EUS-guided biliary drainage versus ERCP for first-line palliation of malignant distal biliary obstruction: A systematic review and meta-analysis

Abstract Endoscopic retrograde cholangiopancreatography (ERCP) with transpapillary metal stenting is the standard palliation method for malignant distal biliary obstruction (MDBO); however, post-ERCP pancreatitis are not uncommon. Endoscopic ultrasonography-guided biliary drainage (EUS-BD) with transmural metal stenting has emerged as an option for primary palliation of MDBO. We compared the efficacy and safety of these procedures as first-line MDBO treatment. We searched for relevant English-language articles in PubMed, Embase, and Cochrane databases. The outcomes of interest were technical success, clinical success, adverse events, stent patency, reintervention rates, and procedure time. Subgroup analysis was performed for patients without duodenal invasion (eg, endoscopically accessible papilla; EUS-choledochoduodenostomy [CDS] vs. ERCP). Ten studies (3 randomized trials and 7 retrospective studies) with 756 patients were included. The cumulative technical and clinical success rates were high for both procedures (EUS-BD: 94.8% [294/310] and 93.8% [286/305], ERCP: 96.5% [386/400] and 95.7% [377/394]). The cumulative adverse event rates were 16.3% (54/331) for EUS-BD and 18.3% (78/425) for ERCP. In subgroup analysis for patients without duodenal invasion, EUS-CDS showed similar cumulative technical and clinical success rate with ERCP (technical success rate, EUS-CDS vs. ERCP: 94.2% [146/155] vs. 97.8% [237/242]; clinical success rate, EUS-CDS vs. ERCP: 94.2% [145/154] vs. 93.0% [225/242]). The cumulative rate of adverse events for EUS-CDS and ERCP was also comparable (15.5% [24/155] for EUS-CDS and 18.6% [45/242] for ERCP). As first-line palliation of MDBO, EUS-BD was similar to ERCP in technical and clinical success and safety; however, larger randomized trials comparing EUS-CDS and ERCP in this setting with endoscopically accessible papilla may be required.

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Endoscopic pancreatic necrosectomy: why scuff when you can flush the muck – make it an easy row to hoe

Endoscopy International Open ◽

10.1055/s-0043-112854 ◽

2017 ◽

Vol 05 (09) ◽

pp. E847-E853 ◽

Cited By ~ 3

Author(s):

Rinkesh Bansal ◽

Rajesh Puri ◽

Narendra Choudhary ◽

Sumit Bhatia ◽

Nisharg Patel ◽

...

Keyword(s):

Hydrogen Peroxide ◽

Adverse Events ◽

Success Rate ◽

Clinical Success ◽

Tertiary Care ◽

Clinical Success Rate ◽

Technical Success ◽

End Points ◽

Technical Success Rate ◽

Life Threatening

Abstract Background and aims Endoscopic ultrasound (EUS) guided drainage of symptomatic pancreatic walled-off necrosis (WON) followed by fully covered self-expanding metal stent (FCSEMS) placement offers several advantages such as higher technical success rate and the option of necrosectomy. The aim of this study was to evaluate the safety and efficacy of EUS guided drainage of patients with WON by using FCSEMS and intracavitary lavage with a solution containing hydrogen peroxide and adopting a step-up approach. Methods A prospective open label study was carried out at a single tertiary care center between January 2014 and January 2016. Patients with symptomatic WON who underwent EUS guided drainage followed by FCSEMS placement were included. Primary end points were complete drainage with improvement in symptoms or major adverse events. Secondary end points were minor adverse events related to the procedures. Results A total of 64 patients (mean age 36 years; 52 males) were included. Technical success was achieved in 100 % of patients and clinical success was achieved in 90.6 %. Complete drainage was achieved with FCSEMS alone in 18 (28.1 %), FCSEMS with necrosectomy using lavage in 40 (62.5 %), FCSEMS with percutaneous drainage (PCD) in 5 (7.8 %), and 1 (1.6 %) patient required salvage surgery. The major adverse event was life threatening bleeding in 3 (4.7 %) patients. Minor adverse events were non-life threatening bleeding in 2 (3.1 %) patients and stent migration in 3 (4.7 %) patients. Conclusion EUS guided WON drainage with FCSEMS followed by necrosectomy with lavage using a solution containing hydrogen peroxide as a step-up approach is a minimally invasive and effective method with a high technical and clinical success rate. Patients with solid debris > 40 % need aggressive management.

