scholarly journals Endoscopic ultrasound-guided hepaticogastrostomy versus percutaneous transhepatic drainage for malignant biliary obstruction after failed endoscopic retrograde cholangiopancreatography: a retrospective expertise-based study from two centers

2017 ◽  
Vol 10 (6) ◽  
pp. 483-493 ◽  
Author(s):  
Adrien Sportes ◽  
Marine Camus ◽  
Michel Greget ◽  
Sarah Leblanc ◽  
Romain Coriat ◽  
...  
Keyword(s):  
Adverse Events ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Endoscopic Ultrasound ◽  
Clinical Success ◽  
Tertiary Care ◽  
Salvage Procedure ◽  
Technical Success ◽  
Ultrasound Guided ◽  
Endoscopic Retrograde ◽  
The Eu

Background: Percutaneous transhepatic biliary drainage (PTBD) is widely performed as a salvage procedure in patients with unresectable malignant obstruction of the common bile duct (CBD) after failed endoscopic retrograde cholangiopancreatography (ERCP) or in case of surgically altered anatomy. Endoscopic ultrasound-guided hepaticogastrostomy (EU-HGS) is a more recently introduced alternative to relieve malignant obstructive jaundice. The aim of this prospective observational study was to compare the outcome, efficacy and adverse events of EU-HGS and PTBD. Methods: From April 2012 to August 2015, consecutive patients with malignant CBD obstruction who underwent EU-HGS or PTBD in two tertiary-care referral centers were included. The primary endpoint was the clinical success rate. Secondary endpoints were technical success, overall survival, procedure-related adverse events, incidence of adverse events, and reintervention rate. Results: A total of 51 patients (EU-HGS, n = 31; PTBD, n = 20) were included. Median survival was 71 days (range 25–75th percentile; 30–95) for the EU-HGS group and 78 days (range 25–75th percentile; 42–108) for the PTBD group ( p = 0.99). Technical success was achieved in all patients in both groups. Clinical success was achieved in 25 (86%) of 31 patients in the EU-HGS group and in 15 (83%) of 20 patients in the PTBD group ( p = 0.88). There was no difference in adverse events rates between the two groups (EU-HGS: 16%; PTBD: 10%) ( p = 0.69). Four deaths within 1 month (two hemorrhagic and two septic) were considered procedure related (two in the EU-HGS group and two in the PTBD group). Overall reintervention rate was significantly lower after EU-HGS ( n = 2) than after PTBD ( n = 21) ( p = 0.0001). Length of hospital stay was shorter after EU-HGS (8 days versus 15 days; p = 0.002). Conclusions: EU-HGS can be an effective and safe mini invasive-procedure alternative to PTBD, with similar success and adverse-event rates, but with lower rates of reintervention and length of hospitalization.

scholarly journals Efficacy and safety of endoscopic ultrasound-guided pancreatic duct drainage (EUS-PDD): A systematic review and meta-analysis of 714 patients

2020 ◽  
Vol 08 (11) ◽  
pp. E1664-E1672
Author(s):  
Saurabh Chandan ◽  
Babu P. Mohan ◽  
Shahab R. Khan ◽  
Lena L. Kassab ◽  
Suresh Ponnada ◽  
...  
Keyword(s):  
Adverse Events ◽  
Pancreatic Duct ◽  
Endoscopic Ultrasound ◽  
Clinical Success ◽  
Meta Analysis ◽  
Fluid Collection ◽  
Technical Success ◽  
Ultrasound Guided ◽  
Anastomotic Strictures ◽  
Pancreatic Duct Drainage

