Endoscopic ultrasound-guided creation of a transgastric fistula for the management of hepatobiliary disease in patients with Roux-en-Y gastric bypass

Endoscopy ◽  
2017 ◽  
Vol 49 (06) ◽  
pp. 549-552 ◽  
Author(s):  
Saowanee Ngamruengphong ◽  
Jose Nieto ◽  
Rastislav Kunda ◽  
Vivek Kumbhari ◽  
Yen-I Chen ◽  
...  
Keyword(s):  
Gastric Bypass ◽  
Endoscopic Ultrasound ◽  
Clinical Success ◽  
Argon Plasma Coagulation ◽  
Gastric Pouch ◽  
Argon Plasma ◽  
Metal Stents ◽  
Ultrasound Guided ◽  
Endoscopic Closure ◽  
Excluded Stomach

Abstract Background and aims Endoscopic retrograde cholangiopancreatography (ERCP) in patients who have undergone Roux-en-Y gastric bypass (RYGB) is technically challenging. We describe our multicenter experience using lumen-apposing metal stents (LAMSs) to create an endoscopic ultrasound-guided transgastric fistula (EUS-TG) to facilitate peroral ERCP in these patients. Patients and methods Thirteen patients with RYGB who underwent EUS-TG at three tertiary centers were included. EUS was used to guide puncture of the excluded stomach from the gastric pouch or jejunum; a LAMS was placed across the transgastric fistula. ERCP was performed via a duodenoscope passed through the LAMS. Results The technical success of EUS-TG was 100 % (13/13). ERCP through the LAMS was successful and clinical success was achieved in all patients. LAMS dislodgement during ERCP occurred in two patients and the stent was successfully repositioned without sequelae. After removal of the LAMS, the fistula was closed in 92 % of patients, either by endoscopic closure devices or argon plasma coagulation. None of the patients experienced procedure-related adverse events. Conclusion EUS-TG is an effective and safe method of accessing the excluded stomach and performing ERCP in patients with RYGB.

scholarly journals Palliation of Obstructive Jaundice: Endoscopic Ultrasound‑guided Choledochoduodenostomy in the Presence of Bleeding Duodenal Infiltration Due to Metastatic Urinary Bladder Cancer

2018 ◽  
Vol 09 (03) ◽  
pp. 118-121
Author(s):  
Surinder Singh Rana ◽  
Ravi Sharma ◽  
Rajesh Gupta ◽  
Sobur Uddin Ahmed
Keyword(s):  
Bladder Cancer ◽  
Urinary Bladder ◽  
Obstructive Jaundice ◽  
Endoscopic Ultrasound ◽  
Argon Plasma Coagulation ◽  
Argon Plasma ◽  
Urinary Bladder Cancer ◽  
Ultrasound Guided ◽  
Duodenal Lesions ◽  
Common Manifestation

Obstructive jaundice is a common manifestation of malignancies involving pancreaticobiliary area of the gastrointestinal tract. The palliation of obstructive jaundice involves bypassing the obstruction by an endoprosthesis using either endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic biliary drainage route. Endoscopic ultrasound‑guided choledochoduodenostomy (ECD) is a challenging alternative for obstructive jaundice due to distal bile duct obstruction in patients who have failed ERCP. In this report, we describe a challenging case of disseminated urinary bladder cancer that presented with extensive duodenal as well as periduodenal infiltration leading on to gastrointestinal bleed and severe pruritus along with obstructive jaundice and was successfully managed with initial argon plasma coagulation of bleeding duodenal lesions followed by ECD.

scholarly journals Successful re-intervention with metal stent trimming using argon plasma coagulation after endoscopic ultrasound-guided hepaticogastrostomy

Endoscopy ◽  
2014 ◽  
Vol 46 (S 01) ◽  
pp. E391-E392
Author(s):  
Kei Yane ◽  
Akio Katanuma ◽  
Hiroyuki Maguchi ◽  
Kuniyuki Takahashi ◽  
Manabu Osanai ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Argon Plasma Coagulation ◽  
Argon Plasma ◽  
Metal Stent ◽  
Ultrasound Guided ◽  
Plasma Coagulation

Efficacy and safety of lumen apposing metal stents or self-expandable metal stents for endoscopic ultrasound-guided choledocho-duodenostomy: a systematic review and meta-analysis

