Endoscopic ultrasonography‐guided hepaticogastrostomy with novel two‐step puncture technique following peroral cholangioscopy‐assisted stone removal

Mukai, Shuntaro; Tsuchiya, Takayoshi; Itoi, Takao

doi:10.1111/den.13556

Cited by 5 publications

(3 citation statements)

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“…In such cases, the IHBD wall was first deeply penetrated by fast puncture, and then, the tip of the needle was slowly pulled back with injecting contrast media into IHBD, such as like “Seldinger technique.” In cases of unsuccessful puncture even using the above technique owing to a thin peripheral IHBD, we used the “two-step puncture technique”. [ 10 ] First, the dilated IHBD was identified and punctured, and a sufficient amount of contrast media was injected, even if the position is inappropriate for EUS-HES. After the injection, a more dilated peripheral IHBD can be seen from a suitable position for EUS-HES.…”

Section: Methodsmentioning

confidence: 99%

EUS-guided hepaticoenterostomy with using a dedicated plastic stent for the benign pancreaticobiliary diseases: A single-center study of a large case series

et al. 2021

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Background and Objectives: EUS-guided biliary drainage (EUS-BD) has recently been used for the treatment of not only malignant pancreaticobiliary diseases, but also for benign diseases. In most previous studies, EUS-BD was performed using a fully covered self-expandable metallic stent (SEMS), and data focusing on the usability of plastic stents for benign diseases are limited. We previously developed a plastic stent dedicated to EUS-guided hepaticoenterostomy (EUS-HES), and achieved favorable results in a feasibility study, although most of the patients had malignant diseases. Therefore, the aim of the present study was to evaluate the usability of dedicated plastic stents for EUS-HES in patients with benign pancreaticobiliary diseases. Patients and Methods: A total of 57 consecutive patients (28 men, median age: 68 years; range: 7–90 years) of normal and surgically altered anatomy with benign pancreaticobiliary diseases who underwent EUS-HES using the dedicated plastic stent between Jan. 2015 and Jun. 2020 were retrospectively analyzed. Results: The overall technical success rate of EUS-HES was 92.9% (53/57). Among the 4 cases of technical failure of plastic stent placement, a SEMS was placed in 1; percutaneous transhepatic biliary drainage was performed in 1; EUS-HES was reperformed 1 week later in 1; and observational management was selected in 1 patient. Adverse events associated with the procedure were seen in 15.7% (9/57) of the patients, namely, biliary peritonitis in 4, bleeding in 2, cholecystitis in 2, and pneumoperitoneum in 1 patient. Except for 1 patient who required blood transfusion owing to bleeding and 1 patient with cholecystitis who required percutaneous transhepatic gallbladder drainage, the other 7 patients were treated by conservative therapy. There were no intervention-associated deaths. Conclusion: Our results demonstrated that for patients with benign pancreaticobiliary diseases in whom conventional ERCP was unsuccessful, EUS-HES using a dedicated plastic stent was safe and feasible.

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Section: Methodsmentioning

confidence: 99%

EUS-guided hepaticoenterostomy with using a dedicated plastic stent for the benign pancreaticobiliary diseases: A single-center study of a large case series

et al. 2021

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“…Patients with hepaticojejunal anastomosis strictures or huge intrahepatic stones may require multiple endoscopic interventions. The application of POC through the HGS route has been described in various case reports and it was effective in performing lithotripsy and stone removal [ 118 , 119 , 120 , 121 , 122 , 123 , 124 , 125 , 126 ] and for the treatment of anastomotic strictures [ 127 , 128 , 129 ]. POC through HGS also allowed for the removal of migrated biliary stents in two case reports [ 130 , 131 ].…”

Section: Cholangioscopy Through Different Routesmentioning

confidence: 99%

The Role of Cholangioscopy in Biliary Diseases

Mauro,

Mazza,

Scalvini

et al. 2023

Diagnostics

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Endoscopy plays a central role in diagnostic and therapeutic approaches to biliary disease in both benign and malignant conditions. A cholangioscope is an endoscopic instrument that allows for the direct exploration of the biliary tree. Over the years, technology has improved endoscopic image quality and allowed for the development of an operative procedure that can be performed during cholangioscopy. Different types of instruments are available in this context, and they can be used in different anatomical access points according to the most appropriate clinical indication. The direct visualization of biliary mucosa is essential in the presence of biliary strictures of unknown significance, allowing for the appropriate allocation of patients to surgery or conservative treatments. Cholangioscopy has demonstrated excellent performance in discriminating malignant conditions (such as colangiocarcinoma) from benign inflammatory strictures, and more recent advances (e.g., artificial intelligence and confocal laser endomicroscopy) could further increase its diagnostic accuracy. Cholangioscopy also plays a primary role in the treatment of benign conditions such as difficult bile stones (DBSs). In this case, it may not be possible to achieve complete biliary drainage using standard ERCP. Therapeutic cholangioscopy-guided lithotripsy allows for stone fragmentation and complete biliary drainage. Indeed, other complex clinical situations, such as patients with intra-hepatic lithiasis and patients with an altered anatomy, could benefit from the therapeutic role of cholangioscopy. The aim of the present review is to explore the most recent diagnostic and therapeutic advances in the roles of cholangioscopy in the management of biliary diseases.

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“…Although peroral cholangioscopy for patients with possible distal cholangiocarcinoma is effective for determination of malignancy and extent of superficial spread [1], the transpapillary approach is challenging to perform in patients with altered anatomies. Therefore, peroral cholangioscopy via an EUS-guided bilioenterostomy route [2] may be a useful alternative to the transpapillary approach for evaluating possible distal cholangiocarcinomas.…”

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Peroral cholangioscopy via an endoscopic ultrasound-guided hepaticojejunostomy route for distal bile duct cancer with Roux-en-Y reconstruction

et al. 2021

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Endoscopic ultrasonography‐guided hepaticogastrostomy with novel two‐step puncture technique following peroral cholangioscopy‐assisted stone removal

Abstract: https://onlinelibrary.wiley.com/pages/journal/14431661/den13556-sup-0001-vids1.htm a video of this article

Cited by 5 publications

References 5 publications

EUS-guided hepaticoenterostomy with using a dedicated plastic stent for the benign pancreaticobiliary diseases: A single-center study of a large case series

EUS-guided hepaticoenterostomy with using a dedicated plastic stent for the benign pancreaticobiliary diseases: A single-center study of a large case series

The Role of Cholangioscopy in Biliary Diseases

Peroral cholangioscopy via an endoscopic ultrasound-guided hepaticojejunostomy route for distal bile duct cancer with Roux-en-Y reconstruction

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