scholarly journals Usefulness of endoscopic nasobiliary drainage-guided ERCP in patients with surgically altered anatomy (with video)

2020 ◽  
Vol 08 (06) ◽  
pp. E805-E808
Author(s):  
Yuichi Takano ◽  
Tetsushi Azami ◽  
Fumitaka Niiya ◽  
Takahiro Kobayashi ◽  
Naotaka Maruoka ◽  
...  
Keyword(s):  
Medical Records ◽  
Distal Gastrectomy ◽  
Papilla Of Vater ◽  
Procedure Time ◽  
Single Session ◽  
Endoscopic Retrograde ◽  
Endoscopic Nasobiliary Drainage ◽  
Surgically Altered Anatomy ◽  
Nasobiliary Drainage ◽  
Duct Stricture

Abstract Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy is one of the most challenging endoscopic procedures. Although single- or double-balloon endoscopes have been widely used, reaching the papilla of Vater (hepaticojejunostomy/pancreaticojejunostomy site) is often difficult. For patients in whom treatment cannot be completed in a single session, we placed endoscopic nasobiliary drainage (ENBD) at the end of the procedure; in the second session, the scope was inserted following ENBD placement. Patients and methods Three patients with surgically altered anatomy and who underwent ENBD-guided ERCP were retrospectively examined using the medical records. Results There were two men and one woman, with an average age of 75 years. The surgical procedure were distal gastrectomy and Roux-en-Y reconstruction in all patients. The diagnosis were choledocholithiasis in two and bile duct stricture in one. Average time to reach the papilla was 50 minutes (range, 21–102) for the first ERCP and was shortened to 11 minutes (range, 5–17) for the second session under an indwelling ENBD. Treatment was successful in all patients without complications. Conclusion ENBD-guided ERCP in patients with surgically altered anatomy was a useful method that facilitated scope insertion and shortened the procedure time.

scholarly journals Endoscopic Hands-Off Technique versus Conventional Technique for Conversion from an Orobiliary to a Nasobiliary Tube

2016 ◽  
Vol 2016 ◽  
pp. 1-5
Author(s):  
Min Jae Yang ◽  
Jae Chul Hwang ◽  
Miyeon Lee ◽  
Choong-Kyun Noh ◽  
Soon Sun Kim ◽  
...  
Keyword(s):  
Retrospective Cohort ◽  
Conventional Technique ◽  
Conventional Group ◽  
Procedure Time ◽  
Technical Success ◽  
Tertiary Referral ◽  
Endoscopic Retrograde ◽  
Tertiary Referral Center ◽  
Endoscopic Nasobiliary Drainage ◽  
Nasobiliary Drainage

Background. The aim of this study was to compare the outcomes of the endoscopic hands-off technique and the conventional technique when repositioning an endoscopic nasobiliary drainage (ENBD) tube from the mouth to the nose.Methods. We conducted a retrospective cohort study of all endoscopic retrograde cholangiopancreatographies (ERCPs) performed between July 2013 and May 2015 at a single tertiary referral center. A total of 1187 ERCPs were performed during the study period. Among them, 114 patients who underwent ENBD were enrolled in this study. In those patients, we used the endoscopic hands-off technique between July 2013 and May 2014 (endoscopy group) and the conventional technique between June 2014 and May 2015 (conventional group).Results. Technical success was achieved in 100% (58/58) of the endoscopy group and 94.6% (53/56) of the conventional group (P=0.115). In the 3 cases of failed conventional technique, the endoscopic hands-off technique was then performed, and conversion of the ENBD tube was successful in all of these patients. The procedure time was significantly shorter in the endoscopy group than in the conventional group (124 s versus 149 s,P=0.001).Conclusion. The endoscopic hands-off technique was feasible and effective for oral-nasal conversion of an ENBD tube.

scholarly journals A case of right hepatic duct entering cystic duct successfully treated by laparoscopic subtotal cholecystectomy through preoperatively placed biliary stent

