The Role of EUS-BD in the Management of Malignant Biliary Obstruction: The Indonesian Perspective

Aims. To evaluate the success rate and related factors of endoscopic ultrasound guided-biliary drainage (EUS-BD). Material and Methods. We conducted a retrospective study among 24 patients with malignant biliary obstruction who underwent EUS-BD after failed ERCP from January 2015 to December 2016 in a tertiary health center. The bilirubin levels before and after the procedure were used to define the clinical success rate, while the stent deployment was used to define the technical success rate. We placed either transluminal biliary stents or transpapillary biliary stents. Results. Among 24 patients, choledochoduodenostomy technique was conducted in 23 patients (95.8%) and hepaticogastrostomy technique in 1 patient (4.2%). Transluminal stent placement was conducted in 23 patients, while transpapillary stent placement was conducted in 1 patient. The clinical success rate was 78.2% (18) in choledochoduodenostomy route and 100% (1) in hepaticogastrostomy route. EUS-BD was 2.37 times and 2.11 times more likely to be successful in reducing the bilirubin level in patients with tumor of the head of pancreas and periampullary tumor, respectively, but not in cholangiocarcinoma. Conclusions. EUS-BD is an effective and efficient procedure to achieve biliary drainage among patients with malignant biliary obstruction after ERCP failure.

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Palliative Endoscopic Ultrasound Biliary Drainage for Advanced Malignant Biliary Obstruction: Should It Replace the Percutaneous Approach?

Case Reports in Gastroenterology ◽

10.1159/000502835 ◽

2019 ◽

Vol 13 (3) ◽

pp. 385-397 ◽

Cited By ~ 1

Author(s):

C. Rinaldi A. Lesmana ◽

Rino A. Gani ◽

Irsan Hasan ◽

Andri Sanityoso Sulaiman ◽

Khek Yu Ho ◽

...

Keyword(s):

Success Rate ◽

Endoscopic Ultrasound ◽

Biliary Drainage ◽

Biliary Obstruction ◽

Clinical Success ◽

Case Series ◽

Clinical Success Rate ◽

Malignant Biliary Obstruction ◽

Technical Success Rate ◽

Case Series Study

Endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic biliary drainage (PTBD) are the standard of care in malignant biliary obstruction cases. Recently, endoscopic ultrasound-guided biliary drainage (EUS-BD) has been widely used after unsuccessful ERCP. However, the patient’s clinical impact of EUS-BD over PTBD is still not obvious. Therefore, this case series study aims to evaluate the clinical outcomes of patients with advanced malignant biliary obstruction who underwent EUS-BD after failed ERCP. A retrospective database study was performed between January 2016 and June 2018 in patients with advanced malignant biliary obstruction. Patients were consecutively enrolled without randomization. Treatment options consisted of ERCP and PTBD or EUS-BD if ERCP failed. Based on 144 biliary obstruction cases, 38 patients were enrolled; 24 (63.2%) were men. The patients’ mean age was 66.8 ± 12.36 years. The most common cause of malignant biliary obstruction was pancreatic cancer (44.7%). Biliary drainage was achieved by ERCP (39.5%), PTBD (39.5%), and EUS-BD (21.1%). The technical success rate was 86.7% by PTBD and 87.5% by EUS-BD (p = 1.000), while the clinical success rate was 93.3% by PTBD and 62.5% by EUS-BD (p = 0.500). The median survival in patients who underwent PTBD versus those wo underwent EUS-BD was 11 versus 3 months (log-rank p = 0.455). In conclusion, there is no significant advantage of EUS-BD when compared to PTBD in terms of clinical success and survival benefit in advanced malignant biliary obstruction.

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Stenting Treatment for Intra- and Extra-Cranial Atherosclerotic Diseases

Interventional Neuroradiology ◽

10.1177/15910199990050s109 ◽

1999 ◽

Vol 5 (1_suppl) ◽

pp. 51-53 ◽

Cited By ~ 3

Author(s):

T. Mori ◽

K. Kazita ◽

K. Chokyu ◽

K. Mori

Keyword(s):

