Balloon enteroscopy-assisted radial incision and cutting method for refractory hepaticojejunostomy anastomotic strictures

Endoscopy ◽  
2019 ◽  
Vol 51 (06) ◽  
pp. 566-570
Author(s):  
Tadahisa Inoue ◽  
Mayu Ibusuki ◽  
Rena Kitano ◽  
Yuji Kobayashi ◽  
Tomohiko Ohashi ◽  
...  
Keyword(s):  
Stent Placement ◽  
Clinical Success ◽  
Balloon Dilation ◽  
Adverse Event Rate ◽  
Treatment Technique ◽  
Technical Success ◽  
Balloon Enteroscopy ◽  
Technical Success Rate ◽  
Radial Incision ◽  
Anastomotic Strictures

Abstract Background Balloon enteroscopy-assisted balloon dilation and temporary biliary stent placement are effective for hepaticojejunostomy anastomotic strictures (HJAS), but the re-stenosis rates are relatively high. We examined the feasibility and efficacy of a novel treatment technique for refractory HJAS, called balloon enteroscopy-assisted radial incision and cutting (BE-RIC). Methods Between January 2016 and June 2018, 11 patients with refractory HJAS that recurred after balloon dilation and/or stent placement, underwent BE-RIC. We evaluated the technical success, clinical success, adverse events, and re-stenosis rates associated with BE-RIC. Results The technical success rate of BE-RIC was 91 % (10/11). Clinical success was achieved in all patients who underwent technically successful procedures. The procedure-related adverse event rate was 9 % (1/11). No re-stenosis was observed during the follow-up period; 9 patients were followed up for more than 6 months, and of these, 5, 4, and 2 patients were followed up for more than 12, 18, and 24 months, respectively, without re-stenosis. Conclusions BE-RIC for refractory HJAS showed favorable results. BE-RIC might be a useful option for treating refractory HJAS.

scholarly journals Radial incision and cutting combined with balloon dilation for refractory pancreaticojejunostomy anastomotic strictures

2021 ◽  
Vol 09 (04) ◽  
pp. E578-E582
Author(s):  
Tadahisa Inoue ◽  
Mayu Ibusuki ◽  
Rena Kitano ◽  
Yuji Kobayashi ◽  
Tomohiko Ohashi ◽  
...  
Keyword(s):  
Clinical Success ◽  
Anastomotic Stricture ◽  
Balloon Dilation ◽  
Recurrence Rates ◽  
Pancreatic Stone ◽  
Radial Incision ◽  
Anastomotic Strictures ◽  
The Mean ◽  
Stricture Recurrence

Abstract Background and study aims Endoscopic balloon dilation (BD) and temporary stent placement for pancreaticojejunostomy anastomotic stricture (PJAS) achieves good short-term outcomes; however, stricture recurrences remain frequent. We examined the feasibility of performing radial incision and cutting (RIC) combined with BD for refractory PJAS. Patients and methods Five consecutive patients with refractory PJAS who underwent RIC with BD between 2015 and 2018 were retrospectively investigated. We evaluated the technical and clinical success, adverse event (AE), and recurrence rates associated with RIC with BD. Results In all five patients, technical and clinical success were achieved. Pancreatic stone removal was simultaneously performed in one patient. The mean procedure time was 18 minutes (range 12–23 minutes). There were no procedure-related AEs. All patients were followed for over 2 years, with a mean follow-up period of 33 months (range 24–40 months). During the follow-up period, none of the patients developed stricture recurrence and all anastomoses remained patent. Conclusions This is the first report of RIC with BD for the treatment of refractory PJAS, showing favorable results. This combined procedure might be a useful option for treating refractory PJAS.

scholarly journals A Prospective Multicenter Study of “Inside Stents” for Biliary Stricture: Multicenter Evolving Inside Stent Registry (MEISteR)

2021 ◽  
Vol 10 (13) ◽  
pp. 2936
Author(s):  
Hirofumi Kogure ◽  
Hironari Kato ◽  
Kazumichi Kawakubo ◽  
Hirotoshi Ishiwatari ◽  
Akio Katanuma ◽  
...  
Keyword(s):  
Multicenter Study ◽  
Stent Placement ◽  
Controlled Trial ◽  
Adverse Event Rate ◽  
Success Rates ◽  
Technical Success ◽  
Biliary Strictures ◽  
Prospective Multicenter Study ◽  
Stent Occlusion ◽  
Benign Biliary Strictures