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Hiroki Hirao ◽  
HiroHisa Okabe ◽  
Daisuke Ogawa ◽  
Daisuke Kuroda ◽  
Katsunobu Taki ◽  
...  
Keyword(s):  
Cystic Duct ◽  
Hepatic Duct ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Endoscopic Retrograde ◽  
Case Presentation ◽  
Endoscopic Nasobiliary Drainage ◽  
Subtotal Cholecystectomy ◽  
Upper Abdominal ◽  
The Right ◽  
Nasobiliary Drainage

Abstract Background Laparoscopic cholecystectomy is a well-established surgical procedure and is one of the most commonly performed gastroenterological surgeries. Therefore, strategy for the management of rare anomalous cystic ducts should be determined. Case presentation A 56-year-old woman was admitted to our hospital owing to upper abdominal pain and diagnosed with acute cholecystitis. Magnetic resonance cholangiopancreatography suspected that several small stones in gallbladder and the right hepatic duct drained into the cystic duct. Endoscopic retrograde cholangiopancreatography confirmed the cystic duct anomaly, and an endoscopic nasobiliary drainage catheter (ENBD) was placed at the right hepatic duct preoperatively. Intraoperative cholangiography with ENBD confirmed the place of division in the gallbladder, and laparoscopic subtotal cholecystectomy was safely performed. Conclusions The present case exhibited rare right hepatic duct anomaly draining into the cystic duct, which might have caused biliary tract disorientation and bile duct injury (BDI) intraoperatively. Any surgical technique without awareness of this anomaly preoperatively might insufficiently prevent BDI, and preoperative ENBD would facilitate safe and successful surgery.

Foreign bodies of common bile duct

1997 ◽  
Vol 78 (4) ◽  
pp. 299-301
Author(s):  
D. M. Krasilnikov ◽  
M. I. Mavrin ◽  
B. Kh. Kim
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Postoperative Period ◽  
Foreign Bodies ◽  
Endoscopic Retrograde ◽  
Endoscopic Nasobiliary Drainage ◽  
The Common ◽  
Nasobiliary Drainage

After endoscopic retrograde pancreatocholangiography, endoscopic nasobiliary drainage and removal of external drains in the postoperative period sometimes fragments of catheters remain in the common bile duct. The left foreign bodies contribute to cholangitis, pancreatitis, mechanical jaundice and concrements formation.

scholarly journals ‘Short’ Double-Balloon Enteroscope for Endoscopic Retrograde Cholangiopancreatography in Patients with a Surgically Altered Upper Gastrointestinal Tract

2011 ◽  
Vol 25 (11) ◽  
pp. 615-619 ◽  
Author(s):  
S Cho ◽  
P Kamalaporn ◽  
G Kandel ◽  
P Kortan ◽  
N Marcon ◽  
...  
Keyword(s):  
Gastrointestinal Tract ◽  
Small Bowel ◽  
Upper Gastrointestinal Tract ◽  
Papilla Of Vater ◽  
Endoscopic Retrograde ◽  
Bilioenteric Anastomosis ◽  
Double Balloon ◽  
Surgically Altered Anatomy ◽  
Working Length ◽  
Upper Gastrointestinal

