scholarly journals Use of fully covered self-expanding metal biliary stents for managing endoscopic biliary sphincterotomy related bleeding

2021 ◽  
Vol 09 (05) ◽  
pp. E667-E673
Author(s):  
Mohammad Bilal ◽  
Madhuri Chandnani ◽  
Nicholas M. McDonald ◽  
Corey S. Miller ◽  
James Saperia ◽  
...  
Keyword(s):  
Case Series ◽  
Common Adverse Event ◽  
Primary Control ◽  
Success Rates ◽  
Technical Success ◽  
Biliary Stents ◽  
Delayed Bleeding ◽  
Technical Success Rate ◽  
Endoscopic Biliary Sphincterotomy ◽  
Biliary Sphincterotomy

Abstract Background and study aims Endoscopic biliary sphincterotomy (EBS) related-bleeding is a common adverse event related to endoscopic retrograde cholangiopancreatography (ERCP). Traditionally, endoscopic modalities such as epinephrine injection, cauterization, and balloon tamponade have been used for management. Recently, use of a fully covered self-expandable metal stent (FCSEMS) to manage EBS-related bleeding has gained popularity. However, data regarding its use are limited to small case series. Therefore, we aimed to evaluate the safety and efficacy of FCSEMS placement for the treatment of EBS-related bleeding. Patients and methods All patients referred to our center from October 2014 to November 2019 who had an FCSEMS placed for EBS-related bleeding were included. FCSEMS was placed either for primary control of bleeding or after failure of other traditional endoscopic hemostasis techniques at the discretion of the endoscopist. Data was collected regarding patient demographics, procedural characteristics, clinical and technical success rates of FCSEMS, as well as adverse events. Results A total of 97 patients underwent placement of FCSEMS for EBS-related bleeding, of which 76.3 % had immediate bleeding and 23.7 % had delayed bleeding. Mean age was 67.2 years and 47.4 % were males. Seven patients who had immediate EBS-related bleeding at index ERCP underwent other endoscopic therapies prior to placement of FCSEMS for rebleeding. The technical success rate for FCSEMS placement was 100 % and the rebleeding rate was 6.2 %. Four patients with FCSEMS placement developed pancreatitis and four had stent migration. Conclusions Our findings suggest that FCSEMS is a highly effective treatment modality for managing EBS-related bleeding and has an acceptable safety profile.

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.

scholarly journals Percutaneous transhepatic drainage is safe and effective in biliary obstruction—A single-center experience of 599 patients

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0260223
Author(s):  
Bálint Kokas ◽  
Attila Szijártó ◽  
Nelli Farkas ◽  
Miklós Ujváry ◽  
Szabolcs Móri ◽  
...  
Keyword(s):  
Success Rate ◽  
Extrahepatic Bile Duct ◽  
Treatment Algorithm ◽  
Success Rates ◽  
Technical Success ◽  
Tertiary Referral Center ◽  
Technical Success Rate ◽  
Percutaneous Transhepatic Drainage ◽  
First Choice ◽  
Transhepatic Drainage

Background Historically, surgical bilioenteric bypass was the only treatment option for extrahepatic bile duct obstruction, but with technological advancements, percutaneous transhepatic drainage (PTD) and endoscopic solutions were introduced as a less invasive alternative. Endoscopic methods may lead to a decreasing indication of PTD in the future, but today it is still the standard treatment method, especially in hilar obstructions. Methods In our retrospective data analysis, we assessed technical success rate, reintervention rate, morbidity, mortality, and the learning curve of patients treated with PTD over 12 years in a tertiary referral center. Results 599 patients were treated with 615 percutaneous interventions. 94.5% (566/599) technical success rate; 2.7% (16/599) reintervention rate were achieved. 111 minor and 22 major complications occurred including 1 case of death. In perihilar obstruction, cholangitis were significantly more frequent in cases where endoscopic retrograde cholangiopancreatography had also been performed prior to PTD compared to PTD alone, with 39 (18.2%) and 15 (10.5%) occurrences, respectively. Discussion The results and especially the excellent success rates demonstrate that PTD is safe and effective, and it is appropriate for first choice in the treatment algorithm of perihilar stenosis. Ultimately, we concluded that PTD should be performed in experienced centers to achieve low mortality, morbidity, and high success rates.

scholarly journals EUS-directed transgastric endoscopic retrograde cholangiopancreatography versus laparoscopic-assisted ERCP versus deep enteroscopy-assisted ERCP for patients with RYGB

