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Hijioka S. New milestone in endoscopic retrograde cholangiopancreatography (ERCP) safety: Key insights from the 2023 Guidelines on Post-ERCP Pancreatitis Prevention and Management. Dig Endosc 2025. [PMID: 40312845 DOI: 10.1111/den.15043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2025] [Accepted: 04/13/2025] [Indexed: 05/03/2025]
Affiliation(s)
- Susumu Hijioka
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
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Mukai S, Takeyama Y, Itoi T, Ikeura T, Irisawa A, Iwasaki E, Katanuma A, Kitamura K, Takenaka M, Hirota M, Mayumi T, Morizane T, Yasuda I, Ryozawa S, Masamune A. Clinical Practice Guidelines for post-ERCP pancreatitis 2023. Dig Endosc 2025. [PMID: 40132896 DOI: 10.1111/den.15004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2024] [Accepted: 01/21/2025] [Indexed: 03/27/2025]
Abstract
The Clinical Practice Guidelines for post-ERCP pancreatitis (PEP) 2023 provide updated recommendations for the prevention, diagnosis, and management of PEP. Endoscopic retrograde cholangiopancreatography (ERCP), a valuable procedure for diagnosing and treating pancreatobiliary diseases, can result in PEP as the most common adverse event. Since the first guidelines were published in 2015, advances in techniques and new research findings have necessitated this revision. The guidelines developed using the GRADE methodology target adult patients undergoing ERCP. They offer a comprehensive framework for clinicians to minimize the risk of PEP. For high-risk patients, endoscopic ultrasound before ERCP is recommended to avoid unnecessary procedures. The guidelines also discuss procedural and patient-related risk factors for PEP, highlighting that operator experience does not significantly affect PEP rates if performed under the supervision of skilled endoscopists. The diagnostic criteria include monitoring serum pancreatic enzyme levels postprocedure, and early computed tomography is advised in suspected cases. For treatment, the guidelines recommend following acute pancreatitis protocols. Key preventive measures include the use of temporary pancreatic duct stents and rectal nonsteroidal anti-inflammatory drugs, both of which are supported by strong evidence for reducing the incidence of PEP. Overall, these guidelines aim to enhance clinical outcomes by reducing PEP incidence and improving its management through evidence-based practices.
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Affiliation(s)
- Shuntaro Mukai
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | | | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Tsukasa Ikeura
- Third Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Atsushi Irisawa
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Eisuke Iwasaki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Akio Katanuma
- Center for Gastroenterology, Teine Keijinkai Hospital, Hokkaido, Japan
| | - Katsuya Kitamura
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Mamoru Takenaka
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Morihisa Hirota
- Division of Gastroentrology, Tohoku Medical and Pharmaceutical University, Miyagi, Japan
| | - Toshihiko Mayumi
- Department of Intensive Care Unit, Japan Community Healthcare Organization Chukyo Hospital, Aichi, Japan
| | - Toshio Morizane
- Center of Gastroenterology and Inflammatory Bowel Disease, Ofuna Chuo Hospital, Kanagawa, Japan
| | - Ichiro Yasuda
- Third Department of Internal Medicine, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Shomei Ryozawa
- Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Atsushi Masamune
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Japan
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Sugimoto M, Takagi T, Suzuki R, Asama H, Shimizu H, Sato K, Ohira R, Nakamura J, Takasumi M, Kato T, Yanagita T, Otsuka M, Hikichi T, Ohira H. Selection methods for endoscopic ultrasound‑guided biliary drainage cases that are appropriate for beginners. Exp Ther Med 2025; 29:53. [PMID: 39885912 PMCID: PMC11775763 DOI: 10.3892/etm.2025.12803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2024] [Accepted: 12/18/2024] [Indexed: 02/01/2025] Open
Abstract
Endoscopic ultrasound-guided biliary drainage (EUS-BD) is performed as a second drainage method when endoscopic retrograde cholangiopancreatography-guided biliary drainage fails. There are several severe adverse events in EUS-BD, and avoiding technical failure is desirable. Although EUS-BD is a skilled endoscopic treatment, the appropriate conditions for EUS-BD beginners are not well known. The present study aimed to clarify the appropriate cases for EUS-BD beginners. The present retrospective cohort study included patients with malignant biliary obstruction who underwent EUS-BD, which was performed by beginners between March 2005 and June 2024. Factors associated with successful EUS-BD performed by beginners were evaluated by multivariate logistic regression analysis. The performance of each factor was evaluated via a receiver operating characteristic (ROC) curve. According to multivariate analysis, the diameter of the punctured bile duct was associated with successful EUS-BD performed by beginners (odds ratio, 1.34; 95% CI, 1.03-1.75; P=0.031). The area under the ROC curve for the diameter of the punctured bile duct was 0.79, and the cutoff value was 6.7 mm (71% sensitivity and 81.8% specificity). The diameter of the punctured bile duct might be associated with successful EUS-BD procedures performed by beginners. When a beginner performs EUS-BD, a diameter of the targeted bile duct >6.7 mm might be desirable for successful procedures.
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Affiliation(s)
- Mitsuru Sugimoto
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Fukushima 960-1295, Japan
| | - Tadayuki Takagi
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Fukushima 960-1295, Japan
| | - Rei Suzuki
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Fukushima 960-1295, Japan
| | - Hiroyuki Asama
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Fukushima 960-1295, Japan
| | - Hiroshi Shimizu
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Fukushima 960-1295, Japan
| | - Kentaro Sato
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Fukushima 960-1295, Japan
| | - Rei Ohira
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Fukushima 960-1295, Japan
| | - Jun Nakamura
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Fukushima 960-1295, Japan
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Fukushima 960-1295, Japan
| | - Mika Takasumi
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Fukushima 960-1295, Japan
| | - Tsunetaka Kato
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Fukushima 960-1295, Japan
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Fukushima 960-1295, Japan
| | - Takumi Yanagita
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Fukushima 960-1295, Japan
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Fukushima 960-1295, Japan
| | - Mitsuru Otsuka
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Fukushima 960-1295, Japan
| | - Takuto Hikichi
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Fukushima 960-1295, Japan
| | - Hiromasa Ohira
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Fukushima 960-1295, Japan
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Takahara N, Nakai Y, Noguchi K, Suzuki T, Sato T, Hakuta R, Ishigaki K, Saito T, Hamada T, Fujishiro M. Endoscopic ultrasound-guided hepaticogastrostomy and endoscopic retrograde cholangiopancreatography-guided biliary drainage for distal malignant biliary obstruction due to pancreatic cancer with asymptomatic duodenal invasion: a retrospective, single-center study in Japan. Clin Endosc 2025; 58:134-143. [PMID: 39188118 PMCID: PMC11837547 DOI: 10.5946/ce.2024.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 05/04/2024] [Accepted: 05/13/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND/AIMS Duodenal invasion (DI) is a risk factor for early recurrent biliary obstruction (RBO) in endoscopic retrograde cholangiopancreatography-guided biliary drainage (ERCP-BD). Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) may reduce early RBO in cases of asymptomatic DI, even when ERCP is possible. METHODS We enrolled 56 patients with pancreatic cancer and asymptomatic DI who underwent EUS-HGS (n=25) or ERCP-BD (n=31). Technical and clinical success, early (<3 months) and overall RBO rates, time to RBO (TRBO), and adverse events were compared between the EUS-HGS and ERCP-BD groups. Risk factors for early RBO were also evaluated. RESULTS Baseline characteristics were similar between the groups. Both procedures demonstrated 100% technical and clinical success rates, with a similar incidence of adverse events (48% vs. 39%, p=0.59). While the median TRBO was comparable (5.7 vs. 8.8 months, p=0.60), EUS-HGS was associated with a lower incidence of early RBO compared to ERCP-BD (8% vs. 29%, p=0.09). The major causes of early RBO in ERCP-BD were sludge and food impaction, rarely occurring in EUS-HGS. EUS-HGS was potentially reduced early RBO (odds ratio, 0.32; p=0.07). CONCLUSIONS EUS-HGS can be a viable option for treating pancreatic cancer with asymptomatic DI.
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Affiliation(s)
- Naminatsu Takahara
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yousuke Nakai
- Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kensaku Noguchi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tatsunori Suzuki
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tatsuya Sato
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryunosuke Hakuta
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazunaga Ishigaki
- Department of Chemotherapy, The University of Tokyo Hospital, Tokyo, Japan
| | - Tomotaka Saito
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tsuyoshi Hamada
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Ni DJ, Yang QF, Nie L, Xu J, He SZ, Yao J. The past, present, and future of endoscopic management for biliary strictures: technological innovations and stent advancements. Front Med (Lausanne) 2024; 11:1334154. [PMID: 39669990 PMCID: PMC11634603 DOI: 10.3389/fmed.2024.1334154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 11/15/2024] [Indexed: 12/14/2024] Open
Abstract
Biliary stricture can be induced by intrinsic narrowing and extrinsic compression, with the majority of cases being malignant. Clinically, distinguishing between benign and malignant biliary strictures remains a considerable challenge, and the ongoing disagreement over the optimal choice of biliary stents significantly influences treatment strategies and impacts patients' survival and prognosis. The utilization and advancement of endoscopic techniques have heightened the diagnostic sensitivity for biliary strictures. Concurrently, innovative technologies such as endoscopic ultrasound and magnetic compression anastomosis emerge as viable alternatives when endoscopic retrograde cholangiopancreatography (ERCP) is not an option, providing fresh insights for the clinical management of these patients. Traditional plastic and metal stents, characterized by their complex application and limited scope, have been unable to fully satisfy clinical needs. The introduction of novel stent varieties has notably improved this scenario, marking a considerable progression towards precision medicine. However, the clinical validation of the diverse stent materials available is incomplete. Hence, a thorough discussion on the present state and evolving trends of biliary stents is warranted.
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Affiliation(s)
- Dong-Jin Ni
- Department of Gastroenterology, The Affiliated People's Hospital of Jiangsu University, Zhenjiang, China
| | - Qi-Fan Yang
- Department of Gastroenterology, The Affiliated People's Hospital of Jiangsu University, Zhenjiang, China
| | - Lu Nie
- Department of Intervention Vascular, Wujin Hospital Affiliated with Jiangsu University, Changzhou, China
| | - Jian Xu
- Department of Gastroenterology, The Affiliated People's Hospital of Jiangsu University, Zhenjiang, China
| | - Si-Zhe He
- Shanghai Academy of Fine Arts, Shanghai University, Shanghai, China
| | - Jun Yao
- Department of Gastroenterology, The Affiliated People's Hospital of Jiangsu University, Zhenjiang, China
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Lyu Y, Wang B. Predictors of the Difficulty of Laparoscopic Cholecystectomy After Percutaneous Transhepatic Gallbladder Drainage for Grade II Acute Cholecystitis. Surg Laparosc Endosc Percutan Tech 2024; 34:479-484. [PMID: 39016308 PMCID: PMC11446531 DOI: 10.1097/sle.0000000000001304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 06/11/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND The predictors of difficulty performing laparoscopic cholecystectomy (LC) following percutaneous transhepatic gallbladder drainage (PTGBD) for grade II acute cholecystitis have not been clearly understood. METHODS This retrospective study was performed between January 2019 and February 2023 and involved 102 eligible patients with grade II acute cholecystitis. Patients were categorized into 2 groups: difficult LC group (n=14) and nondifficult LC group (n=88). Preoperative characteristics and postoperative outcomes were analyzed, and a logistic regression model was used for multivariate analyses of the significant factors identified in the univariate analyses. RESULTS Logistic multivariable regression analysis revealed that C-reactive protein (CRP) levels (odds ratio [OR]: 1.028, 95% confidence interval [CI]: 1.013-1.044; P <0.05), and time intervals between PTGBD and LC (OR: 1.047, 95% CI: 1.003-1.092; P =0.034) were independent predictors of difficult LC. When preoperative CRP was >154 mg/L, LC difficulty, blood loss, and operative time increased ( P <0.05, P =0.01, P =0.01, respectively) compared with CRP <154 mg/L. Difficult LC, increased blood loss, and longer operative time occurred more frequently when the interval between PTGBD and LC was >35 days compared with <35 days ( P <0.05, P =0.003, P =0.002, respectively). CONCLUSIONS CRP levels >154 mg/L and intervals between PTGBD and LC exceeding 35 days are associated with greater LC difficulty.
