scholarly journals Endoscopic Ultrasound Guided Rendezvous Drainage of Biliary Obstruction Using a New Flexible 19-Gauge Fine Needle Aspiration Needle

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Zhouwen Tang ◽  
Efehi Igbinomwanhia ◽  
Sherif Elhanafi ◽  
Mohamed O. Othman
Keyword(s):  
Success Rate ◽  
Endoscopic Ultrasound ◽  
Biliary Drainage ◽  
Biliary Obstruction ◽  
Guide Wire ◽  
Case Series ◽  
Ultrasound Guided ◽  
Retrospective Case ◽  
Technical Success Rate ◽  
Significant Difference

Background and Aim. A successful endoscopic ultrasound guided rendezvous (EUS-RV) biliary drainage is dependent on accurate puncture of the bile duct and precise guide wire manipulation across the ampulla of Vater. We aim to study the feasibility of using a flexible 19-gauge fine aspiration needle in the performance of EUS-RV biliary drainage. Method. This is a retrospective case series of EUS-RV biliary drainage procedures at a single center. Patients who failed ERCP during the same session for benign or malignant biliary obstruction underwent EUS-RV using a flexible, nitinol covered, 19-gauge needle for biliary access and guide wire manipulation. Result. 24 patients underwent EUS-RV biliary drainage via extrahepatic access while 1 attempt was via intrahepatic access. The technical success rate was 80%, including 83.3% of cases via extrahepatic access. There was no significant difference in success rate of inpatient and outpatient procedures, benign or malignant indications, or type of guide wire used. Adverse events included mild pancreatitis (3 patients) and cholangitis (1 patient). Conclusion. A flexible 19-gauge needle for biliary access can be safe and effective when used to perform EUS-RV biliary drainage. Direct comparison between the nitinol needle and conventional metal needles in the performance of EUS guided biliary drainage is needed.

scholarly journals Palliative Endoscopic Ultrasound Biliary Drainage for Advanced Malignant Biliary Obstruction: Should It Replace the Percutaneous Approach?

2019 ◽  
Vol 13 (3) ◽  
pp. 385-397 ◽  
Author(s):  
C. Rinaldi A. Lesmana ◽  
Rino A. Gani ◽  
Irsan Hasan ◽  
Andri Sanityoso Sulaiman ◽  
Khek Yu Ho ◽  
...  
Keyword(s):  
Success Rate ◽  
Endoscopic Ultrasound ◽  
Biliary Drainage ◽  
Biliary Obstruction ◽  
Clinical Success ◽  
Case Series ◽  
Clinical Success Rate ◽  
Malignant Biliary Obstruction ◽  
Technical Success Rate ◽  
Case Series Study

Endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic biliary drainage (PTBD) are the standard of care in malignant biliary obstruction cases. Recently, endoscopic ultrasound-guided biliary drainage (EUS-BD) has been widely used after unsuccessful ERCP. However, the patient’s clinical impact of EUS-BD over PTBD is still not obvious. Therefore, this case series study aims to evaluate the clinical outcomes of patients with advanced malignant biliary obstruction who underwent EUS-BD after failed ERCP. A retrospective database study was performed between January 2016 and June 2018 in patients with advanced malignant biliary obstruction. Patients were consecutively enrolled without randomization. Treatment options consisted of ERCP and PTBD or EUS-BD if ERCP failed. Based on 144 biliary obstruction cases, 38 patients were enrolled; 24 (63.2%) were men. The patients’ mean age was 66.8 ± 12.36 years. The most common cause of malignant biliary obstruction was pancreatic cancer (44.7%). Biliary drainage was achieved by ERCP (39.5%), PTBD (39.5%), and EUS-BD (21.1%). The technical success rate was 86.7% by PTBD and 87.5% by EUS-BD (p = 1.000), while the clinical success rate was 93.3% by PTBD and 62.5% by EUS-BD (p = 0.500). The median survival in patients who underwent PTBD versus those wo underwent EUS-BD was 11 versus 3 months (log-rank p = 0.455). In conclusion, there is no significant advantage of EUS-BD when compared to PTBD in terms of clinical success and survival benefit in advanced malignant biliary obstruction.

scholarly journals Endoscopic Ultrasound-Guided Angiotherapy for Gastric Varices—A Small Retrospective Study

