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pISSN 2636-0004
eISSN 2636-0012
pISSN 2636-0004
eISSN 2636-0012
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Abstract : During the past 30 years, the endoscopic approach to benign biliary strictures (BBS) became the preferred “mini-invasive” treatment modality for benign diseases. Endoscopic plastic or metallic stenting, and balloon dilation represent the gold standard treatment for BBS. Side-by-side insertion of multiple plastic stents is a very effective treatment option for BBS following cholecystectomy or liver transplantation. This strategy has a low recurrence rate on long-term follow-up, with better results than fully covered self-expandable metal stents (FC-SEMS). FC-SEMS seems to have an advantage and higher stricture resolution rate in patients with BBS secondary to chronic pancreatitis. Dilation of dominant biliary strictures in patients with primary sclerosing cholangitis has a lower rate of infective complications than the stenting treatment. Endoscopic retrograde cholangiopancreatography represents a safe and effective approach to BBS, with a very high success rate, especially when such cases are managed in a multidisciplinary setting.
Abstract : Benign biliary strictures can be attributable to a large variety of causes, but are commonly iatrogenic after direct or vascular injury during laparoscopic cholecystectomy and other biliary procedures. An increasing number of patients present with strictures of bilioenteric anastomoses after liver transplantation and radical surgery for hepatopancreaticobiliary cancer. Endoscopic access to the biliary tree may be difficult or impossible following pancreaticoduodenectomy, and in this context strictures are best approached percutaneously. In the past, strictures could only be managed with repeated balloon dilatations and/or long-term transhepatic catheter placement. This is not very satisfactory from a patient point of view. A long-term external drain is disfiguring and challenging to manage, and the patient has to undergo repeated, potentially very painful procedures. Newer developments attempting to achieve long-term resolution of benign strictures include fully covered, removable metal stents and the emerging option of biodegradable stents. Early outcomes of these new technologies are promising, but require a careful and considered multidisciplinary approach and heavy clinical involvement of the interventional radiologist.
Abstract : The most common cause of malignant distal biliary obstruction is pancreatic cancer, as 70?90% of patients will develop jaundice during the course of their disease. Pancreatic cancer is usually advanced at presentation, and curative resection is possible in < 15% of patients. If a patient is to undergo early surgical resection, biliary drainage is not prerequisite. Early surgery without preoperative biliary drainage does not increase the risk of complications, as compared with preoperative biliary drainage, followed by surgery. Postoperative complications do not differ significantly between the two approaches. In light of no significant improvements in patient survival in large trials of a surgery-first followed by adjuvant therapy over the past 2 decades, there has been a shift towards preoperative neoadjuvant chemotherapy in the setting of borderline resectable disease. Consequently, effective preoperative biliary drainage has become a paramount concern in this setting. Multiple retrospective and prospective studies have compared the outcomes between covered metal stents and uncovered metal stents in malignant biliary obstruction. In patients undergoing neoadjuvant chemoradiation or surgical resection, no significant self-expanding metal stent-related complications or adverse events were seen. Additionally, no significant difference in overall survival was seen between the two groups. Within the palliative realm, self-expanding metal stents have also become the stent of choice with greater duration of patency. In an effort to deliver a survival benefit, there are many ongoing trials and developments in the realm of the therapeutic endoscopy. In this review, we will examine what we have accomplished and further explore the potential benefits of endoscopic interventions on the horizon.
Abstract : Preoperative biliary drainage (PBD) has been a matter of controversy for years. It was initially aimed to improve the clinical status of patients with malignant obstructive jaundice prior to surgery. However, its efficacy and safety have not been proven by randomized controlled trials. Most drawbacks of PBD are related to the increase in procedure-related adverse events and inappropriate biliary decompression. Current trends in PBD show that using self-expanding metallic stents (SEMSs) may reduce the high incidence of stent-related complications with improved outcomes. The aim of this study was to review the current literature regarding PBD in patients with resectable distal pancreaticobiliary and hilar tumors.
Abstract : Palliative therapy of advanced pancreatobiliary cancers is focused primarily on biliary stenting in most patients. However, biliary stent occlusion or dysfunction is a main concern. Several types of stents are bleed designed and studied to improve stent function, but with limited success. Local ablative therapy, such as photodynamic therapy (PDT) and radiofrequency ablation (RFA) in combination with biliary stenting is a paradigm shift in the management of advanced pancreatobiliary malignancies. The current review analyzes the data on the role of combining either PDT or RFA with biliary stenting in inoperable pancreatobiliary malignancies.
Abstract : Endoscopic retrograde cholangiopancreatography (ERCP) is the first-choice treatment for patients with obstructive jaundice. However, there are patients in whom bile duct access is not possible. In these patients, percutaneous transhepatic biliary drainage (PTBD) may be performed as an alternative biliary drainage method. PTBD is reportedly associated with a moderate mortality rate. In recent years, endoscopic ultrasonography-guided biliary drainage (EUS-BD) in patients with failed ERCP has been reported as an alternative to PTBD. EUS-BD is classified into three techniques: (1) EUS-guided choledocoduodenostomy (EUS-CDS); (2) EUS-guided hepatogastrostomy (EUS-HGS); and (3) EUS-guided antegrade (EUS-AG) approach. Herein, we focus on the current status of EUS-BD in light of these techniques.