Success Rate ◽

Balloon Angioplasty ◽

Stent Placement ◽

Clinical Success ◽

Clinical Success Rate ◽

Morbidity Rate ◽

Biliary Stents ◽

Stent Deformation ◽

Cranial Arteries

The purpose of this study was to investigate the effect, safety and short-term outcome of stenting treatment for extra- and intra-cranial atherosclerotic diseases. Forty-one patients underwent stenting treatment using coronary and biliary stents. Eleven patients had tubular or diffuse high-grade stenoses not amenable to standard balloon angioplasty involving intra-cranial arteries, while in thirty, extra-cranial arteries were involved. Stents were successfully implanted in 36 out of 41 lesions (88%) with 2% (1/41) of overall procedural morbidity rate. Procedural and clinical success rate of intra-cranial stent placement was 64% (7/11) and no complications occurred during or after intra-cranial stent placement: the morbidity rate was 0%. Hyperperfusion injury occurred in two patients after successful implantation of stents in subtotal occlusion of the internal carotid artery, and consequently the overall clinical success rate was 80% (33/41). Restenosis occurred in four (12%) out of 33 patients who underwent six month follow-up arteriography. No ischemic attacks or stent-deformation occurred during follow-up after stenting treatment. For lesions not amenable to standard balloon angioplasty, endovascular stent placement seems to be a safe and effective treatment of modality.

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Clinical Feasibility and Safety of Endoscopic Self-Expandable Metal Stent Placement for Upper Gastrointestinal Pathologies

International Surgery ◽

10.9738/intsurg-d-15-00169.1 ◽

2019 ◽

Vol 103 (11-12) ◽

pp. 605-612

Author(s):

Bünyamin Gürbulak ◽

Esin Kabul Gürbulak ◽

Hasan Bektaş ◽

İsmail Ethem Akgün ◽

Hızır Yakup Akyildiz ◽

...

Keyword(s):

Success Rate ◽

Stent Placement ◽

Clinical Success ◽

Clinical Success Rate ◽

Endoscopic Stenting ◽

Covered Stents ◽

Success Rates ◽

Endoscopic Stent ◽

Technical Success Rate ◽

Upper Gastrointestinal

We aimed to review our experiences to evaluate the practicality, safety, and effectiveness of endoscopic stent placement for the palliation of malignant obstructions of the upper gastrointestinal system (GIS) and the treatment of postoperative complications such as failure of anastomoses and fistulae. Endoscopic stent placement is increasingly used in the upper GIS for the management of both high grade malignancies causing obstruction and benign pathologies such as anastomosis failures, gastrointestinal fistulae, and strictures. Hospital records, clinical data, and endoscopy reports of 61 patients who had undergone endoscopic stenting between the years 2012 and 2015 were analyzed retrospectively. For all patients, self-expandable metal covered stents were used. Data involving technical and clinical success rates, complication, morbidity, and mortality rates of the endoscopic stenting procedure was collected and simple statistical analyses were made. Endoscopic stenting was successful in 60 of 61 patients (98.3%). Overall technical success rate was found to be 98.3%; clinical success rate, 86.6%; complication rate, 4.9%. No stent related mortality was observed in our series. Endoscopic stents can be effectively and safely used in the treatment of various lesions of the upper GIS.

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Comparison of alteplase and urokinase for pharmacomechanical thrombolysis of clotted hemodialysis access

The Journal of Vascular Access ◽

10.1177/1129729818819735 ◽

2018 ◽

Vol 20 (5) ◽

pp. 501-506 ◽

Cited By ~ 6

Author(s):

Ru Yu Tan ◽

Suh Chien Pang ◽

Swee Ping Teh ◽

Kian Guan Lee ◽

Tze Tec Chong ◽

...

Keyword(s):