Background: Endoscopic biliary stent placement is the standard of care for biliary strictures, but stents across the papilla are prone to duodenobiliary reflux, which can cause stent occlusion. Preliminary studies of “inside stents” placed above the papilla showed encouraging outcomes, but prospective data with a large cohort were not reported. Methods: This was a prospective multicenter registry of commercially available inside stents for benign and malignant biliary strictures. Primary endpoint was recurrent biliary obstruction (RBO). Secondary endpoints were technical success of stent placement and removal, adverse events, and stricture resolution. Results: A total of 209 inside stents were placed in 132 (51 benign and 81 malignant) cases with biliary strictures in 10 Japanese centers. During the follow-up period of 8.4 months, RBO was observed in 19% of benign strictures. The RBO rate was 49% in malignant strictures, with the median time to RBO of 4.7 months. Technical success rates of stent placement and removal were both 100%. The adverse event rate was 8%. Conclusion: This prospective multicenter study demonstrated that inside stents above the papilla were feasible in malignant and benign biliary strictures, but a randomized controlled trial is warranted to confirm its superiority to conventional stents across the papilla.

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.

Long-term outcomes after endoscopic retrograde pancreatic drainage for symptomatic pancreaticojejunal anastomotic stenosis

2020 ◽  
Author(s):  
Akihiko Kida ◽  
Taro Kawane ◽  
Hitoshi Omura ◽  
Tatsuo Kumai ◽  
Masaaki Yano ◽  
...  
Keyword(s):  
Adverse Events ◽  
Stent Placement ◽  
Stent Migration ◽  
Anastomotic Stenosis ◽  
Technical Success ◽  
Long Term Outcomes ◽  
Endoscopic Retrograde ◽  
Technical Success Rate

Abstract 【Background】 There is limited evidence demonstrating the usefulness of endoscopic retrograde pancreatic drainage (ERPD) for symptomatic pancreaticojejunal anastomotic stenosis (sPJS). We examined the usefulness of ERPD for sPJS. 【Methods】 We conducted a retrospective analysis of 10 benign sPJS patients. Following items were evaluated: technical success, adverse events and clinical outcome of ERPD. 【Results】 Technical success rate was 100% (10/10); 9 patients had a pancreatic stent (no-internal-flap: n=4, internal-flap: n=5). Median follow-up was 920 days. Four patients developed recurrence. Among them, 3 patients had a stent with no-internal-flap in initial ERPD and the stent migrated in 3 patients at recurrence, and a stent was not placed in 1 patient in initial ERPD. Four follow-up ERPD were performed. No recurrence was observed in 6 patients. Among them, none of the stents migrated (no-internal-flap: n=1, internal-flap: n=5), and none were replaced stents due to stent failure. A stent placement with no-internal-flap was associated with recurrence (p=0.042). Mild adverse events developed in 14.3% (2/14). 【Conclusions】 ERPD was performed safely with high technical success. Recurrence was common in a stent placement with no-internal-flap, which was associated with stent migration. Long-term stent placement didn’t result in stent failure.

A novel “hitch-and-ride” deep biliary cannulation method during rendezvous endoscopic ultrasound-guided ERCP technique

Endoscopy ◽  
2017 ◽  
Vol 49 (10) ◽  
pp. 983-988 ◽  
Author(s):  
Yousuke Nakai ◽  
Hiroyuki Isayama ◽  
Saburo Matsubara ◽  
Hirofumi Kogure ◽  
Suguru Mizuno ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Event Rate ◽  
The Other ◽  
Adverse Event Rate ◽  
Technical Success ◽  
Ultrasound Guided ◽  
Endoscopic Retrograde ◽  
Biliary Cannulation ◽  
Technical Success Rate ◽  
The Wire

Abstract Background and study aim Endoscopic ultrasound-guided rendezvous (EUS-RV) is increasingly reported as a treatment option after failed endoscopic retrograde cholangiopancreatography. We developed a novel “hitch-and-ride” catheter for biliary cannulation to reduce the risk of guidewire loss during EUS-RV. Patients and methods We retrospectively evaluated safety and technical success of EUS-RV between June 2011 and May 2016. Biliary cannulation during EUS-RV using three methods – over-the-wire, along-the-wire, and hitch-and-ride – were compared. Results A total of 30 EUS-RVs were attempted and the technical success rate was 93.3 %, with two failures (one bile duct puncture and one guidewire insertion). After 28 cases of successful guidewire passage, cannulation was attempted by the over-the-wire (n = 13), along-the-wire (n = 4) or hitch-and-ride (n = 11) method. Only the hitch-and-ride method achieved biliary cannulation without guidewire loss or conversion to the other methods. Time to cannulation was shorter with the hitch-and-ride method (4 minutes) than with over-the-wire and along-the-wire methods (9 and 13 minutes, respectively). The adverse event rate of EUS-RV was 23.3 %. Conclusion A novel hitch-and-ride catheter was feasible for biliary cannulation after EUS-RV.

