scholarly journals Effectiveness of the endoscopic treatment for malignant extrahepatic biliary obstruction

2018 ◽  
Vol 22 (3) ◽  
pp. 509-512
Author(s):  
I.N. Mamontov ◽  
T.I. Tamm ◽  
K. A. Kramarenko ◽  
A. I. Bardiuk
Keyword(s):  
Biliary Drainage ◽  
Biliary Obstruction ◽  
Pancreatic Head ◽  
Mean Value ◽  
Endoscopic Drainage ◽  
Endoscopic Biliary Drainage ◽  
Level Data ◽  
Extrahepatic Biliary Obstruction ◽  
Distal Obstruction ◽  
Pancreatic Head Carcinoma

The causes of malignant extrahepatic biliary obstruction (MEBO) are pancreatic head carcinoma, ampulloma, cholangiocarcinoma, gall bladder cancer, less often — metastatic lymph nodes. Endoscopic biliary drainage (EBD) of extrahepatic ducts (ED) including stent placement plays a key role for cholestasis resolving. Aim — to evaluate the effectiveness of EBD in case of MEBO, depending on its level. Data of 36 patients with MEBO treated with EBD were retrospectively analyzed. Statistic methods: mean value and standart diviation were used. Ampulloma was the cause of MEBO in 7 cases, EBD was effective in all of them. Of 18 patients with MEBO at the level of distal 1/3 of ED, EBD was effective in 13. In the case of an MEBO of the middle 1/3of ED, EBD was successful in 3 of 6 patients, in the proximal 1/3 — in 3 out of 5. Thus, endoscopic biliary drainage was successful in 72% cases of malignant biliary obstruction. In case of obstruction at the papilla level, the success of endoscopic drainage has been achieved in all cases. Failure of EBD was due to inability of performing ERCP — mainly in cases of distal obstruction and the inability to get through obstruction — in the middle and proximal sections of the extrahepatic biliary tract.

scholarly journals ELEMENT TRIAL: study protocol for a randomized controlled trial on endoscopic ultrasound-guided biliary drainage of first intent with a lumen-apposing metal stent vs. endoscopic retrograde cholangio-pancreatography in the management of malignant distal biliary obstruction

Trials ◽  
2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Yen-I Chen ◽  
◽  
Kashi Callichurn ◽  
Avijit Chatterjee ◽  
Etienne Desilets ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Biliary Drainage ◽  
Biliary Obstruction ◽  
Locally Advanced ◽  
Endoscopic Drainage ◽  
Metal Stent ◽  
Ultrasound Guided ◽  
Endoscopic Retrograde ◽  
Promising Alternative ◽  
Randomized Controlled

Abstract Background & aims Endoscopic ultrasound guided-biliary drainage (EUS-BD) is a promising alternative to endoscopic retrograde cholangiopancreatography (ERCP); however, its growth has been limited by a lack of multicenter randomized controlled trials (RCT) and dedicated devices. A dedicated EUS-BD lumen- apposing metal stent (LAMS) has recently been developed with the potential to greatly facilitate the technique and safety of the procedure. We aim to compare a first intent approach with EUS-guided choledochoduodenostomy with a dedicated biliary LAMS vs. standard ERCP in the management of malignant distal biliary obstruction. Methods The ELEMENT trial is a multicenter single-blinded RCT involving 130 patients in nine Canadian centers. Patients with unresectable, locally advanced, or borderline resectable malignant distal biliary obstruction meeting the inclusion and exclusion criteria will be randomized to EUS-choledochoduodenostomy using a LAMS or ERCP with traditional metal stent insertion in a 1:1 proportion in blocks of four. Patients with hilar obstruction, resectable cancer, or benign disease are excluded. The primary endpoint is the rate of stent dysfunction needing re-intervention. Secondary outcomes include technical and clinical success, interruptions in chemotherapy, rate of surgical resection, time to stent dysfunction, and adverse events. Discussion The ELEMENT trial is designed to assess whether EUS-guided choledochoduodenostomy using a dedicated LAMS is superior to conventional ERCP as a first-line endoscopic drainage approach in malignant distal biliary obstruction, which is an important and timely question that has not been addressed using an RCT study design. Trial registration Registry name: ClinicalTrials.gov. Registration number: NCT03870386. Date of registration: 03/12/2019.

scholarly journals Nationwide practice and outcomes of endoscopic biliary drainage in resectable pancreatic head and periampullary cancer

HPB ◽  
2020 ◽  
Author(s):  
Anouk E.J. Latenstein ◽  
Tara M. Mackay ◽  
Nadine C.M. van Huijgevoort ◽  
Bert A. Bonsing ◽  
Koop Bosscha ◽  
...  
Keyword(s):  
Biliary Drainage ◽  
Pancreatic Head ◽  
Periampullary Cancer ◽  
Endoscopic Biliary Drainage

Mo1287 Impact of Endoscopic Biliary Drainage on Quality of Life in Patients With Unresectable Malignant Biliary Obstruction

2012 ◽  
Vol 75 (4) ◽  
pp. AB376
Author(s):  
Yukiko Ito ◽  
Hiroyuki Isayama ◽  
Takeshi Tsujino ◽  
Takashi Sasaki ◽  
Hirofumi Kogure ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Biliary Drainage ◽  
Biliary Obstruction ◽  
Malignant Biliary Obstruction ◽  
Endoscopic Biliary Drainage

scholarly journals Sphincterotomy with endoscopic biliary drainage for severe acute cholangitis: a meta-analysis