Success Rate ◽

Vascular Access ◽

Clinical Success ◽

Univariate Analysis ◽

Clinical Success Rate ◽

Skin Dose ◽

Hemodialysis Access ◽

Procedure Time ◽

Technical Success Rate ◽

Tertiary Teaching

Background: Percutaneous pharmacomechanical thrombolysis is increasingly used to salvage thrombosed hemodialysis access. We aim to evaluate the effectiveness of alteplase compared to urokinase in percutaneous pharmacomechanical thrombolysis clotted access. Methods: Records of patients who underwent pharmacomechanical thrombolysis at Interventional Nephrology Suite in a tertiary teaching hospital from 1 January 2016 to 31 December 2016 were reviewed. Technical and clinical success rates, thrombosis-free and cumulative survivals, procedure time, and radiation dose imparted to patients were compared for pharmacomechanical thrombolysis with urokinase versus alteplase. Results: A total of 122 incident patients underwent pharmacothrombolysis (n = 53 for urokinase, n = 69 for alteplase) during the study period. The mean dose of urokinase and alteplase used was 176,897 ± 73,418 units and 3.7 ± 0.8 mg, respectively. Pharmacomechnical thrombolysis using urokinase versus alteplase has similar technical success rate (98.1% vs 97.1%, p = 0.599), clinical success rate (88.7% vs 97.1%, p = 0.068), complication rate (9.4% vs 13.0%, p = 0.373), and primary patency rates at 3 months (57.1% vs 70.1%, p = 0.106). Thrombosis-free survivals of the vascular access were 113.2 (35.3, 196) days versus 122 (84, 239) days (p = 0.168). Cumulative survivals were 239 (116, 320) vs 213 (110.5, 316.5) days (p = 0.801). Procedure time, fluoroscopy time, skin dose, and dose were significantly lower for pharmacomechanical thrombolysis using alteplase compared to urokinase (p = 0.045, p < 0.0001, p = 0.006, p = 0.001, respectively). Stenting was found to be associated with successful dialysis following thrombolysis on univariate analysis (odds ratio: 9.167, 95% confidence interval: 1.391–19.846, p = 0.021), although this was no longer significant in multivariate analysis (p = 0.078). Conclusion: Alteplase is an effective and safe alternative to urokinase for pharmacomechanical thrombolysis of clotted vascular access.

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Long-Term Management of Recurrent Cholecystitis after Initial Conservative Treatment: Endoscopic Transpapillary Gallbladder Stenting

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2018/3983707 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7

Author(s):

Hideki Kamada ◽

Hideki Kobara ◽

Naohito Uchida ◽

Kiyohito Kato ◽

Takayuki Fujimori ◽

...

Keyword(s):

High Risk ◽

Acute Cholecystitis ◽

Success Rate ◽

Clinical Success ◽

Clinical Success Rate ◽

Technical Success ◽

Technical Success Rate ◽

High Risk Patients ◽

Risk Patients

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.

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Analysis of Outcomes of Endovascular Embolisation: A Cross-Sectional Multicenter Study on 46 Visceral Artery Pseudoaneurysms

10.21203/rs.3.rs-559515/v1 ◽

2021 ◽

Author(s):

Mohammad Koriem Mahmoud Omar ◽

Moustafa H. M. Othman ◽

Robert A. Morgan ◽

Abdelkarem Hasan Abdallah ◽

Hany M. A. Seif ◽

...

Keyword(s):

Success Rate ◽

Clinical Success ◽

Clinical Success Rate ◽

Visceral Artery ◽

Endovascular Management ◽

Cross Sectional ◽

Technical Success Rate ◽

Endovascular Embolisation ◽

Visceral Artery Aneurysms ◽

Perioperative Complication

Abstract Purpose Visceral artery aneurysms are subdivided into true aneurysms and pseudoaneurysms. Visceral artery pseudoaneurysms (VAPAs) are uncommon in clinical practice but may have serious clinical outcomes up to death. Endovascular management is a safe effective alternative option to traditional surgical procedures. This study assesses the outcome of different embolic materials and techniques used in the endovascular management of visceral artery pseudoaneurysms. Materials and methods This is a multicentric prospective analysis of endovascular embolisation of 46 VAPAs with a mean pseudoaneurysm size of 13 ± 11.35 mm. Management using coils only was done in 28/46 patients (60.87%), NBCA glue only in 16/46 patients (34.78%), combined coils and NBCA glue in 1/46 patient (2.17%), and Amplatzer plugs only in 1 patient (2.17%). The management techniques were sac packing in 9/46 patients (19.57%), inflow occlusion in 28/46 patients (60.87%) and trapping in 9/46 patients (19.57%). Results The overall clinical success rate was 93.48%, the overall perioperative complication rate was 15.22% and 30-day mortality was zero. For the coil subgroup (n = 28), the clinical success was 92.86%, while the subgroup of NBCA glue (n = 16) showed clinical success of 93.75%. There was no significant statistical difference between clinical success among coil, and NBCA glue subgroups (P > 0.05). The technical success rate was 100%. Effectiveness of the procedures during the follow-up was 97.83%. Target lesion re-intervention rate was 2.17%. Conclusion Transarterial embolisation can provide high technical and clinical success rates with low perioperative complication and re-intervention rates, as well as satisfactory procedure effectiveness in the management of VAPAs.

