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Case Report
Endoscopic ultrasound-guided hepaticogastrostomy by puncturing both B2 and B3: a single center experience
Moaz Elshair, Kazuo Hara, Nozomi Okuno, Shin Haba, Takamichi Kuwahara, Asmaa Bakr, Abdou Elshafei, Mohamed Z. Abu-Amer
Received August 12, 2022  Accepted November 23, 2022  Published online May 3, 2023  
DOI: https://doi.org/10.5946/ce.2022.209    [Epub ahead of print]
AbstractAbstract PDFPubReaderePub
Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) through ducts B2 or B3 is effective in most patients with biliary obstruction, because B2 and B3 commonly join together. However, in some patients, B2 and B3 do not join each other due to invasive hilar tumors; therefore, single-route drainage is insufficient. Here, we investigated the feasibility and efficacy of EUS-HGS through both B2 and B3 simultaneously in seven patients. We decided to perform EUS-HGS through both B2 and B3 to achieve adequate biliary drainage because these two ducts were separate from each other. Here, we report a 100% technical and overall clinical success rate. Early adverse effects were closely monitored. Minimal bleeding was reported in one patient (1/7) and mild peritonitis in one patient (1/7). None of the patients experienced stent dysfunction, fever, or bile leakage after the procedure. EUS-HGS through both B2 and B3 simultaneously is safe, feasible, and effective for biliary drainage in patients with separated ducts.
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Original Article
Utility of forward-view endoscopic ultrasound in fine-needle aspiration in patients with a surgically altered upper gastrointestinal anatomy
Asmaa Bakr, Kazuo Hara, Moaz Elshair, Shin Haba, Takamichi Kuwahara, Nozomi Okuno, Daiki Fumihara, Takafumi Yanaidani, Samy Zaky, Hanaa Omar
Clin Endosc 2023;56(3):367-374.   Published online January 5, 2023
DOI: https://doi.org/10.5946/ce.2021.238
Graphical AbstractGraphical Abstract AbstractAbstract PDFPubReaderePub
Background
/Aims: Endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) using oblique-view EUS in patients with a surgically altered anatomy (SAA) of the upper gastrointestinal tract is limited because of difficult scope insertion due to the disturbed anatomy. This study aimed to investigate the efficiency of forward-view (FV)-EUS in performing FNA in patients with a SAA.
Methods
We retrospectively investigated 32 patients with a SAA of the upper gastrointestinal tract who visited Aichi Cancer Center Hospital in Nagoya, Japan, between January 2014 and December 2020. We performed-upper gastrointestinal EUS-FNA using FV-EUS combined with fluoroscopic imaging to confirm tumor recurrence or to make a decision before chemotherapy or after a failure of diagnosis by radiology.
Results
We successfully performed EUS-FNA in all studied patients (100% technical success), with the specificity, sensitivity, and accuracy of 100%, 87.5%, and 87.8%, respectively, with no complications.
Conclusions
EUS-FNA using FV-EUS combined with fluoroscopic imaging is an effective and safe technique for tissue acquisition in patients with a SAA.
  • 1,743 View
  • 169 Download
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Case Report
Endoscopic ultrasound-guided portal vein coiling: troubleshooting interventional endoscopic ultrasonography
Shin Haba, Kazuo Hara, Nobumasa Mizuno, Takamichi Kuwahara, Nozomi Okuno, Akira Miyano, Daiki Fumihara, Moaz Elshair
Clin Endosc 2022;55(3):458-462.   Published online November 30, 2021
DOI: https://doi.org/10.5946/ce.2021.114
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Endoscopic ultrasound (EUS)-guided hepaticogastrostomy (HGS) is widely performed not only as an alternative to transpapillary biliary drainage, but also as primary drainage for malignant biliary obstruction. For anatomical reasons, this technique carries an unavoidable risk of mispuncturing intrahepatic vessels. We report a technique for troubleshooting EUS-guided portal vein coiling to prevent bleeding from the intrahepatic portal vein after mispuncture during interventional EUS. EUS-HGS was planned for a 59-year-old male patient with unresectable pancreatic cancer. The dilated bile duct (lumen diameter, 2.8 mm) was punctured with a 19-gauge needle, and a guidewire was inserted. After bougie dilation, the guidewire was found to be inside the intrahepatic portal vein. Embolizing coils were placed to prevent bleeding. Embolization coils were successfully inserted under stabilization of the catheter using a double-lumen cannula with a guidewire. Following these procedures, the patient was asymptomatic. Computed tomography performed the next day revealed no complications.