2020 ◽  
Vol 11 (03) ◽  
pp. 201-204
Author(s):  
Kapil Sharma ◽  
Mamta Sharma ◽  
Sanchit Singh
Keyword(s):  
Endoscopic Ultrasound ◽  
Case Series ◽  
Gastric Varices ◽  
Secondary Prophylaxis ◽  
Limited Data ◽  
Technical Success ◽  
Ultrasound Guided ◽  
Retrospective Case ◽  
Technical Success Rate ◽  
Complete Obliteration

Abstract Introduction Conventional n-butyl-cyanoacrylate (CYA) recommended for secondary prophylaxis of gastric varices (GV) is associated with significant rebleeding and glue embolism. Limited data are available on more successful and less risky endoscopic ultrasound-guided coils and CYA (EUS-Coils-CYA) injection in GV. Methods We present a retrospective case series of 12 patients with GV bleeding managed successfully with EUS-Coils-CYA injection leading to variceal eradication in 11 patients. Results From January 2018 to June 2019, 12 cases of GV, which were either bleeding or bled recently, were included. Complete obliteration was achieved in 91.6% of patients with 100% technical success. Mean number of deployed coils and volume of injected CYA glue were 1.16 and 1.58 mL, respectively. Conclusions EUS-guided angiotherapy is an effective and safe intervention for managing GV bleeding with high technical success rate.

Comparative Outcomes of EUS-Guided Lumen-Apposing Mental Stents Drainage for Pancreatic Pseudocysts and Walled-off Necrosis: Case Series and Meta-Analysis

2020 ◽  
Author(s):  
Jing Li ◽  
Qian Zhang ◽  
Anni Zhou ◽  
Guiping Zhao ◽  
Wenhai Wang ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Clinical Success ◽  
Medical Center ◽  
Meta Analysis ◽  
Case Series ◽  
Pancreatic Pseudocysts ◽  
Ultrasound Guided ◽  
Technical Success Rate ◽  
Significant Difference ◽  
Walled Off Necrosis

Abstract Background and Aims: Endoscopic ultrasound-guided transmural drainage for pancreatic fluid collections (PFCs) has become the first-line treatment with quicker recovery and less injury compared with surgery and percutaneous drainage. The efficacy of stents implantation and drainage for different types of PFCs remains controversial, especially lumen-apposing mental stents (LAMS). This study aims to compare efficacy and safety of LAMS drainage for pancreatic pseudocysts (PPC) and walled-off necrosis (WON).Methods: A meta-analysis was performed for LAMS drainage for WON and PPC by systematically searching PubMed, Cochrane, and Embase databases from January 2010 to January 2020. From 2017 to 2019, 12 patients who were treated with LAMS drainage for PFCs in our medical center were also reviewed and included in this study.Results: Combining 11 searched literatures with the data from our medical center, a total of 585 patients with PFCs were enrolled in this meta-analysis, including 343 patients with WON and 242 with PPC. The technical success rate in WON is not significant different from that of PPC (P = 0.08 > 0.05). The clinical success of LAMS placement was achieved in 99% versus 89% in PPC and WON, respectively (RR = 0.92, 95% CI: 0.86–0.98, P = 0.01 < 0.05). Further intervention of direct endoscopic necrosectomy was required in 60% of patients in WON group. There was no significant difference in the incidence of adverse events after LAMS placement between WON and PPC, including infection, bleeding, stent migration and stent occlusion.Conclusions: Endoscopic ultrasound-guided LAMS for PFCs is feasible, effective with preferable technical and clinical success rates. The clinical effect of LAMS on PPC is better than that of WON, but its adverse reactions still need to be verified in a large-sample prospective study.

scholarly journals ELEMENT TRIAL: study protocol for a randomized controlled trial on endoscopic ultrasound-guided biliary drainage of first intent with a lumen-apposing metal stent vs. endoscopic retrograde cholangio-pancreatography in the management of malignant distal biliary obstruction

Trials ◽  
2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Yen-I Chen ◽  
◽  
Kashi Callichurn ◽  
Avijit Chatterjee ◽  
Etienne Desilets ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Biliary Drainage ◽  
Biliary Obstruction ◽  
Locally Advanced ◽  
Endoscopic Drainage ◽  
Metal Stent ◽  
Ultrasound Guided ◽  
Endoscopic Retrograde ◽  
Promising Alternative ◽  
Randomized Controlled

