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 The Role of EUS-BD in the Management of Malignant Biliary Obstruction: The Indonesian Perspective

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Dadang Makmun ◽  
Achmad Fauzi ◽  
Murdani Abdullah ◽  
Ari Fahrial Syam
Keyword(s):  
Success Rate ◽  
Stent Placement ◽  
Biliary Drainage ◽  
Biliary Obstruction ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Malignant Biliary Obstruction ◽  
Biliary Stents ◽  
Technical Success Rate ◽  
Periampullary Tumor

Aims. To evaluate the success rate and related factors of endoscopic ultrasound guided-biliary drainage (EUS-BD). Material and Methods. We conducted a retrospective study among 24 patients with malignant biliary obstruction who underwent EUS-BD after failed ERCP from January 2015 to December 2016 in a tertiary health center. The bilirubin levels before and after the procedure were used to define the clinical success rate, while the stent deployment was used to define the technical success rate. We placed either transluminal biliary stents or transpapillary biliary stents. Results. Among 24 patients, choledochoduodenostomy technique was conducted in 23 patients (95.8%) and hepaticogastrostomy technique in 1 patient (4.2%). Transluminal stent placement was conducted in 23 patients, while transpapillary stent placement was conducted in 1 patient. The clinical success rate was 78.2% (18) in choledochoduodenostomy route and 100% (1) in hepaticogastrostomy route. EUS-BD was 2.37 times and 2.11 times more likely to be successful in reducing the bilirubin level in patients with tumor of the head of pancreas and periampullary tumor, respectively, but not in cholangiocarcinoma. Conclusions. EUS-BD is an effective and efficient procedure to achieve biliary drainage among patients with malignant biliary obstruction after ERCP failure.

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 Endoscopic ultrasound guided biliary drainage: a multicenter retrospective experience of a technique slowly gaining acceptance in Egypt

2019 ◽  
Vol 12 ◽  
pp. 263177451988945
Author(s):  
Ahmed Youssef Altonbary ◽  
Ahmed Galal ◽  
Mohamed El-Nady ◽  
Hazem Hakim
Keyword(s):  
Endoscopic Retrograde Cholangiopancreatography ◽  
Endoscopic Ultrasound ◽  
Biliary Drainage ◽  
Biliary Obstruction ◽  
Clinical Success ◽  
Malignant Biliary Obstruction ◽  
Safe Procedure ◽  
Ultrasound Guided ◽  
Endoscopic Retrograde ◽  
Increased Risk

Background and aim: Endoscopic ultrasound-guided biliary drainage is an alternative to failed endoscopic retrograde cholangiopancreatography. Unfortunately, this procedure remains relatively less explored in Egypt due to its high cost, lack of adequate training, and the perception of increased risk. This study is the first multicenter Egyptian experience of an endoscopic ultrasound-guided biliary drainage in patients with malignant biliary obstruction. Patients and methods: We retrospectively reviewed 15 patients (10 men and five women) with malignant biliary obstruction who from October 2013 to May 2019, following a failed or inaccessible endoscopic retrograde cholangiopancreatography, underwent an endoscopic ultrasound-guided choledochoduodenostomy, endoscopic ultrasound-guided hepaticogastrostomy, or endoscopic ultrasound-guided rendezvous. Their mean age was 57.4 years and mean bilirubin was 18.2 mg/dL. The outcome parameters included technical and clinical success. Technical success was defined as the successful placement of a stent in the biliary system, while clinical success was defined as a greater than 50% decrease in the bilirubin levels 2 weeks after the procedure. Patients were monitored for complications during and after the procedure. Results: In total, 15 patients underwent endoscopic ultrasound-guided biliary drainage (eight underwent endoscopic ultrasound-guided choledochoduodenostomy, five underwent endoscopic ultrasound-guided hepaticogastrostomy, and two underwent endoscopic ultrasound-guided rendezvous). The technical and clinical success rates were 100% (15/15 patients) and 93.3% (14/15 patients), respectively. The complication rate was 26.6% (4/15 patients). All complications were mild and self-limited, and included fever, mild biliary peritonitis, pneumoperitoneum, and a slight migration of one plastic stent during insertion. Conclusion: Although slowly gaining acceptance in Egypt, endoscopic ultrasound-guided biliary drainage is an effective and safe procedure in patients with a malignant biliary obstruction after a failed or inaccessible endoscopic retrograde cholangiopancreatography.

