Clinical Endoscopy

Original Articles

The efficacy of a novel integrated outside biliary stent and nasobiliary drainage catheter system for acute cholangitis: a single center pilot study: Naosuke Kuraoka, Tetsuro Ujihara, Hiromi Kasahara, Yuto Suzuki, Shun Sakai, Satoru Hashimoto; Clin Endosc 2023;56(6):795-801. Published online April 11, 2023; DOI: https://doi.org/10.5946/ce.2022.289

Graphical Abstract Abstract PDF Supplementary Material PubReader ePub: Background
/Aims: Endoscopic biliary drainage is the gold standard treatment for cholangitis. The two methods of biliary drainage are endoscopic biliary stenting and nasobiliary drainage. A novel integrated outside biliary stent and nasobiliary drainage catheter system (UMIDAS NB stent; Olympus Medical Systems) was recently developed. In this study, we evaluated the efficacy of this stent in the treatment of cholangitis caused by common bile duct stones or distal bile duct strictures.
Methods
We conducted a retrospective pilot study by examining the medical records of patients who required endoscopic biliary drainage for cholangitis due to common bile duct stones or distal bile duct strictures, and who were treated with a UMIDAS NB stent, between December 2021 and July 2022.
Results
Records of 54 consecutive patients were reviewed. Technical and clinical success rates were 47/54 (87.0%) and 52/54 (96.3%), respectively. Adverse events were observed in 12 patients, with six patients experiencing pancreatitis as an adverse event, following endoscopic retrograde cholangiopancreatography (ERCP). Regarding late adverse events, five cases of biliary stent migration into the bile duct were observed. Disease-related death occurred in one patient.
Conclusions
The outside-type UMIDAS NB stent is an efficacious new method for biliary drainage and can be applied to many indications.

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Covered self-expandable metallic stents versus plastic stents for endoscopic ultrasound-guided hepaticogastrostomy in patients with malignant biliary obstruction: Taro Shibuki, Kei Okumura, Masanari Sekine, Ikuhiro Kobori, Aki Miyagaki, Yoshihiro Sasaki, Yuichi Takano, Yusuke Hashimoto; Clin Endosc 2023;56(6):802-811. Published online April 5, 2023; DOI: https://doi.org/10.5946/ce.2022.211

Graphical Abstract Abstract PDF PubReader ePub

Background
/Aims: Covered self-expandable metallic stents (cSEMS) have become popular for endoscopic ultrasound-guided hepaticogastrostomy with transmural stenting (EUS-HGS). We compared the time to recurrent biliary obstruction (TRBO), complications, and reintervention rates between EUS-HGS using plastic stent (PS) and cSEMS in patients with unresectable malignancies at multicenter institutions in Japan.
Methods
Patients with unresectable malignant biliary obstruction who underwent EUS-HGS between April 2015 and July 2020 at any of the six participating facilities were enrolled. Primary endpoint: TRBO; secondary endpoints: rate of complications other than recurrent biliary obstruction and technical success rate of reintervention were evaluated.
Results
PS and cSEMS were used for EUS-HGS in 109 and 43 patients, respectively. The TRBO was significantly longer in the cSEMS group than in the PS group (646 vs. 202 days). Multivariate analysis identified two independent factors associated with a favorable TRBO: combined EUS-guided antegrade stenting with EUS-HGS and the use of cSEMS. No significant difference was observed in the rate of complications other than recurrent biliary obstruction between the two groups. The technical success rate of reintervention was 85.7% for PS and 100% for cSEMS (p=0.309).
Conclusions
cSEMS might be a better option for EUS-HGS in patients with unresectable malignancies, given the longer TRBO.

