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 simple and novel marking method for correctly identifying the precutting direction to achieve safe and efficacious precut sphincterotomy (with video)

2019 ◽  
Vol 07 (01) ◽  
pp. E3-E8
Author(s):  
Kazumasa Nagai ◽  
Akio Katanuma ◽  
Kuniyuki Takahashi ◽  
Kei Yane ◽  
Toshifumi Kin ◽  
...  
Keyword(s):  
Bile Duct ◽  
Technical Success ◽  
Tertiary Referral ◽  
Endoscopic Retrograde ◽  
Incision Length ◽  
Tertiary Referral Center ◽  
Preliminary Study ◽  
Needle Knife ◽  
The Right ◽  
Precut Sphincterotomy

Abstract Background and study aims Failure to recognize the right direction and precise incision length during precutting has been reported. To address these concerns, we developed a marking method that places a marking on the cutting endpoint before starting precutting. This preliminary study aimed to assess the effectiveness and safety of precut sphincterotomy using our new marking method. Patients and methods Between April 2015 and May 2017, 21 patients from our tertiary referral center were included in this study. Precut sphincterotomy using our marking method was employed for difficult common bile duct cannulation cases. Before starting precutting, a marking was placed slightly before the upper margin of the bulge of the papilla in the 11- to 12-o’clock direction as a cutting endpoint by cauterization with a needle knife. Results Technical success was obtained in all 21 procedures. There were no post-endoscopic retrograde cholangiopancreatography (ERCP) complications except for one mild case of post-ERCP pancreatitis. Conclusion Our new marking method before precutting enabled precise incision and quick bile duct cannulation without causing severe complications.

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 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.

Outcomes of Isolated Fetal Ventriculomegaly That Resolve In Utero

2020 ◽  
Author(s):  
Marwan Ma'ayeh ◽  
Calvin L. Ward ◽  
Abigail Chitwood ◽  
Stephen E. Gee ◽  
Patrick Schneider ◽  
...  
Keyword(s):  
Retrospective Cohort ◽  
Chromosomal Abnormalities ◽  
Incidental Finding ◽  
In Utero ◽  
Tertiary Referral ◽  
Fetal Ultrasound ◽  
Tertiary Referral Center ◽  
Key Points ◽  
Fetal Ventriculomegaly ◽  
Risk Patients

Objective Isolated fetal ventriculomegaly is often an incidental finding on antenatal ultrasound. It is benign in up to 90% of cases, although it can be associated with genetic, structural, and neurocognitive disorders. The literature suggests that over 40% of isolated mild ventriculomegaly will resolve in utero, but it is unclear if resolution decreases the associated risks.The aim of this study is to compare the fetal and neonatal genetic outcomes of ventriculomegaly that persists or resolves on subsequent ultrasound. Study Design This is a retrospective cohort study of women diagnosed with isolated ventriculomegaly via fetal ultrasound at a tertiary referral center between 2011 and 2019. Patients were excluded if other structural anomalies were identified on ultrasound. Results A total of 49 patients were included in the study, 19 in the resolved ventriculomegaly group and 30 in the persistent ventriculomegaly group. Women in the resolved ventriculomegaly group were more likely to be diagnosed earlier (24 vs. 28 weeks, p = 0.007). Additionally, they were more likely to have mild ventriculomegaly (63 vs. 84%, p = 0.15), and less likely to have structural neurological abnormalities diagnosed on postnatal imaging (5 vs. 17%, p = 0.384), although these were not statistically significant. Aneuploidy risk for resolved compared with persistent ventriculomegaly was similar (5 vs. 7%, p = 0.999). Conclusion This study suggests that resolution of isolated ventriculomegaly in utero may not eliminate the risk of genetic or chromosomal abnormalities in this population and may warrant inclusion as part of the counselling of these at-risk patients. Larger prospective studies are needed to confirm these findings. Key Points

scholarly journals Prospective Comparison of Moderate Conscious Sedation and Anesthesia Assistance for the Performance of Endoscopic Retrograde Cholangiopancreatography (ERCP)

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Ahmed Akhter ◽  
Ravi Patel ◽  
Eric Nelsen ◽  
Mark E. Benson ◽  
Deepak V. Gopal ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Conscious Sedation ◽  
Medical Center ◽  
Cost Savings ◽  
Success Rates ◽  
Procedure Time ◽  
Technical Success ◽  
Endoscopic Retrograde ◽  
Prospective Comparison

Objectives. Recent trends have favored the use of anesthesia personnel more frequently for advanced endoscopic procedures. We hypothesize a selective sedation approach based on patient and procedural factors using either moderate conscious sedation (MCS) or general anesthesia (GA) will result in similar outcomes and safety with significant cost savings. Methods. A 12-month prospective study of all adult endoscopic retrograde cholangiopancreatography (ERCPs) performed at a tertiary medical center was enrolled. Technical success, cannulation rates, procedural related complications, procedure time, and cost were compared between MCS and GA. Results. A total of 876 ERCPs were included in the study with 74% performed with MCS versus 26% with GA. The intended intervention was completed successfully in 95% of cases with MCS versus 96% cases with GA ( p  = 0.59). Cannulation success rates with MCS were 97.5 versus 97.8% with GA ( p  = 0.81). Overall, adverse event rates were similar in both groups (MCS: 6.6% vs. GA: 9.2%, p  = 0.21). Mean procedure time was less for MCS versus GA, 18.3 and 26 minutes, respectively ( p  < 0.0001). Selective use of MCS vs. universal sedation with GA resulted in estimated savings of $8,190 per case and $4,735,202 per annum. Conclusions. Preselection of ERCP sedation of moderate conscious sedation versus general anesthesia based upon patient risk factors and planned therapeutic intervention allows for the majority of ERCPs to be completed with MCS with similar rates of technical success and improvement in resource utilization and cost savings compared to performing ERCPs universally with anesthesia assistance.

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.

scholarly journals Disección endoscópica con técnica de bolsillo submucoso. ¿Puede reemplazar a la disección convencional?

2021 ◽  
Vol 51 (3) ◽  
Author(s):  
Martín Yantorno ◽  
Gustavo Javier Correa ◽  
Sebastián Esteves ◽  
Florencia Giraudo ◽  
Agustina Redondo ◽  
...  
Keyword(s):  
High Risk ◽  
En Bloc Resection ◽  
Conventional Technique ◽  
Bloc Resection ◽  
Complete Resection ◽  
High Rate ◽  
Procedure Time ◽  
Technical Success ◽  
En Bloc

Endoscopic submucosal dissection is a complex technique that allows en bloc resection of large lesions. It is associated with long-term, technically complex procedures and a high risk of complications. The creation of a submucosal pocket is a variant of the conventional technique that reduces these difficulties, generating a high rate of complete resection with a shorter procedure time, a faster dissection speed and a lower rate of adverse events. Even though this variant was initially described in the stomach, its application has been generalized to other areas of the digestive tract. We present two cases where this variant technique was applied to treat large early lesions, with technical success.

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