scholarly journals Efficacy and safety of endoscopic ultrasound-guided pancreatic duct drainage (EUS-PDD): A systematic review and meta-analysis of 714 patients

2020 ◽  
Vol 08 (11) ◽  
pp. E1664-E1672
Author(s):  
Saurabh Chandan ◽  
Babu P. Mohan ◽  
Shahab R. Khan ◽  
Lena L. Kassab ◽  
Suresh Ponnada ◽  
...  
Keyword(s):  
Adverse Events ◽  
Pancreatic Duct ◽  
Endoscopic Ultrasound ◽  
Clinical Success ◽  
Meta Analysis ◽  
Fluid Collection ◽  
Technical Success ◽  
Ultrasound Guided ◽  
Anastomotic Strictures ◽  
Pancreatic Duct Drainage

Abstract Background and study aims Endoscopic ultrasound guided pancreatic duct drainage (EUS-PDD) is a minimal-invasive therapeutic option to surgery and in patients with failed endoscopic retrograde pancreatography (ERP). The aim of this review was to quantitatively appraise the clinical outcomes of EUS-PDD by meta-analysis methods. Methods We searched multiple databases from inception through March 2020 to identify studies that reported on EUS-PDD. Pooled rates of technical success, successful drainage of pancreatic duct, clinical success, and adverse events were calculated. Study heterogeneity was assessed using I2% and 95 % prediction interval. Results A total of 22 studies (714 patients) were included. The pooled rate of technical success in EUS-PDD was 84.8 % (95 % CI 79.1–89.2). The pooled rate of successful PD drained by EUS-PDD was 77.5 % (95 % CI 63.1–87.4). The pooled rate of clinical success of EUS-PDD was 89.2 % (95 % CI 82.1–93.7). The pooled rate of all adverse events was 18.1 % (95 % CI 14.2–22.9). On sub-group analysis, the pooled technical success and clinical success of EUS-PDD from Japanese data were considerably superior (91.2 %, 83–95.6 & 92.5 %, 83.9–96.7, respectively). The pooled rate of post EUS-PDD acute pancreatitis was 6.6 % (95 % CI 4.5–9.4), bleeding was 4.1 % (95 % CI 2.7–6.2), perforation and/or pneumoperitoneum was 3.1 % (95 % CI 1.9–5), pancreatic leak and/or pancreatic fluid collection was 2.3 % (95 % CI 1.4–4), and infection was 2.8 % (95 % CI 1.7–4.6). Conclusion EUS-PDD demonstrates high technical success and clinical success rates with acceptable adverse events. Technical success was especially high for anastomotic strictures.

Usefulness of a long sheath in ureteral catheterization after failure of antegrade ureteral stent placement using a short sheath

2020 ◽  
pp. 028418512096995
Author(s):  
Cheng Shi Chen ◽  
Jong Woo Kim ◽  
Ji Hoon Shin ◽  
Hai-Liang Li ◽  
Hyung Jin Lee ◽  
...  
Keyword(s):  
Success Rate ◽  
Stent Placement ◽  
Balloon Catheter ◽  
Ureteral Stent ◽  
Ureteral Stricture ◽  
Technical Success ◽  
Exact Test ◽  
Technical Success Rate ◽  
Ureteral Catheterization ◽  
A Minor

Background When antegrade ureteral intervention fails due to severe ureteral stricture or tortuosity, a longer sheath can be used to facilitate ureteral catheterization. Purpose To evaluate the feasibility and effectiveness of the use of a long sheath in antegrade ureteral stent placement after failure of antegrade ureteral stent placement using a short sheath. Material and Methods Among 1284 procedures in 934 patients who received ureteral stent placement, a long sheath was used after stricture negotiation failure using a short sheath in 57 (4.4%) procedures in 53 patients. The data of these 53 patients were retrospectively reviewed. Results The most common reasons for long sheath use were failure of balloon catheter (59.6%) or guidewire (29.8%) advancement across the stricture. Technical success, successful stricture negotiation after using a long sheath, was achieved in 50/57 (87.7%) procedures. In two of seven failed procedures, an additional TIPS sheath was used and the technical success rate improved to 91.2% (52/57). The technical success rate was significantly higher in the patients who have failed balloon catheter advancement (97.1%, 33/34) than the patients who have failed guidewire advancement (64.7%, 11/17) (Fisher’s exact test, P = 0.004). Self-limiting hematoma occurred in one patient after use of the long sheath and was considered a minor complication. Conclusion Ureteral catheterization using a long sheath is feasible and effective when antegrade ureteral intervention using a short sheath fails. When using a long sheath, the technical success rate was higher when advancing the balloon catheter over the guidewire than when advancing the guidewire through tight stricture.