Citations

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Comparison of stent patency between EUS-guided hepaticogastrostomy with bridging and endoscopic transpapillary biliary drainage for hilar obstruction
Kotaro Takeshita, Susumu Hijioka, Yoshikuni Nagashio, Yuta Maruki, Akihiro Ohba, Yuki Kawasaki, Tetsuro Takasaki, Shin Yagi, Daiki Agarie, Hidenobu Hara, Yuya Hagiwara, Daiki Yamashige, Kohei Okamoto, Soma Fukuda, Masaru Kuwada, Mark Chatto, Shunsuke Kond
Endoscopy International Open.2024; 12(07): E875. CrossRef
Multicenter study comparing EUS‐guided hepaticogastrostomy and ERCP for malignant biliary obstruction in patients with accessible papillae
Takeshi Ogura, Hirotoshi Ishiwatari, Susumu Hijioka, Kotaro Takeshita, Junya Sato, Mamoru Takenaka, Tomohiro Fukunaga, Shunsuke Omoto, Nao Fujimori, Akihisa Ohno, Keiichi Hatamaru, Takaaki Tamura, Hajime Imai, Masanori Yamada, Akitoshi Hakoda, Hiroki Nish
Journal of Hepato-Biliary-Pancreatic Sciences.2024; 31(9): 680. CrossRef
EUS-guided hepaticogastrostomy: practical tips and tricks
Kambiz Kadkhodayan, Shayan Irani
VideoGIE.2024; 9(9): 417. CrossRef
Advances in self-expandable metal stents for endoscopic ultrasound-guided interventions
Dong Kee Jang, Dong Wook Lee, Seong-Hun Kim, Kwang Bum Cho, Sundeep Lakhtakia
Clinical Endoscopy.2024; 57(5): 588. CrossRef
The updated Asia-Pacific consensus statement on the role of endoscopic management in malignant hilar biliary obstruction
Phonthep Angsuwatcharakon, Santi Kulpatcharapong, Alan Chuncharunee, Christopher Khor, Benedict Devereaux, Jong Ho Moon, Thawee Ratanachu-ek, Hsiu Po Wang, Nonthalee Pausawasdi, Amit Maydeo, Takao Itoi, Ryan Ponnudurai, Mohan Ramchandani, Yousuke Nakai, D
Endoscopy International Open.2024; 12(09): E1065. CrossRef
The writing on the wall: self-expandable stents for endoscopic ultrasound-guided hepaticogastrostomy?
Hyung Ku Chon, Shayan Irani, Tae Hyeon Kim
Clinical Endoscopy.2023; 56(6): 741. CrossRef
Therapeutic Endoscopic Ultrasound for Complications of Pancreatic Cancer
Samuel Han, Georgios I. Papachristou
Cancers.2023; 16(1): 29. CrossRef

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Case Reports

Endoscopic Self-Expandable Metal Stent Placement for Malignant Afferent Loop Obstruction After Pancreaticoduodenectomy: A Case Series and Review: Arata Sakai, Hideyuki Shiomi, Takao Iemoto, Ryota Nakano, Takuya Ikegawa, Takashi Kobayashi, Atsuhiro Masuda, Yuzo Kodama; Clin Endosc 2020;53(4):491-496. Published online March 3, 2020; DOI: https://doi.org/10.5946/ce.2019.145

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In this study, we assessed a series of our cases in which endoscopic self-expandable metal stents (SEMSs) were used to treat malignant afferent loop obstruction (ALO) that arose after pancreaticoduodenectomy (PD). We retrospectively examined the records of 7 patients who underwent endoscopic SEMS placement for malignant ALO following PD. Clinical success was achieved in all cases. The median procedure time was 30 min (range, 15–50 min). There were no cases of stent occlusion, and no procedure-related adverse events were encountered. All patients died of their primary disease, and the median overall survival period was 155 days (range, 96–374 days). A re-intervention involving endoscopic ultrasound-guided hepaticogastrostomy combined with antegrade stenting was performed for obstructive jaundice and acute cholangitis in 1 case. In conclusion, endoscopic SEMS placement may be an effective and safe treatment for malignant ALO that arises after PD.