Abstract Background & aims Endoscopic ultrasound guided-biliary drainage (EUS-BD) is a promising alternative to endoscopic retrograde cholangiopancreatography (ERCP); however, its growth has been limited by a lack of multicenter randomized controlled trials (RCT) and dedicated devices. A dedicated EUS-BD lumen- apposing metal stent (LAMS) has recently been developed with the potential to greatly facilitate the technique and safety of the procedure. We aim to compare a first intent approach with EUS-guided choledochoduodenostomy with a dedicated biliary LAMS vs. standard ERCP in the management of malignant distal biliary obstruction. Methods The ELEMENT trial is a multicenter single-blinded RCT involving 130 patients in nine Canadian centers. Patients with unresectable, locally advanced, or borderline resectable malignant distal biliary obstruction meeting the inclusion and exclusion criteria will be randomized to EUS-choledochoduodenostomy using a LAMS or ERCP with traditional metal stent insertion in a 1:1 proportion in blocks of four. Patients with hilar obstruction, resectable cancer, or benign disease are excluded. The primary endpoint is the rate of stent dysfunction needing re-intervention. Secondary outcomes include technical and clinical success, interruptions in chemotherapy, rate of surgical resection, time to stent dysfunction, and adverse events. Discussion The ELEMENT trial is designed to assess whether EUS-guided choledochoduodenostomy using a dedicated LAMS is superior to conventional ERCP as a first-line endoscopic drainage approach in malignant distal biliary obstruction, which is an important and timely question that has not been addressed using an RCT study design. Trial registration Registry name: ClinicalTrials.gov. Registration number: NCT03870386. Date of registration: 03/12/2019.

scholarly journals ERCP plus endoscopic ultrasound-guided biliary drainage versus percutaneous transhepatic biliary drainage for malignant hilar biliary obstruction: a multicenter observational open-label study

Endoscopy ◽  
2020 ◽  
Vol 53 (01) ◽  
pp. 55-62 ◽  
Author(s):  
Pradermchai Kongkam ◽  
Theerapat Orprayoon ◽  
Chaloemphon Boonmee ◽  
Passakorn Sodarat ◽  
Orathai Seabmuangsai ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Biliary Drainage ◽  
Biliary Obstruction ◽  
Percutaneous Transhepatic Biliary Drainage ◽  
Ultrasound Guided ◽  
Group A ◽  
Hilar Biliary Obstruction ◽  
Malignant Hilar Biliary Obstruction ◽  
Group B ◽  
Transhepatic Biliary Drainage

Abstract Background Endoscopic retrograde cholangiopancreatography (ERCP) may not provide complete biliary drainage in patients with Bismuth III/IV malignant hilar biliary obstruction (MHBO). Complete biliary drainage is accomplished by adding percutaneous transhepatic biliary drainage (PTBD). We prospectively compared recurrent biliary obstruction (RBO) rates between combined ERCP and endoscopic ultrasound-guided biliary drainage (EUS-BD) vs. bilateral PTBD. Methods Patients with MHBO undergoing endoscopic procedures (group A) were compared with those undergoing bilateral PTBD (group B). The primary outcome was the 3-month RBO rate. Results 36 patients were recruited into groups A (n = 19) and B (n = 17). Rates of technical and clinical success, and complications of group A vs. B were 84.2 % (16/19) vs. 100 % (17/17; P = 0.23), 78.9 % (15/19) vs. 76.5 % (13/17; P > 0.99), and 26.3 % (5/19) vs. 35.3 % (6/17; P = 0.56), respectively. Within 3 and 6 months, RBO rates of group A vs. group B were 26.7 % (4/15) vs. 88.2 % (15/17; P  = 0.001) and 22.2 % (2/9) vs. 100 % (9/9; P = 0.002), respectively. At 3 months, median number of biliary reinterventions in group A was significantly lower than in group B (0 [interquartile range] 0–1 vs. 1 [1–2.5]), respectively (P < 0.001). Median time to development of RBO was longer in group A than in group B (92 [56–217] vs. 40 [13.5–57.8] days, respectively; P  =  0.06). Conclusions Combined ERCP and EUS procedures provided significantly lower RBO rates at 3 and 6 months vs. bilateral PTBD, with similar complication rates and no significant mortality difference.

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