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Affiliation(s)
- Yunxiao Lyu
- Department of Hepatobiliary Surgery, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang People's Hospital, Dongyang, Zhejiang, China
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Nabi Z, Samanta J, Dhar J, Aggarwal M, Basha J, Gahra A, Golchha A, Crinò SF, Facciorusso A, Lakhtakia S, Reddy DN. Comparative Effectiveness of ERCP and EUS-Guided Techniques for "Primary Biliary Drainage" in Malignant Distal Biliary Obstruction: A Systematic Review and Meta-Analysis. J Clin Gastroenterol 2024:00004836-990000000-00351. [PMID: 39312532 DOI: 10.1097/mcg.0000000000002075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 08/14/2024] [Indexed: 09/25/2024]
Abstract
BACKGROUND AND OBJECTIVES Endoscopic ultrasound-guided biliary drainage (EUS-BD) is a viable alternative in cases with failed ERCP transpapillary drainage (ERCP-TPD). This systematic review and meta-analysis aimed to compare the efficacy and safety of EUS-BD and ERCP-TPD for primary biliary drainage in patients with distal malignant biliary obstruction (DMBO). METHODS We searched Embase, PubMed, and Medline databases for studies comparing EUS-BD and ERCP-TPD in DMBO, from inception until September 2023. The primary endpoint was clinical success and secondary endpoints included technical success, procedure duration, and adverse events. RESULTS Eight studies (815 patients, 56.1% male) were included in this analysis. Indications for biliary drainage were pancreatic carcinoma (75.1%), followed by cholangiocarcinoma (10.1%). Clinical success was comparable between EUS-BD and ERCP-TPD groups (OR 1.34; 95% CI, 0.75-2.40; P=0.32). Technical success was similar between the 2 groups (OR 2.09; 95% CI, 0.83-5.25; P=0.12). There was a trend toward fewer adverse events in the EUS-BD group (OR 0.65; 95% CI, 0.40-1.07; P=0.09), with significantly lower odds of post-procedure pancreatitis (OR 0.17; 95% CI, 0.06-0.50; P=0.001). CONCLUSION EUS-BD is comparable to ERCP for primary biliary drainage in DMBO patients with shorter procedural time and a significantly reduced risk of post-procedure pancreatitis.
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Affiliation(s)
- Zaheer Nabi
- Interventional Endoscopy, Asian Institute of Gastroenterology, Hyderabad
| | | | - Jahnvi Dhar
- Department of Gastroenterology, PGIMER, Chandigarh
| | - Mona Aggarwal
- Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Jahangeer Basha
- Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Amrit Gahra
- Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Aman Golchha
- Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Stefano Francesco Crinò
- Diagnostic and Interventional Endoscopy of the Pancreas, The Pancreas Institute, University Hospital of Verona, Verona
| | - Antonio Facciorusso
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Sundeep Lakhtakia
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - D Nageshwar Reddy
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
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Sugimoto M, Takagi T, Suzuki R, Waragai Y, Konno N, Asama H, Sato Y, Irie H, Nakamura J, Takasumi M, Hashimoto M, Kato T, Yanagita T, Hikichi T, Ohira H. Factors Associated With Difficult Endoscopic Ultrasonography-guided Biliary Drainage. J Clin Gastroenterol 2024; 58:494-501. [PMID: 37390043 DOI: 10.1097/mcg.0000000000001876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 05/22/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND AND AIMS When endoscopic retrograde cholangiopancreatography-guided biliary drainage is challenging, endoscopic ultrasound-guided biliary drainage (EUS-BD) can be used as an alternate treatment; however, this method requires operator expertise. Therefore, this study aimed to clarify the factors that are associated with a difficult EUS-BD. PATIENTS AND METHODS Patients who successfully underwent EUS-BD were enrolled in this study. The patients were divided into the easy group and difficult group depending on whether the procedural time was more than 60 minutes, which was the cutoff value elicited from past reports. Patient characteristics and procedural factors were compared between the two groups. The factors associated with difficult procedures were also investigated. RESULTS The patient characteristics were not significantly different between the easy group (n=22) and the difficult group (n=19). The diameter of the punctured bile duct was significantly different between the two groups. In the multivariate analysis, the diameter of the punctured bile duct was the only factor associated with a difficult EUS-BD (odds ratio 0.65, 95% confidence interval 0.46-0.91, P value=0.012). The cutoff value for the diameter of the punctured bile duct in predicting a difficult EUS-BD was 7.0 mm (area under the curve: 0.83, sensitivity 84.2%, specificity 86.4%). CONCLUSIONS A nondilated bile duct might be a predictive factor for a difficult EUS-BD. For beginners of EUS-BD, the cutoff value for the punctured bile duct diameter found in this study, 7.0 mm, might become a barometer for puncture point selection.
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Affiliation(s)
- Mitsuru Sugimoto
- Department of Gastroenterology, School of Medicine, Fukushima Medical University
| | - Tadayuki Takagi
- Department of Gastroenterology, School of Medicine, Fukushima Medical University
| | - Rei Suzuki
- Department of Gastroenterology, School of Medicine, Fukushima Medical University
| | - Yuichi Waragai
- Department of Gastroenterology, Soma General Hospital, Niinuma, Soma, Japan
| | - Naoki Konno
- Department of Gastroenterology, School of Medicine, Fukushima Medical University
| | - Hiroyuki Asama
- Department of Gastroenterology, School of Medicine, Fukushima Medical University
| | - Yuki Sato
- Department of Gastroenterology, School of Medicine, Fukushima Medical University
| | - Hiroki Irie
- Department of Gastroenterology, School of Medicine, Fukushima Medical University
| | - Jun Nakamura
- Department of Gastroenterology, School of Medicine, Fukushima Medical University
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima
| | - Mika Takasumi
- Department of Gastroenterology, School of Medicine, Fukushima Medical University
| | - Minami Hashimoto
- Department of Gastroenterology, School of Medicine, Fukushima Medical University
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima
| | - Tsunetaka Kato
- Department of Gastroenterology, School of Medicine, Fukushima Medical University
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima
| | - Takumi Yanagita
- Department of Gastroenterology, School of Medicine, Fukushima Medical University
| | - Takuto Hikichi
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima
| | - Hiromasa Ohira
- Department of Gastroenterology, School of Medicine, Fukushima Medical University
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Pietrzak J, Przybyłkowski A. Endoscopic Treatment of Malignant Hilar Biliary Obstruction. Cancers (Basel) 2023; 15:5819. [PMID: 38136363 PMCID: PMC10741735 DOI: 10.3390/cancers15245819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/01/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
Stent implantation is an effective approach for palliative treatment of Bismuth-Corlette type III-IV malignant hilar biliary obstructions (MHBOs). In this article, we reviewed the currently used access methods for biliary stent placement (percutaneous transhepatic biliary drainage, endoscopic biliary drainage, endosonography guided biliary drainage), the available stent types (plastic stent, self-expanding metallic stent, full cover self-expanding metallic stent, radioactive self-expanding metallic stent), major approaches (unilateral, bilateral) and deployment methods (stent-in-stent, stent-by-stent). Finally, this review gives an outlook on perspectives of development in stenting and other palliative methods in MHBO.
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Affiliation(s)
| | - Adam Przybyłkowski
- Department of Gastroenterology and Internal Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland;
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10
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Giri S, Mohan BP, Jearth V, Kale A, Angadi S, Afzalpurkar S, Harindranath S, Sundaram S. Adverse events with EUS-guided biliary drainage: a systematic review and meta-analysis. Gastrointest Endosc 2023; 98:515-523.e18. [DOI: https:/doi.org/10.1016/j.gie.2023.06.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2025]
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Tyberg A, Sarkar A, Shahid HM, Shah-Khan SM, Gaidhane M, Simon A, Eisenberg IA, Lajin M, Karagyozov P, Liao K, Patel R, Zhao E, Martínez MG, Artifon EL, Lino AD, Vanella G, Arcidiacono PG, Kahaleh M. EUS-Guided Biliary Drainage Versus ERCP in Malignant Biliary Obstruction Before Hepatobiliary Surgery: An International Multicenter Comparative Study. J Clin Gastroenterol 2023; 57:962-966. [PMID: 36730114 DOI: 10.1097/mcg.0000000000001795] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 10/07/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Endoscopic ultrasound-guided biliary drainage (EUS-BD) is the procedure of choice for patients who cannot undergo endoscopic retrograde cholangiopancreatography (ERCP). The outcomes of patients undergoing surgery after EUS-BD for malignancy are unknown. METHODS We conducted an international, multicenter retrospective comparative study of patients who underwent hepatobiliary surgery after having undergone EUS-BD or ERCP from 6 tertiary care centers. Patient demographics, procedural data, and follow-up care were collected in a registry. RESULTS One hundred forty-five patients were included: EUS-BD n=58 (mean age 66, 45% male), ERCP n=87 (mean age 68, 53% male). The majority of patients had pancreatic cancer, cholangiocarcinoma, or gallbladder malignancy. In the EUS-BD group, 29 patients had hepaticogastrostomy, 24 had choledochoduodenostomy, and 5 had rendezvous technique done. The most common surgery was Whipple in both groups (n=41 EUS-BD, n=56 ERCP) followed by partial hepatectomy (n=7 EUS-BD, n=14 ERCP) and cholecystectomy (n=2 EUS-BD, n=2 ERCP). Endoscopy clinical success was comparable in both groups (98% EUS-BD, 94% ERCP). Adverse event rates were similar in both groups: EUS-BD (n=10, 17%) and ERCP (n=23, 26%). Surgery technical success and clinical success were significantly higher in the EUS-BD group compared with the ERCP group (97% vs. 83%, 97% vs. 75%). Total Hospital stay from surgery to discharge was significantly higher in the ERCP group (19 d vs. 10 d, P =0.0082). DISCUSSION Undergoing EUS-BD versus ERCP before hepatobiliary surgery is associated with fewer repeat endoscopic interventions, shorter duration between endoscopy and surgical intervention, higher rates of surgical clinical success, and shorter length of hospital stay after surgery.
