scholarly journals Initial experience with a homemade “hybrid-tome” for needle-knife precut in patients with difficult biliary cannulation

2021 ◽  
Vol 09 (11) ◽  
pp. E1611-E1616
Author(s):  
Emilio J. De la Morena Madrigal ◽  
Isabel Rodríguez García ◽  
Ana Belén Galera Ródenas ◽  
Elena Pérez Arellano

Abstract Background and study aims Current clinical guidelines recommend needle-knife precut (NKP) as the primary and best method for performing a biliary cannulation (BC) when simple techniques fail and the criteria are met for difficult BC (DBC). However, many endoscopists avoid or defer early NKP in favor of alternative, simpler techniques that have not been shown to be either safer or more effective. Our goal is to test a device that provides the needle-knife papillotome (NKPT) with traction capability and which can facilitate the learning and execution of NKP. Patients and methods This was a descriptive bicentric observational study of a personal cohort of patients undergoing early NKP to analyse the efficacy and safety of the technique with a “hybrid-tome” (HT) built using the isolated core of a NKPT and a conventional canulotome. Results Over a 4-year period, we performed 43 NKPs with the HT, achieving BC in one or two steps in all cases. The 100 % technical success was matched by a 95 % clinical success rate. We recorded 11 adverse events (23 %): five hemorrhages, four pancreatitis, and two cholangitis. In addition to the objective data, we confirmed that HT facilitates alignment with the duodenal papilla and the execution of pre-cutting, especially if the papilla is intradiverticular or hidden by folds. Conclusions The HT tested seems to help trained endoscopists to perform NKP, especially in some anatomic situations, which can improve compliance with the guidelines recommended for early NKP in patients with DBC.

2021 ◽  
Vol 10 (17) ◽  
pp. 3936
Author(s):  
Kensuke Yokoyama ◽  
Tomonori Yano ◽  
Atsushi Kanno ◽  
Eriko Ikeda ◽  
Kozue Ando ◽  
...  

Balloon enteroscopy-assisted endoscopic retrograde cholangiography (BEA-ERC) is useful and feasible in adults with pancreatobiliary diseases, but its efficacy and safety have not been established in pediatric patients. We compared the success rate and safety of BEA-ERC between adults and pediatric patients. This single-center retrospective study reviewed 348 patients (pediatric: 57, adult: 291) with surgically altered gastrointestinal anatomies who underwent BEA-ERC for biliary disorders from January 2007 to December 2019. The success rate of reaching the anastomosis or duodenal papilla was significantly lower in pediatric patients than in adult patients (66.7% vs. 88.0%, p < 0.01). The clinical success rate was also significantly lower in pediatric patients (64.9% vs. 80.4%, p = 0.014). The rate of adverse events was significantly higher in pediatric patients than in adults (14.2% vs. 7.7%, p = 0.037). However, if the anastomotic sites were reached in pediatric patients, the treatment was highly successful (97.3%). The time of reaching target site was significantly longer in pediatric patients than in adult patients. This study shows that BEA-ERC in pediatric patients is more difficult than that in adult patients. However, in patients where the balloon enteroscope was advanced to the anastomosis, clinical outcomes comparable to those in adults can be achieved.


2021 ◽  
Author(s):  
Mark op den Winkel ◽  
Jörg Schirra ◽  
Christian Schulz ◽  
Enrico N. De Toni ◽  
Christian J. Steib ◽  
...  