2017 ◽  
Vol 05 (02) ◽  
pp. E103-E109 ◽  
Author(s):  
Tarek Sawas ◽  
Noura Arwani ◽  
Shadi Al Halabi ◽  
John Vargo
Keyword(s):  
Success Rate ◽  
Biliary Drainage ◽  
Meta Analysis ◽  
Acute Cholangitis ◽  
Endoscopic Drainage ◽  
Endoscopic Biliary Drainage ◽  
Significant Difference ◽  
Obstructive Cholangitis ◽  
Effective Drainage

Abstract Aims To investigate the role of endoscopic sphincterotomy (ES) with endoscopic biliary drainage (EBD) in acute severe obstructive cholangitis management by performing a meta-analysis of controlled trials. Method We searched PubMed and Embase for controlled studies that compared endoscopic drainage with ES versus Non-ES in acute obstructive cholangitis. Two reviewers selected the studies and extracted the data. Disagreement was addressed by a third reviewer. Heterogeneity of the studies was analyzed by Cochran’s Q statistics. A Mantel–Haenszel risk ratio was calculated utilizing a random effects model. Results Four controlled studies met our inclusion criteria with 392 participants (201 ES, 191 Non-ES). The outcomes were drainage insertion success rate, drainage effectiveness, post drainage pancreatitis, bleeding, procedure duration, perforation, cholecystitis, and 30-day mortality. Drainage insertion success rate was identical in both groups (RR: 1.00, 95 %CI% 0.96 – 1.04). Effective drainage was not significantly different (RR: 1.11, 95 %CI 0.73 – 1.7). There was no significant difference in the incidence of pancreatitis post EBD between the ES and Non-ES groups at 3 % and 4 %, respectively (RR: 0.73, 95 %CI 0.24 – 2.27). However, there was a significant increase in post EBD bleeding with ES compared to Non-ES (RR: 8.58, 95 %CI 2.03 – 36.34). Thirty-day mortality was similar between ES and Non-ES groups at 0.7 % and 1 %, respectively (RR: 0.5, 95 %CI 0.05 – 5.28). Conclusion Our findings show that EBD without ES is an effective drainage technique and carries less risk for post procedure bleeding. Patients who are critically ill and have coagulopathy should be spared from undergoing ES in the acute phase.

Does preoperative biliary drainage compromise the long-term survival of patients with pancreatic head carcinoma?

2014 ◽  
Vol 111 (3) ◽  
pp. 270-276 ◽  
Author(s):  
Yoshiaki Murakami ◽  
Kenichiro Uemura ◽  
Yasushi Hashimoto ◽  
Naru Kondo ◽  
Naoya Nakagawa ◽  
...  
Keyword(s):  
Biliary Drainage ◽  
Pancreatic Head ◽  
Preoperative Biliary Drainage ◽  
Term Survival ◽  
Long Term Survival ◽  
Pancreatic Head Carcinoma

scholarly journals Endoscopic biliary drainage in unresectable biliary obstruction: the role of endoscopic ultrasound-guidance in a cohort study

2019 ◽  
Vol 111 ◽  
Author(s):  
Manuel Puga ◽  
Nat�lia Pallar�s ◽  
Julio Velásquez-Rodríguez ◽  
Albert García-Sumalla ◽  
Claudia F. Consiglieri ◽  
...  
Keyword(s):  
Cohort Study ◽  
Endoscopic Ultrasound ◽  
Biliary Drainage ◽  
Biliary Obstruction ◽  
Ultrasound Guidance ◽  
Endoscopic Biliary Drainage ◽  
Endoscopic Ultrasound Guidance

scholarly journals Technical tips and troubleshooting of endoscopic biliary drainage for unresectable malignant hilar biliary obstruction

2014 ◽  
Vol 22 (4) ◽  
pp. E12-E21 ◽  
Author(s):  
Hiroshi Kawakami ◽  
Takao Itoi ◽  
Masaki Kuwatani ◽  
Kazumichi Kawakubo ◽  
Yoshimasa Kubota ◽  
...  
Keyword(s):  
Biliary Drainage ◽  
Biliary Obstruction ◽  
Endoscopic Biliary Drainage ◽  
Hilar Biliary Obstruction ◽  
Malignant Hilar Biliary Obstruction

scholarly journals A Case of Malignant Biliary Obstruction with Severe Obesity Successfully Treated by Endoscopic Ultrasonography-Guided Biliary Drainage

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Takashi Obana ◽  
Shuuji Yamasaki
Keyword(s):  
Biliary Tract ◽  
Endoscopic Ultrasonography ◽  
Biliary Drainage ◽  
Biliary Obstruction ◽  
Severe Obesity ◽  
Pancreatic Head ◽  
Biliary Tree ◽  
Malignant Biliary Obstruction ◽  
Metallic Stent ◽  
Pancreatic Head Cancer

Here, we present a case of malignant biliary tract obstruction with severe obesity, which was successfully treated by endoscopic ultrasonography-guided biliary drainage (EUS-BD). A female patient in her sixties who had been undergoing chemotherapy for unresectable pancreatic head cancer was admitted to our institution for obstructive jaundice. She had diabetes mellitus, and her body mass index was 35.1 kg/m2. Initially, endoscopic retrograde cholangiopancreatography (ERCP) was performed, but bile duct cannulation was unsuccessful. Percutaneous transhepatic biliary drainage (PTBD) from the left hepatic biliary tree also failed. Although a second PTBD attempt from the right hepatic lobe was accomplished, biliary tract bleeding followed, and the catheter was dislodged. Consequently, EUS-BD (choledochoduodenostomy), followed by direct metallic stent placement, was performed as a third drainage method. Her postprocedural course was uneventful. Following discharge, she spent the rest of her life at home without recurrent jaundice or readmission. In cases of severe obesity, we consider EUS-BD, rather than PTBD, as the second drainage method of choice for distal malignant biliary obstruction when ERCP fails.

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