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Affiliation(s)
- Amy Tyberg
- Gastroenterology, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Avik Sarkar
- Gastroenterology, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Haroon M Shahid
- Gastroenterology, Robert Wood Johnson Medical School, New Brunswick, NJ
| | | | - Monica Gaidhane
- Gastroenterology, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Alexa Simon
- Gastroenterology, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Ian A Eisenberg
- Gastroenterology, Robert Wood Johnson Medical School, New Brunswick, NJ
| | | | | | - Kelvin Liao
- Gastroenterology, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Roohi Patel
- Gastroenterology, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Eric Zhao
- Gastroenterology, Robert Wood Johnson Medical School, New Brunswick, NJ
| | | | | | - André D Lino
- Universidade de Sao Paulo Faculdade de Medicina, Sao Paulo, Brazil
| | | | | | - Michel Kahaleh
- Gastroenterology, Robert Wood Johnson Medical School, New Brunswick, NJ
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12
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Giri S, Mohan BP, Jearth V, Kale A, Angadi S, Afzalpurkar S, Harindranath S, Sundaram S. Adverse events with EUS-guided biliary drainage: a systematic review and meta-analysis. Gastrointest Endosc 2023; 98:515-523.e18. [PMID: 37392952 DOI: 10.1016/j.gie.2023.06.055] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/01/2023] [Accepted: 06/20/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND AND AIMS Multiple meta-analyses have evaluated the technical and clinical success of EUS-guided biliary drainage (BD), but meta-analyses concerning adverse events (AEs) are limited. The present meta-analysis analyzed AEs associated with various types of EUS-BD. METHODS A literature search of MEDLINE, Embase, and Scopus was conducted from 2005 to September 2022 for studies analyzing the outcome of EUS-BD. The primary outcomes were incidence of overall AEs, major AEs, procedure-related mortality, and reintervention. The event rates were pooled using a random-effects model. RESULTS One hundred fifty-five studies (7887 patients) were included in the final analysis. The pooled clinical success rates and incidence of AEs with EUS-BD were 95% (95% confidence interval [CI], 94.1-95.9) and 13.7% (95% CI, 12.3-15.0), respectively. Among early AEs, bile leak was the most common followed by cholangitis with pooled incidences of 2.2% (95% CI, 1.8-2.7) and 1.0% (95% CI, .8-1.3), respectively. The pooled incidences of major AEs and procedure-related mortality with EUS-BD were .6% (95% CI, .3-.9) and .1% (95% CI, .0-.4), respectively. The pooled incidences of delayed migration and stent occlusion were 1.7% (95% CI, 1.1-2.3) and 11.0% (95% CI, 9.3-12.8), respectively. The pooled event rate for reintervention (for stent migration or occlusion) after EUS-BD was 16.2% (95% CI, 14.0-18.3; I2 = 77.5%). CONCLUSIONS Despite a high clinical success rate, EUS-BD may be associated with AEs in one-seventh of the cases. However, major AEs and mortality incidence remain less than 1%, which is reassuring.
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Affiliation(s)
- Suprabhat Giri
- Department of Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Babu P Mohan
- Department of Gastroenterology, University of Utah, Salt Lake City, Utah, USA
| | - Vaneet Jearth
- Department of Gastroenterology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Aditya Kale
- Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Sumaswi Angadi
- Department of Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Shivaraj Afzalpurkar
- Department of Gastroenterology, Nanjappa Multispecialty Hospital, Davanagere, India
| | - Sidharth Harindranath
- Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Sridhar Sundaram
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
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13
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On W, Ahmed W, Everett S, Huggett M, Paranandi B. Utility of interventional endoscopic ultrasound in pancreatic cancer. Front Oncol 2023; 13:1252824. [PMID: 37781196 PMCID: PMC10540845 DOI: 10.3389/fonc.2023.1252824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/30/2023] [Indexed: 10/03/2023] Open
Abstract
Endoscopic ultrasound (EUS) has an important role in the management algorithm of patients with pancreatic ductal adenocarcinoma (PDAC), typically for its diagnostic utilities. The past two decades have seen a rapid expansion of the therapeutic capabilities of EUS. Interventional EUS is now one of the more exciting developments within the field of endoscopy. The local effects of PDAC tend to be in anatomical areas which are difficult to target and endoscopy has cemented itself as a key role in managing the clinical sequelae of PDAC. Interventional EUS is increasingly utilized in situations whereby conventional endoscopy is either impossible to perform or unsuccessful. It also adds a different dimension to the host of oncological and surgical treatments for patients with PDAC. In this review, we aim to summarize the various ways in which interventional EUS could benefit patients with PDAC and aim to provide a balanced commentary on the current evidence of interventional EUS in the literature.
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Affiliation(s)
- Wei On
- Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
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14
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Fugazza A, Andreozzi M, De Marco A, Da Rio L, Colombo M, Spadaccini M, Carrara S, Giacchetto M, Sharma M, Craviotto V, Busacca A, Ferrari C, Repici A. Endoscopy Ultrasound-Guided Biliary Drainage Using Lumen Apposing Metal Stent in Malignant Biliary Obstruction. Diagnostics (Basel) 2023; 13:2788. [PMID: 37685326 PMCID: PMC10487072 DOI: 10.3390/diagnostics13172788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/16/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
This narrative review provides an overview of the application of endoscopic ultrasound-guided biliary drainage (EUS-BD), including EUS-guided gallbladder drainage (EUS-GBD), for the treatment of malignant biliary obstruction. EUS-BD has demonstrated excellent technical and clinical success rates, with lower rates of adverse events when compared with percutaneous trans-hepatic biliary drainage (PTBD). EUS-BD is currently the preferred alternative technique for biliary drainage (BD) in patients with distal malignant biliary obstruction (DMBO) after failed endoscopic retrograde cholangiopancreatography (ERCP). Particularly, this review will focus on EUS-BD performed with the use of lumen apposing metal stent (LAMS). The introduction of these innovative devices, followed by the advent of electrocautery-enhanced LAMS (EC-LAMS), gave the procedure a great technical implementation and a widespread application.
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Affiliation(s)
- Alessandro Fugazza
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital–IRCSS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (A.F.); (M.A.); (A.D.M.); (L.D.R.); (M.C.); (M.S.); (S.C.); (M.G.); (V.C.); (A.B.)
| | - Marta Andreozzi
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital–IRCSS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (A.F.); (M.A.); (A.D.M.); (L.D.R.); (M.C.); (M.S.); (S.C.); (M.G.); (V.C.); (A.B.)
| | - Alessandro De Marco
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital–IRCSS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (A.F.); (M.A.); (A.D.M.); (L.D.R.); (M.C.); (M.S.); (S.C.); (M.G.); (V.C.); (A.B.)
| | - Leonardo Da Rio
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital–IRCSS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (A.F.); (M.A.); (A.D.M.); (L.D.R.); (M.C.); (M.S.); (S.C.); (M.G.); (V.C.); (A.B.)
| | - Matteo Colombo
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital–IRCSS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (A.F.); (M.A.); (A.D.M.); (L.D.R.); (M.C.); (M.S.); (S.C.); (M.G.); (V.C.); (A.B.)
| | - Marco Spadaccini
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital–IRCSS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (A.F.); (M.A.); (A.D.M.); (L.D.R.); (M.C.); (M.S.); (S.C.); (M.G.); (V.C.); (A.B.)
| | - Silvia Carrara
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital–IRCSS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (A.F.); (M.A.); (A.D.M.); (L.D.R.); (M.C.); (M.S.); (S.C.); (M.G.); (V.C.); (A.B.)
| | - Marco Giacchetto
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital–IRCSS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (A.F.); (M.A.); (A.D.M.); (L.D.R.); (M.C.); (M.S.); (S.C.); (M.G.); (V.C.); (A.B.)
| | - Mrigya Sharma
- G.M.E.R.S Medical College & Hospital, Gotri, Vadodara 390021, India
| | - Vincenzo Craviotto
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital–IRCSS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (A.F.); (M.A.); (A.D.M.); (L.D.R.); (M.C.); (M.S.); (S.C.); (M.G.); (V.C.); (A.B.)
| | - Anita Busacca
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital–IRCSS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (A.F.); (M.A.); (A.D.M.); (L.D.R.); (M.C.); (M.S.); (S.C.); (M.G.); (V.C.); (A.B.)
| | - Chiara Ferrari
- Division of Anaesthesiology, Humanitas Research Hospital–IRCCS, Via Manzoni 56, Rozzano, 20089 Milan, Italy;
| | - Alessandro Repici
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital–IRCSS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (A.F.); (M.A.); (A.D.M.); (L.D.R.); (M.C.); (M.S.); (S.C.); (M.G.); (V.C.); (A.B.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
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15
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Doyle JB, Sethi A. Endoscopic Ultrasound-Guided Biliary Drainage. J Clin Med 2023; 12:jcm12072736. [PMID: 37048819 PMCID: PMC10095139 DOI: 10.3390/jcm12072736] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 04/14/2023] Open
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic biliary drainage (PTBD) are currently first- and second-line therapeutic options, respectively, for the relief of biliary obstruction. In recent years, however, endoscopic ultrasound-guided biliary drainage (EUS-BD) has become an established alternative therapy for biliary obstruction. There are multiple different techniques for EUS-BD, which can be distinguished based on the access point within the biliary tree (intrahepatic versus extrahepatic) and the location of stent placement (transenteric versus transpapillary). The clinical and technical success rates of biliary drainage for EUS-BD are similar to both ERCP and PTBD, and complication rates are favorable for EUS-BD relative to PTBD. As EUS-BD becomes more widely practiced and endoscopic tools continue to advance, the outcomes will likely improve, and the breadth of indications for EUS-BD will continue to expand.
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Affiliation(s)
- John B Doyle
- Division of Digestive and Liver Diseases, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, NY 10032, USA
| | - Amrita Sethi
- Division of Digestive and Liver Diseases, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, NY 10032, USA
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16
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Chen Y, Zhang C, Luo T. Percutaneous transhepatic cholangial drainage/percutaneous transhepatic biliary stent implantation for treatment of extrahepatic cholangiocarcinoma with obstructive jaundice. Shijie Huaren Xiaohua Zazhi 2023; 31:165-171. [DOI: 10.11569/wcjd.v31.i5.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
Extrahepatic cholangiocarcinoma is a malignant tumor originating from the extrahepatic bile duct including the hilar region to the lower bile duct of the common bile duct. With the development of interventional techniques and medical materials, percutaneous transhepatic cholangial drainage (PTCD) or percutaneous transhepatic biliary stent implantation (PTBS) has become the main treatment to relieve biliary obstruction. However, the occurrence of postoperative complications seriously affects the prognosis of patients, and the combination of biliary stenting with local treatment has been found to significantly prolong the time to biliary patency. This article reviews the progress of PTCD/PTBS in the treatment of extrahepatic cholangiocarcinoma with obstructive jaundice, evaluates its clinical efficacy, and points out the current problems and posible solutions to provide more reference for subsequent related studies.
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Affiliation(s)
- Yue Chen
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Chao Zhang
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Tao Luo
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
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17
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Hashimoto S, Iwashita Y, Taguchi H, Tanoue S, Ohi T, Shibata R, Haraguchi T, Kamikihara Y, Toyodome K, Kojima I, Araki N, Tsuneyoshi K, Nakamura Y, Fujita T, Hinokuchi M, Iwaya H, Arima S, Sasaki F, Kanmura S, Ido A. Comparison of recurrent biliary obstruction with the use of metal and plastic stents in EUS-guided biliary drainage: A propensity score-matched analysis. Endosc Ultrasound 2023; 12:64-73. [PMID: 36510868 PMCID: PMC10134919 DOI: 10.4103/eus-d-21-00251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background and Objectives In transpapillary biliary drainage, metal stents (MSs) exhibit a lower incidence of a biliary obstruction than plastic stents (PSs). However, few studies have compared recurrent biliary obstruction (RBO) when MSs and PSs are used in EUS-guided hepaticogastrostomy (EUS-HGS) and choledochoduodenostomy (EUS-CDS). We retrospectively evaluated the RBO for both stents in each procedure. Patients and Methods : Between November 2012 and December 2020, 85 and 53 patients who underwent EUS-HGS and EUS-CDS for unresectable malignant biliary obstruction, respectively, were enrolled. Factors associated with RBO were assessed. Clinical outcomes were compared between the MS and PS groups using propensity score matching. Results : The clinical success rate and procedure-related adverse events were similar in the MS and PS groups. Multivariate analysis identified the use of PS as a factor associated with RBO (EUS-HGS, P = 0.03; EUS-CDS, P = 0.02). After matching, the median time to RBO in EUS-HGS (MS: 313; PS: 125 days; P = 0.01) in the MS group was longer than that in the PS group. The cumulative incidence of RBO at 1, 3, and 6 months in the MS group was significantly lower than that in the PS group for EUS-HGS (MS: 4.0%, 8.2%, and 8.2%; PS: 12.4%, 24.9%, and 39.5%, respectively, P = 0.01). Conclusions : MS exhibited a lower rate of RBO than PS for EUS-HGS and EUS-CDS.