2020 ◽  
Vol 08 (07) ◽  
pp. E877-E882 ◽  
Author(s):  
Gursimran S. Kochhar ◽  
Nabeeha Mohy-ud-din ◽  
Abhinav Grover ◽  
Neil Carleton ◽  
Abhijit Kulkarni ◽  
...  
Keyword(s):  
Endoscopic Retrograde Cholangiopancreatography ◽  
Retrospective Chart Review ◽  
Complication Rates ◽  
Success Rates ◽  
Technical Success ◽  
Endoscopic Retrograde ◽  
Technical Success Rate ◽  
Edge Group ◽  
History Of ◽  
Laparoscopic Assisted

Abstract Background and study aims Endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography (ERCP) (EDGE) is a novel technique for managing pancreaticobiliary diseases in patients with a history of Roux-en-Y Gastric Bypass (RYGB). It has shown to have high technical success rates and fewer adverse events as compared to laparoscopic-assisted ERCP (LA-ERCP). We compared the technical success and clinical outcomes of EDGE vs. LA-ERCP vs. E-ERCP. Patients and methods A retrospective chart review was performed for 56 patients, of whom 18 underwent LA-ERCP, 12 underwent E-ERCP, and 26 had EDGE, and a comparison of technical success and complication rates was done. Results Baseline demographic characteristics of patients undergoing these procedures, including age and gender, were comparable. The technical success rate for patients in the EDGE group were 100 % (n = 26), compared with 94 % (n = 17) and 75 % (n = 9) in the LA-ERCP and E-ERCP groups (P = 0.02). In the EDGE group, 8 % of patients (n = 2) had bleeding, and 4 % of patients (n = 1) had lumen-apposing metal stent migration occur during the procedure. In the LA-ERCP group 6 % (n = 1) of patient had bleeding, 6 % (n = 1) post-ERCP pancreatitis and 6 % (n = 1) were diagnosed with an intra-abdominal infection post-procedure. Time to complete the EDGE procedure was significantly shorter at 79 ± 31 mins, compared with 158 ± 50 mins for LA-ERCP and 102 ± 43 mins for E-ERCP (P < 0.001). Conclusion EDGE is a novel procedure with short procedure times and an effective alternative to LA-ERCP and E-ERCP in management of pancreaticobiliary diseases in patients with a history of RYGB.

scholarly journals Feasibility of balloon endoscope-assisted endoscopic retrograde cholangiopancreatography for the elderly

2020 ◽  
Vol 08 (09) ◽  
pp. E1202-E1211
Author(s):  
Ryunosuke Hakuta ◽  
Hirofumi Kogure ◽  
Yousuke Nakai ◽  
Tsuyoshi Hamada ◽  
Tatsuya Sato ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
The Elderly ◽  
Group Differences ◽  
Success Rates ◽  
Technical Success ◽  
Endoscopic Retrograde ◽  
Elderly Individuals ◽  
Technical Success Rate ◽  
Surgically Altered Anatomy

Abstract Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) for patients with surgically altered anatomy is challenging. Recently, balloon endoscopy has been shown to facilitate ERCP for this population with a high technical success rate, but adverse events (AEs) are not uncommon. Compared to non-elderly patients, elderly patients may be at higher risk of AEs due to underlying comorbidities. The current study aimed to evaluate the feasibility of balloon endoscope-assisted ERCP (BE-ERCP) for the elderly. Patients and methods We retrospectively identified patients who underwent BE-ERCP between January 2010 and September 2019. For patients who underwent multiple procedures during the study period, the first session was analyzed. Early AEs associated with BE-ERCP were compared between elderly (≥ 75 years) and non-elderly patients. Results A total of 1,363 BE-ERCP procedures were performed, and 568 patients (211 elderly and 357 non-elderly) were included for the analyses. Technical success rates were high in both the elderly and non-elderly groups (80 % vs. 80 %, respectively). The rates of early AEs were similar between the groups (12 % vs. 9.0 % in the elderly and non-elderly group, respectively; P = 0.31). The mltivariable-adjusted odds ratio for early AEs comparing elderly to non-elderly patients was 1.36 (95 % confidence interval, 0.74–2.51; P = 0.32). Specifically, we did not observe between-group differences in rates of gastrointestinal perforation (2.4 % vs. 2.8 % in elderly and non-elderly groups, respectively; P = 0.99) and aspiration pneumonia (1.9 % vs. 0.6 %, P = 0.20). Conclusions BE-ERCP is a feasible procedure for elderly individuals with surgically altered anatomy.