Citations

Citations to this article as recorded by

Early and late effects of endoscopic interventions in patients with malignant afferent loop syndrome: A single‐center experience and literature review
Kenjiro Yamamoto, Takao Itoi, Yukitoshi Matsunami, Atsushi Sofuni, Takayoshi Tsuchiya, Shuntaro Mukai, Hiroyuki Kojima, Hirohito Minami, Ryosuke Nakatsubo, Ryosuke Tonozuka
Journal of Hepato-Biliary-Pancreatic Sciences.2024; 31(2): 120. CrossRef
Efficacy of endoscopic ultrasound‐guided gastroenterostomy using self‐expandable metallic stent for afferent loop syndrome: A single‐center retrospective study
Yuya Hagiwara, Susumu Hijioka, Yoshikuni Nagashio, Yuta Maruki, Akihiro Ohba, Yuki Kawasaki, Kotaro Takeshita, Tetsuro Takasaki, Daiki Agarie, Hidenobu Hara, Shin Yagi, Soma Fukuda, Masaru Kuwada, Daiki Yamashige, Kohei Okamoto, Mark Chatto, Shunsuke Kond
Journal of Gastroenterology and Hepatology.2024;[Epub] CrossRef
Successful metal stent placement using short single-balloon endoscope for afferent loop syndrome after pancreaticoduodenectomy
Takuto Furukawa, Yuichi Takano, Jun Noda, Masataka Yamawaki, Tetsushi Azami, Fumitaka Niiya, Fumiya Nishimoto, Naotaka Maruoka, Masatsugu Nagahama
Progress of Digestive Endoscopy.2024; 104(1): 98. CrossRef
Antegrade metallic stent placement using a slim cholangioscope for malignant afferent loop obstruction
Haruo Miwa, Ritsuko Oishi, Kazuki Endo, Hiromi Tsuchiya, Akihiro Funaoka, Yuichi Suzuki, Shin Maeda
Endoscopy.2024; 56(S 01): E774. CrossRef
The Role of Endoscopic Management in Afferent Loop Syndrome
Clement Chun Ho Wu, Elizabeth Brindise, Rami El Abiad, Mouen A. Khashab
Gut and Liver.2023; 17(3): 351. CrossRef
Simultaneous stent placement for biliary and afferent loop obstruction due to tumor recurrence after pancreatoduodenectomy
Tatsunori Satoh, Hirotoshi Ishiwatari, Kazuma Ishikawa, Hidenori Kimura, Hiroyuki Matsubayashi, Hiroyuki Ono
Endoscopy.2022; 54(09): E524. CrossRef
Extra-anatomic percutaneous stenting of a malignant afferent loop obstruction following pancreaticoduodenectomy
Stefan Lam, Sarah Khan, Robert Hutchins, Tim Fotheringham
International Journal of Gastrointestinal Intervention.2022; 11(2): 77. CrossRef
Endoscopic Transluminal Stent Placement for Malignant Afferent Loop Obstruction
Chinatsu Yonekura, Takashi Sasaki, Takafumi Mie, Takeshi Okamoto, Tsuyoshi Takeda, Takaaki Furukawa, Yuto Yamada, Akiyoshi Kasuga, Masato Matsuyama, Masato Ozaka, Naoki Sasahira
Journal of Clinical Medicine.2022; 11(21): 6357. CrossRef
Clinical management for malignant afferent loop obstruction
Arata Sakai, Hideyuki Shiomi, Atsuhiro Masuda, Takashi Kobayashi, Yasutaka Yamada, Yuzo Kodama
World Journal of Gastrointestinal Oncology.2021; 13(7): 684. CrossRef
Clinical management for malignant afferent loop obstruction
Arata Sakai, Hideyuki Shiomi, Atsuhiro Masuda, Takashi Kobayashi, Yasutaka Yamada, Yuzo Kodama
World Journal of Gastrointestinal Oncology.2021; 13(7): 509. CrossRef
Endoscopic Ultrasound-Guided Gastroenterostomy for Afferent Loop Syndrome
Hideyuki Shiomi, Arata Sakai, Ryota Nakano, Shogo Ota, Takashi Kobayashi, Atsuhiro Masuda, Hiroko Iijima
Clinical Endoscopy.2021; 54(6): 810. CrossRef
Percutaneous- and EUS-guided gastroenterostomy for malignant afferent limb syndrome
Dayyan Adoor, Zachary L. Smith
VideoGIE.2020; 5(11): 542. CrossRef

