh, Everson LA Artifon, Manuel Perez-Miranda, Monica Gaidhane, Carlos Rondon, Takao Itoi, Marc Giovannini
    World Journal of Gastroenterology.2015; 21(3): 726.     CrossRef
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    Nikhil A. Kumta, Prashant Kedia, Michel Kahaleh
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    Jessica L. Widmer, Kahaleh Michel
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    M. Dollhopf, W. Schmitt
    Der Gastroenterologe.2014; 9(5): 458.     CrossRef
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    Vinay Dhir, Rajesh Kumar Paramasivam, Josef Carlo Lazaro, Amit Maydeo
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Case Reports
Fracture of Self-Expandable Metal Stent during Endoscopic Removal in Benign Biliary Stricture
Kyu Re Joo, Chang Nyol Paik, Woo Chul Chung, Kang-Moon Lee, Jin Mo Yang
Clin Endosc 2013;46(1):95-97.   Published online January 31, 2013
DOI: https://doi.org/10.5946/ce.2013.46.1.95
AbstractAbstract PDFPubReaderePub

The endoscopic insertion of the self-expandable metal stent (SEMS) in benign biliary stricture has become an alternative to surgery. Fracture or migration of SEMS can occur rarely as complications. We report a case of fracture of SEMS during endoscopic retrieval in patients with chronic pancreatitis. In this case, broken stent was successfully removed with endoscopic ballooning of bile duct and with a snare device.

Citations

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  • Plastic biliary stent fracture: A rare complication of percutaneous biliary drain placement
    Kurren A. Mehta, Paul S. Jowell, Joshua P. Spaete
    American Journal of Interventional Radiology.2022; 6: 5.     CrossRef
  • Successful endoscopic removal of a fully covered self-expandable metallic stent that fractured above a benign distal bile duct stricture
    Masatoshi Murakami, Nao Fujimori, Yuta Suehiro, Tomonobu Hioki, Kazuhide Matsumoto, Takamasa Oono, Yoshihiro Ogawa
    Endoscopy.2021; 53(01): E11.     CrossRef
  • Fracture of a Colonic Self-expandable Metallic Stent in Malignant Colonic Obstruction
    Akinari Takao, Taku Tabata, Koichi Koizumi, Go Kuwata, Satomi Shibata, Makiko Mori, Kazuro Chiba, Sawako Kuruma, Tomoko Onishi, Takashi Fujiwara, Terumi Kamisawa, Junko Fujiwara, Takeo Arakawa, Kumiko Momma, Tatsu Shimoyama, Keiichi Takahashi
    Internal Medicine.2018; 57(3): 329.     CrossRef
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A Case of Clonorchiasis with Focal Intrahepatic Duct Dilatation Mimicking an Intrahepatic Cholangiocarcinoma
Bong Gap Kim, Dae Hwan Kang, Cheol Woong Choi, Hyung Wook Kim, Jae Hyung Lee, Suk Hun Kim, Hye Ju Yeo, Soo Yong Lee
Clin Endosc 2011;44(1):55-58.   Published online September 30, 2011
DOI: https://doi.org/10.5946/ce.2011.44.1.55
AbstractAbstract PDFPubReaderePub

Biliary strictures can be caused by various diseases. Intrahepatic duct (IHD) strictures are usually related to IHD stones and cholangitis. However, focal IHD strictures without IHD stones often create diagnostic problems. Parasitic diseases such as clonorchiasis can be a rare cause of an IHD stricture. Human clonorchiasis (Clonorchis sinensis infection) is an endemic parasitic disease in Eastern Asia, including Korea, and patients acquire the infestation by eating raw fish. On radiological examinations, clonorchiasis shows typically diffuse, minimal, or mild dilatation of the small IHD, particularly in the periphery, without dilatation of the extrahepatic duct. However, diagnosis of clonorchiasis can sometimes be difficult when radiological changes are atypical. We report a case of focal left IHD dilatation caused by clonorchiasis that was confused with a malignancy.

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    Heung Up Kim
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    Jae Min Lee
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    M. P. Senthil Kumar, R. Marudanayagam
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A Case of Benign Biliary Stricture as a Complication of Photodynamic Therapy for Biliary Papillomatosis
Mun Ki Choi, M.D., Dong Uk Kim, M.D., Gwang Ha Kim, M.D., Geun Am Song, M.D., Hyung Seok Nam, M.D., Yang Seon Yi, M.D., Kang Hee Ahn, M.D. and Jung Seop Eom, M.D.
Korean J Gastrointest Endosc 2011;42(5):327-333.   Published online May 28, 2011
AbstractAbstract PDF
Biliary papillomatosis is a rare disease with a high risk of recurrence and malignant transformation. Therapeutic options include partial hepatectomy, Whipple's procedure and liver transplantation. If there is no surgical option left due to several reasons, local palliative procedures such as biliary stenting and drainage for the treatment of cholestasis are considered, but tumor growth cannot be influenced. Photodynamic therapy might be a new additional, palliative option for patients with biliary papillomatosis who are not eligible for surgery. Benign biliary stricture is a rare complication of photodynamic therapy. We report here a case of a 63-year-old male who developed benign biliary stricture after photodynamic therapy using the photosensitizer photofrin. (Korean J Gastrointest Endosc 2011;42:327-333)
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The Efficacy and Safety of Fully Covered Self-expandable Metal Stents in Benign Extrahepatic Biliary Strictures
Byeong Uk Kim, M.D., Ja Chung Goo, M.D., Young Shim Cho, M.D., Jung Ho Han, M.D., Soon Man Yoon, M.D., Hee Bok Chae, M.D., Seon Mee Park, M.D. and Sei Jin Youn, M.D.
Korean J Gastrointest Endosc 2011;42(1):11-19.   Published online January 30, 2011
AbstractAbstract PDF
Background/Aims: For the endoscopic treatment of benign biliary strictures (BBS), it has been a drawback to use plastic stents or uncovered self-expandable metal stents. We investigated the efficacy and safety of temporary placing fully covered self-expandable metal stents (FCSEMS) in BBS.

Methods: We enrolled 12 cases that followed up more than 6 months after insertion of a FCSEMS in BBS via ERCP. The cohort consisted of 9 patients with recurrent cholangitis, 2 patients with postcholecystectomy and 1 patient with chronic pancreatitis. The efficacy was assessed according to the resolution of strictures and also the restricture after stent removal, and the safety was evaluated according to the complications associated with stent placement. Finally, the removability of FCSEMSs was assessed.

Results: The median time of FCSEMS placement was 6.0 months. Resolution of the BBS was confirmed in 8 cases (67%) after a median post-removal follow-up of 8.5 months. Restricture after stent removal happened in 4 cases (33%). The complications were severe abdominal pain (n=2), pancreatic abscess (n=1) and stent migration (n=6). In 7 cases, all the FCSEMSs were successfully removed by grasping them with forceps.

Conclusions: Temporary placement of a FCSEMS in BBS showed good therapeutic effects, relative safety and easy removability. Further evaluation is needed for determining the causes of restricture and for developing a new stent with antimigration features. (Korean J Gastrointest Endosc 2011;42:11-19)

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