scholarly journals Endoscopic biliary self-expandable metallic stent in malignant biliary obstruction with or without sphincterotomy: systematic review and meta-analysis

2019 ◽  
Vol 07 (01) ◽  
pp. E26-E35 ◽  
Author(s):  
Benedetto Mangiavillano ◽  
Amedeo Montale ◽  
Leonardo Frazzoni ◽  
Mario Bianchetti ◽  
Amrita Sethi ◽  
...  
Keyword(s):  
Adverse Events ◽  
Success Rate ◽  
Meta Analysis ◽  
Stent Insertion ◽  
Metallic Stent ◽  
Success Rates ◽  
Technical Success ◽  
Technical Success Rate ◽  
Expandable Metallic Stent ◽  
Increased Risk

Abstract Background and aim To assess the rate of adverse events and the technical success rate of biliary stenting with or without EBS.  Methods A literature search up to February 2017 was performed. Studies assessing adverse events (AEs) and technical success rates of stenting with or without EBS were considered. Results Seven studies (870 patients; 12 treatment arms) were included. Early AEs, i. e. those occurring within 30 days, were significantly lower in no-EBS vs. EBS-group (11 % vs. 20.1 %; OR: 0.36, 95 %CI: 0.13 – 1.00). Rates of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis were not significantly different in the two groups (no-EBS vs. EBS: 6.1 % vs 5 %; OR: 1.33, 95 %CI: 0.68 – 2.59). The rate of bleeding was significantly lower in patients without EBS (no-EBS vs EBS: 0 % vs 5 %; OR: 0.12, 95 % CI: 0.03 – 0.45). Rates of cholangitis were significantly lower in patients without EBS (no-EBS vs. EBS: 3.3 % vs. 7.4 %; OR: 0.38, 95 %CI: 0.17 – 0.83). Both late AEs and mortality rates did not significantly differ between no-EBS and EBS patients (19.9 % vs. 18.9 %; OR: 0.93, 95 %CI: 0.56 – 1.53, and 2.5 % vs. 2.9 %; OR: 1.18, 95 %CI: 0.22 – 6.29, respectively). The technical success rate for stent insertion also did not differ (98 % vs. 97.6 %; OR: 1.05, 95 %CI: 0.42 – 2.63). Conclusion EBS seems to be associated, in the first 30 days after the procedure, with an increased risk of cholangitis and bleeding. No difference was observed in the rate of post-ERCP pancreatitis.

scholarly journals Clinical evaluation of physician-controlled guidewire manipulation during endoscopic ultrasound-guided hepaticogastrostomy (with video)

2021 ◽  
Vol 09 (03) ◽  
pp. E395-E400
Author(s):  
Kyohei Nishiguchi ◽  
Takeshi Ogura ◽  
Nobu Nishioka ◽  
Saori Ueno ◽  
Atsushi Okuda ◽  
...  
Keyword(s):  
Bile Duct ◽  
Success Rate ◽  
Endoscopic Ultrasound ◽  
Intrahepatic Bile Duct ◽  
Plastic Stents ◽  
Metal Stents ◽  
Success Rates ◽  
Technical Success ◽  
Technical Success Rate ◽  
Tract Dilation

Abstract Background and study aims Endoscopic ultrasound (EUS)-guided hepaticogastrostomy (HGS) may be most complex because of the EUS-guided biliary drainage procedure and variations in the course of the intrahepatic bile duct compared with the common bile duct (CBD). Appropriate guidewire insertion is essential. Physician-controlled guidewire manipulation (PCGW) might improve technical success rates of bile duct cannulation. The present study aimed to determine the technical feasibility and safety of PCGW during EUS-HGS. Patients and methods A total of 122 consecutive patients who were scheduled to undergo EUS-HGS between October 2017 and April 2019 were prospectively registered. The primary endpoint was the technical success rate of guidewire insertion into the CBD or hepatic hilum. Guidewire insertion was considered to have failed if the HGS assistant failed to achieve manipulation. Results The intrahepatic bile duct was successfully punctured in 120 of 122 patients. During guidewire insertion by the HGS assistant, guidewire fracture was observed in one patient. The guidewire was successfully inserted into the biliary tract and manipulated by the HGS assistant in 96 patients. PCGW was thus attempted for the remaining 23 patients. The guidewire was inserted by PCGW in all 23 patients, improving the technical success rate for guidewire insertion from 80 % to 100 %. After tract dilation, we deployed covered metal stents and plastic stents in 117 and two patients, respectively. The overall technical success rate for EUS-HGS was 97.5 % (119/122). Adverse events comprising bile peritonitis or leakage developed in five patients. Conclusion PCGW might contribute to improving the success rate of EUS-HGS.