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Affiliation(s)
- Shinichi Hashimoto
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Yuji Iwashita
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences; Department of Gastroenterology, Kagoshima City Hospital, Kagoshima, Japan
| | - Hiroki Taguchi
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Shiroh Tanoue
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Takayuki Ohi
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences; Department of Gastroenterology, Saiseikai Sendai Hospital, Kagoshima, Japan
| | - Ryusuke Shibata
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences; Department of Gastroenterology, Saiseikai Sendai Hospital, Kagoshima, Japan
| | - Tomoaki Haraguchi
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences; Department of Gastroenterology, Kagoshima Prefectural Satsunan Hospital, Kagoshima, Japan
| | - Yusuke Kamikihara
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Koshiro Toyodome
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Issei Kojima
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Norimasa Araki
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Kengo Tsuneyoshi
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences; Department of Gastroenterology, Kagoshima Prefectural Ooshima Hospital, Kagoshima, Japan
| | - Yoshitaka Nakamura
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Toshihiro Fujita
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences; Department of Gastroenterology, Saiseikai Sendai Hospital, Kagoshima, Japan
| | - Makoto Hinokuchi
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Hiromichi Iwaya
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Shiho Arima
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Fumisato Sasaki
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Shuji Kanmura
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Akio Ido
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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18
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Minaga K, Kitano M, Uenoyama Y, Hatamaru K, Shiomi H, Ikezawa K, Miyagahara T, Imai H, Fujimori N, Matsumoto H, Shimokawa Y, Masuda A, Takenaka M, Kudo M, Chiba Y. Feasibility and efficacy of endoscopic reintervention after covered metal stent placement for EUS-guided hepaticogastrostomy: A multicenter experience. Endosc Ultrasound 2022; 11:478-486. [PMID: 36537385 PMCID: PMC9921972 DOI: 10.4103/eus-d-22-00029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background and Objectives Although the use of a long metal stent is favored for EUS-guided hepaticogastrostomy (EUS-HGS) for the relief of malignant biliary obstruction (MBO), endoscopic reintervention (E-RI) at the time of recurrent biliary obstruction (RBO) is challenging due to a long intragastric portion. This study evaluated the feasibility and safety of E-RI after a long partially covered metal stent (L-PCMS) placement during EUS-HGS. Materials and Methods We performed a multicenter retrospective study between January 2015 and December 2019 examining patients with MBO who underwent E-RI for RBO through the EUS-HGS route after the L-PCMS placement. Technical and clinical success rates, details of E-RI, adverse events (AEs), stent patency, and survival time were evaluated. Results Thirty-three patients at eight referral centers in Japan who underwent E-RI through the EUS-HGS route were enrolled. The location of MBO was distal in 54.5%. The median intragastric length of the L-PCMS was 5 cm. As the first E-RI attempt, E-RI via the distal end of the existing L-PCMS was successful in 60.6%. The overall technical and clinical success rates of E-RI were 100% and 81.8%, respectively. Liver abscess was noted in one patient. A proximal biliary stricture was associated with the clinical ineffectiveness of E-RI in multivariable analysis (odds ratio, 12.5, P = 0.04). The median survival and stent patency duration after E-RI were 140 and 394 days, respectively. Conclusions Our study findings suggest that E-RI for RBO after EUS-HGS with a L-PCMS is technically feasible and clinically effective, without any severe AEs, especially for patients with distal MBO.
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Affiliation(s)
- Kosuke Minaga
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan,Address for correspondence Dr. Kosuke Minaga, Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama 589-8511, Japan. E-mail:
| | - Masayuki Kitano
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yoshito Uenoyama
- Department of Gastroenterology, Japan Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Keiichi Hatamaru
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Hideyuki Shiomi
- Department of Internal Medicine, Division of Gastroenterology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kenji Ikezawa
- Department of Hepatobiliary and Pancreatic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Tsukasa Miyagahara
- Department of Gastroenterology, Nakatsu Municipal Hospital, Nakatsu, Japan
| | - Hajime Imai
- Department of Gastroenterology, Okanami General Hospital, Iga, Japan
| | - Nao Fujimori
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hisakazu Matsumoto
- Department of Gastroenterology, Japan Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Yuzo Shimokawa
- Department of Gastroenterology, Nakatsu Municipal Hospital, Nakatsu, Japan
| | - Atsuhiro Masuda
- Department of Internal Medicine, Division of Gastroenterology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Mamoru Takenaka
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Yasutaka Chiba
- Clinical Research Center, Kindai University Hospital, Osaka-Sayama, Japan
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19
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Mukai S, Itoi T, Tsuchiya T, Ishii K, Tonozuka R, Nagakawa Y, Kozono S, Takishita C, Osakabe H, Sofuni A. Clinical feasibility of endoscopic ultrasound-guided biliary drainage for preoperative management of malignant biliary obstruction (with videos). JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2022. [PMID: 36458423 DOI: 10.1002/jhbp.1292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/18/2022] [Accepted: 11/26/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND/PURPOSE EUS-guided biliary drainage (EUS-BD) has recently been reported to be a useful salvage technique after ERCP fail. However, data on EUS-BD used for preoperative biliary drainage (PBD) are limited. The aim of this study was to verify the clinical feasibility of EUS-BD for PBD. METHODS PBD was performed for malignant biliary obstruction in 318 patients at our institution between July 2014 and April 2022. Fifteen (4.7%) of these patients underwent surgical resection after preoperative EUS-BD (HGS 13; HDS 1; AGS with HGS 1) and were retrospectively analyzed. RESULTS The stent was successfully placed in all 15 cases with a median procedure time of 15 min (technical success rate 100%). The median total bilirubin value decreased significantly from 3.7 before drainage to 0.9 after surgery (p < .001) and cholangitis was well managed (clinical success rate 100%). Surgery was performed at a median of 22 days after drainage, and there were no stent-related adverse events or recurrences of biliary obstruction. Severe surgery-related adverse events occurred in three cases, but none were associated with EUS-BD. The stent was removed during surgery in 12 cases. CONCLUSIONS EUS-BD can be a feasible and safe alternative method of PBD for malignant biliary obstruction after ERCP fail.
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Affiliation(s)
- Shuntaro Mukai
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Takayoshi Tsuchiya
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Kentaro Ishii
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Ryosuke Tonozuka
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Yuichi Nagakawa
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
| | - Shingo Kozono
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
| | - Chie Takishita
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
| | - Hiroaki Osakabe
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
| | - Atsushi Sofuni
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
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20
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Abdellatef A, Wifi MN. Biliary drainage guided by endoscopic ultrasonography is a doable objective. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2022. [DOI: 10.1186/s43162-022-00151-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractThe therapeutic usage of EUS is being developed. EUS-guided biliary drainage (EUSBD) is a recognized viable replacement for percutaneous transhepatic biliary drainage (PTBD) in severe cases with the obstructive biliary disease having ERCP failure due to a failure in cannulation or those with surgically altered anatomies, such as hepatico-jejunal anastomosis following Billroth II reconstruction, Roux-en-Y limb, Whipple procedure, or Roux-en-Y gastric bypass, or cases with inaccessible papilla because of severe duodenal inflammatory structure.
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21
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The Clinical Benefit of Percutaneous Transhepatic Biliary Drainage for Malignant Biliary Tract Obstruction. Cancers (Basel) 2022; 14:cancers14194673. [PMID: 36230596 PMCID: PMC9563508 DOI: 10.3390/cancers14194673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/30/2022] [Accepted: 09/22/2022] [Indexed: 11/23/2022] Open
Abstract
Percutaneous transhepatic biliary drainage (PTBD) is a decompression procedure for malignant proximal biliary obstruction. In this research, over a six-year period, 89 patients underwent PTBD procedure for jaundice caused by malignant disease to restart chemotherapy or for palliative intent. Clinical outcomes after PTBD procedure in the two groups of patients, according to the adequate bilirubin decline (ABD) needed for subsequent chemotherapy, are presented in this paper. Survival and logistic regression were plotted and compared using Kaplan−Meier survival multivariate analysis with a long-range test. Results were processed by MEDCALC software. In the series, 58.4% (52/89) of patients were in good performance status (ECOG 0/1), and PTBD was performed with the intention to (re)start chemotherapy. The normalization of the bilirubin level was seen in 23.0% (12/52), but only 15.4% (8/52) received chemotherapy. The median survival time after PTBD was 9 weeks. In patients with ABD that received chemotherapy, the median survival time was 64 weeks, with 30-day mortality of 27.7%, and 6.4% of death within 7 days. The best outcome was in patients with good performance status (ECOG 0−1), low bilirubin (<120 µmol/L) and LDH (<300 µmol/L) levels and elevated leukocytes at the time of the procedures. PTBD is considered in ABD patients who are candidates for chemotherapy.
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22
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Abstract
PURPOSE OF REVIEW To summarize the current status and future perspectives of the endoscopic management of biliary strictures. RECENT FINDINGS In addition to conventional diagnostic modalities, such as cross-sectional imaging and endoscopic ultrasonography (EUS), per-oral cholangioscopy is helpful for indeterminate biliary strictures. It allows direct visualization of the biliary tract and targeted biopsy. For distal malignant biliary obstruction (MBO), a self-expandable metal stent (SEMS) via endoscopic retrograde cholangiopancreatography (ERCP) is a standard of care. EUS-guided biliary drainage (EUS-BD) is an emerging alternative to percutaneous transhepatic biliary drainage in cases with failed ERCP. EUS-BD is also an effective salvage option for perihilar MBO, which can not be managed via ERCP or percutaneous transhepatic biliary drainage. Preoperative drainage is necessary for most jaundiced patients as neoadjuvant chemotherapy is widely administered for resectable and borderline resectable pancreatic cancer, and a SEMS is preferred in this setting, too. For benign biliary strictures, a covered SEMS can improve stricture resolution and reduce the number of endoscopic sessions as compared to plastic stents. SUMMARY ERCP and EUS play a central role in the diagnosis and drainage for both malignant and benign biliary strictures.
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Dell'Anna G, Ogura T, Vanella G, Nishikawa H, Lakhtakia S, Arcidiacono PG. Endoscopic ultrasound guided biliary interventions. Best Pract Res Clin Gastroenterol 2022; 60-61:101810. [PMID: 36577530 DOI: 10.1016/j.bpg.2022.101810] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 11/10/2022] [Indexed: 11/17/2022]
Abstract
Endoscopic Retrograde Cholangiopancreatography (ERCP), even in expert hands, may fail in 5-10% of cases, especially in cases of papillary infiltration, malignant gastric outlet obstruction, or surgically altered anatomy. Percutaneous transhepatic biliary drainage (PTBD) has represented the traditional rescue therapy, despite associated with high rate of adverse events, need for re-interventions and an inferior quality of life. The evolution of Endoscopic Ultrasound (EUS) from a diagnostic to a therapeutic tool offers an effective and safe alternative for internal biliary drainage (BD) into the stomach or the duodenum. EUS-BD is reported to have similar or even improved efficacy and increased safety when compared to PTBD and can be performed in the same session of a failed ERCP. This review summarizes technical aspects of intra-hepatic and extra-hepatic EUS-BD (including hepatico-gastrostomy, choledocho-duodenostomy and rendezvous) together with current evidence and future perspectives that steadily cements EUS-BD's place in multidisciplinary management of bilio-pancreatic diseases.