scholarly journals Is radiofrequency ablation safe and effective in treating osteoid osteomas? A prospective single-center study with atypical cases

2020 ◽  
Vol 28 (3) ◽  
pp. 230949902096055
Author(s):  
Gokhan Yuce ◽  
Nedim Aytekin ◽  
Serhan Eren ◽  
Birgul Genç ◽  
Ömer Faruk Ateş ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Osteoid Osteoma ◽  
Rating Scale ◽  
Clinical Success ◽  
Numeric Rating Scale ◽  
Radiology Department ◽  
Surgical Removal ◽  
Single Center ◽  
Technical Success ◽  
Technical Success Rate

Purpose: Osteoid osteomas are benign and nonprogressive lesions. The clinical presentation of osteoid osteoma is typical with night pain responsive to nonsteroidal anti-inflammatory agents. The typical radiological appearance is lucent nidus and adjacent reactive sclerosis. The most traditional management of osteoid osteoma is surgical removal which is associated with significant morbidity. This article aims to demonstrate our single-center experience of 55 patients with osteoid osteoma treated with percutaneous radiofrequency ablation (RFA). Methods: Fifty-five symptomatic patients who were seen at our orthopedics outpatient clinics, diagnosed with osteoid osteoma, and referred to interventional radiology department between May 2015 and April 2019 were enrolled. The nidus size, pain numeric rating scale score, and intramedullary edema diameter before and after RFA were compared. Clinical and technical success, intervention-related complications, and need for subsequent ablation were recorded. Results: Of the 55 patients, including 12 pediatric cases, 6 had atypical locations such as metatarsal, vertebra, and scapula, while 1 case had osteoid osteoma with multiple nidus. The mean age was 18.5 ± 9.6 years. Preintervention maximum nidus diameter, pain score, and edema diameter were significantly lower in postintervention measurements ( p < 0.001). Technical success rate was 98.1%, and clinical success was 96.36%. Severe complication occurred in one patient with soft tissue burn and osteomyelitis. Conclusion: This is one of the largest series of osteoid osteoma treated with RFA done in a single center with atypical cases. In conclusion, RFA is safe and effective in both pediatric and adult patients with rare complications even in challenging cases with atypical locations.

A novel method of biopsy for indeterminate pancreaticobiliary strictures: tube-assisted biopsy

Endoscopy ◽  
2020 ◽  
Vol 52 (07) ◽  
pp. 589-594
Author(s):  
Sung Woo Ko ◽  
Sang Soo Lee ◽  
Hoonsub So ◽  
Jun Seong Hwang ◽  
Tae Jun Song ◽  
...  
Keyword(s):  
Success Rate ◽  
Diagnostic Yield ◽  
Rate Sensitivity ◽  
Adverse Event Rate ◽  
Technical Success ◽  
Serious Adverse Events ◽  
Technical Success Rate ◽  
Single Operator ◽  
Novel Method ◽  
Sensitivity Specificity

Abstract Background Single-operator cholangioscopy (SOC) provides an accurate diagnosis of indeterminate pancreaticobiliary strictures. However, the procedure is expensive and can be performed using only limited accessories. Therefore, we devised a novel tube-assisted biopsy (TAB) technique and evaluated its feasibility, diagnostic yield, and safety for indeterminate pancreaticobiliary strictures. Methods The medical records of patients with indeterminate pancreaticobiliary strictures who underwent TAB between September 2018 and July 2019 were reviewed. We assessed the technical success rate, adverse event rate, sensitivity, specificity, and overall accuracy of TAB in differentiating malignant from benign lesions. Results TABs were performed in 16 patients: 12 had biliary strictures; four had pancreatic strictures. The technical success rate was 93.7 % (15/16), and the sensitivity, specificity, and overall accuracy of TAB were 87.5 %, 100 %, and 93.7 %, respectively. No serious adverse events occurred either during or after the procedure in any of the patients. Conclusions TAB has an acceptable accuracy for the diagnosis of indeterminate pancreaticobiliary strictures and may represent a useful diagnostic method in patients where SOC cannot be implemented.

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