Abstract : Endoscopic ultrasonography (EUS)-guided translumenal drainage of pancreatic fluid collections and obstructed bile and pancreatic ducts has been widely practiced for over a decade now, using conventional tubular plastic and metal stents. Their application for transmural drainage has been “off label” and limited by the lack of lumen-to-lumen anchorage that can lead to leakage, perforation, and stent migration. In addition, the length of a tubular stent exceeding the anatomical requirement of a translumenal anastomosis can lead to tissue trauma at the stent ends. Novel stent designs dedicated to applications of translumenal drainage have recently emerged and promise to make transmural drainage quicker, safer, and more effective. Importantly, passage of an endoscope through a translumenal stent will enable the endoscopist to expand the frontier of endoscopic intervention to structures outside of the gastrointestinal tract.
Abstract : There are various types of self-expandable metallic stent (SEMS) for biliary obstruction, but it is unknown which one is ideal. Ideal SEMS should prevent recurrent biliary obstruction or other complications after SEMS placement until the patient’s death. In this review, risk factors for recurrent biliary obstruction or complications are discussed. Based on the current literature, the combination of a high radial force and a low axial force is important. SEMS should be fully covered with a smooth inner surface to prevent stent occlusion by tumor ingrowth, sludge, or food impaction. There are attempts to further prolong time to recurrent biliary obstruction: a large bore SEMS to prevent stent occlusion by sludge or a SEMS with antimigration systems. Taking these results of various SEMS into consideration, an ideal biliary SEMS should be further developed.
Abstract : Biliary drainage in malignant biliary obstruction improves patient survival and quality of life. Although bypass surgery was historically the main method of treating malignant biliary obstruction, stent insertion using endoscopy or interventional radiology is currently recognized as the first-line of treatment. Biliary stents have undergone various modifications in terms of material and structure, with the aim of increasing stent patency. One such modification is the antitumor-agent-eluting stent, which is intended to suppress tumor ingrowth through chemical changes in the membrane. Another modified stent is the antireflux stent, which physically prevents the reflux of food by using an antireflux valve. Although the safety of these modified stents has been demonstrated in both animal and human studies, their efficacy, compared with conventional stents, remains unknown. Although the development of these functional stents is challenging, their potential is promising. Effort is necessary to increase stent patency, which requires much modification and development, to prolong patient survival.
Abstract : Return of spontaneous circulation after termination of resuscitation attempts for cardiac arrest is an extremely rare event. Here we describe an unusual case of a 50-year-old man with massive upper gastrointestinal bleeding from a ruptured common hepatic artery pseudoaneurysm who survived after termination of resuscitation attempts for cardiac arrest during coil embolization. One month earlier, he had undergone total gastrectomy and Roux-en-Y esophagojejunostomy secondary to Stage IV gastric adenocarcinoma. Immediately after the deployment of a Nester coil in the common hepatic artery at the site of a pseudoaneurysm, he sustained cardiopulmonary arrest. After 30 minutes of resuscitation attempts, he died. Approximately 2 minutes after he was pronounced dead, his spontaneous cardiopulmonary circulation resumed. After placement of additional coils in the common hepatic artery, he fully recovered without neurologic disability.
Hyung Ku Chon 
and Seong-Hun Kim
Int J Gastrointest Interv 2023; 12(1): 7-15
https://doi.org/10.18528/ijgii220037
Se Hwan Kwon , Seung Yeon Noh , and Joo Hyeong Oh
Int J Gastrointest Interv 2023; 12(1): 37-42
https://doi.org/10.18528/ijgii220005
Nam Hee Kim and Hong Joo Kim
Int J Gastrointest Interv 2023; 12(2): 57-63
https://doi.org/10.18528/ijgii220004
Partha Mandal , Barrett P. O'Donnell , Eric Reuben Smith , Osamah Al-Bayati , Adam Khalil , Serena Jen , Mario Vela , and Jorge Lopera
Int J Gastrointest Interv 2022; 11(1): 18-23
https://doi.org/10.18528/ijgii210028
Young Koog Cheon
Int J Gastrointest Interv 2021; 10(3): 96-100
https://doi.org/10.18528/ijgii210032
Dominic Andre Staudenmann , Ellie Patricia Skacel , Tatiana Tsoutsman , Arthur John Kaffes , and Payal Saxena
Int J Gastrointest Interv 2021; 10(3): 128-132
https://doi.org/10.18528/ijgii200050
pISSN 2636-0004
eISSN 2636-0012
| TODAY | 71 |
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| TOTAL | 233,025 |
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