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Affiliation(s)
- Giuseppe Dell'Anna
- Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Takeshi Ogura
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Giuseppe Vanella
- Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
| | - Hiroki Nishikawa
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Sundeep Lakhtakia
- Department of Gastroenterology, Asian Institute of Gastroenterology, AIG Hospitals, Hyderabad, India
| | - Paolo Giorgio Arcidiacono
- Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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Vanella G, Dell’Anna G, Loria A, Petrone MC, Del Vecchio A, Arcidiacono PG. Radiation exposure during modern therapeutic endoscopic ultrasound procedures and standard alternatives. Endosc Int Open 2022; 10:E1105-E1111. [PMID: 36247073 PMCID: PMC9558486 DOI: 10.1055/a-1853-0451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/12/2022] [Indexed: 10/24/2022] Open
Abstract
Background and study aims Therapeutic EUS (t-EUS) is increasingly being adopted in clinical practice in tertiary referral centers; however, little is known about radiation exposure (RE) metrics and diagnostic reference limits for it. Methods Kerma-area product (KAP [Gy·cm 2 ]), Air Kerma and fluoroscopy time were retrospectively evaluated for all consecutive t-EUS procedures performed in San Raffaele Institute between 2019 and 2021. For EUS-guided choledochoduodenostomies (EUS-CDS) and gastroenterostomies (EUS-GE), an equal number of endoscopic retrograde cholangiopancreatographies (ERCPs) plus metal stenting and duodenal stents were included respectively for comparison. Results Data from 141 t-EUS procedures were retrieved (49 % pancreatic cancer, 38 % peripancreatic fluid collections). EUS-CDS (N = 44) were mainly performed fluoroless, while ERCPs required a significantly higher RE (KAP = 25 [17-55], P < 0.0001). Fluid collection drainage (EUS-FCD) with lumen apposing metal stents (LAMS, N = 26) were performed fluoroless, while EUS-FCD with double-pigtail plastic stents (DPPS, N = 28) required higher RE (KAP = 23 [13-45]). EUS-guided gallbladder drainage (EUS-GBD, N = 6) required scarce RE (KAP = 9 [3-21]) for coaxial DPPS placement. EUS-GE (N = 27) required higher RE than duodenal stenting (KAP = 44 [28-88] versus 29 [19-46], P = 0.03). EUS-guided hepaticogastrostomies (EUS-HGS, N = 10) had the highest RE among t-EUS procedures (KAP = 81 [49-123]). Procedure complexity or intervening complications were evaluated and resulted in higher RE within each procedure. Conclusions t-EUS procedures have different RE ( P < 0.000001). EUS-CDS, EUS-GBD, and EUS-FCD with LAMS can be performed with no-to-mild radioscopy, unlike standard alternatives. However, radioscopy remains essential in case of technical difficulties or complications. EUS-GE and EUS-HGS involve a high RE. Endoscopists involved in t-EUS might experience RE higher than category standards, which indicates a need for increased awareness and personalized preventive measures.
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Affiliation(s)
- Giuseppe Vanella
- Pancreatobiliary endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Centre, IRCSS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Dell’Anna
- Pancreatobiliary endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Centre, IRCSS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Loria
- Medical Physics Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Chiara Petrone
- Pancreatobiliary endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Centre, IRCSS San Raffaele Scientific Institute, Milan, Italy
| | | | - Paolo Giorgio Arcidiacono
- Pancreatobiliary endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Centre, IRCSS San Raffaele Scientific Institute, Milan, Italy
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CRP and ALT Levels in Individuals with Acute Biliary Pancreatitis after Endoscopic Retrograde Cholangiopancreatography and Endoscopic Sphincterotomy. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:6492551. [PMID: 35726289 PMCID: PMC9206583 DOI: 10.1155/2022/6492551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/24/2022] [Accepted: 05/24/2022] [Indexed: 11/17/2022]
Abstract
Objective The goal of this study was to see how effective endoscopic retrograde cholangiopancreatography combined with endoscopic sphincterotomy was in treating acute biliary pancreatitis and how it affected CRP and ALT levels. Methods This analysis is based on a 100-patient acute pancreatitis (ABP) study conducted at our institution from June 2019 to June 2020. They were divided into two groups of 50 cases each, the control group and the observational group, according to the random number table. Endoscopic sphincterotomy and ERCP were performed on the observation group instead of open surgery on the control group as a point of comparison (EST). The followings were compared including abdominal pain relief duration, blood amylase recovery duration, and hospital stay duration, as well as Serum C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) level; the ALT, AST, and GGT levels of the two groups were compared, as well as the occurrence of problems in both groups. Results The observation group had a significantly shorter duration of abdominal pain, blood amylase recovery, and hospital stay. Presurgery CRP, IL-6, and TNF-α levels in both groups were significantly lower in the observation group than in the control group. According to the results of the study, both groups saw significant decreases in ALT, AST, and GGT after surgery; however, the levels of these markers in both groups were significantly lower in the observation group after surgery than in the control group. The observation group's (14.00 percent) complication rate was substantially lower. Conclusion ERCP and EST in the treatment of ABP can not only successfully improve clinical indexes and facilitate the recovery of patients but also reduce the levels of CRP and alt, reduce the level of inflammation, and enhance renal function, with reduced problems, which has a high clinical reference value.
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Kozakai F, Ogawa T, Ito K. Novel spiral dilator for endoscopic ultrasonography-guided drainage. Dig Endosc 2022; 34:e66-e67. [PMID: 35199388 DOI: 10.1111/den.14258] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 01/24/2022] [Accepted: 01/30/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Fumisato Kozakai
- Department of Gastroenterology, Sendai City Medical Center, Miyagi, Japan
| | - Takahisa Ogawa
- Department of Gastroenterology, Sendai City Medical Center, Miyagi, Japan
| | - Kei Ito
- Department of Gastroenterology, Sendai City Medical Center, Miyagi, Japan
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Tanikawa T, Ishii K, Katsumata R, Urata N, Nishino K, Suehiro M, Kawanaka M, Haruma K, Kawamoto H. Efficacy of primary drainage by endoscopic ultrasound-guided biliary drainage for unresectable pancreatic adenocarcinoma. JGH Open 2022; 6:251-256. [PMID: 35475205 PMCID: PMC9021712 DOI: 10.1002/jgh3.12732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/15/2022] [Accepted: 03/17/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND AND AIM Obstructive jaundice induced by pancreatic adenocarcinoma is typically treated with biliary drainage with endoscopic retrograde cholangiopancreatography (ERCP)-guided biliary drainage (ERCP-BD). Recently, endoscopic ultrasonography-guided biliary drainage (EUS-BD) was employed as an alternative method after ERCP-BD failed. We aimed to determine the efficacy and safety of EUS-BD for primary biliary drainage. METHODS Between December 2011 and February 2019, at Kawasaki General Medical Center, we retrospectively enrolled 33 patients who had undergone endoscopic biliary drainage with a metal stent, in a first attempt to relieve obstructive jaundice caused by unresectable pancreatic adenocarcinoma. We compared the technical and clinical outcomes between ERCP-BD and EUS-BD. RESULTS Twenty-three patients underwent ERCP-BD and 10 underwent EUS-BD. Both groups achieved 100% technical success. The clinical success rates were similar between the groups: 91% (21/23 patients) for ERCP-BD and 100% (10/10 patients) for EUS-BD (P = 0.48). Biliary obstruction recurred in 6/23 patients (26%) treated with ERCP-BD and 1/10 patients (10%) treated with EUS-BD (P = 0.40). Other adverse events occurred in 4/23 patients (17%) in the ERCP-BD group and 1/10 patients (10%) in the EUS-BD group (P = 0.99). CONCLUSION We suggest that EUS-BD could be employed for primary biliary drainage in patients with obstructive jaundice caused by unresectable pancreatic adenocarcinoma.
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Affiliation(s)
- Tomohiro Tanikawa
- Department of General Internal Medicine 2Kawasaki Medical SchoolOkayamaJapan
| | - Katsunori Ishii
- Department of General Internal Medicine 2Kawasaki Medical SchoolOkayamaJapan
| | - Ryo Katsumata
- Department of General Internal Medicine 2Kawasaki Medical SchoolOkayamaJapan
| | - Noriyo Urata
- Department of General Internal Medicine 2Kawasaki Medical SchoolOkayamaJapan
| | - Ken Nishino
- Department of General Internal Medicine 2Kawasaki Medical SchoolOkayamaJapan
| | - Mitsuhiko Suehiro
- Department of General Internal Medicine 2Kawasaki Medical SchoolOkayamaJapan
| | - Miwa Kawanaka
- Department of General Internal Medicine 2Kawasaki Medical SchoolOkayamaJapan
| | - Ken Haruma
- Department of General Internal Medicine 2Kawasaki Medical SchoolOkayamaJapan
| | - Hirofumi Kawamoto
- Department of General Internal Medicine 2Kawasaki Medical SchoolOkayamaJapan
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28
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Palliation in Gallbladder Cancer: The Role of Gastrointestinal Endoscopy. Cancers (Basel) 2022; 14:cancers14071686. [PMID: 35406458 PMCID: PMC8997124 DOI: 10.3390/cancers14071686] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 12/24/2022] Open
Abstract
Gallbladder cancer is a rare malignancy burdened by poor prognosis with an estimated 5-year survival of 5% to 13% due to late presentation, early infiltration of surrounding tissues, and lack of successful treatments. The only curative approach is surgery; however, more than 50% of cases are unresectable at the time of diagnosis. Endoscopy represents, together with surgery and chemotherapy, an available palliative option in advanced gallbladder cancers not eligible for curative treatments. Cholangitis, jaundice, gastric outlet obstruction, and pain are common complications of advanced gallbladder cancer that may need endoscopic management in order to improve the overall survival and the patients’ quality of life. Endoscopic biliary drainage is frequently performed to manage cholangitis and jaundice. ERCP is generally the preferred technique allowing the placement of a plastic stent or a self-expandable metal stent depending on the singular clinical case. EUS-guided biliary drainage is an available alternative for patients not amenable to ERCP drainage (e.g., altered anatomy). Gastric outlet obstruction is another rare complication of gallbladder malignancy growing in contact with the duodenal wall and causing its compression. Endoscopy is a less invasive alternative to surgery, offering different options such as an intraluminal self-expandable metal stent or EUS-guided gastroenteroanastomosis. Abdominal pain associated with cancer progression is generally managed with medical treatments; however, for incoercible pain, EUS-guided celiac plexus neurolysis has been described as an effective and safe treatment. Locoregional treatments, such as radiofrequency ablation (RFA), photodynamic therapy (PDT), and intraluminal brachytherapy (IBT), have been described in the control of disease progression; however, their role in daily clinical practice has not been established yet. The aim of this study is to perform a review of the literature in order to assess the role of endoscopy and the available techniques in the palliative therapy of advanced gallbladder malignancy.