Comparison of alteplase and urokinase for pharmacomechanical thrombolysis of clotted hemodialysis access

2018 ◽  
Vol 20 (5) ◽  
pp. 501-506 ◽  
Author(s):  
Ru Yu Tan ◽  
Suh Chien Pang ◽  
Swee Ping Teh ◽  
Kian Guan Lee ◽  
Tze Tec Chong ◽  
...  
Keyword(s):  
Success Rate ◽  
Vascular Access ◽  
Clinical Success ◽  
Univariate Analysis ◽  
Clinical Success Rate ◽  
Skin Dose ◽  
Hemodialysis Access ◽  
Procedure Time ◽  
Technical Success Rate ◽  
Tertiary Teaching

Background: Percutaneous pharmacomechanical thrombolysis is increasingly used to salvage thrombosed hemodialysis access. We aim to evaluate the effectiveness of alteplase compared to urokinase in percutaneous pharmacomechanical thrombolysis clotted access. Methods: Records of patients who underwent pharmacomechanical thrombolysis at Interventional Nephrology Suite in a tertiary teaching hospital from 1 January 2016 to 31 December 2016 were reviewed. Technical and clinical success rates, thrombosis-free and cumulative survivals, procedure time, and radiation dose imparted to patients were compared for pharmacomechanical thrombolysis with urokinase versus alteplase. Results: A total of 122 incident patients underwent pharmacothrombolysis (n = 53 for urokinase, n = 69 for alteplase) during the study period. The mean dose of urokinase and alteplase used was 176,897 ± 73,418 units and 3.7 ± 0.8 mg, respectively. Pharmacomechnical thrombolysis using urokinase versus alteplase has similar technical success rate (98.1% vs 97.1%, p = 0.599), clinical success rate (88.7% vs 97.1%, p = 0.068), complication rate (9.4% vs 13.0%, p = 0.373), and primary patency rates at 3 months (57.1% vs 70.1%, p = 0.106). Thrombosis-free survivals of the vascular access were 113.2 (35.3, 196) days versus 122 (84, 239) days (p = 0.168). Cumulative survivals were 239 (116, 320) vs 213 (110.5, 316.5) days (p = 0.801). Procedure time, fluoroscopy time, skin dose, and dose were significantly lower for pharmacomechanical thrombolysis using alteplase compared to urokinase (p = 0.045, p < 0.0001, p = 0.006, p = 0.001, respectively). Stenting was found to be associated with successful dialysis following thrombolysis on univariate analysis (odds ratio: 9.167, 95% confidence interval: 1.391–19.846, p = 0.021), although this was no longer significant in multivariate analysis (p = 0.078). Conclusion: Alteplase is an effective and safe alternative to urokinase for pharmacomechanical thrombolysis of clotted vascular access.

Endoscopic Ultrasound-Guided Drainage and Treatment of Symptomatic Pancreatic Fluid Collection following Acute or Acute-on-Chronic Pancreatitis – A Single Center Case Series

2018 ◽  
Vol 143 (06) ◽  
pp. 577-585
Author(s):  
Dominik Kaczmarek ◽  
Jacob Nattermann ◽  
Christian Strassburg ◽  
Tobias Weismüller
Keyword(s):  
Success Rate ◽  
Endoscopic Ultrasound ◽  
Clinical Success ◽  
Fluid Collection ◽  
Clinical Success Rate ◽  
Long Term Results ◽  
Pancreatic Fluid Collection ◽  
Endoscopic Procedures ◽  
Pancreatic Fluid

