EUS in patients with surgically altered upper GI anatomy

Wilson, Jason; Hoffman, Brenda J.; Hawes, Robert H.; Romagnuolo, Joseph

doi:10.1016/j.gie.2010.07.016

Cited by 48 publications

(45 citation statements)

References 17 publications

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“…Intrahepatic access is the only choice for patients with hilar biliary obstruction. It is also the preferred route for patients who had prior gastrectomy [69] or duodenal obstruction. It is in cases of distal common bile duct obstruction without prior surgery where both the extrahepatic and intrahepatic ducts are dilated that causes a dilemma.…”

Section: Indicationmentioning

confidence: 99%

Endoscopic Ultrasound-Guided Biliary Drainage: a Review

Chan

Teoh

2015

Curr Treat Options Gastro

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Endoscopic retrograde cholangiography (ERCP) has become the standard tool for diagnosis and treatment of patients with biliary obstruction. However, despite the reported success rate of >90 % in expert centers, the common bile duct may still be occasionally inaccessible due to anatomical or technical issues. Over the past decade, endoscopic ultrasound-guided biliary drainage (EUS-BD) has emerged as an effective alternative over percutaneous transhepatic biliary drainage (PTBD) or surgical bypass for biliary drainage after unsuccessful ERCP. EUS-BD includes rendezvous techniques (EUS-RV), EUS-guided choledochoduodenostomy (EUS-CDS), and EUS-guided hepatogastrostomy (EUS-HGS). Published data demonstrated high success rates especially for EUS-CDS and EUS-HGS. Complication rates, however, are also higher in these two techniques. The indications and anatomical requirements for the three techniques differ and should be considered complementary to each other. Most reported studies only included a small number of patients, and larger-scaled randomized trials are required to establish the efficacy among various EUS techniques and to compare to traditional means of radiological or surgical drainage.

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Section: Indicationmentioning

confidence: 99%

Endoscopic Ultrasound-Guided Biliary Drainage: a Review

Chan

Teoh

2015

Curr Treat Options Gastro

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“…However, imaging of the pancreatic body and tail and FNA biopsies can be safely obtained using a trans-pouch approach [31]. In our patient, localization of the insulinoma remained occult until successful EUS imaging with Optison [32].…”

Section: Resultsmentioning

confidence: 99%

Insulinoma After Bariatric Surgery: Diagnostic Dilemma and Therapeutic Approaches

et al. 2016

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Hypoglycemia is increasingly recognized as a complication of bariatric surgery. Typically hypoglycemia does not appear immediately postoperatively, but rather more than 1 year later, and usually occurs 1–3 hours after meals. While rare, insulinoma has been reported after bariatric surgery. Clinical factors which should raise suspicion for insulinoma and the need for comprehensive clinical and biochemical evaluation include hypoglycemia occurring in the fasting state, predating bariatric surgery and/or worsening immediately postoperatively, and lack of response to conservative therapy. Localization and successful resection of insulinoma can be achieved using novel endoscopic ultrasound and surgical approaches. In summary, hypoglycemia presenting shortly after gastric bypass or with a dominant fasting pattern should be fully evaluated to exclude insulinoma. Additionally, evaluation prior to gastric bypass should include screening for history of hypoglycemia symptoms.

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“…Diagnostic EUS in patients with Billroth II is best performed using a linear echoendoscope, as it allows a more complete examination of the pancreatic head and bile duct than a radial echoendoscope [16]. A small series demonstrated that an echoendoscope could be safely advanced to the papilla in 10 out of 11 patients with Billroth II anatomy, although another study reported a success rate of only 66% for reaching the papilla [16,17]. Once at the papilla, both radial and linear echoendoscopes visualized the uncinate, superior mesenteric vessels, and periampullary ducts.…”

Section: Diagnostic Eus In Surgically Altered Anatomymentioning

confidence: 99%

“…In the remaining six patients, the proximal duodenum could not be reached due to difficult intubation of the biliopancreatic limb or long limb length [17]. With a FV echoendoscope, visualization of the pancreatic head and CBD improved slightly to 25% (3 out of 12 patients).…”

Section: Diagnostic Eus In Surgically Altered Anatomymentioning

confidence: 99%

Endoscopic Ultrasound-Guided Pancreatobiliary Endoscopy in Surgically Altered Anatomy

Jirapinyo

Lee

2016

Clin Endosc

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Endoscopic retrograde cholangiopancreatography (ERCP) has become the mainstay of therapy for pancreatobiliary diseases. While ERCP is safe and highly effective in the general population, the procedure remains challenging or impossible in patients with surgically altered anatomy (SAA). Endoscopic ultrasound (EUS) allows transmural access to the bile or pancreatic duct (PD) prior to ductal drainage using ERCP-based techniques. Also known as endosonography-guided cholangiopancreatography (ESCP), the procedure provides multiple advantages over overtube-assisted enteroscopy ERCP or percutaneous or surgical approaches. However, the procedure should only be performed by endoscopists experienced in both EUS and ERCP and with the proper tools. In this review, various EUS-guided diagnostic and therapeutic drainage techniques in patients with SAA are examined. Detailed step-by-step procedural descriptions, technical tips, feasibility, and safety data are also discussed.

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EUS in patients with surgically altered upper GI anatomy

Cited by 48 publications

References 17 publications

Endoscopic Ultrasound-Guided Biliary Drainage: a Review

Endoscopic Ultrasound-Guided Biliary Drainage: a Review

Insulinoma After Bariatric Surgery: Diagnostic Dilemma and Therapeutic Approaches

Endoscopic Ultrasound-Guided Pancreatobiliary Endoscopy in Surgically Altered Anatomy

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