Single-session EUS-directed transgastric endoscopic retrograde cholangiopancreatography and transpapillary gallbladder drainage

Hanscom, Mark; Stead, Courtney; Akhtar, Sumayyah; Marya, Neil B.

doi:10.1016/j.vgie.2022.08.012

Cited by 3 publications

(1 citation statement)

References 3 publications

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“…While both procedures had comparable technical and clinical efficacy with similar safety profiles, EDGE offered a significantly shorter procedure time compared to LA-ERCP (73 min vs. 184 min, P < 0.00001) and a shorter length of hospital stay (0.8 vs. 2.65 days, P ¼ 0.00008) [29]. Besides performing standard EUS/ERCP with the aid of the EDGE procedure, case reports have shown that EDGE can also be used for the management of walled-off necrosis [30] or for gallbladder drainage in patient with RYGB [31].…”

Section: Nonpancreaticobiliary Interventions Such As the Management O...mentioning

confidence: 99%

Use of lumen apposing metal stents in patients with altered gastrointestinal anatomy

Ichkhanian,

Jovani

2023

Current Opinion in Gastroenterology

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Purpose of review Lumen apposing metal stents (LAMS) have been increasingly used to manage patients with surgically altered anatomy (SAA), who would have otherwise required percutaneous or surgical interventions. Via the creation of de-novo anastomoses, LAMS provides a conduit to access distal parts of the gastrointestinal tract to perform various interventions. Recent findings Pancreatobiliary (PB) and non-PB interventions are challenging in patients with SAA. Endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography (ERCP) (EDGE) and endoscopic ultrasound (EUS)-directed transenteric ERCP (EDEE) are effective procedures that are being increasingly utilized to perform ERCP in patient with Roux-en-Y gastric bypass (RYGB) and non-RYGB SAA, respectively. Furthermore, EUS-directed trans-gastric intervention (EDGI) is a collective term for the non-PB procedures that could be performed in patients with SAA. EDGE/EDEE/EDGI are considered relatively safe procedures, however, intra-procedural stent misdeployement, and long-term ramifications of persistent fistula and stent migration could require endoscopic or, in rare instances, surgical management. Summary The advent of LAMS has revolutionized the therapeutic capabilities of EUS, by allowing the creation of new gastrointestinal anastomoses. With the growing body of literature, it is expected that such techniques will be more commonly performed in the community, providing less invasive and more effective treatment options for patients with SAA.

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Section: Nonpancreaticobiliary Interventions Such As the Management O...mentioning

confidence: 99%

Use of lumen apposing metal stents in patients with altered gastrointestinal anatomy

Ichkhanian,

Jovani

2023

Current Opinion in Gastroenterology

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Updates on therapeutic endoscopic ultrasound

Wahba,

Lee

2024

Current Opinion in Gastroenterology

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Purpose of review Multiple endoscopic ultrasound (EUS) guided therapeutic interventions have been developed for the management of benign and malignant pancreaticobiliary and gastrointestinal luminal pathology. Recent high-quality evidence is increasingly validating these interventions and positioning them within evidence-based therapeutic algorithms. Recent findings Here we review therapeutic EUS-guided interventions including pancreatic fluid collection drainage, gastroenterostomy, biliary drainage, pancreatic duct drainage and gallbladder drainage. The most up-to-date high-quality evidence supporting these interventions is presented including comparative data with other conventional treatment options. Newer emerging interventions such as tumor ablation are also reviewed. Current controversies and future avenues for research are discussed. The key role of EUS-guided interventions in managing pancreaticobiliary pathology in patients with a surgically altered anatomy is highlighted. Summary Multiple EUS therapeutic interventions have evolved from experimental or rescue options to now well established first- and second-line interventions over other endoscopic, percutaneous and surgical alternatives with the support of high-quality data. Further research is needed to better optimize patient selection and guide long term postintervention follow-up.

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Comparative analysis of the therapeutic efficacy of remimazolam tosylate and propofol in older adults undergoing painless endoscopic retrograde cholangiopancreatography

Tian,

Chen,

Zhang

et al. 2024

Front. Pharmacol.

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ObjectiveThe aim of this study is to conduct a comparative analysis of the therapeutic outcomes associated with the administration of remimazolam and propofol during painless endoscopic retrograde cholangiopancreatography (ERCP) procedures in older adults.MethodsA total of 140 older adults who underwent elective painless ERCP were randomly assigned to two groups using the random number table method: the remimazolam group and the propofol group, each consisting of 70 patients. In the remimazolam group, anesthesia was administered using a combination of remimazolam and opioids, while in the propofol group, a combination of propofol and opioids was used. Comparative assessments between the two groups included anesthesia induction time, first induction success rate, intraoperative hemodynamics, awakening duration, stress response index, and the incidence of adverse reactions.ResultsThe remimazolam group exhibited a prolonged anesthesia induction time compared to the propofol group and a lower success rate of first induction (P < 0.05). At the point of endoscope entry (T2) and 10 min post-operation (T3), patients in the remimazolam group demonstrated higher mean arterial pressure (MAP), heart rate (HR), and bispectral index (BIS) values compared to those in the propofol group (P < 0.05). Furthermore, the remimazolam group had shorter durations for eye-opening, consciousness recovery, and residence in the recovery room compared to the propofol group (P < 0.05). Post-surgery levels of epinephrine (E), norepinephrine (NE), and cortisol (Cor) at 24 h were lower in the remimazolam group than in the propofol group (P < 0.05). The incidence of adverse reactions was significantly lower in the remimazolam group (18.57%) compared to the propofol group (31.43%) (P < 0.05).ConclusionRemimazolam exhibits a longer induction time compared to propofol in the painless diagnosis and treatment of ERCP in older adults. However, it provides a more stable circulatory state post-induction and throughout the operation, reduces stress response, enables rapid recovery, and has a lower incidence of serious adverse reactions. These attributes suggest that remimazolam has potential for widespread clinical application and adoption.Clinical Trial Registration:clinicaltrials.gov, identifier ChiCTR2400080926.

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Single-session EUS-directed transgastric endoscopic retrograde cholangiopancreatography and transpapillary gallbladder drainage

Cited by 3 publications

References 3 publications

Use of lumen apposing metal stents in patients with altered gastrointestinal anatomy

Use of lumen apposing metal stents in patients with altered gastrointestinal anatomy

Updates on therapeutic endoscopic ultrasound

Comparative analysis of the therapeutic efficacy of remimazolam tosylate and propofol in older adults undergoing painless endoscopic retrograde cholangiopancreatography

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