Abstracts Introduction Pancreatic fluid collection (PFC) is a common complication of acute pancreatitis. Endoscopic ultrasound (EUS)-guided drainage, which is often followed by direct endoscopic necrosectomy (DEN), has become the primary approach to treat PFC, including pancreatic pseudocysts (PP) and walled-off necrosis (WON). We aimed to determine retrospectively the short- and long-term results of patients treated in our endoscopy unit and to identify parameters that are associated with treatment efficacy and outcome. Methods The data of 41 consecutive patients with post-pancreatitic PFC, who underwent endoscopic transmural intervention between 2014 and 2016, were analyzed retrospectively. After an initial EUS-guided puncture, one or more plastic stents were placed and DEN was performed if necrotic tissue remained. Results The mean diameter of the PFC was 74.0 ± 4.8 mm. Of the PFCs, 29.3% were classified as PP and 70.7% as WON. Altogether, 196 transmural endoscopic procedures were performed, including 73 endoscopic necrosectomies in a subgroup of 21 patients (20 WON, 1 PP). Initial technical success was achieved in 97.6% of patients and the short-term clinical success rate was 90.2%. The long-term clinical success rate was 82.9%, since four patients died from septic shock and/or multiple organ failure and three patients developed recurrent PFC some months after the initial discharge from endoscopic treatment. Procedural complications were registered in 9 patients during 10 of 196 endoscopic procedures (5.1%): bleeding (6), cardiorespiratory insufficiency (2), perforation with pneumoperitoneum (1), aspiration with respiratory insufficiency (1), and non-perforating superficial damage of the gastric wall (1). Neither the size of the PFC nor the initial value of C-reactive protein (CRP) or other biochemical markers were correlated with efficacy or outcome of treatment. Only the cumulative number of days with CRP > 50 mg/L significantly correlated with the number of follow-up endoscopic sessions and DEN. Fungal colonization of PFC correlated significantly (p < 0.05) with the risk of mortality (44% vs. 0%), need for intensive care treatment (66.7% vs. 25%), and sepsis (55.6% vs. 12.5%). Conclusions We confirm that EUS-guided drainage followed by DEN in patients with solid necrotic material is an effective and relatively safe therapeutic approach. Prolonged elevation of CRP and fungal colonisation of the PFC are associated with a worse course of the disease.

scholarly journals Long-Term Management of Recurrent Cholecystitis after Initial Conservative Treatment: Endoscopic Transpapillary Gallbladder Stenting

2018 ◽  
Vol 2018 ◽  
pp. 1-7
Author(s):  
Hideki Kamada ◽  
Hideki Kobara ◽  
Naohito Uchida ◽  
Kiyohito Kato ◽  
Takayuki Fujimori ◽  
...  
Keyword(s):  
High Risk ◽  
Acute Cholecystitis ◽  
Success Rate ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Technical Success ◽  
Technical Success Rate ◽  
High Risk Patients ◽  
Risk Patients

Background. Endoscopic transpapillary gallbladder stenting (ETGBS) is an effective procedure for treating high-risk patients with acute cholecystitis and severe comorbidities. However, the efficacy of ETGBS for recurrent cholecystitis (RC) remains unclear. This study aimed to explore its efficacy in patients with RC for whom cholecystectomy is contraindicated because of its high surgical risk.Methods. Data on 19 high-risk patients who had undergone ETGBS for RC after initial conservative therapy in our institution between June 2006 and May 2012 were retrospectively examined. The primary outcome was the clinical success rate, which was defined as no recurrences of acute cholecystitis after ETGBS until death or the end of the follow-up period. Secondary outcomes were technical success rate and adverse events (AEs).Results. The clinical success rate of ETGBS was 100%, the technical success rate 94.7%, and AE rate 5%: one patient developed procedure-related mild acute pancreatitis. The clinical courses of all patients were as follows: four died of nonbiliary disease, and the remaining 15 were subsequently treated conservatively. The median duration of follow-up was 14.95 months (range 3–42 months).Conclusions. ETGBS is an effective alternative for managing RC in high-risk patients with severe comorbidities.