Endoscopy ◽  
2020 ◽  
Author(s):  
Arnaldo Amato ◽  
Emanuele Sinagra ◽  
Ciro Celsa ◽  
Marco Enea ◽  
Andrea Buda ◽  
...  
Keyword(s):  
Adverse Events ◽  
Endoscopic Ultrasound ◽  
Primary Outcome ◽  
Clinical Success ◽  
Meta Analysis ◽  
Metal Stents ◽  
Efficacy And Safety ◽  
Technical Success ◽  
Ultrasound Guided ◽  
Post Procedure

BACKGROUND Endoscopic ultrasound (EUS)-guided biliary drainage is becoming an option for palliation of malignant biliary obstruction. Lumen apposing metal stents (LAMS) are replacing self-expandable metal stents (SEMS). Aim of this meta-analysis was to evaluate the efficacy and safety of LAMS or SEMS for EUS-guided choledocho-duodenostomy. METHODS A meta-analysis was performed using PRISMA protocols. Electronic databases were searched for studies on EUS-guided choledocho-duodenostomy. The primary outcome was the clinical success. Technical success, re-intervention and adverse events were secondary outcomes. We used the random effects model with the DerSimonian-Laird estimation and the results were depicted using the forest plots. Furthermore, we performed analysis of the outcomes with the data stratified by selected variables. RESULTS Overall, 31 studies (820 patients) were included. The pooled rates of clinical and technical success were 93.6% (95% CI [95%CI] 88.6-96.5%) and 94.8% (95%CI 90.2-97.3%), for LAMS , and 91.7% (95%CI 88.1-94.2) and 92.7 % (95%CI 89.9-94.9%) for SEMS, respectively. The pooled rates of adverse events were 17.1% (95%CI 12.5-22.8%) for LAMS compared to 18.3% (95% CI 14.3-23.0%) for SEMS. The pooled rates of re-intervention were 10.9% (95% CI 7.7-15.3%) for LAMS compared to 13.9% (95% CI 9.6-19.7%) for SEMS. Subgroup analyses confirmed these results. CONCLUSIONS This meta-analysis shows that LAMS and SEMS are comparable in terms of efficacy for EUS-guided choledocho-duodenostomy. The use of LAMS was associated with similar clinical and technical success, post-procedure adverse events and re-intervention rate when compared with SEMS placement. These last two points require further investigation.

Modified endoscopic ultrasound-guided double-balloon-occluded gastroenterostomy bypass (M-EPASS): a pilot study

Endoscopy ◽  
2021 ◽  
Author(s):  
Amanda Marino ◽  
Ali Bessissow ◽  
Corey Miller ◽  
David Valenti ◽  
Louis Boucher ◽  
...  
Keyword(s):  
Gastric Outlet Obstruction ◽  
Endoscopic Ultrasound ◽  
Clinical Success ◽  
Outlet Obstruction ◽  
Stent Migration ◽  
Stent Insertion ◽  
Ultrasound Guided ◽  
Double Balloon ◽  
Low Residue Diet ◽  
The Mean

Abstract Introduction We recently developed a double-balloon device, using widely available existing technology, to facilitate endoscopic ultrasound-guided gastroenterostomy (EUS-GE). Our aim is to assess the feasibility of this modified approach to EUS-guided double-balloon-occluded gastroenterostomy bypass (M-EPASS). Methods This was a single-center retrospective study of consecutive patients undergoing M-EPASS from January 2019 to August 2020. The double-balloon device consists of two vascular balloons that optimize the distension of a targeted small-bowel segment for EUS-guided stent insertion. The primary end point was the rate of technical success. Results 11 patients (45 % women; mean [standard deviation (SD)] age 64.9 [8.6]) with malignant gastric outlet obstruction were included. Technical and clinical success (ability to tolerate an oral diet) were achieved in 91 % (10/11) and 80 % (8/10) of patients, respectively. There was one adverse event (9 %) due to stent migration. Two patients (18 %) required re-intervention for stent obstruction secondary to food impaction. The mean (SD) time to a low residue diet was 3.5 (2.4) days. Conclusion M-EPASS appears to facilitate the technique of EUS-GE, potentially enhancing its safety and clinical adoption. Larger studies are needed to validate this innovative approach to gastric outlet obstruction.