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29
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Kato A, Yoshida M, Hayashi K. Endoscopic ultrasound-guided covered metal stent deployment through endoscopic tapered sheath preventing bile leakage. Dig Endosc 2022; 34:e34-e35. [PMID: 34904298 DOI: 10.1111/den.14209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/24/2021] [Accepted: 11/29/2021] [Indexed: 12/13/2022]
Affiliation(s)
- Akihisa Kato
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Michihiro Yoshida
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Kazuki Hayashi
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
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30
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Takenaka M, Hosono M, Rehani MM, Chiba Y, Ishikawa R, Okamoto A, Yamazaki T, Nakai A, Omoto S, Minaga K, Kamata K, Yamao K, Hayashi S, Nishida T, Kudo M. Comparison of radiation exposure between endoscopic ultrasound-guided drainage and transpapillary drainage by endoscopic retrograde cholangiopancreatography for pancreatobiliary diseases. Dig Endosc 2022; 34:579-586. [PMID: 34107099 PMCID: PMC9292288 DOI: 10.1111/den.14060] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 05/24/2021] [Accepted: 06/08/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVES The transpapillary drainage by endoscopic retrograde cholangiopancreatography (ERCP-D) cannot be performed without fluoroscopy, and there are many situations in which fluoroscopy is required even in endoscopic ultrasound-guided drainage (EUS-D). Previous studies have compared the efficacy, but not the radiation exposure of EUS-D and ERCP-D. While radiation exposure in ERCP-D has been previously evaluated, there is a paucity of information regarding radiation doses in EUS-D. This study aimed to assess radiation exposure in EUS-D compared with that in ERCP-D. METHODS This retrospective single-center cohort study included consecutive patients who underwent EUS-D and ERCP-D between October 2017 and March 2019. The air kerma (AK, mGy), kerma-area product (KAP, Gycm2 ), fluoroscopy time (FT, min), and procedure time (PT, min) were assessed. The invasive probability weighting method was used to qualify the comparisons. RESULTS We enrolled 372 and 105 patients who underwent ERCP-D and EUS-D, respectively. The mean AK, KAP, and FT in the EUS-D group were higher by 53%, 28%, and 27%, respectively, than those in the ERCP-D group, whereas PT was shorter by approximately 11% (AK, 135.0 vs. 88.4; KAP, 28.1 vs. 21.9; FT, 20.4 vs. 16.0; PT, 38.7 vs. 43.5). The sub-analysis limited to biliary drainage cases showed the same trend (AK, 128.3 vs. 90.9; KAP, 27.0 vs. 22.2; FT, 16.4 vs. 16.1; PT, 32.5 vs. 44.4). CONCLUSIONS This is the first study to assess radiation exposure in EUS-D compared with that in ERCP-D. Radiation exposure was significantly higher in EUS-D than in ERCP-D, despite the shorter procedure time.
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Affiliation(s)
- Mamoru Takenaka
- Departments ofGastroenterology and HepatologyKindai University Faculty of MedicineOsakaJapan
| | - Makoto Hosono
- Department ofRadiologyKindai University Faculty of MedicineOsakaJapan
| | - Madan M. Rehani
- Global Outreach for Radiation Protection ProgramRadiation Safety CommitteeMassachusetts General HospitalBostonUSA
| | - Yasutaka Chiba
- Clinical Research CenterKindai University HospitalOsakaJapan
| | - Rei Ishikawa
- Departments ofGastroenterology and HepatologyKindai University Faculty of MedicineOsakaJapan
| | - Ayana Okamoto
- Departments ofGastroenterology and HepatologyKindai University Faculty of MedicineOsakaJapan
| | - Tomohiro Yamazaki
- Departments ofGastroenterology and HepatologyKindai University Faculty of MedicineOsakaJapan
| | - Atsushi Nakai
- Departments ofGastroenterology and HepatologyKindai University Faculty of MedicineOsakaJapan
| | - Shunsuke Omoto
- Departments ofGastroenterology and HepatologyKindai University Faculty of MedicineOsakaJapan
| | - Kosuke Minaga
- Departments ofGastroenterology and HepatologyKindai University Faculty of MedicineOsakaJapan
| | - Ken Kamata
- Departments ofGastroenterology and HepatologyKindai University Faculty of MedicineOsakaJapan
| | - Kentaro Yamao
- Departments ofGastroenterology and HepatologyKindai University Faculty of MedicineOsakaJapan
| | - Shiro Hayashi
- Department of GastroenterologyToyonaka Municipal HospitalOsakaJapan
- Department of Gastroenterology and Internal MedicineHayashi ClinicOsakaJapan
| | - Tsutomu Nishida
- Department of GastroenterologyToyonaka Municipal HospitalOsakaJapan
| | - Masatoshi Kudo
- Departments ofGastroenterology and HepatologyKindai University Faculty of MedicineOsakaJapan
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31
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van der Merwe SW, van Wanrooij RLJ, Bronswijk M, Everett S, Lakhtakia S, Rimbas M, Hucl T, Kunda R, Badaoui A, Law R, Arcidiacono PG, Larghi A, Giovannini M, Khashab MA, Binmoeller KF, Barthet M, Perez-Miranda M, van Hooft JE. Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2022; 54:185-205. [PMID: 34937098 DOI: 10.1055/a-1717-1391] [Citation(s) in RCA: 256] [Impact Index Per Article: 85.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
1: ESGE recommends the use of endoscopic ultrasound-guided biliary drainage (EUS-BD) over percutaneous transhepatic biliary drainage (PTBD) after failed endoscopic retrograde cholangiopancreatography (ERCP) in malignant distal biliary obstruction when local expertise is available.Strong recommendation, moderate quality evidence. 2: ESGE suggests EUS-BD with hepaticogastrostomy only for malignant inoperable hilar biliary obstruction with a dilated left hepatic duct when inadequately drained by ERCP and/or PTBD in high volume expert centers.Weak recommendation, moderate quality evidence. 3: ESGE recommends that EUS-guided pancreatic duct (PD) drainage should only be considered in symptomatic patients with an obstructed PD when retrograde endoscopic intervention fails or is not possible.Strong recommendation, low quality evidence. 4: ESGE recommends rendezvous EUS techniques over transmural PD drainage in patients with favorable anatomy owing to its lower rate of adverse events.Strong recommendation, low quality evidence. 5: ESGE recommends that, in patients at high surgical risk, EUS-guided gallbladder drainage (GBD) should be favored over percutaneous gallbladder drainage where both techniques are available, owing to the lower rates of adverse events and need for re-interventions in EUS-GBD.Strong recommendation, high quality of evidence. 6: ESGE recommends EUS-guided gastroenterostomy (EUS-GE), in an expert setting, for malignant gastric outlet obstruction, as an alternative to enteral stenting or surgery.Strong recommendation, low quality evidence. 7: ESGE recommends that EUS-GE may be considered in the management of afferent loop syndrome, especially in the setting of malignancy or in poor surgical candidates. Strong recommendation, low quality evidence. 8: ESGE suggests that endoscopic ultrasound-directed transgastric ERCP (EDGE) can be offered, in expert centers, to patients with a Roux-en-Y gastric bypass following multidisciplinary decision-making, with the aim of overcoming the invasiveness of laparoscopy-assisted ERCP and the limitations of enteroscopy-assisted ERCP.Weak recommendation, low quality evidence.
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Affiliation(s)
- Schalk W van der Merwe
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Roy L J van Wanrooij
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam, AGEM Institute, Amsterdam, The Netherlands
| | - Michiel Bronswijk
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
- Department of Gastroenterology and Hepatology, Imelda General Hospital, Bonheiden, Belgium
| | - Simon Everett
- Department of Gastroenterology and Hepatology, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - Sundeep Lakhtakia
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology Hospitals, Gachibowli, Hyderabad, India
| | - Mihai Rimbas
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
| | - Tomas Hucl
- Department of Gastroenterology and Hepatology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Rastislav Kunda
- Department of Surgery, Department of Gastroenterology and Hepatology, and Department of Advanced Interventional Endoscopy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Abdenor Badaoui
- Department of Gastroenterology and Hepatology, Université catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
| | - Ryan Law
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Paolo G Arcidiacono
- Pancreatobiliary Endoscopy and Endosonography Division, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Larghi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, and Center for Endoscopic Research Therapeutics and Training (CERTT), Catholic University, Rome, Italy
| | - Marc Giovannini
- Paoli-Calmettes Institute, Department of Gastrointestinal Disease, Marseille, France
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Kenneth F Binmoeller
- Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, California, USA
| | - Marc Barthet
- Department of Gastroenterology, Aix-Marseille Université, APHM, Hôpital Nord, Marseille, France
| | - Manuel Perez-Miranda
- Gastroenterology Department, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
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32
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Bang JY, Hawes R, Varadarajulu S. Endoscopic biliary drainage for malignant distal biliary obstruction: Which is better - endoscopic retrograde cholangiopancreatography or endoscopic ultrasound? Dig Endosc 2022; 34:317-324. [PMID: 34748675 PMCID: PMC9299777 DOI: 10.1111/den.14186] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/03/2021] [Accepted: 11/05/2021] [Indexed: 12/13/2022]
Abstract
Presently, following endoscopic ultrasound (EUS)-guided biopsy, an endoscopic retrograde cholangiopancreatography (ERCP) with transpapillary stenting is performed for palliation of malignant distal biliary obstruction (MDBO). However, technical failure and postprocedure pancreatitis are limitations to ERCP. Endoscopic ultrasonography-guided biliary drainage (EUS-BD) after a failed ERCP has a 90% technical success rate and has been shown to be superior when compared to percutaneous methods, making EUS an increasingly recognized option for biliary drainage. Supporting this approach, findings from recently concluded randomized trials suggest that the safety profile and technical outcomes for EUS-BD are comparable or even superior to that of ERCP for primary biliary decompression in patients with MDBO. Also, EUS-BD is increasingly being utilized in patients with altered surgical anatomy in lieu of percutaneous techniques and balloon-assisted enteroscopy. A growing body of evidence supports the notion that, in the future, EUS may become the primary modality by which biliary decompression is undertaken in the majority of patients with MDBO. The roadmap to this eventuality may require further optimization of procedural techniques, technological innovations, and cost reduction.
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Affiliation(s)
| | - Robert Hawes
- Digestive Health InstituteOrlando HealthOrlandoUSA
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Sugimoto M, Takagi T, Suzuki R, Waragai Y, Konno N, Asama H, Sato Y, Irie H, Nakamura J, Takasumi M, Hashimoto M, Kato T, Hikichi T, Ohira H. Factors Associated With Successful Fistula Dilation in Endoscopic Ultrasound-guided Biliary Drainage. TECHNIQUES AND INNOVATIONS IN GASTROINTESTINAL ENDOSCOPY 2022; 24:316-323. [DOI: 10.1016/j.tige.2022.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/14/2025]
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Karagyozov PI, Tishkov I, Boeva I, Draganov K. Endoscopic ultrasound-guided biliary drainage-current status and future perspectives. World J Gastrointest Endosc 2021; 13:607-618. [PMID: 35070022 PMCID: PMC8716984 DOI: 10.4253/wjge.v13.i12.607] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/17/2021] [Accepted: 11/25/2021] [Indexed: 02/06/2023] Open
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) with stenting is the treatment modality of choice for patients with benign and malignant bile duct obstruction. ERCP could fail in cases of duodenal obstruction, duodenal diverticulum, ampullary neoplastic infiltration or surgically altered anatomy. In these cases percutaneous biliary drainage (PTBD) is traditionally used as a rescue procedure but is related to high morbidity and mortality and lower quality of life. Endoscopic ultrasound-guided biliary drainage (EUS-BD) is a relatively new interventional procedure that arose due to the development of curvilinear echoendoscope and the various endoscopic devices. A large amount of data is already collected that proves its efficacy, safety and ability to replace PTBD in cases of ERCP failure. It is also possible that EUS-BD could be chosen as a first-line treatment option in some clinical scenarios in the near future. Several EUS-BD techniques are developed EUS-guided transmural stenting, antegrade stenting and rendezvous technique and can be personalized depending on the individual anatomy. EUS-BD is normally performed in the same session from the same endoscopist in case of ERCP failure. The lack of training, absence of enough dedicated devices and lack of standardization still makes EUS-BD a difficult and not very popular procedure, which is related to life-threatening adverse events. Developing training models, dedicated devices and guidelines hopefully will make EUS-BD easier, safer and well accepted in the future. This paper focuses on the technical aspects of the different EUS-BD procedures, available literature data, advantages, negative aspects and the future perspectives of these modalities.