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

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2018/3983707 ◽

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.

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Endoscopic Self-Expandable Metallic Stent Insertion without Fluoroscopic Guidance Is Feasible and Safe for Acute Colonic Obstruction Caused by Colorectal Cancer

Gastroenterology Research and Practice ◽

10.1155/2020/6810164 ◽

2020 ◽

Vol 2020 ◽

pp. 1-5

Author(s):

Yadong Feng ◽

Qian Yu ◽

Ming Li ◽

Wei Xu ◽

Ye Zhu ◽

...

Keyword(s):

Success Rate ◽

Clinical Success ◽

Colonic Obstruction ◽

Clinical Success Rate ◽

Metallic Stent ◽

Fluoroscopic Guidance ◽

Procedure Time ◽

Technical Success ◽

Short Term ◽

Expandable Metallic Stent

Aims. Endoscopic self-expandable metallic stent (SEMS) insertion for acute colonic obstruction caused by colorectal cancer (CRC) is always performed under fluoroscopic guidance. This study evaluated the feasibility and safety of an endoscopic stenting procedure without fluoroscopic guidance. Methods. A total of 36 patients with an acute colonic obstruction caused by CRC underwent endoscopic SEMS insertion using a colonoscope without fluoroscopic guidance, followed by analyses of the technical and clinical success and short-term complications. Results. Total technical success rate and clinical success rate were 91.7% and 86.1%, respectively. The mean procedure time was 21.2±10.3 minutes. There was no stent dislodgement. One case of hematochezia and two cases of tenesmus occurred in patients with left-sided complete obstructions. No other short-term complications occurred. Procedure time, technical success, and clinical success rate were 16.3±9.4 minutes, 93.1%, and 89.6% for left-sided obstructions, respectively, and were 26.8±10.7 minutes, 85.7%, and 71.4% for right-sided obstructions, respectively. For complete obstructions, procedure time, technical success, and clinical success rate were 22.5±8.9 minutes, 90%, and 83.3%, respectively. In the incomplete cases, procedure time, technical success, and clinical success were 13.5±6.7 minutes, 100%, and 100%, respectively. Technical success, clinical success, and short-term complications were not differed between lesion locations and degrees. Conclusions. This simple technique is feasible and safe for palliation of acute colonic obstruction caused by CRC.

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

Case Reports in Gastroenterology ◽

10.1159/000502835 ◽

2019 ◽

Vol 13 (3) ◽

pp. 385-397 ◽

Cited By ~ 1

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.

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Outcomes of Endovascular Therapy for Salvage of Hemodialysis Arteriovenous Fistulae

Journal of Clinical Interventional Radiology ISVIR ◽

10.1055/s-0041-1728983 ◽

2021 ◽

Author(s):

Nishtha Yadav ◽

Shivanand Gamanagatti ◽

Raju Sharma ◽

Sanjay Kumar Aggarwal ◽

V K Bansal ◽

...

Keyword(s):