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) remains a challenge for endoscopists in patients with surgically altered anatomy of the upper gastrointestinal tract. Double-balloon enteroscopes (DBEs) have revolutionized the ability to access the small bowel. The indication for its therapeutic use is expanding to include ERCP for patients who have undergone small bowel reconstruction. Most of the published experiences in DBE-assisted ERCP have used conventional double-balloon enteroscopes that are 200 cm in length, which do not permit use of the standard ERCP accessories. The authors report their experience with DBE-assisted ERCP using a ‘short’ DBE in patients with surgically altered anatomy.METHODS: A retrospective review of patients with previous small bowel reconstruction who underwent ERCP with a ‘short’ DBE at the Centre for Therapeutic Endoscopy and Endoscopic Oncology (Toronto, Ontario) between February 2007 and November 2008 was performed.RESULTS: A total of 20 patients (10 men) with a mean age of 57.9 years (range 26 to 85 years) underwent 29 sessions of ERCP with a DBE. Six patients underwent Billroth II gastroenterostomy, seven patients Roux-en-Y hepaticojejunostomy, five patients Roux-en-Y gastrojejunostomy, one patient Roux-en-Y esophagojejunostomy and one patient a Whipple’s operation with choledochojejunostomy. Some patients (n=12 [60%]) underwent previous attempts at ERCP in which the papilla of Vater or bilioenteric anastomosis could not be reached with either a duodenoscope or pediatric colonoscope. All procedures were performed with a commercially available DBE (working length 152 cm, distal end diameter 9.4 mm, channel diameter 2.8 mm). The procedures were performed under conscious sedation with intravenous midazolam, fentanyl and diazepam, except in one patient in whom general anesthesia was administered. Either the papilla of Vater or bilioenteric anastomosis was reached in 25 of 29 cases (86.2%) in a mean duration of 20.8 min (range 5 min to 82 min). Bile duct cannulation was successful in 24 of 25 cases in which the papilla or bilioenteric anastomosis was reached. Therapeutic interventions were successful in 15 patients (24 procedures) including sphincterotomy (n=7), stone extraction (n=9), biliary dilation (n=8), stent placement (n=9) and stent removal (n=8). The mean total duration of the procedures was 70.7 min (range 30 min to 117 min). There were no procedure-related complications.CONCLUSION: DBEs enable successful diagnostic and therapeutic ERCP in patients with a surgically altered anatomy of the upper gastrointestinal tract. It is a safe, feasible and less invasive therapeutic option in this group of patients. Standard ‘long’ DBEs have limitations of long working length and the need for modified ERCP accessories. ‘Short’ DBEs are equally as effective in reaching the target limb as standard ‘long’ DBEs, and overcomes some limitations of long DBEs to result in high success rates for endoscopic therapy.

scholarly journals Role of Endoscopic Retrograde Cholangiography and Nasobiliary Drainage in the Management of Postoperative Biliary Leak

1997 ◽  
Vol 3 (4) ◽  
pp. 221-229 ◽  
Author(s):  
M. K. Goenka ◽  
R. Kochhar ◽  
D. Bhasin ◽  
B. Nagi ◽  
J. D. Wig ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Endoscopic Retrograde Cholangiography ◽  
Biliary Leak ◽  
Endoscopic Retrograde ◽  
Large Defect ◽  
Endoscopic Nasobiliary Drainage ◽  
Associated Lesions ◽  
Nasobiliary Drainage

In order to assess the role of endoscopic retrograde cholangiography in evaluating the patients with post-operative biliary leak and of endoscopic nasobiliary drainage in its management, 36 patients with biliary leak seen over a period of 9 years were studied. Thirty-two had biliary leak following cholecystectomy, 3 following repair of liver trauma and 1 following choledochoduodenostomy. Patients presented at an interval of 4 days to 210 days (mean ± SEM, 32.4 ± 6.7 days) following laparotomy. Hyperbilirubinemia was noticed in only 13 patients (36.1%), while abdominal ultrasonogram showed ascites or biloma in 24 (66.7%). Endoscopic retrograde cholangiography showed the leak to involve the common bile duct in 55.6%, cystic duct in 33.3% and intrahepatic biliary radicles in 8.3%. Associated lesions included bile duct obstruction due to stricture or accidental ligature in 20%, bile duct stone in 20% and liver abscess in 2.8%.Endoscopic nasobiliary drainage using a 7 Fr pig-tail catheter was attempted in 14 patients and could be established in 12 of them. Bile duct leak sealed in all but one of these 12 patients after an interval of 3 days to 40 days (mean ± SEM, 12.2 ± 3.2 days). A single patient with large defect and a proximal bile duct stricture did not respond and required surgery. Common bile duct stones were removed by endoscopic sphincterotomy in 3 out of 4 patients. One patient with large stone required surgical choledocholithotomy. In conclusion, endoscopic retrograde cholangiography was safe and useful in confirming the presence of leak as well as its site, size and associated abnormalities. Endoscopic nasobiliary drainage proved an effective therapy in post-operative biliary leak and could avoid re-exploration in 71.4% patients.