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Affiliation(s)
- Petko Ivanov Karagyozov
- Department of Interventional Gastroenterology, Clinic of Gastroenterology, Acibadem City Clinic Tokuda Hopsital, Sofia 1407, Bulgaria
| | - Ivan Tishkov
- Department of Interventional Gastroenterology, Clinic of Gastroenterology, Acibadem City Clinic Tokuda Hopsital, Sofia 1407, Bulgaria
| | - Irina Boeva
- Department of Interventional Gastroenterology, Clinic of Gastroenterology, Acibadem City Clinic Tokuda Hopsital, Sofia 1407, Bulgaria
| | - Kiril Draganov
- Clinic of Liver, Biliary, Pancreatic and General Surgery, Acibadem City Clinic Tokuda Hospital, Sofia 1407, Bulgaria
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Emergent endoscopic ultrasound-guided cholecystoduodenostomy does not prevent R0 resection in a pancreaticoduodenectomy for pancreatic cancer. Clin J Gastroenterol 2021; 15:263-267. [PMID: 34694600 DOI: 10.1007/s12328-021-01540-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 10/16/2021] [Indexed: 12/07/2022]
Abstract
Endoscopic ultrasound-guided biliary drainage, mainly choledochoduodenostomy, is commonly used as rescue therapy after Endoscopic Retrograde Cholangiopancreatography (ERCP) in malignant distal biliary obstruction due to un-resectable pancreatic cancer. An alternative when the cystic duct is patent and choledochoduodenostomy is not feasible is performing an Endoscopic Ultrasound-gallbladder drainage. The advent of the Lumen Apposing Metal Stents (LAMS) has shortened and simplified this procedure. However, many concerns exist about the performance of these procedures with metal stents preoperatively in resectable tumors. The evidence about Endoscopic Ultrasound-gallbladder drainage before surgery of pancreatic cancer is scarce. An emergent Endoscopic Ultrasound (EUS)-gallbladder drainage (cholecysto-duodenostomy) was performed due to acute cholangitis in the setting of a resectable pancreatic tumor. Surgery after neoadjuvant therapy was done three months later. A complete resection of tumor was feasible. EUS-guided gallbladder drainage using LAMS does not preclude performing a complete resection of a pancreatic head tumor.
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Endoscopic ultrasound-guided vs ERCP-guided biliary drainage for malignant biliary obstruction: A up-to-date meta-analysis and systematic review. Dig Liver Dis 2021; 53:1247-1253. [PMID: 33926814 DOI: 10.1016/j.dld.2021.03.029] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 12/11/2022]
Abstract
Endoscopic ultrasound-guided biliary drainage (EUS-BD) is being used increasingly as an alternative treatment for malignant biliary obstruction (MBO). However, few studies have compared EUS-BD and endoscopic retrograde cholangiopancreatography biliary drainage (ERCP-BD). We searched the PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases until 1 November 2020 for studies comparing EUS-BD versus ERCP-BD. The primary outcomes of interest in this study were technical and clinical success. Nine studies involving 634 patients were included in this meta-analysis. Regarding technical and clinical success, there were no significant differences between EUS-BD and ERCP-BD (odds ratio [OR], 0.76; 95% CI: 0.30-1.91; OR, 1.45, 95% confidence interval [CI], 0.66-3.16, respectively). EUS-BD was associated with significantly less reintervention vs ERCP-BD (OR, 0.36, 95% CI, 0.15-0.86). Regarding adverse events, the rates were similar for EUS-BD and ERCP-BD (OR: 0.75, 95% CI, 0.45-1.24). There were no significant differences in the types of adverse events (stent occlusion, stent migration, stent dysfunction, and duration of stent patency) between the two techniques. EUS-BD was associated with lower reintervention rates compared with ERCP-BD, with comparable safety and efficacy outcomes. However, more high-quality randomized trials are required.
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Madhusudhan KS, Jineesh V, Keshava SN. Indian College of Radiology and Imaging Evidence-Based Guidelines for Percutaneous Image-Guided Biliary Procedures. Indian J Radiol Imaging 2021; 31:421-440. [PMID: 34556927 PMCID: PMC8448229 DOI: 10.1055/s-0041-1734222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
Percutaneous biliary interventions are among the commonly performed nonvascular radiological interventions. Most common of these interventions is the percutaneous transhepatic biliary drainage for malignant biliary obstruction. Other biliary procedures performed include percutaneous cholecystostomy, biliary stenting, drainage for bile leaks, and various procedures like balloon dilatation, stenting, and large-bore catheter drainage for bilioenteric or post-transplant anastomotic strictures. Although these procedures are being performed for ages, no standard guidelines have been formulated. This article attempts at preparing guidelines for performing various percutaneous image-guided biliary procedures along with discussion on the published evidence in this field.
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Affiliation(s)
| | - Valakkada Jineesh
- Department of Radiology, Sree Chitra Tirunal Institute of Medical Sciences and Technology (Thiruvananthapuram), Kerala, India
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Abstract
PURPOSE OF REVIEW To update on recent advances in interventional endoscopic ultrasound (INVEUS) techniques. RECENT FINDINGS The introduction of linear echoendoscopes with larger instrument channels and the combined development of new tools and devices have enabled various new applications of minimally invasive endoscopic ultrasound (EUS)-guided transluminal interventions of the pancreas, biliary system and peri-gastrointestinal structures. In this review, EUS-guided interventions are discussed and evaluated: drainage of peripancreatic fluid collections, access and drainage of bile ducts, gallbladder and pancreatic duct, treatment of gastrointestinal haemorrhage, coeliac plexus block and coeliac plexus neurolysis, fiducial placement, solid and cystic tumour ablation, drug delivery and brachytherapy, gastroenterostomy, angiotherapy and other EUS-guided applications. The EUS-guided interventions are classified based on the available evidence as established or experimental, standardized or nonstandardized procedures in common or rare diseases with well or little known complications and their established or nonestablished treatment. SUMMARY Some EUS-guided interventions have sparse published evidence with only single-centre studies, case series or individual case reports, others like drainage of peripancreatic fluid collections have become widely accepted practice. INVEUS has been accepted as an alternative to several surgical approaches, EUS-guided techniques result in faster recovery times, shorter hospital stay and lower costs.
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Affiliation(s)
- Christoph F Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permanence, Switzerland
| | - Barbara Braden
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Christian Jenssen
- Department of Internal Medicine, Krankenhaus Maerkisch-Oderland, D-15344 Strausberg and Brandenburg Institute of Clinical Ultrasound at Medical University Brandenburg, Germany
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Shimatani M, Mitsuyama T, Tokuhara M, Masuda M, Miyamoto S, Ito T, Nakamaru K, Ikeura T, Takaoka M, Naganuma M, Okazaki K. Recent advances of endoscopic retrograde cholangiopancreatography using balloon assisted endoscopy for pancreaticobiliary diseases in patients with surgically altered anatomy: Therapeutic strategy and management of difficult cases. Dig Endosc 2021; 33:912-923. [PMID: 32981141 DOI: 10.1111/den.13848] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 09/17/2020] [Indexed: 12/17/2022]
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is an endoscopic modality established for diagnosis and treatment of pancreaticobiliary diseases. However ERCP in patients with surgically altered anatomy (SAA) has been difficult, and more invasive therapies have been primarily selected. The development of balloon assisted endoscopes (BAEs) innovatively facilitated ERCP in such patients. Recent advances of BAEs and other devices greatly contributed to increasing success of ERCP using BAEs (BAE-ERCP). Furthermore, interventions using Endoscopic Ultrasound (EUS-intervention) have been reported to be useful for pancreaticobiliary diseases in patients with SAA, which provide more options for endoscopic therapies and are also expected as a rescue therapy for difficult cases of BAE-ERCP. In order to thoroughly complete endoscopic treatment for pancreaticobiliary diseases with SAA, it is important to standardize the BAE-ERCP procedures based on the features of respective endoscopes and to establish a strategy for endoscopic treatment which includes analysis of BAE-ERCP difficult cases and selection of cases for rescue therapy. In addition, it is essential to be acquainted with the characteristics of possible adverse events of the procedure and to be able to deal with them for safe accomplishment of endoscopic treatment.
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Affiliation(s)
- Masaaki Shimatani
- Division of Gastroenterology and Hepatology, The Third Department of Internal Medicine, Kansai Medical University, Osaka, Japan.,Division of Gastroenterology and Hepatology, Kansai Medical University Medical Center, Osaka, Japan
| | - Toshiyuki Mitsuyama
- Division of Gastroenterology and Hepatology, The Third Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Mitsuo Tokuhara
- Division of Gastroenterology and Hepatology, The Third Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Masataka Masuda
- Division of Gastroenterology and Hepatology, The Third Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Sachi Miyamoto
- Division of Gastroenterology and Hepatology, The Third Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Takashi Ito
- Division of Gastroenterology and Hepatology, The Third Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Koh Nakamaru
- Division of Gastroenterology and Hepatology, The Third Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Tsukasa Ikeura
- Division of Gastroenterology and Hepatology, The Third Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Makoto Takaoka
- Division of Gastroenterology and Hepatology, The Third Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Makoto Naganuma
- Division of Gastroenterology and Hepatology, The Third Department of Internal Medicine, Kansai Medical University, Osaka, Japan
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Iwashita T, Ogura T, Ishiwatari H, Nakai Y, Iwata K, Mukai T, Shimizu M, Isayama H, Yasuda I, Itoi T. Utility of dedicated bougie dilator for a 0.018-inch guidewire during EUS-guided biliary drainage: A multi-center retrospective cohort study. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2021; 29:810-816. [PMID: 34272831 DOI: 10.1002/jhbp.1021] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/04/2021] [Accepted: 07/08/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND During endoscopic ultrasound-guided biliary drainage (EUS-BD), a combination of a 19-gauge needle and a 0.025-inch guidewire is generally used. However, a 19-gauge needle has poor maneuverability because of their stiffness and rigidity and might have poor penetrability in non-dilated bile ducts because of their large bore. In contrast, the application of a 22-gauge needle is expected to have improved maneuverability. However, only a 0.018-inch guidewire, which has less supportability, is applicable in the subsequent guidewire selection. This study aimed to evaluate the feasibility and safety of a dedicated bougie dilator for a 0.018-inch guidewire. METHODS From September 2019 to May 2020, 26 patients underwent fistula dilation using the dilator after accessing the bile duct using a 22-gauge needle and a 0.018-inch guidewire during EUS-BD. The success and adverse event rates of EUS-BD were evaluated. RESULTS Biliary access with a combination of a 22-gauge needle and a 0.018-inch guidewire was successful in all with a median bile duct diameter of 5 mm. Dilation of the fistula using the dedicated dilator was also successful in all cases. Subsequently, the dilator was successfully exchanged to an ERCP catheter that allowed for exchange to a 0.025-inch guidewire, except in one case where the catheter did not cross the fistula and a dilation balloon was inserted for an exchange to a 0.025-inch guidewire. The technical success rate of the EUS-BD was 100%. The adverse event rate was 19%. CONCLUSION The application of the dedicated dilator for a 0.018-inch guidewire was considered feasible and safe for EUS-BD.