Success Rate ◽

Endovascular Therapy ◽

Complication Rate ◽

Clinical Success ◽

Clinical Signs ◽

Clinical Success Rate ◽

Low Flow ◽

Endovascular Management ◽

Technical Success ◽

Arteriovenous Fistulae

Abstract Introduction Arteriovenous fistulae (AVF) for hemodialysis (HD) are prone to development of multiple complications, which can lead to nonfunctioning of the fistula. We report outcomes of endovascular management for dysfunctional HD AVF. Materials and Methods In this prospective study, patients (43 men, 28 women, mean age 47.4 years) with clinical signs and symptoms of dysfunctional HD AVF and referred to interventional radiology for endovascular management were included. The most common clinical presentation included low flows during hemodialysis (n = 20), absent flow (n = 37), and failure of fistula maturation (n = 14). Patients with central venous obstruction who presented with limb swelling were excluded from this study. Patients underwent venography, venoplasty and thrombectomy, as appropriate, to salvage the fistula. The study outcomes were technical success, hemodynamic success, and clinical success of endovascular therapies in salvaging the fistulae. Results The technical, hemodynamic and clinical success rates of endovascular therapy for low-flow symptoms were 95%, 70% and 95%, respectively. Among patients who presented with absent flow, endovascular therapy had 81% technical success, 78.3% hemodynamic success, and 81% clinical success. Endovascular therapy was associated with 64.2% technical success, 57.1% hemodynamic success, and 64.2% clinical success in patients presenting with failed maturation of the fistula. The overall clinical success rate was 58/71 (81.7%) and failure rate was 13/71 (18.3%). The overall complication rate of endovascular therapy was 8.4% and the complications included vein rupture in 5 (7%) and balloon rupture in 1 (1.4%). Conclusion Endovascular therapy for salvage of nonfunctioning hemodialysis AVF is associated with a high-clinical success rate (81.7%) and low-complication rate.

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Safety and efficacy of the use of lumen-apposing metal stents in the management of postoperative fluid collections: a large, international, multicenter study

Endoscopy ◽

10.1055/a-0924-5591 ◽

2019 ◽

Vol 51 (08) ◽

pp. 715-721

Author(s):

Juliana Yang ◽

Jeremy H. Kaplan ◽

Amrita Sethi ◽

Enad Dawod ◽

Reem Z. Sharaiha ◽

...

Keyword(s):

Adverse Events ◽

Clinical Success ◽

Clinical Success Rate ◽

Metal Stents ◽

Technical Success ◽

Common Etiology ◽

Feasible Alternative ◽

International Multicenter Study ◽

Fluid Collections ◽

International Multicenter

Abstract Background Multiple studies have examined the use of lumen-apposing metal stents (LAMSs) for the drainage of peripancreatic fluid collections. Data on the use of LAMSs for postoperative fluid collections (POFCs) are scarce. POFCs may lead to severe complications without appropriate treatment. We aimed to study the outcomes (technical success, clinical success, rate/severity of adverse events, length of stay, recurrence) of the use of LAMSs for the drainage of POFCs. Methods This international, multicenter, retrospective study involved 19 centers between January 2012 and October 2017. The primary outcome was clinical success. Secondary outcomes included technical success and rate/severity of adverse events using the ASGE lexicon. Results A total of 62 patients were included during the study period. The most common etiology of the POFCs was distal pancreatectomy (46.8 %). The mean (standard deviation) diameter was 84.5 mm (30.7 mm). The most common indication for drainage was infection (48.4 %) and transgastric drainage was the most common approach (82.3 %). Technical success was achieved in 60/62 patients (96.8 %) and clinical success in 57/62 patients (91.9 %) during a median (interquartile range) follow-up of 231 days (90 – 300 days). Percutaneous drainage was needed in 8.1 % of patients. Adverse events occurred intraoperatively in 1/62 patients (1.6 %) and postoperatively in 7/62 (11.3 %). There was no procedure-related mortality. Conclusion This is the largest study on the use of LAMSs for POFCs. It suggests good clinical efficacy and safety of this approach. The use of LAMSs in the management of POFCs is a feasible alternative to percutaneous and surgical drainage.

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Endoscopic ultrasound-guided biliary drainage for distal malignant obstruction: a systematic review and meta-analysis of randomized trials

Endoscopy International Open ◽

10.1055/a-0998-8129 ◽

2019 ◽

Vol 07 (11) ◽

pp. E1563-E1573 ◽

Cited By ~ 9

Author(s):

Corey S. Miller ◽

Alan N. Barkun ◽

Myriam Martel ◽

Yen-I Chen

Keyword(s):