Abstract Background and study aims Endoscopic ultrasound guided pancreatic duct drainage (EUS-PDD) is a minimal-invasive therapeutic option to surgery and in patients with failed endoscopic retrograde pancreatography (ERP). The aim of this review was to quantitatively appraise the clinical outcomes of EUS-PDD by meta-analysis methods. Methods We searched multiple databases from inception through March 2020 to identify studies that reported on EUS-PDD. Pooled rates of technical success, successful drainage of pancreatic duct, clinical success, and adverse events were calculated. Study heterogeneity was assessed using I2% and 95 % prediction interval. Results A total of 22 studies (714 patients) were included. The pooled rate of technical success in EUS-PDD was 84.8 % (95 % CI 79.1–89.2). The pooled rate of successful PD drained by EUS-PDD was 77.5 % (95 % CI 63.1–87.4). The pooled rate of clinical success of EUS-PDD was 89.2 % (95 % CI 82.1–93.7). The pooled rate of all adverse events was 18.1 % (95 % CI 14.2–22.9). On sub-group analysis, the pooled technical success and clinical success of EUS-PDD from Japanese data were considerably superior (91.2 %, 83–95.6 & 92.5 %, 83.9–96.7, respectively). The pooled rate of post EUS-PDD acute pancreatitis was 6.6 % (95 % CI 4.5–9.4), bleeding was 4.1 % (95 % CI 2.7–6.2), perforation and/or pneumoperitoneum was 3.1 % (95 % CI 1.9–5), pancreatic leak and/or pancreatic fluid collection was 2.3 % (95 % CI 1.4–4), and infection was 2.8 % (95 % CI 1.7–4.6). Conclusion EUS-PDD demonstrates high technical success and clinical success rates with acceptable adverse events. Technical success was especially high for anastomotic strictures.

scholarly journals Endoscopic Ultrasound Guided Pancreatic Pseudocyst drainage experience at a tertiary care unit

2020 ◽  
Vol 36 (4) ◽  
Author(s):  
Erum Kazim ◽  
Muhammad Ali Taj ◽  
Imrana Zulfikar ◽  
Jawad Azeem
Keyword(s):  
Endoscopic Ultrasound ◽  
Pancreatic Pseudocyst ◽  
Clinical Success ◽  
Demographic Data ◽  
Tertiary Care ◽  
Stent Migration ◽  
Technical Success ◽  
Ultrasound Guided ◽  
Number Of Patients ◽  
Pseudocyst Drainage

Objective: To evaluate the clinical success, technical success and complications related to Endoscopic ultrasound (EUS) guided Pancreatic pseudocyst (PPC) drainage. Methods: This retrospective study was conducted on the patients with symptomatic PPC who presented over a period of three years, between January 2015 and September 2018, at Endoscopic Suite of Surgical Unit 4, Civil Hospital, Karachi. Record was analyzed for demographic data, indications for the procedure, complications and success related to EUS guided drainage. Statistical analyses were performed using the SPSS Version 22. Results: Total number of patients was 71. Mean age was 37.20 ± 17.27 years with a range of 6 to 68 years. Complications occurred in 12 (8.52%) patients, including stent migration (5/12), bleeding (4/12), infection (1/12), intra-abdominal abscess (1/12) and perforation (1/12). Technical success was achieved in 100% and clinical success in 97.1%. There was no procedure-related mortality. Conclusion: Pancreatic pseudocyst (PPC) is a known complication of acute as well as chronic pancreatitis which can have dreaded and appalling effects. In this part of the world with limited and scarce resources, EUS guided drainage of PPC is most feasible and rational with minimal complications, thus making it a front runner procedure. doi: https://doi.org/10.12669/pjms.36.4.1442 How to cite this:Kazim E, Taj MA, Zulfikar I, Azeem J. Endoscopic Ultrasound Guided Pancreatic Pseudocyst drainage experience at a tertiary care unit. Pak J Med Sci. 2020;36(4):---------. doi: https://doi.org/10.12669/pjms.36.4.1442 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

scholarly journals Endoscopic ultrasound guided biliary drainage: a multicenter retrospective experience of a technique slowly gaining acceptance in Egypt

2019 ◽  
Vol 12 ◽  
pp. 263177451988945
Author(s):  
Ahmed Youssef Altonbary ◽  
Ahmed Galal ◽  
Mohamed El-Nady ◽  
Hazem Hakim
Keyword(s):  
Endoscopic Retrograde Cholangiopancreatography ◽  
Endoscopic Ultrasound ◽  
Biliary Drainage ◽  
Biliary Obstruction ◽  
Clinical Success ◽  
Malignant Biliary Obstruction ◽  
Safe Procedure ◽  
Ultrasound Guided ◽  
Endoscopic Retrograde ◽  
Increased Risk