scholarly journals World’s First Experience Treating TASC II C and D Tibial Occlusive Disease Using the Selution SLR Sirolimus-Eluting Balloon: Six-Month Results From the PRESTIGE Study

2021 ◽  
pp. 152660282110074
Author(s):  
Tjun Yip Tang ◽  
Charyl Yap ◽  
Shereen Xue Yun Soon ◽  
Sze Ling Chan ◽  
QingWei Shaun Lee ◽  
...  
Keyword(s):  
Renal Failure ◽  
Clinical Success ◽  
Target Lesion ◽  
Lesion Length ◽  
Success Rates ◽  
Technical Success ◽  
Free Survival ◽  
End Stage Renal Failure ◽  
Technical Success Rate ◽  
End Stage

Purpose: The performance of sirolimus-coated devices has not been studied in patients with chronic limb-threatening ischemia patients. PRESTIGE aims to investigate the 6-month efficacy and safety profile of the Selution Sustained Limus Release (SLR) sirolimus-eluting balloon for treatment of TASC II C and D tibial occlusive lesions in patients with CLTI. Materials and Methods: PRESTIGE is a pilot prospective, nonrandomized, single-arm, multi-investigator, single-center clinical study. Endpoints were adverse event-free survival at 1 month, technical success rate, primary tibial patency at 6 months, limb salvage success, target lesion revascularization (TLR), and amputation free survival (AFS). Results: A total of 25 patients were included. There were 17 (68.0%) males; mean age, 63.7±9.73 years. CLTI severity was based on the Rutherford scale (R5=25/25; 100.0%). Significant comorbidities included diabetes mellitus (n=22; 88.0%) and end-stage renal failure (n=11; 44.0%). A total of 33 atherosclerotic lesions were treated (TASC II D=15 (45.5%)). Mean lesion length treated was 191±111 mm. Technical success was 100%. Primary tibial patency at 6 months was 22/27 (81.5%) and freedom from clinically driven TLR was 25/30 (83.3%). AFS was 21/25 (84.0%; 3 deaths and 1 major lower extremity amputation). Mean Rutherford score improved from 5.00 at baseline to 1.14±2.10 (p<0.05) at 6 months. There was a wound healing rate of 13/22 (59.1%) and 17/21 (81.0%) at 3 and 6 months respectively. Conclusions: Selution SLR drug-eluting balloon is a safe and efficacious modality in treating complex tibial arterial occlusive lesions in what is an otherwise frail cohort of CLTI patients, with a high prevalence of diabetes and end-stage renal failure. Technical and clinical success rates are high and 6-month target lesion patency and AFS are more than satisfactory.

scholarly journals SP6.1.7 Meta-analysis of procedural outcomes of laparoscopic-assisted endoscopic retrograde cholangiopancreatography in patients with previous Roux-en-Y gastric bypass surgery

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Shahab Hajibandeh ◽  
Shahin Hajibandeh ◽  
Moustafa Mansour ◽  
Thomas Satyadas
Keyword(s):  
Gastric Bypass ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Case Series ◽  
Complication Rates ◽  
Success Rates ◽  
Technical Success ◽  
Endoscopic Retrograde ◽  
The Mean ◽  
Laparoscopic Assisted ◽  
Procedural Outcomes

Abstract Aims To investigate the procedural outcomes of laparoscopic-assisted endoscopic retrograde cholangiopancreatography (ERCP) in patients with previous Roux-en-Y gastric bypass (RYGB) surgery. Methods We performed a systematic review in accordance with PRISMA statement standards to identify all studies reporting procedural outcomes of laparoscopic-assisted ERCP in patients with previous RYGB. The ROBINS-I tool was used to assess the risk of bias of the included studies. Fixed-effect and random-effects models were applied to calculate pooled outcome data. Results A total of 17 case series, enrolling 256 patients, were included. The mean age of included patients was 49. The mean procedure time was 137 minutes (95% CI 102-172). In terms of procedural success rates, the overall technical success was 95.3% (95% CI 92.5-97.5,I2=0%), papillary access success was 95.3% (95% CI 92.5-97.5,I2=0%), cannulation success was 95.3% (95% CI 92.5-97.5,I2=0%), sphincterotomy success was 96.1% (95% CI 93.5-98.1,I2=0%), and stone removal success was 95.9% (95% CI 92.4-98.4, I2=0%). Conversion to open was required in 4.7% (95% CI 2.5-7.6,I2=0%). In terms of complications, pancreatitis occurred in 4.7% (95% CI 2.3-8,I2=17%), cholangitis in 1.7% (95% CI 0.5 to 3.6,I2=0%), and perforation in 3.7% (95% CI 1.8- 6.3,I2=0%). The length of hospital stay was 3 days (95% CI 2-4). Conclusions Laparoscopic-assisted ERCP seems to be feasible, effective, and a safe method to access the biliary tract in patients with previous RYGB as indicated by high technical success rates and low complication rates. There is a need for comparative evidence regarding outcomes of laparoscopic ERCP in comparison with alternative treatment options.