Biliary Drainage ◽

Biliary Obstruction ◽

Randomized Trials ◽

Clinical Success ◽

Meta Analysis ◽

Malignant Biliary Obstruction ◽

First Line ◽

First Line Therapy ◽

Catheter Dysfunction ◽

Distal Malignant Biliary Obstruction

Abstract Background and study aims Endoscopic ultrasound (EUS)-guided biliary drainage (BD) is increasingly used for distal malignant biliary obstruction, yet its safety and efficacy compared to endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic biliary drainage (PTBD) remain unclear. We performed a meta-analysis to improve our understanding of the role of EUS-BD in this patient population. Methods We searched Embase, MEDLINE, CENTRAL, and ISI Web of Knowledge through September 2018 for randomized controlled trials (RCTs) comparing EUS-BD to ERCP-BD or PTBD as treatment of distal malignant biliary obstruction. Risk ratios (RRs) with 95 % confidence intervals (CIs) were combined using random effects models. The primary outcome was risk of stent/catheter dysfunction requiring reintervention. Results Of six trials identified, three (n = 222) compared EUS-BD to ERCP-BD for first-line therapy; three others (n = 132) evaluated EUS-BD versus PTBD after failed ERCP-BD. EUS-BD was associated with a decreased risk of stent/catheter dysfunction overall (RR, 0.39; 95 %CI 0.27 – 0.57) and in planned subgroup analysis when compared to ERCP (RR, 0.41; 95 %CI 0.23 – 0.74) or PTBD (RR, 0.37, 95 %CI 0.22 – 0.61). Compared to ERCP, EUS was associated with a decreased risk of post-procedure pancreatitis (RR, 0.12; 95 %CI 0.01 – 0.97). No differences were noted in technical or clinical success. Conclusions In a meta-analysis of randomized trials comparing EUS-BD to conventional biliary drainage modalities, no difference in technical or clinical success was observed. Importantly, EUS-BD was associated with decreased risks of stent/catheter dysfunction when compared to both PTBD and ERCP, and decreased post-procedure pancreatitis when compared to ERCP, suggesting the potential role for EUS-BD as an alternative first-line therapy in distal malignant biliary obstruction.

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Outcome after percutaneous transluminal angioplasty of arterial stenosis in renal transplant patients

Acta Radiologica ◽

10.1080/02841850902718763 ◽

2009 ◽

Vol 50 (3) ◽

pp. 270-275 ◽

Cited By ~ 25

Author(s):

G. Hagen ◽

J. Wadström ◽

M. Magnusson ◽

A. Magnusson

Keyword(s):

Renal Transplant ◽

Success Rate ◽

Clinical Success ◽

Clinical Success Rate ◽

Transluminal Angioplasty ◽

Technical Success ◽

Technical Success Rate ◽

Transplant Patients ◽

Renal Transplant Patients ◽

Percutaneous Transluminal

Background: Ensuring graft survival in renal transplant patients is of paramount importance. Early detection and treatment of complications such as transplant renal artery stenosis (TRAS) are essential. Purpose: To evaluate the technical and clinical success rate of renal transplant patients with stenosis in the transplant renal artery or in the iliac artery after percutaneous transluminal angioplasty (PTA). Material and Methods: PTA was carried out on 24 patients with TRAS or iliac artery stenosis. Altogether, 28 stenoses were treated with PTA. The immediate technical result and the clinical outcomes after 1 and 3 months were assessed as well as clinical adverse events. A reduction in serum creatinine and/or a reduction in the number of antihypertensive drugs were criteria for clinical success. Results: The immediate technical success rate after PTA was 93%. The clinical success rate after 1 month was 58%, increasing to 75% after 3 months. Conclusion: The technical success rate is not equivalent to the clinical success rate when treating TRAS with PTA. Furthermore, there is a delay in clinical response, sometimes of 3 months, after a technically successful PTA.

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The Effect of Peroral Endoscopic Myotomy in Achalasia Patients with Prior Endoscopic Intervention: A Systematic Review and Meta-Analysis

Digestive Surgery ◽

10.1159/000512627 ◽

2021 ◽

pp. 1-13

Author(s):

Chunyu Zhong ◽

Bowen Ni ◽

Sixiu Liu ◽

Shali Tan ◽

Muhan Lü ◽

...

