scholarly journals Fully Covered Self-Expandable Metal Stents for Treatment of Both Benign and Malignant Biliary Disorders

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Ahmed Abdel Samie ◽  
Lorenz Theilmann
Keyword(s):  
Bile Duct ◽  
Endoscopic Sphincterotomy ◽  
Biliary Obstruction ◽  
Therapeutic Option ◽  
Metal Stents ◽  
Distal Bile Duct ◽  
Biliary Strictures ◽  
Bile Duct Stenosis ◽  
Self Expanding Metal Stents ◽  
Duct Stenosis

Transpapillary stents are increasingly being used for biliary strictures, whether benign or malignant. However, there are different stent types and available data is controversial. Recently, completely covered self-expandable metal stents (CSEMSs) have been proposed as an alternative therapeutic option in different biliary indications, including strictures of the distal bile duct, anastomotic stenosis after orthotopic liver transplantation, bile duct leaks, periampullary perforation following endoscopic sphincterotomy (ES), and postsphincterotomy bleeding. Despite the higher costs of these devices, fully covered self-expanding metal stents seem to be a suitable therapeutic option to relief biliary obstruction due to bile duct stenosis, regardless of the underlying cause.

scholarly journals Difficulty Achieving a Preoperative Diagnosis of IgG4-Related Sclerosing Cholangitis

2018 ◽  
Vol 12 (2) ◽  
pp. 425-431
Author(s):  
Kazuhiro Suzumura ◽  
Etsuro Hatano ◽  
Masaharu Tada ◽  
Hideaki Sueoka ◽  
Hiroshi Nishida ◽  
...  
Keyword(s):  
Bile Duct ◽  
Preoperative Diagnosis ◽  
Sclerosing Cholangitis ◽  
Wall Thickening ◽  
Distal Bile Duct ◽  
Obliterative Phlebitis ◽  
Bile Duct Stenosis ◽  
Storiform Fibrosis ◽  
Lymphoplasmacytic Infiltration ◽  
Duct Stenosis

A 75-year-old male was admitted to our hospital because of bile duct stenosis. He had no medical history of autoimmune disease. The level of tumor markers, serum IgG, and IgG4 were within normal ranges. Computed tomography showed perihilar and distal bile duct stenosis and wall thickening without swelling or abnormal enhancement of the pancreas. Endoscopic retrograde cholangiopancreatography showed perihilar and distal bile duct stenosis. A biopsy and cytology from the distal bile duct stenosis suggested adenocarcinoma, and cytology from the perihilar bile duct also suggested adenocarcinoma. A preoperative diagnosis of perihilar and distal bile duct cancer was made, and the patient underwent left hepatectomy and pancreaticoduodenectomy. Resected specimens showed wall thickening in the perihilar and distal bile duct; however, tumors were unclear. A histopathological examination revealed lymphoplasmacytic infiltration, storiform fibrosis, and obliterative phlebitis in the perihilar and distal bile ducts. Immunohistochemistry revealed diffuse infiltration of IgG4-positive plasma cells in the perihilar and distal bile ducts. Lymphoplasmacytic infiltration, inflammatory change, storiform fibrosis, and obliterative phlebitis were shown in the pancreas. A final diagnosis of IgG4-related sclerosing cholangitis (IgG4-SC) with autoimmune pancreatitis was made. We herein report a case in which a preoperative diagnosis of IgG4-SC was difficult due to normal serum IgG4 levels and no obvious pancreatic lesion.

A Rare Cause of Distal Bile Duct Stenosis

2007 ◽  
Vol 38 (2-4) ◽  
pp. 157-159 ◽  
Author(s):  
F. Stoeckler ◽  
E. Hagmüller ◽  
H.-J. Rumpelt ◽  
U. Weickert
Keyword(s):  
Bile Duct ◽  
Distal Bile Duct ◽  
Bile Duct Stenosis ◽  
Duct Stenosis

scholarly journals New Stents for Endoscopic Ultrasound-Guided Procedures

2021 ◽  
Vol 26 (4) ◽  
pp. 248-253
Author(s):  
Gunn Huh ◽  
Tae Jun Song
Keyword(s):  
Bile Duct ◽  
Endoscopic Ultrasound ◽  
Therapeutic Option ◽  
Fluid Collection ◽  
Metal Stents ◽  
Efficacy And Safety ◽  
Ultrasound Guided ◽  
Therapeutic Outcomes ◽  
Transmural Drainage ◽  
Self Expanding Metal Stents

Endoscopic ultrasound (EUS)-guided transmural drainage of peripancreatic fluid collection, gallbladder, bile duct, or pancreatic duct has emerged as a therapeutic option in patients with pancreatobiliary diseases. Recently, dedicated stents for EUS-guided interventions, which include lumen-apposing metal stents and modified tubular self-expanding metal stents, have been developed to improve efficacy and safety of these procedures. This article has reviewed newly developed stents for EUSguided interventions and their therapeutic outcomes.

