scholarly journals Outcomes of Endoscopic Ultrasound-Guided Biliary Drainage in a General Hospital for Patients with Endoscopic Retrograde Cholangiopancreatography-Difficult Transpapillary Biliary Drainage

2021 ◽  
Vol 10 (18) ◽  
pp. 4105
Author(s):  
Naosuke Kuraoka ◽  
Satoru Hashimoto ◽  
Shigeru Matsui ◽  
Shuji Terai
Keyword(s):  
Bile Duct ◽  
Endoscopic Ultrasound ◽  
Biliary Drainage ◽  
Duodenal Bulb ◽  
Distal Bile Duct ◽  
Ultrasound Guided ◽  
Difficult Patients ◽  
Stent Patency ◽  
Bile Duct Stenosis ◽  
Duct Stenosis

Endoscopic ultrasound-guided biliary drainage (EUS-BD) has been developed as an alternative treatment for percutaneous transhepatic biliary drainage for patients with bile duct stenosis. At specialized hospitals, the high success rate and effectiveness of EUS-BD as primary drainage has been reported. However, the procedure is highly technical and difficult, and it has not been generally performed. In this study, we retrospectively examined the effectiveness of EUS-BD in ERCP-difficult patients with distal bile duct stenosis. We retrospectively examined 24 consecutive cases in which EUS-BD was performed at our hospital for distal bile duct stenosis from October 2018 to December 2020. EUS-guided choledochoduodenostomy (EUS-CDS) was selected for cases that could be approached from the duodenal bulb, and EUS-HGS was selected for other cases. In the EUS-CDS and EUS-HGS groups, the technical success rates were 83.3% (10/12] and 91.7% (11/12], respectively. An adverse event occurred in one case in the EUS-CDS group, which developed severe biliary peritonitis. The stent patency period was 91 and 101 days in the EUS-CDS and EUS-HGS groups, respectively. EUS-BD for ERCP-difficult patients with distal bile duct stenosis is considered to be an effective alternative for biliary drainage that can be performed not only in specialized hospitals but also in general hospitals.

scholarly journals Difficulty Achieving a Preoperative Diagnosis of IgG4-Related Sclerosing Cholangitis

2018 ◽  
Vol 12 (2) ◽  
pp. 425-431
Author(s):  
Kazuhiro Suzumura ◽  
Etsuro Hatano ◽  
Masaharu Tada ◽  
Hideaki Sueoka ◽  
Hiroshi Nishida ◽  
...  
Keyword(s):  
Bile Duct ◽  
Preoperative Diagnosis ◽  
Sclerosing Cholangitis ◽  
Wall Thickening ◽  
Distal Bile Duct ◽  
Obliterative Phlebitis ◽  
Bile Duct Stenosis ◽  
Storiform Fibrosis ◽  
Lymphoplasmacytic Infiltration ◽  
Duct Stenosis

A 75-year-old male was admitted to our hospital because of bile duct stenosis. He had no medical history of autoimmune disease. The level of tumor markers, serum IgG, and IgG4 were within normal ranges. Computed tomography showed perihilar and distal bile duct stenosis and wall thickening without swelling or abnormal enhancement of the pancreas. Endoscopic retrograde cholangiopancreatography showed perihilar and distal bile duct stenosis. A biopsy and cytology from the distal bile duct stenosis suggested adenocarcinoma, and cytology from the perihilar bile duct also suggested adenocarcinoma. A preoperative diagnosis of perihilar and distal bile duct cancer was made, and the patient underwent left hepatectomy and pancreaticoduodenectomy. Resected specimens showed wall thickening in the perihilar and distal bile duct; however, tumors were unclear. A histopathological examination revealed lymphoplasmacytic infiltration, storiform fibrosis, and obliterative phlebitis in the perihilar and distal bile ducts. Immunohistochemistry revealed diffuse infiltration of IgG4-positive plasma cells in the perihilar and distal bile ducts. Lymphoplasmacytic infiltration, inflammatory change, storiform fibrosis, and obliterative phlebitis were shown in the pancreas. A final diagnosis of IgG4-related sclerosing cholangitis (IgG4-SC) with autoimmune pancreatitis was made. We herein report a case in which a preoperative diagnosis of IgG4-SC was difficult due to normal serum IgG4 levels and no obvious pancreatic lesion.