Usage of transmural metal stents for endoscopic ultrasound guided drainage of pseudocysts may lead to lower reintervention rates

Pancreatology ◽  
2017 ◽  
Vol 17 (3) ◽  
pp. S84
Author(s):  
Jayapal Ramesh ◽  
Rebecca Saunders ◽  
Jonathan Evans ◽  
Paula Ghaneh ◽  
Michael Raraty ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Metal Stents ◽  
Ultrasound Guided

Endoscopic ultrasound-guided entero-enterostomy for the treatment of afferent loop syndrome: a multicenter experience

Endoscopy ◽  
2018 ◽  
Vol 50 (09) ◽  
pp. 891-895 ◽  
Author(s):  
Olaya Brewer Gutierrez ◽  
Shayan Irani ◽  
Saowanee Ngamruengphong ◽  
Hanaa Aridi ◽  
Rastislav Kunda ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Clinical Success ◽  
Indirect Comparison ◽  
Procedure Time ◽  
Technical Success ◽  
Ultrasound Guided ◽  
Common Procedure ◽  
Afferent Loop ◽  
Afferent Loop Syndrome

Abstract Background Afferent loop syndrome (ALS) is traditionally managed surgically and, more recently, endoscopically. The role of endoscopic ultrasound-guided entero-enterostomy (EUS-EE) has not been well described. The aim of this study was to assess the technical and clinical success and safety of EUS-EE. Methods This was a multicenter, retrospective series at six centers in patients with ALS treated by EUS-EE. Data on patients treated with enteroscopy-assisted luminal stenting (EALS) at a single center were also collected. Results 18 patients (mean age 64.2 years, 72 % post-pancreaticoduodenectomy, 10 female) underwent EUS-EE. The most common symptoms were vomiting (27.8 %) and jaundice (33.3 %). Clinical success included resolution of symptoms in 88.9 % and improvement to allow hospital discharge in 11.1 %. Technical success was achieved in 100 % of cases, with a mean procedure time of 29.7 minutes. The most common procedure was a gastro-jejunostomy (72.2 %). Three adverse events (16.7 %) occurred (two mild, one moderate). When compared with data on EALS, patients treated with EUS-EE needed fewer re-interventions (16.6 % vs. 76.5 %; P < 0.001). Conclusion EUS-EE seems to be safe and effective in the treatment of ALS. Indirect comparison with EALS suggested that EUS-EE is associated with a reduced need for re-intervention.

Novel 15-mm-long lumen-apposing metal stent for endoscopic ultrasound-guided drainage of pancreatic fluid collections located ≥10 mm from the luminal wall

Endoscopy ◽  
2021 ◽  
Author(s):  
Linda Y. Zhang ◽  
Rastislav Kunda ◽  
Maridi Aerts ◽  
Nouredin Messaoudi ◽  
Rishi Pawa ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Clinical Symptoms ◽  
Clinical Success ◽  
Duodenal Wall ◽  
Metal Stents ◽  
Pancreatic Fluid Collections ◽  
Pancreatic Fluid ◽  
Maximal Diameter ◽  
International Multicenter Study ◽  
Fluid Collections

Abstract Background Endoscopic ultrasound (EUS)-guided drainage of pancreatic fluid collections (PFCs) by cautery-enhanced lumen-apposing metal stents (LAMS) has largely been limited to collections located < 10 mm from the luminal wall. We present outcomes of the use of a novel 15-mm-long cautery-enhanced LAMS for drainage of PFCs located ≥ 10 mm away. Methods This international, multicenter study analyzed all adults with PFCs located ≥ 10 mm from the luminal wall who were treated by EUS-guided drainage using the 15-mm-long cautery-enhanced LAMS. The primary outcome was technical success. Secondary outcomes included clinical success (decrease in PFC size by ≥ 50 % at 30 days and resolution of clinical symptoms without surgical intervention), complications, and recurrence. Results 35 patients (median age 57 years; interquartile range [IQR] 47–64 years; 49 % male) underwent novel LAMS placement for drainage of PFCs (26 walled-off necrosis, 9 pseudocysts), measuring 85 mm (IQR 64–117) maximal diameter and located 11.8 mm (IQR 10–12.3; range 10–14) from the gastric/duodenal wall. Technical and clinical success were high (both 97 %), with recurrence in one patient (3 %) at a median follow-up of 123 days (58–236). Three complications occurred (9 %; one mild, two moderate). Conclusions The 15-mm-long cautery-enhanced LAMS was feasible and safe for drainage of PFCs located 10–14 mm from the luminal wall.

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