Solitaire stents for the treatment of complex symptomatic intracranial stenosis after antithrombotic failure: safety and efficacy evaluation

2015 ◽  
Vol 8 (7) ◽  
pp. 680-684 ◽  
Author(s):  
Guoli Duan ◽  
Zhengzhe Feng ◽  
Lei Zhang ◽  
Ping Zhang ◽  
Lei Chen ◽  
...  
Keyword(s):  
Success Rate ◽  
Balloon Angioplasty ◽  
Stent Placement ◽  
Case Series ◽  
Intracranial Stenosis ◽  
Technical Success ◽  
Safety And Efficacy ◽  
Technical Success Rate ◽  
Case Series Study

ObjectivesTo evaluate the feasibility, safety, and efficacy of Solitaire stent placement after balloon angioplasty for the treatment of complex symptomatic intracranial atherosclerotic stenosis (ICAS).MethodsWe retrospectively reviewed the clinical data from 44 patients who underwent Solitaire stent placement for complex symptomatic ICAS at our department between November 2010 and March 2014, with focus on the clinical factors, lesion characteristics, treatment results, and periprocedural complications. We also summarized the early outcomes and imaging findings during the follow-up period.ResultsOverall, the technical success rate was 100% (44/44). Post-stenting residual stenosis ranged from 0% to 40% (mean 15.00±12.94%). The overall 30-day rate of procedure-related complications was 9.09% (4/44). The incidence of recurrent ischemic events related to the territory artery was 4.55% during a mean clinical follow-up period of 25.5 months. Five patients (11.36%) developed in-stent restenosis during a mean angiographic follow-up period of 9.3 months.ConclusionsThis is the first case series study of ICAS treated by Solitaire stent placement. Deployment of a Solitaire stent with balloon angioplasty in the treatment of complex severe intracranial stenosis appears safe and effective, with a high technical success rate, relatively low periprocedural complication rate, and favorable outcome during follow-up.

scholarly journals Safety and efficacy of arteriovenous fistula angioplasties performed by nephrologists: report from a Brazilian interventional nephrology center

2021 ◽  
Author(s):  
Ricardo P. Franco ◽  
Miguel C. Riella ◽  
Domingos C. Chula ◽  
Marcia T. de Alcântara ◽  
Marcelo M. do Nascimento
Keyword(s):  
Success Rate ◽  
Low Income ◽  
Complication Rates ◽  
Technical Failure ◽  
Success Rates ◽  
Technical Success ◽  
Safety And Efficacy ◽  
Technical Success Rate ◽  
Venous Stenosis ◽  
First Choice

ABSTRACT Introduction: Arteriovenous fistulas (AVF) are the first choice vascular access for hemodialysis. However, they present a high incidence of venous stenosis leading to thrombosis. Although training in interventional nephrology may improve accessibility for treatment of venous stenosis, there is limited data on the safety and efficacy of this approach performed by trained nephrologists in low-income and developing countries. Methods: This study presents the retrospective results of AVF angioplasties performed by trained nephrologists in a Brazilian outpatient interventional nephrology center. The primary outcome was technical success rate (completion of the procedure with angioplasty of all stenoses) and secondary outcomes were complication rates and overall AVF patency. Findings: Two hundred fifty-six angioplasties were performed in 160 AVF. The technical success rate was 88.77% and the main cause of technical failure was venous occlusion (10%). The incidence of complications was 13.67%, with only one patient needing hospitalization and four accesses lost due to the presence of hematomas and/or thrombosis. Grade 1 hematomas were the most frequent complication (8.2%). The overall patency found was 88.2 and 80.9% at 180 and 360 days after the procedure, respectively. Conclusion: Our findings suggest that AVF angioplasty performed by trained nephrologists has acceptable success rates and patency, with a low incidence of major complications as well as a low need for hospitalization.

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