Background: In the setting of a naïve papilla, biliary cannulation is a key step in successfully performing endoscopic retrograde cholangiography (ERC). Difficult biliary cannulation (DBC) is associated with an increased risk of post-ERCP-pancreatitis and failure of the whole procedure. Summary: Recommendations for biliary cannulation can be divided in (a) measures to reduce the likelihood of a difficult papilla-situation a priori and (b) rescue techniques in case the endoscopist is actually facing DBC. (a): careful inspection of the papillary anatomy and optimizing its accessibility by scope-positioning is fundamental. A sphincterotome in combination with a soft-tip hydrophilic guide-wire rather than a standard catheter with a standard guide-wire should be used. (b): The most important rescue techniques are needle-knife precut, double-guidewire technique and transpancreatic sphincterotomy. In few cases, anterograde techniques are needed. To this regard, the EUS-guided biliary drainage (EUS-BD) followed by rendezvous is increasingly used as an alternative to percutaneous-transhepatic biliary drainage. Key Messages: Biliary cannulation can be accomplished with alternative retrograde or less frequently by salvage-anterograde techniques, once conventional direct cannulation attempts have failed. Considering recent favorable data for the early use of transpancreatic sphincterotomy, an adopted version of the 2016 European-Society-for-Gastrointestinal-Endoscopy (ESGE)-algorithm on biliary cannulation is proposed.


2013 ◽  
Vol 58 (12) ◽  
pp. 3606-3610 ◽  
Author(s):  
Jian-hong Zhu ◽  
Qiang Liu ◽  
De-qing Zhang ◽  
Huang Feng ◽  
Wei-chang Chen

2018 ◽  
Vol 2018 ◽  
pp. 1-7
Author(s):  
Hideki Kamada ◽  
Hideki Kobara ◽  
Naohito Uchida ◽  
Kiyohito Kato ◽  
Takayuki Fujimori ◽  
...  

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.


2020 ◽  
Vol 93 (1106) ◽  
pp. 20190256 ◽  
Author(s):  
Andrea Contegiacomo ◽  
Enrico Maria Amodeo ◽  
Alessandro Cina ◽  
Carmine Di stasi ◽  
Roberto Iezzi ◽  
...  

Objective: Evaluate the efficacy and safety of renal artery embolization (RAE) for iatrogenic renal vascular injuries (IRVI) management at Fondazione Policlinico Universitario "A. Gemelli" IRCCS, in the last 5 years. Methods: Retrospective analysis of all RAE procedures performed from January 2013 to December 2017. Patients-related (age, sex, vascular variants, hemoglobin and serum creatinine), IRVI-related (type and vascular level of IRVI, presence and extension of hematoma), management-related (temporal interval between diagnostic imaging and RAE) and procedure-related (embolic materials, technical success, clinical success and complications) parameters were evaluated. Results: 28 RAE procedures performed on 28 patients (21 males; 7 females) were included. 19/28 patients had pseudoaneurysm, 7/28 active bleeding and 1/28 arteriovenous fistula; 4/28 patients had a combination of 2 IRVI. The extent of perirenal hematoma showed correlation with the cause of IRVI (p = 0.028). Technical success was achieved in all patients whereas clinical success in 25/28 (89.3%), with 3 patients requiring re-treatment. Minor complications were observed during 2/28 (7.1%) endovascular procedures. No major complications occurred. A longer procedural time was observed in patients with lower pre-procedural levels of hemoglobin (p = 0.016). No differences were found in mean serum creatinine (p = 0.23) before and immediately after treatment, while values of creatinine at 1 week from the procedure were significantly lower (p = 0.04). Conclusion: RAE is safe and effective for the management of iatrogenic IRVI showing high technical and clinical success rate and low complication rate. Advances in knowledge: Low pre-procedural hemoglobin levels increase procedural duration time. Glue alone or in combination with other materials is as safe as coils.


2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Yadong Feng ◽  
Qian Yu ◽  
Ming Li ◽  
Wei Xu ◽  
Ye Zhu ◽  
...  

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.


2013 ◽  
Vol 58 (4) ◽  
pp. 1847-1854 ◽  
Author(s):  
Joseph S. Solomkin ◽  
Mayakonda Krishnamurthy Ramesh ◽  
Gintaras Cesnauskas ◽  
Nikolajs Novikovs ◽  
Penka Stefanova ◽  
...  