Background and aim: Endoscopic ultrasound-guided biliary drainage is an alternative to failed endoscopic retrograde cholangiopancreatography. Unfortunately, this procedure remains relatively less explored in Egypt due to its high cost, lack of adequate training, and the perception of increased risk. This study is the first multicenter Egyptian experience of an endoscopic ultrasound-guided biliary drainage in patients with malignant biliary obstruction. Patients and methods: We retrospectively reviewed 15 patients (10 men and five women) with malignant biliary obstruction who from October 2013 to May 2019, following a failed or inaccessible endoscopic retrograde cholangiopancreatography, underwent an endoscopic ultrasound-guided choledochoduodenostomy, endoscopic ultrasound-guided hepaticogastrostomy, or endoscopic ultrasound-guided rendezvous. Their mean age was 57.4 years and mean bilirubin was 18.2 mg/dL. The outcome parameters included technical and clinical success. Technical success was defined as the successful placement of a stent in the biliary system, while clinical success was defined as a greater than 50% decrease in the bilirubin levels 2 weeks after the procedure. Patients were monitored for complications during and after the procedure. Results: In total, 15 patients underwent endoscopic ultrasound-guided biliary drainage (eight underwent endoscopic ultrasound-guided choledochoduodenostomy, five underwent endoscopic ultrasound-guided hepaticogastrostomy, and two underwent endoscopic ultrasound-guided rendezvous). The technical and clinical success rates were 100% (15/15 patients) and 93.3% (14/15 patients), respectively. The complication rate was 26.6% (4/15 patients). All complications were mild and self-limited, and included fever, mild biliary peritonitis, pneumoperitoneum, and a slight migration of one plastic stent during insertion. Conclusion: Although slowly gaining acceptance in Egypt, endoscopic ultrasound-guided biliary drainage is an effective and safe procedure in patients with a malignant biliary obstruction after a failed or inaccessible endoscopic retrograde cholangiopancreatography.

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.

A novel “hitch-and-ride” deep biliary cannulation method during rendezvous endoscopic ultrasound-guided ERCP technique

Endoscopy ◽  
2017 ◽  
Vol 49 (10) ◽  
pp. 983-988 ◽  
Author(s):  
Yousuke Nakai ◽  
Hiroyuki Isayama ◽  
Saburo Matsubara ◽  
Hirofumi Kogure ◽  
Suguru Mizuno ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Event Rate ◽  
The Other ◽  
Adverse Event Rate ◽  
Technical Success ◽  
Ultrasound Guided ◽  
Endoscopic Retrograde ◽  
Biliary Cannulation ◽  
Technical Success Rate ◽  
The Wire

Abstract Background and study aim Endoscopic ultrasound-guided rendezvous (EUS-RV) is increasingly reported as a treatment option after failed endoscopic retrograde cholangiopancreatography. We developed a novel “hitch-and-ride” catheter for biliary cannulation to reduce the risk of guidewire loss during EUS-RV. Patients and methods We retrospectively evaluated safety and technical success of EUS-RV between June 2011 and May 2016. Biliary cannulation during EUS-RV using three methods – over-the-wire, along-the-wire, and hitch-and-ride – were compared. Results A total of 30 EUS-RVs were attempted and the technical success rate was 93.3 %, with two failures (one bile duct puncture and one guidewire insertion). After 28 cases of successful guidewire passage, cannulation was attempted by the over-the-wire (n = 13), along-the-wire (n = 4) or hitch-and-ride (n = 11) method. Only the hitch-and-ride method achieved biliary cannulation without guidewire loss or conversion to the other methods. Time to cannulation was shorter with the hitch-and-ride method (4 minutes) than with over-the-wire and along-the-wire methods (9 and 13 minutes, respectively). The adverse event rate of EUS-RV was 23.3 %. Conclusion A novel hitch-and-ride catheter was feasible for biliary cannulation after EUS-RV.

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