Analysis of Outcomes of Endovascular Embolisation: A Cross-Sectional Multicenter Study on 46 Visceral Artery Pseudoaneurysms

2021 ◽  
Author(s):  
Mohammad Koriem Mahmoud Omar ◽  
Moustafa H. M. Othman ◽  
Robert A. Morgan ◽  
Abdelkarem Hasan Abdallah ◽  
Hany M. A. Seif ◽  
...  
Keyword(s):  
Success Rate ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Visceral Artery ◽  
Endovascular Management ◽  
Cross Sectional ◽  
Technical Success Rate ◽  
Endovascular Embolisation ◽  
Visceral Artery Aneurysms ◽  
Perioperative Complication

Abstract Purpose Visceral artery aneurysms are subdivided into true aneurysms and pseudoaneurysms. Visceral artery pseudoaneurysms (VAPAs) are uncommon in clinical practice but may have serious clinical outcomes up to death. Endovascular management is a safe effective alternative option to traditional surgical procedures. This study assesses the outcome of different embolic materials and techniques used in the endovascular management of visceral artery pseudoaneurysms. Materials and methods This is a multicentric prospective analysis of endovascular embolisation of 46 VAPAs with a mean pseudoaneurysm size of 13 ± 11.35 mm. Management using coils only was done in 28/46 patients (60.87%), NBCA glue only in 16/46 patients (34.78%), combined coils and NBCA glue in 1/46 patient (2.17%), and Amplatzer plugs only in 1 patient (2.17%). The management techniques were sac packing in 9/46 patients (19.57%), inflow occlusion in 28/46 patients (60.87%) and trapping in 9/46 patients (19.57%). Results The overall clinical success rate was 93.48%, the overall perioperative complication rate was 15.22% and 30-day mortality was zero. For the coil subgroup (n = 28), the clinical success was 92.86%, while the subgroup of NBCA glue (n = 16) showed clinical success of 93.75%. There was no significant statistical difference between clinical success among coil, and NBCA glue subgroups (P > 0.05). The technical success rate was 100%. Effectiveness of the procedures during the follow-up was 97.83%. Target lesion re-intervention rate was 2.17%. Conclusion Transarterial embolisation can provide high technical and clinical success rates with low perioperative complication and re-intervention rates, as well as satisfactory procedure effectiveness in the management of VAPAs.

scholarly journals Outcomes and Limitations of Endoscopic Ultrasound-guided Hepaticogastrostomy in Malignant Biliary Obstruction

2021 ◽  
Author(s):  
Mateusz Jagielski ◽  
Michał Zieliński ◽  
Jacek Piątkowski ◽  
Marek Jackowski
Keyword(s):  
Gastrointestinal Tract ◽  
Biliary Drainage ◽  
Biliary Obstruction ◽  
Bile Ducts ◽  
Clinical Success ◽  
Hepatic Metastases ◽  
Symptomatic Treatment ◽  
Malignant Biliary Obstruction ◽  
Biliary Duct ◽  
Factors Affecting

Abstract Background: Transpapillary biliary drainage in ERCP is an established method for symptomatic treatment of patients with irresectable malignant biliary obstruction. Percutaneous transhepatic biliary drainage frequently remains the treatment of choice when the transpapillary approach proves ineffective. Recently, EUS-guided extra-anatomical anastomoses of bile ducts to the gastrointestinal tract have been reported as an alternative to percutaneous biliary drainage. To assess the usefulness of extra-anatomical intrahepatic biliary duct anastomoses to the gastrointestinal tract as endotherapy for irresectable malignant biliary obstruction and to determine factors affecting the efficacy of treatment. Methods: A prospective analysis of the treatment results of all patients with irresectable biliary obstruction treated with endoscopic hepaticogastrostomy at our institution in the years 2016–2019. Results: Transmural intrahepatic biliary drainage (endoscopic hepaticogastrostomy) was performed due to the ineffectiveness of ERCP in 53 patients (38 males, 15 females; mean age 74.66 [56–89] years) with irresectable biliary obstruction. Technical success of endoscopic hepaticogastrostomy was achieved in 52/53 (98.11%) patients. Complications of endoscopic treatment were observed in 10/53 (18.87%) patients. Clinical success of endoscopic hepaticogastrostomy was achieved in 46/53 (86.79%) patients. Bismuth type II–IV cholangiocarcinoma, hepatic metastases, ascites, suppurative cholangitis, and high blood bilirubin levels exceeding 30 mg/dL were independent factors for increased complications and inefficacy of endoscopic hepaticogastrostomy. Conclusions: In the event of transpapillary biliary drainage proving ineffective, extra-anatomical anastomoses of bile ducts to the gastrointestinal tract provide an effective method for the treatment of patients with malignant biliary obstruction.

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