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Outcomes and Limitations of Endoscopic Ultrasound-guided Hepaticogastrostomy in Malignant Biliary Obstruction

10.21203/rs.3.rs-147757/v1 ◽

2021 ◽

Author(s):

Mateusz Jagielski ◽

Michał Zieliński ◽

Jacek Piątkowski ◽

Marek Jackowski

Keyword(s):

Gastrointestinal Tract ◽

Biliary Drainage ◽

Biliary Obstruction ◽

Bile Ducts ◽

Clinical Success ◽

Hepatic Metastases ◽

Symptomatic Treatment ◽

Malignant Biliary Obstruction ◽

Biliary Duct ◽

Factors Affecting

Abstract Background: Transpapillary biliary drainage in ERCP is an established method for symptomatic treatment of patients with irresectable malignant biliary obstruction. Percutaneous transhepatic biliary drainage frequently remains the treatment of choice when the transpapillary approach proves ineffective. Recently, EUS-guided extra-anatomical anastomoses of bile ducts to the gastrointestinal tract have been reported as an alternative to percutaneous biliary drainage. To assess the usefulness of extra-anatomical intrahepatic biliary duct anastomoses to the gastrointestinal tract as endotherapy for irresectable malignant biliary obstruction and to determine factors affecting the efficacy of treatment. Methods: A prospective analysis of the treatment results of all patients with irresectable biliary obstruction treated with endoscopic hepaticogastrostomy at our institution in the years 2016–2019. Results: Transmural intrahepatic biliary drainage (endoscopic hepaticogastrostomy) was performed due to the ineffectiveness of ERCP in 53 patients (38 males, 15 females; mean age 74.66 [56–89] years) with irresectable biliary obstruction. Technical success of endoscopic hepaticogastrostomy was achieved in 52/53 (98.11%) patients. Complications of endoscopic treatment were observed in 10/53 (18.87%) patients. Clinical success of endoscopic hepaticogastrostomy was achieved in 46/53 (86.79%) patients. Bismuth type II–IV cholangiocarcinoma, hepatic metastases, ascites, suppurative cholangitis, and high blood bilirubin levels exceeding 30 mg/dL were independent factors for increased complications and inefficacy of endoscopic hepaticogastrostomy. Conclusions: In the event of transpapillary biliary drainage proving ineffective, extra-anatomical anastomoses of bile ducts to the gastrointestinal tract provide an effective method for the treatment of patients with malignant biliary obstruction.

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Endoscopic ultrasound-guided biliary drainage for distal malignant obstruction: a systematic review and meta-analysis of randomized trials

Endoscopy International Open ◽

10.1055/a-0998-8129 ◽

2019 ◽

Vol 07 (11) ◽

pp. E1563-E1573 ◽

Cited By ~ 9

Author(s):

Corey S. Miller ◽

Alan N. Barkun ◽

Myriam Martel ◽

Yen-I Chen

Keyword(s):

Biliary Drainage ◽

Biliary Obstruction ◽

Randomized Trials ◽

Clinical Success ◽

Meta Analysis ◽

Malignant Biliary Obstruction ◽

First Line ◽

First Line Therapy ◽

Catheter Dysfunction ◽

Distal Malignant Biliary Obstruction

Abstract Background and study aims Endoscopic ultrasound (EUS)-guided biliary drainage (BD) is increasingly used for distal malignant biliary obstruction, yet its safety and efficacy compared to endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic biliary drainage (PTBD) remain unclear. We performed a meta-analysis to improve our understanding of the role of EUS-BD in this patient population. Methods We searched Embase, MEDLINE, CENTRAL, and ISI Web of Knowledge through September 2018 for randomized controlled trials (RCTs) comparing EUS-BD to ERCP-BD or PTBD as treatment of distal malignant biliary obstruction. Risk ratios (RRs) with 95 % confidence intervals (CIs) were combined using random effects models. The primary outcome was risk of stent/catheter dysfunction requiring reintervention. Results Of six trials identified, three (n = 222) compared EUS-BD to ERCP-BD for first-line therapy; three others (n = 132) evaluated EUS-BD versus PTBD after failed ERCP-BD. EUS-BD was associated with a decreased risk of stent/catheter dysfunction overall (RR, 0.39; 95 %CI 0.27 – 0.57) and in planned subgroup analysis when compared to ERCP (RR, 0.41; 95 %CI 0.23 – 0.74) or PTBD (RR, 0.37, 95 %CI 0.22 – 0.61). Compared to ERCP, EUS was associated with a decreased risk of post-procedure pancreatitis (RR, 0.12; 95 %CI 0.01 – 0.97). No differences were noted in technical or clinical success. Conclusions In a meta-analysis of randomized trials comparing EUS-BD to conventional biliary drainage modalities, no difference in technical or clinical success was observed. Importantly, EUS-BD was associated with decreased risks of stent/catheter dysfunction when compared to both PTBD and ERCP, and decreased post-procedure pancreatitis when compared to ERCP, suggesting the potential role for EUS-BD as an alternative first-line therapy in distal malignant biliary obstruction.