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Original Article
Outcomes of Endoscopic Ultrasound-Guided Biliary Drainage in Patients Undergoing Antithrombotic Therapy
Nozomi Okuno, Kazuo Hara, Nobumasa Mizuno, Shin Haba, Takamichi Kuwahara, Hiroki Koda, Masahiro Tajika, Tsutomu Tanaka, Sachiyo Onishi, Keisaku Yamada, Akira Miyano, Daiki Fumihara, Moaz Elshair
Clin Endosc 2021;54(4):596-602.   Published online February 17, 2021
DOI: https://doi.org/10.5946/ce.2020.194
AbstractAbstract PDFPubReaderePub
Background
/Aims: The Japan Gastroenterological Endoscopy Society (JGES) has published guidelines for gastroenterological endoscopy in patients undergoing antithrombotic treatment. These guidelines classify endoscopic ultrasound-guided biliary drainage (EUS-BD) as a high-risk procedure. Nevertheless, the bleeding risk of EUS-BD in patients undergoing antithrombotic therapy is uncertain. Therefore, this study aimed to assess the bleeding risk in patients undergoing antithrombotic therapy.
Methods
This single-center retrospective study included 220 consecutive patients who underwent EUS-BD between January 2013 and December 2018. We managed the withdrawal and continuation of antithrombotic agents according to the JGES guidelines. We compared the bleeding event rates among patients who received and those who did not receive antithrombotic agents.
Results
A total of 18 patients (8.1%) received antithrombotic agents and 202 patients (91.8%) did not. Three patients experienced bleeding events, with an overall bleeding event rate of 1.3% (3/220): one patient was in the antithrombotic group (5.5%) and two patients were in the non-antithrombotic group (0.9%) (p=0.10). All cases were moderate. The sole thromboembolic event (0.4%) was a cerebral infarction in a patient in the non-antithrombotic group.
Conclusions
The rate of EUS-BD-related bleeding events was low. Even in patients receiving antithrombotic therapy, the bleeding event rates were not significantly different from those in patients not receiving antithrombotic therapy.

Citations

Citations to this article as recorded by  
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    Internal Medicine.2024;[Epub]     CrossRef
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    Gastrointestinal Endoscopy.2023; 97(6): 1171.     CrossRef
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    Endoscopic Ultrasound.2023; 12(3): 347.     CrossRef
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    Suprabhat Giri, Babu P. Mohan, Vaneet Jearth, Aditya Kale, Sumaswi Angadi, Shivaraj Afzalpurkar, Sidharth Harindranath, Sridhar Sundaram
    Gastrointestinal Endoscopy.2023; 98(4): 515.     CrossRef
  • Endoscopic Ultrasound-Guided Biliary Interventions in Liver Disease
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    Clinics in Liver Disease.2022; 26(1): 101.     CrossRef
  • B2 puncture with forward-viewing EUS simplifies EUS-guided hepaticogastrostomy (with video)
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    Endoscopic Ultrasound.2022; 11(4): 319.     CrossRef
  • The Value of Rivaroxaban Combined with Ticagrelor in Antithrombotic Therapy after PCI in Patients with Nonvalvular Atrial Fibrillation with Acute Coronary Syndrome
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    Evidence-Based Complementary and Alternative Medicine.2022; 2022: 1.     CrossRef
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    Reactions Weekly.2022; 1936(1): 165.     CrossRef
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  • 11 Crossref
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