One-stage fluoroscopic-guided laparoscopic transcystic papillary balloon dilation and laparoscopic cholecystectomy for the treatment of choledocholithiasis after Roux-en-Y reconstruction

2020 ◽  
Vol 13 (7) ◽  
pp. e234654
Author(s):  
Teppei Kamada ◽  
Hironori Ohdaira ◽  
Eigoro Yamanouchi ◽  
Yutaka Suzuki
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Distal Gastrectomy ◽  
Balloon Dilation ◽  
Operation Time ◽  
Papilla Of Vater ◽  
Endoscopic Retrograde ◽  
Intraoperative Bleeding ◽  
One Stage ◽  
Billroth Ii Reconstruction ◽  
History Of

Patients with a history of gastrectomy have a higher incidence of cholecystocholedocholithiasis and morbidities. In particular, the management of choledocholithiasis with endoscopic retrograde cholangiopancreatography (ERCP) has been challenging in patients after Roux-en-Y or Billroth II reconstruction due to the altered gastrointestinal anatomy. A 92-year-old man presented with high fever. He had undergone laparoscopic distal gastrectomy with Roux-en-Y reconstruction 9 years earlier for gastric cancer. Choledocholithiasis was diagnosed and ERCP was attempted, but cannulation of the papilla of Vater failed. An elective one-stage operation was planned. One-stage fluoroscopic-guided laparoscopic transcystic papillary balloon dilation (LTPBD) and laparoscopic cholecystectomy (LC) were performed. The operation time was 130 min with 3 mL of intraoperative bleeding. The patient was discharged on postoperative day 3 with no complications. We report this case in which one-stage LTPBD and LC was successfully performed for a super-elderly patient with choledocholithiasis after Roux-en-Y reconstruction.

scholarly journals Hemorrhagic Cholecystitis in a Patient on Maintenance Dialysis

2017 ◽  
Vol 11 (2) ◽  
pp. 488-493 ◽  
Author(s):  
Masayuki Shishida ◽  
Masahiro Ikeda ◽  
Nozomi Karakuchi ◽  
Kosuke Ono ◽  
Naofumi Tsukiyama ◽  
...  
Keyword(s):  
Bile Duct ◽  
Endoscopic Retrograde ◽  
Endoscopic Nasobiliary Drainage ◽  
Abdominal Symptoms ◽  
Blood Clots ◽  
Weighted Magnetic Resonance Imaging ◽  
The Common ◽  
Maintenance Dialysis ◽  
Nasobiliary Drainage ◽  
Hemorrhagic Cholecystitis

The present paper describes a case of hemorrhagic cholecystitis in a patient on maintenance dialysis. The patient presented with right upper quadrant abdominal pain. Computed tomography revealed swelling of the gallbladder, high- and isodensity contents of the gallbladder, and high-density stone in the gallbladder neck. He was hospitalized for suspected acute cholecystitis. After hospitalization, his levels of total bilirubin, aspartate aminotransferase, and alanine aminotransferase increased. T2-weighted magnetic resonance imaging showed low-intensity contents expanded to include a wide area from the common bile duct to the cystic duct and gallbladder neck. Endoscopic retrograde cholangiopancreatography revealed clotting from the duodenal papilla. After cannulation of the bile duct, old blood and pus began to flow from the mammary papilla, and an endoscopic nasobiliary drainage tube was placed. After his liver function had improved, the patient underwent laparoscopic cholecystectomy. His sample revealed that the gallbladder was filled with blood clots and stones. His postoperative course was uneventful and he was discharged on day 19 after the procedure. Although hemorrhagic cholecystitis is rare, it should be considered as a differential diagnosis for patients on dialysis who have acute abdominal symptoms.

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