scholarly journals Flat Papilla of Vater and Bleeding during Endoscopic Sphincterotomy: Two New Risk Factors for Post-Endoscopic Pancreatitis

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Jamry A ◽  
Keyword(s):  
Risk Factors ◽  
Bile Duct ◽  
Endoscopic Sphincterotomy ◽  
Multivariate Regression ◽  
Pathological Examination ◽  
Papilla Of Vater ◽  
Bleeding Control ◽  
Endoscopic Retrograde ◽  
Bile Duct Stenosis ◽  
Duct Stenosis

Objective: To analyze the risk factors for post-endoscopic pancreatitis (PEP). Background: PEP occurs in 4%-42% of patients, depending on their risk factors. Over 56 risk factors were analyzed, but only 4were found to be repeated in most studies. Study: A single-center retrospective study analyzing 402 consecutive patients with naïve papillae who underwent Endoscopic Retrograde Cholangiopancreatography (ERCP) was conducted. The significance of 14 potentially new risk factors was evaluated, and it was found that they were associated with the level of bile duct stenosis, papilla anatomy, bleeding during sphincterotomy, endoscopic bleeding control, and pathological examination. Furthermore, 13 of the most frequently published risk factors were re-analyzed. Results: Five risk factors (containing two new ones) were significant with the following univariate and multivariate regression values: flat papilla (odds ratio [OR] 5.1, p=0.0049; OR 4.59, p=0.0244) and bleeding during endoscopic sphincterotomy (OR 3.58, p=0.148; OR 4.07, p=0.0257), and significance of the three already known risk factors was confirmed: age <40 years (OR 6.89, p=0.0139; OR 4.96, p=0.0139), common bile duct (CBD) diameter < 9 mm (OR 5.35, p=0.0007; OR 3.98, p=0.0203), and difficulty in cannulation (OR 3.2, p=0.0298; OR 7.72, p=0.004). Conclusion: This study reaffirms the risk of PEP associated with age, difficulty in cannulation, and CBD diameter. It also identifies two new risk factors: flat papilla and bleeding during sphincterotomy. These results suggest the need for a change in ERCP methodology in patients with these risk factors, but this finding requires confirmation in subsequent studies.

scholarly journals Outcomes of Endoscopic Ultrasound-Guided Biliary Drainage in a General Hospital for Patients with Endoscopic Retrograde Cholangiopancreatography-Difficult Transpapillary Biliary Drainage

2021 ◽  
Vol 10 (18) ◽  
pp. 4105
Author(s):  
Naosuke Kuraoka ◽  
Satoru Hashimoto ◽  
Shigeru Matsui ◽  
Shuji Terai
Keyword(s):  
Bile Duct ◽  
Endoscopic Ultrasound ◽  
Biliary Drainage ◽  
Duodenal Bulb ◽  
Distal Bile Duct ◽  
Ultrasound Guided ◽  
Difficult Patients ◽  
Stent Patency ◽  
Bile Duct Stenosis ◽  
Duct Stenosis

Endoscopic ultrasound-guided biliary drainage (EUS-BD) has been developed as an alternative treatment for percutaneous transhepatic biliary drainage for patients with bile duct stenosis. At specialized hospitals, the high success rate and effectiveness of EUS-BD as primary drainage has been reported. However, the procedure is highly technical and difficult, and it has not been generally performed. In this study, we retrospectively examined the effectiveness of EUS-BD in ERCP-difficult patients with distal bile duct stenosis. We retrospectively examined 24 consecutive cases in which EUS-BD was performed at our hospital for distal bile duct stenosis from October 2018 to December 2020. EUS-guided choledochoduodenostomy (EUS-CDS) was selected for cases that could be approached from the duodenal bulb, and EUS-HGS was selected for other cases. In the EUS-CDS and EUS-HGS groups, the technical success rates were 83.3% (10/12] and 91.7% (11/12], respectively. An adverse event occurred in one case in the EUS-CDS group, which developed severe biliary peritonitis. The stent patency period was 91 and 101 days in the EUS-CDS and EUS-HGS groups, respectively. EUS-BD for ERCP-difficult patients with distal bile duct stenosis is considered to be an effective alternative for biliary drainage that can be performed not only in specialized hospitals but also in general hospitals.

scholarly journals Extraluminal recanalization for postoperative biliary obstruction using transseptal needle

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Hiroki Horinouchi ◽  
Eisuke Ueshima ◽  
Keitaro Sofue ◽  
Shohei Komatsu ◽  
Takuya Okada ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Bile Duct ◽  
Biliary Obstruction ◽  
Hepatic Duct ◽  
Drainage Tube ◽  
Biliary Strictures ◽  
Hepatic Bile ◽  
Hepatic Bile Duct ◽  
Benign Biliary Strictures ◽  
The Right