Keyword(s):

Adverse Events ◽

Randomized Clinical Trials ◽

Clinical Success ◽

Meta Analysis ◽

Clinical Success Rate ◽

Peroral Endoscopic Myotomy ◽

Technical Success ◽

Endoscopic Intervention ◽

Eckardt Score ◽

Endoscopic Myotomy

Background: Peroral endoscopic myotomy (POEM) has been reported to be effective in achalasia patients with prior failed endoscopic intervention (PFI). We performed this meta-analysis to compare and summarize the clinical outcome of POEM in patients with or without prior endoscopic intervention. Method: We searched relevant studies published up to March 2020. Meta-analysis for technical success, clinical success, Eckardt score, lower esophageal sphincter (LES) pressure, clinical reflux, and adverse event were conducted based on a random-effects model. Results: Eight studies enrolling 1,797 patients who underwent POEM were enrolled, including 1,128 naïve achalasia patients and 669 patients with PFI. In the PFI group, the pooled estimated rate of technical success was 97.7% (95% confidence interval [CI], 95.8–98.8%), the pooled clinical success rate was 91.0% (95% CI, 88.0–93.4%), and the pooled adverse events rate was 23.5% (95% CI, 10.6–44.1%). The Eckardt score significantly decreased by 5.95 points (95% CI, 5.50–6.40, p < 0.00001) and the LES pressure significantly reduced by 19.74 mm Hg (95% CI, 14.10–25.39, p < 0.00001) in the PFI group. There were no difference in the technical success, clinical success, and adverse events rate between the treatment-naïve group and PFI group, with a risk ratio of 1.0 (95% CI, 0.99–1.01, p = 0.89), 1.02 (95% CI, 0.98–1.06, p = 0.36), and 0.88 (95% CI, 0.67–1.16, p = 0.38), respectively. Conclusions: POEM is an effective and safe treatment for achalasia patients with prior endoscopic intervention. Randomized clinical trials are needed to further verify the efficiency and safety of the POEM in those patients.

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First experience of efficacy and radiation exposure in 320-detector row CT fluoroscopy-guided interventions

British Journal of Radiology ◽

10.1259/bjr.20200754 ◽

2021 ◽

pp. 20200754

Author(s):

Shota Yamamoto ◽

Tomohiro Matsumoto ◽

Satoshi Suda ◽

Kosuke Tomita ◽

Shunsuke Kamei ◽

...

Keyword(s):

Radiation Dose ◽

Success Rate ◽

Dose Reduction ◽

Clinical Success ◽

Clinical Success Rate ◽

Total Radiation ◽

Success Rates ◽

Technical Success ◽

Total Radiation Dose ◽

Interventional Ct

Objective: We investigated the efficacy and exposure to radiation in 320-detector row computed tomography fluoroscopy-guided (CTF-guided) interventions. Methods: We analysed 231 320-detector row CTF-guided interventions (207 patients over 2 years and 6 months) in terms of technical success rates, clinical success rates, complications, scanner settings, overall radiation doses (dose–length product, mGy*cm), patient doses of peri-interventional CT series, and interventional CT (including CTF), as a retrospective cohort study. The relationships between patient radiation dose and interventional factors were assessed using multivariate analysis. Results: Overall technical success rate was 98.7% (228/231). The technical success rates of biopsies, drainages, and aspirations were 98.7% (154/156), 98.5% (66/67), and 100% (8/8), respectively. The clinical success rate of biopsies was 93.5% (146/156). All three major complications occurred in chest biopsies. The median total radiation dose was 522.4 (393.4–819.8) mGy*cm. Of the total radiation dose, 87% was applied during the pre- and post-interventional CT series. Post-interventional CT accounted for 24.4% of the total radiation dose. Only 11.4% of the dose was applied by CTF-guided intervention. Multilinear regression demonstrated that male sex, body mass index, drainage, intervention time, and helical scan as post-interventional CT were significantly associated with higher dose. Conclusion: The 320-detector row CTF interventions achieved a high success rate. Dose reduction in post-interventional CT provides patient dose reduction without decreasing the technical success rates. Advances in knowledge: This is the first study on the relationship between various interventional outcomes and patient exposure to radiation in 320-detector row CTF-guided interventions, suggesting a new perspective on dose reduction.

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