A Rare Cause of Distal Bile Duct Stenosis

2007 ◽  
Vol 38 (2-4) ◽  
pp. 157-159 ◽  
Author(s):  
F. Stoeckler ◽  
E. Hagmüller ◽  
H.-J. Rumpelt ◽  
U. Weickert
Keyword(s):  
Bile Duct ◽  
Distal Bile Duct ◽  
Bile Duct Stenosis ◽  
Duct Stenosis

scholarly journals A Proposed Algorithm for Endoscopic Ultrasound-Guided Rendezvous Technique in Failed Biliary Cannulation

2020 ◽  
Vol 9 (12) ◽  
pp. 3879
Author(s):  
Saburo Matsubara ◽  
Keito Nakagawa ◽  
Kentaro Suda ◽  
Takeshi Otsuka ◽  
Hiroyuki Isayama ◽  
...  
Keyword(s):  
Bile Duct ◽  
Endoscopic Ultrasound ◽  
Extrahepatic Bile Duct ◽  
Intrahepatic Bile Duct ◽  
Duodenal Bulb ◽  
Ultrasound Guided ◽  
Biliary Cannulation ◽  
Rendezvous Technique ◽  
Selection Of ◽  
Approach Route

Background: The selection of an approach route in endoscopic ultrasound-guided rendezvous (EUS-RV) for failed biliary cannulation is complicated. We proposed an algorithm for EUS-RV. Methods: We retrospectively evaluated consecutive EUS-RV cases between April 2017 and July 2020. Puncturing the distal extrahepatic bile duct (EHBD) from the duodenal second part (D2) (DEHBD/D2 route) was attempted first. If necessary, puncturing the proximal EHBD from the duodenal bulb (D1) (PEHBD/D1 route), puncturing the left intrahepatic bile duct (IHBD) from the stomach (LIHBD/S route), or puncturing the right IHBD from the D1 (RIHBD/D1 route) were attempted in this order. Results: A total of 16 patients were included. The DEHBD/D2 route was used in 10 (62.5%) patients. The PEHBD/D1 route was attempted in five (31.3%) patients, and the biliary puncture failed in one patient in whom the RIHBD/D1 route was used because of tumor invasion to the left hepatic lobe. The LIHBD/S route was applied in one (6.3%) patient. Successful biliary cannulation was achieved in all patients eventually. The time from the puncture to the guidewire placement in the DEHBD/D2 route (3.5 min) was shorter than that in other methods (14.0 min) (p = 0.014). Adverse events occurred in one (6.3%) patient with moderate pancreatitis. Conclusions: The proposed algorithm might be useful for the selection of an appropriate approach route in EUS-RV.

scholarly journals Endoscopic Ultrasound-Guided Biliary Drainage Using Self-Expandable Metal Stent for Malignant Biliary Obstruction

2017 ◽  
Vol 2017 ◽  
pp. 1-10 ◽  
Author(s):  
Lei Lu ◽  
Xiaowei Tang ◽  
Hangbin Jin ◽  
Jianfeng Yang ◽  
Xiaofeng Zhang
Keyword(s):  
Endoscopic Ultrasound ◽  
Biliary Drainage ◽  
Clinical Success ◽  
Mainland China ◽  
Success Rates ◽  
Ultrasound Guided ◽  
Stent Patency ◽  
Safe Alternative ◽  
Stent Occlusion ◽  
Rendezvous Technique

Purpose. Endoscopic ultrasound-guided biliary drainage (EUS-BD) has been increasingly reported worldwide. However, studies concerning EUS-BD from Mainland China are sporadic. This study aims to investigate the feasibility, efficacy, and safety of EUS-BD using SEMS in a single center from Mainland China. Methods. Between November 2011 and August 2015, 24 patients underwent EUS-BD using a standardized algorithm. Results. Three patients underwent rendezvous technique (RV), 4 underwent hepaticogastrostomy (HGS), and 17 underwent choledochoduodenostomy (CDS). The technical and clinical success rates were 95.8% (23/24) and 100% (23/23), respectively. Mean procedure time for the CDS group (35.9 ± 5.0 min) or HGS group (39.3 ± 5.0 min) was significantly shorter than that for the RV group (64.7 ± 9.1 min) (P<0.05). Complications (13%) included (1) cholangitis and (2) postprocedure hemorrhage. During the follow-up periods (mean 6.4 months), 22 (91.7%) patients died of tumor progression with mean stent patency of 5.8 ± 2.2 months. Stent occlusion occurred in 2 (8.7%) patients. Conclusion. EUS-BD using SEMS is a feasible, effective, and safe alternative for biliary decompression after failed ERCP. EUS-RV may not be the first-line choice for EUS-BD in a medium volume center. Further evaluation and experience of this method are needed.

Endoscopic ultrasound-guided biliary drainage for right hepatic bile duct obstruction: novel technical tips

Endoscopy ◽  
2014 ◽  
Vol 47 (01) ◽  
pp. 72-75 ◽  
Author(s):  
Takeshi Ogura ◽  
Tatsushi Sano ◽  
Saori Onda ◽  
Akira Imoto ◽  
Daisuke Masuda ◽  
...  
Keyword(s):  
Bile Duct ◽  
Endoscopic Ultrasound ◽  
Biliary Drainage ◽  
Bile Duct Obstruction ◽  
Ultrasound Guided ◽  
Hepatic Bile ◽  
Duct Obstruction ◽  
Hepatic Bile Duct
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