Abstract Background Postoperative biliary strictures are commonly related to accidental bile duct injuries or occur at the site of biliary anastomosis. The first-line treatment for benign biliary strictures is endoscopic therapy, which is less invasive and repeatable. However, recanalization for biliary complete obstruction is technically challenging to treat. The present report describes a successful case of treatment by extraluminal recanalization for postoperative biliary obstruction using a transseptal needle. Case presentation A 66-year-old woman had undergone caudal lobectomy for the treatment of hepatocellular carcinoma. The posterior segmental branch of the bile duct was injured and repaired intraoperatively. Three months after the surgery, the patient had developed biliary leakage from the right hepatic bile duct, resulting in complete biliary obstruction. Since intraluminal recanalization with conventional endoscopic and percutaneous approaches with a guidewire failed, extraluminal recanalization using a transseptal needle with an internal lumen via percutaneous approach was performed under fluoroscopic guidance. The left lateral inferior segmental duct was punctured, and an 8-F transseptal sheath was introduced into the ostium of right hepatic duct. A transseptal needle was advanced, and the right hepatic duct was punctured by targeting an inflated balloon that was placed at the end of the obstructed right hepatic bile duct. After confirming successful puncture using contrast agent injected through the internal lumen of the needle, a 0.014-in. guidewire was advanced into the right hepatic duct. Finally, an 8.5-F internal–external biliary drainage tube was successfully placed without complications. One month after the procedure, the drainage tube was replaced with a 10.2-F drainage tube to dilate the created tract. Subsequent endoscopic internalization was performed 5 months after the procedure. At the 1-year follow-up examination, there was no sign of biliary obstruction and recurrence of hepatocellular carcinoma. Conclusions Recanalization using a transseptal needle can be an alternative technique for rigid biliary obstruction when conventional techniques fail.

scholarly journals Obstructive Jaundice Following Transarterial Chemoembolization for Hepatocellular Carcinoma with Bile Duct Invasion

2021 ◽  
Vol 5 (02) ◽  
pp. 127-130
Author(s):  
Kazuki Matsushita ◽  
Ken Kageyama ◽  
Natsuhiko Kameda ◽  
Yurina Koizumi ◽  
Akira Yamamoto
Keyword(s):  
Hepatocellular Carcinoma ◽  
Bile Duct ◽  
Obstructive Jaundice ◽  
Transarterial Chemoembolization ◽  
Tumor Invasion ◽  
Endoscopic Sphincterotomy ◽  
Biliary Obstruction ◽  
Intraductal Tumor ◽  
Bile Duct Invasion ◽  
The Common

AbstractHepatocellular carcinoma (HCC) with bile duct invasion is considered rare. A case in which a fragment of intraductal tumor dropped into the common bile duct after transarterial chemoembolization (TACE) and caused abdominal pain, and obstructive jaundice secondary to biliary obstruction is presented. This case was successfully managed by emergent endoscopic sphincterotomy. Physicians should recognize one of the complications due to TACE for HCC with intraductal tumor invasion.

scholarly journals Endoscopic laser lithotripsy for complicated bile duct stones: is cholangioscopic guidance necessary?

2007 ◽  
Vol 44 (2) ◽  
pp. 137-140 ◽  
Author(s):  
Ralf Jakobs ◽  
Julio C. Pereira-Lima ◽  
Aline W. Schuch ◽  
Lucas F. Pereira-Lima ◽  
Axel Eickhoff ◽  
...  
Keyword(s):  
Bile Duct ◽  
Laser Lithotripsy ◽  
Bile Duct Stones ◽  
Distal Bile Duct ◽  
Laser Guidance ◽  
Endoscopic Papillotomy ◽  
Intrahepatic Stones ◽  
Bile Duct Stenosis ◽  
Extracorporeal Shock Wave ◽  
Fluoroscopic Control

BACKGROUND: Endoscopic papillotomy is successful in more than 95% of the cases of choledocholithiasis. For patients with difficult bile duct stones not responding to mechanical lithotripsy, different methods for stone fragmentation have been developed. AIM: To compare the results of laser lithotripsy with a stone-tissue recognizing system, when guided by fluoroscopy only or by cholangioscopy. METHODS: Between 1992 and 2002 we have treated 89 patients with difficult bile duct stones by endoscopic retrograde cholangiopancreatography and laser lithotripsy. Unsuccessful extracorporeal shock-wave lithotripsy and electrohydraulic were also performed before laser in 35% and 26% of the cases, respectively. RESULTS: Laser was effective in 79.2% of 72 patients guided by cholangioscopy and in 82.4% of 17 cases steered by fluoroscopy. The median number of impulses in the latter was 4,335 and 1,800 with the former technique. Two parameters influenced the manner of laser guidance. In cases of stones situated above a stricture, cholangioscopic control was more effective (64.7% vs. 31.9%). When the stones were in the distal bile duct, fluoroscopic control was more successful. CONCLUSION: In cases of difficult stones in the distal bile duct, laser lithotripsy under fluoroscopic control is very effective and easily performed. Cholangioscopic guidance should be recommended just in cases of intrahepatic stones or in patients with stones situated proximal to a bile duct stenosis. In these cases, cholangioscopy should be performed either endoscopically or percutaneously.

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