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Superselective Renal Artery Embolization Management of Post-percutaneous Nephrolithotomy Hemorrhage and Its Methods

Frontiers in Surgery ◽

10.3389/fsurg.2020.582261 ◽

2020 ◽

Vol 7 ◽

Author(s):

Xiangjun Dong ◽

Yanqiao Ren ◽

Ping Han ◽

Lei Chen ◽

Tao Sun ◽

...

Keyword(s):

Serum Creatinine ◽

Success Rate ◽

Clinical Data ◽

Clinical Success ◽

Clinical Success Rate ◽

Arterial Embolization ◽

Interventional Therapy ◽

Technical Success Rate ◽

Renal Hemorrhage ◽

Significant Difference

Objective: The purpose of this study was to evaluate the therapeutic efficacy and safety of superselective renal arterial embolization (SRAE) in the treatment of patients with renal hemorrhage after percutaneous nephroscopy (PCNL). In addition, embolization techniques and embolization materials during operation were also worthy of further discussion.Methods: From February 2015 to December 2019, clinical data of 49 consecutive patients with renal hemorrhage after PCNL were retrospectively analyzed. Demographic and clinical data of patients were recorded, changes in serum creatinine values were analyzed, and the safety and efficacy of TAE were evaluated. Clinical experience was also recorded.Results: A total of 49 patients underwent angiography, of which 46 patients received SRAE due to positive hemorrhagic foci detected by angiography, and the technical success rate of 46 patients was 100%. Among the three patients who did not receive embolization, one patient underwent nephrectomy, and two patients improved with conservative treatment, with a clinical success rate of 98%. There was no statistically significant difference between serum creatinine before PCNL and 7 days after SRAE (101.6 ± 36.5 to 100.5 ± 27.1 μmol/L; P = 0.634), and no significant change was observed in serum creatinine at the last follow-up (99.4 ± 34 μmol/L, P = 0.076). No major complications occurred after embolization.Conclusions: SRAE is safe and effective in patients with renal hemorrhage after PCNL. The experience of interventional therapy and the choice of embolization materials in this study may provide certain benefits for the treatment of patients with renal hemorrhage after PCNL.

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Outcome after percutaneous transluminal angioplasty of arterial stenosis in renal transplant patients

Acta Radiologica ◽

10.1080/02841850902718763 ◽

2009 ◽

Vol 50 (3) ◽

pp. 270-275 ◽

Cited By ~ 25

Author(s):

G. Hagen ◽

J. Wadström ◽

M. Magnusson ◽

A. Magnusson

Keyword(s):

Renal Transplant ◽

Success Rate ◽

Clinical Success ◽

Clinical Success Rate ◽

Transluminal Angioplasty ◽

Technical Success ◽

Technical Success Rate ◽

Transplant Patients ◽

Renal Transplant Patients ◽

Percutaneous Transluminal

Background: Ensuring graft survival in renal transplant patients is of paramount importance. Early detection and treatment of complications such as transplant renal artery stenosis (TRAS) are essential. Purpose: To evaluate the technical and clinical success rate of renal transplant patients with stenosis in the transplant renal artery or in the iliac artery after percutaneous transluminal angioplasty (PTA). Material and Methods: PTA was carried out on 24 patients with TRAS or iliac artery stenosis. Altogether, 28 stenoses were treated with PTA. The immediate technical result and the clinical outcomes after 1 and 3 months were assessed as well as clinical adverse events. A reduction in serum creatinine and/or a reduction in the number of antihypertensive drugs were criteria for clinical success. Results: The immediate technical success rate after PTA was 93%. The clinical success rate after 1 month was 58%, increasing to 75% after 3 months. Conclusion: The technical success rate is not equivalent to the clinical success rate when treating TRAS with PTA. Furthermore, there is a delay in clinical response, sometimes of 3 months, after a technically successful PTA.

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