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Affiliation(s)
- Takuji Iwashita
- First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan
| | - Takeshi Ogura
- Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | | | - Yousuke Nakai
- Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Keisuke Iwata
- Department of Gastroenterology, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Tsuyoshi Mukai
- Department of Gastroenterology, Gifu Municipal Hospital, Gifu, Japan
| | - Masahito Shimizu
- First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan
| | - Hiroyuki Isayama
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Ichiro Yasuda
- Third Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
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Guardado NV, Llorente K, Blondeau B. Evaluation and Management of Malignant Biliary Obstruction. Surg Oncol Clin N Am 2021; 30:491-503. [PMID: 34053664 DOI: 10.1016/j.soc.2021.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
There is no reason to be pollyannaish when approaching patients with malignant biliary obstruction (MBO). Although technology has allowed refining diagnosis and resectability of cancers causing biliary obstruction, outcomes have not improved significantly. The previous preponderant place of surgical procedures now is replaced by endoluminal and percutaneous techniques for the management of symptoms of MBO. Because quantity of life often is the primary and sole outcome for evaluation of various interventions, the main focus of patient quality of life may be erroneously deemphasized. Lagging behind scientific advances are the availability of palliative care services and studies of patient-related outcomes.
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Affiliation(s)
- Nadia V Guardado
- Department of Surgery, University of New Mexico School of Medicine, 2425 Camino de Salud, Albuquerque, NM 87106, USA
| | - Kaysey Llorente
- Department of Surgery, University of New Mexico School of Medicine, 2425 Camino de Salud, Albuquerque, NM 87106, USA
| | - Benoit Blondeau
- Department of Surgery, Division of Trauma Surgery, University of New Mexico; Division of Palliative Medicine, University of New Mexico, Albuquerque, NM, USA.
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Sundaram S, Dhir V. EUS-guided biliary drainage for malignant hilar biliary obstruction: A concise review. Endosc Ultrasound 2021; 10:154-160. [PMID: 34137381 PMCID: PMC8248311 DOI: 10.4103/eus-d-21-00004] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/23/2021] [Indexed: 12/17/2022] Open
Abstract
EUS-guided biliary drainage (EUS-BD) has emerged as an alternative to ERCP for distal biliary obstruction in expert hands. Various routes for EUS-guided access in distal biliary obstruction include EUS choledochoduodenostomy, EUS-guided rendezvous, and EUS-antegrade (EUS-AG) stent placement. While percutaneous transhepatic biliary drainage and ERCP are established modalities in management of malignant hilar biliary obstruction, the role of EUS-BD is emerging. Various methods of drainage in hilar obstruction include EUS hepaticogastrostomy, EUS hepaticoduodenostomy, EUS-guided bridging stent placement, and combined ERCP and EUS-guided biliary drainage. In this review, we discuss the role of EUS-BD in malignant hilar biliary obstruction with the currently available evidence, along with the limitations and challenges to the use of this modality in management of these patients.
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Affiliation(s)
- Sridhar Sundaram
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Vinay Dhir
- Institute of Digestive and Liver Care, SL Raheja Hospital, Mumbai, Maharashtra, India
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Vanbiervliet G, Strijker M, Arvanitakis M, Aelvoet A, Arnelo U, Beyna T, Busch O, Deprez PH, Kunovsky L, Larghi A, Manes G, Moss A, Napoleon B, Nayar M, Pérez-Cuadrado-Robles E, Seewald S, Barthet M, van Hooft JE. Endoscopic management of ampullary tumors: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2021; 53:429-448. [PMID: 33728632 DOI: 10.1055/a-1397-3198] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
1: ESGE recommends against diagnostic/therapeutic papillectomy when adenoma is not proven.Strong recommendation, low quality evidence. 2: ESGE recommends endoscopic ultrasound and abdominal magnetic resonance cholangiopancreatography (MRCP) for staging of ampullary tumors.Strong recommendation, low quality evidence. 3: ESGE recommends endoscopic papillectomy in patients with ampullary adenoma without intraductal extension, because of good results regarding outcome (technical and clinical success, morbidity, and recurrence).Strong recommendation, moderate quality evidence. 4: ESGE recommends en bloc resection of ampullary adenomas up to 20-30 mm in diameter to achieve R0 resection, for optimizing the complete resection rate, providing optimal histopathology, and reduction of the recurrence rate after endoscopic papillectomy.Strong recommendation, low quality evidence. 5: ESGE suggests considering surgical treatment of ampullary adenomas when endoscopic resection is not feasible for technical reasons (e. g. diverticulum, size > 4 cm), and in the case of intraductal involvement (of > 20 mm). Surveillance thereafter is still mandatory.Weak recommendation, low quality evidence. 6: ESGE recommends direct snare resection without submucosal injection for endoscopic papillectomy.Strong recommendation, moderate quality evidence. 7: ESGE recommends prophylactic pancreatic duct stenting to reduce the risk of pancreatitis after endoscopic papillectomy.Strong recommendation, moderate quality evidence. 8: ESGE recommends long-term monitoring of patients after endoscopic papillectomy or surgical ampullectomy, based on duodenoscopy with biopsies of the scar and of any abnormal area, within the first 3 months, at 6 and 12 months, and thereafter yearly for at least 5 years.Strong recommendation, low quality evidence.
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Affiliation(s)
- Geoffroy Vanbiervliet
- Department of Digestive Endoscopy, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Marin Strijker
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marianna Arvanitakis
- Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Arthur Aelvoet
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Urban Arnelo
- Department of Surgery, Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Torsten Beyna
- Department of Gastroenterology, Evangelisches Krankenhaus Düsseldorf, Dusseldorf, Nordrhein-Westfalen, Germany
| | - Olivier Busch
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Pierre H Deprez
- Gastroenterology and Hepatology Department, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Lumir Kunovsky
- Department of Gastroenterology and Internal Medicine, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Department of Surgery, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Alberto Larghi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gianpiero Manes
- Aziende Socio Sanitaria Territoriale Rhodense, Gastroenterology, Garbagnate Milanese, Italy
| | - Alan Moss
- Department of Endoscopic Services, Western Health, Melbourne, Australia
- Department of Medicine, Western Health, Melbourne Medical School, University of Melbourne, Victoria, Australia
| | - Bertrand Napoleon
- Service de Gastroentérologie, Hôpital Privé Jean Mermoz, Ramsay Générale de Santé, Lyon, France
| | - Manu Nayar
- Department of Gastroenterology, Freeman Hospital, Newcastle upon Tyne, UK
| | - Enrique Pérez-Cuadrado-Robles
- Department of Gastroenterology, Georges-Pompidou European Hospital, AP-HP Centre - Université de Paris, Paris, France
| | - Stefan Seewald
- Gastroenterology Center, Klinik Hirslanden, Zurich, Switzerland
| | - Marc Barthet
- Department of Gastroenterology, Hôpital Nord, Assistance publique des hôpitaux de Marseille, Marseille, France
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, The Netherlands
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Abstract
PURPOSE OF REVIEW Bile duct cannulation using conventional techniques fails in up to 16% of endoscopic retrograde cholangiopancreatography (ERCP) procedures. Advanced techniques to gain biliary access include ERCP-based maneuvers, and newer endoscopic ultrasound (EUS)-guided interventions. In this article, we review the evidence supporting the use of various ERCP and EUS techniques for biliary access, as well as studies comparing these different techniques. RECENT FINDINGS In comparative studies, biliary access after failed conventional cannulation was more successful with EUS-rendezvous compared to precut papillotomy. EUS-guided drainage compares favorably with percutaneous drainage with respect to clinical success, safety profile, and cost-efficiency. Recent randomized trials comparing EUS to ERCP drainage in malignant obstruction have found similar success rates between these techniques. EUS-guided techniques compare favorably to ERCP-based methods for biliary access and drainage. The advent of newer technologies to facilitate interventional EUS may further change current treatment approaches.
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Affiliation(s)
- Abdul H El Chafic
- Department of Gastroenterology, Ochsner Health - New Orleans, 1514 Jefferson Hwy, New Orleans, LA, 70121, USA
| | - Janak N Shah
- Department of Gastroenterology, Ochsner Health - New Orleans, 1514 Jefferson Hwy, New Orleans, LA, 70121, USA.
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Nakai Y. Technical tips for endoscopic ultrasound-guided pancreatic duct access and drainage. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2020. [DOI: 10.18528/ijgii200032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Yousuke Nakai
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Teoh AYB. Endoscopic ultrasound-guided anastomosis: Is it ready for prime time? J Gastroenterol Hepatol 2020; 35:1288-1293. [PMID: 32415861 DOI: 10.1111/jgh.15099] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/08/2020] [Accepted: 05/10/2020] [Indexed: 12/12/2022]
Abstract
Significant advancements in endoscopic ultrasound (EUS)-guided drainage procedures and EUS-guided anastomosis have recently been described. The described procedures include EUS-guided drainage of pancreatic fluid collections, biliary drainage, pancreatic duct drainage, gallbladder drainage, and gastroenterostomy. These procedures have been made possible with novel devices that can reduce the difficulties of the procedures and potentially reducing the risk of adverse events. The procedures are also becoming standardized, which is essential for dissemination of the techniques. Furthermore, results from randomized studies are becoming available showing definite benefits associated with these procedures. In this paper, we will provide a review on EUS-guided anastomotic procedures.
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Affiliation(s)
- Anthony Yuen Bun Teoh
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
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Irisawa A, Miyoshi H, Itoi T, Ryozawa S, Kida M, Inui K. Recent innovations in therapeutic endoscopy for pancreatobiliary diseases. Dig Endosc 2020; 32:309-315. [PMID: 31240746 DOI: 10.1111/den.13473] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 06/23/2019] [Indexed: 02/08/2023]
Abstract
The development of endoscopic treatment for pancreatobiliary diseases in recent years is remarkable. In addition to conventional transpapillary treatments under endoscopic retrograde cholangiopancreatography (ERCP), new endoscopic ultrasound-guided therapy is being developed and implemented. On the other hand, due to the development/improvement of various devices such as new metal stents, a new therapeutic strategy under ERCP is also advocated. The present review focuses on recent advances in the endoscopic treatment of pancreatic pseudocysts, walled-off necrosis, malignant biliary strictures, and benign biliary/pancreatic duct strictures.
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Affiliation(s)
- Atsushi Irisawa
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Hironao Miyoshi
- Department of Gastroenterology, Bantane Hospital, Fujita Health University, Aichi, Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Shomei Ryozawa
- Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Mitsuhiro Kida
- Department of Gastroenterology, Kitasato University School of Medicine, Kanagawa, Japan
| | - Kazuo Inui
- Department of Gastroenterology, Bantane Hospital, Fujita Health University, Aichi, Japan
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Tringali A. Endoscopic Management in Malignant Biliary Strictures: Tips and Tricks. ENDOTHERAPY IN BILIOPANCREATIC DISEASES: ERCP MEETS EUS 2020:431-461. [DOI: 10.1007/978-3-030-42569-2_40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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