ABSTRACTEravacycline is a novel fluorocycline, highly active against Gram-positive and Gram-negative pathogensin vitro, including those with tetracycline and multidrug resistance. This phase 2, randomized, double-blind study was conducted to evaluate the efficacy and safety of two dose regimens of eravacycline compared with ertapenem in adult hospitalized patients with complicated intra-abdominal infections (cIAIs). Patients with confirmed cIAI requiring surgical or percutaneous intervention and antibacterial therapy were randomized (2:2:1) to receive eravacycline at 1.5 mg/kg of body weight every 24 h (q24h), eravacycline at 1.0 mg/kg every 12 h (q12h), or ertapenem at 1 g (q24h) for a minimum of 4 days and a maximum of 14 days. The primary efficacy endpoint was the clinical response in microbiologically evaluable (ME) patients at the test-of-cure (TOC) visit 10 to 14 days after the last dose of study drug therapy. Overall, 53 patients received eravacycline at 1.5 mg/kg q24h, 56 received eravacycline at 1.0 mg/kg q12h, and 30 received ertapenem. For the ME population, the clinical success rate at the TOC visit was 92.9% (39/42) in the group receiving eravacycline at 1.5 mg/kg q24h, 100% (41/41) in the group receiving eravacycline at 1.0 mg/kg q12h, and 92.3% (24/26) in the ertapenem group. The incidences of treatment-emergent adverse events were 35.8%, 28.6%, and 26.7%, respectively. Incidence rates of nausea and vomiting were low in both eravacycline groups. Both dose regimens of eravacycline were as efficacious as the comparator, ertapenem, in patients with cIAI and were well tolerated. These results support the continued development of eravacycline for the treatment of serious infections, including those caused by drug-resistant Gram-negative pathogens. (This study has been registered at ClinicalTrials.gov under registration no. NCT01265784.)


2019 ◽  
Vol 07 (11) ◽  
pp. E1474-E1482 ◽  
Author(s):  
Thomas R. McCarty ◽  
Rajat Garg ◽  
Christopher C. Thompson ◽  
Tarun Rustagi

Abstract Background and study aims Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is a novel endoscopic procedure designed to facilitate sustained luminal patency in patients with gastric outlet obstruction. The primary aim of this study was to evaluate the efficacy and safety of EUS-GE for treatment of gastric outlet obstruction. Methods Searches of PubMed, EMBASE, Web of Science, and Cochrane Library databases were performed through April 2019. Patients with benign and malignant gastric outlet obstruction were included. Measured outcomes included: immediate technical and clinical success as well as rate of serious adverse events (AEs). Heterogeneity was assessed with Cochran Q test and I 2 statistics. Publication bias was ascertained by funnel plot and Egger regression testing. Results A total of five studies (n = 199 patients; 45.73 % male) were included in this study. Four retrospective studies and one prospective study were analyzed. Mean age of patients that underwent the EUS-GE procedure was 64.52 ± 1.37 years with a pooled mean follow-up period of 4.32 ± 1.65 months. In 21 % of patients (n = 43), gastric outlet obstruction was due to benign causes. Immediate technical success was 92.90 % (95 % CI; 88.26 – 95.79; I2 = 0.00 %) and reported in all studies. The clinical success rate of EUS-GE was 90.11 % (95 % CI; 84.64 – 93.44; I2 = 0.00 %). Serious AEs occurred in 5.61 % (95 % CI; 2.87 – 10.67; I2 = 1.67 %) of cases and were related to peritonitis, perforation, bleeding, and abdominal pain. Re-intervention rate was 11.43 % (95 % CI; 7.29 – 17.46; I2 = 17.38 %). Conclusions EUS-GE appears to provide an effective and safe minimally invasive alternative for treatment of benign and malignant gastric outlet obstruction.


2017 ◽  
Vol 85 (5) ◽  
pp. AB60
Author(s):  
Su Jung Han ◽  
Tae Hoon Lee ◽  
Sang-Heum Park ◽  
Hyun Jong Choi ◽  
Yun Nah Lee ◽  
...  

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