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Pneumoperitoneum after Endoscopic Duodenal Stent Insertion in a Patient with Percutaneous Transhepatic Biliary Drainage and Biliary Stent: A Case Report: Jinwoo Choi, Min Ji Lee, Hyodeok Lee, Yook Kim, Joung-Ho Han, Seon Mee Park; Clin Endosc 2019;52(3):288-292. Published online August 29, 2018; DOI: https://doi.org/10.5946/ce.2018.128

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Early removal of a percutaneous transhepatic biliary drainage (PTBD) tube commonly causes pneumoperitoneum. However, we encountered a patient who developed pneumoperitoneum even with an indwelling PTBD tube. An 84-year-old man was admitted with type III combined duodenal and biliary obstruction secondary to metastatic bladder cancer. A biliary stent was placed using a percutaneous approach, and a duodenal stent was placed endoscopically. A large amount of subphrenic free air was detected after the procedures. Laboratory tests indicated intestinal perforation; however, peritoneal signs were absent. The patient was treated conservatively using an indwelling Levin tube. Seven days later, the massive amount of subphrenic free air disappeared. Follow-up tubography revealed unrestricted bile flow into the small intestine, and the PTBD tube was removed. Prolonged endoscopic procedures in patients with a PTBD tract communicating with the gastrointestinal tract can precipitate pneumoperitoneum. Clinicians should be careful to avoid misdiagnosing this condition as intestinal perforation.

Citations

Citations to this article as recorded by

The characteristics of residual pneumoperitoneum after laparoscopic colorectal surgery
Sotaro Fukuhara, Hiroyuki Egi, Masatoshi Kochi, Wataru Shimizu, Yuji Takakura, Kazuhiro Taguchi, Ikki Nakashima, Yusuke Sumi, Shintaro Akabane, Koki Sato, Hisaaki Yoshinaka, Yoshifumi Teraoka, Minoru Hattori, Hideki Ohdan
Asian Journal of Endoscopic Surgery.2022; 15(2): 320. CrossRef

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1 Web of Science
1 Crossref

Review

Endoscopic Management of Anastomotic Strictures after Liver Transplantation: Dong Wook Lee, Hyeong Ho Jo, Juveria Abdullah, Michel Kahaleh; Clin Endosc 2016;49(5):457-461. Published online September 30, 2016; DOI: https://doi.org/10.5946/ce.2016.130

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Endoscopic treatment of biliary strictures involving plastic stent placement has been used widely. The use of self-expandable metal stents (SEMSs) has been described for anastomotic strictures following liver transplantation (LT). This review aimed to assess and compare the efficacy of plastic stents with SEMS in LT patients. Information was retrieved regarding technical success, stricture resolution, the number of endoscopic retrograde cholangiography procedures, follow-up, immediate, and late complications. Eight studies involving plastic stents had a stricture resolution rate of 84.5%, with the rates ranging from 63% to 100%. These rates are comparable with the stricture resolution rate of 75% determined from six studies that involved 236 patients who received metal stents and the rates ranged from 53% to 81%. The observed success rate for metal stents used to manage post-LT anastomotic biliary strictures was below the reported rate for multiple plastic stents. Hence, the currently available metal stents should not be offered for the management of post-LT anastomotic biliary strictures.

Citations

Citations to this article as recorded by

Long-Term Results of Endoscopic Metal Stenting for Biliary Anastomotic Stricture after Liver Transplantation
Aymeric Becq, Alexis Laurent, Quentin De Roux, Cristiano Cremone, Hugo Rotkopf, Yann Le Baleur, Farida Mesli, Christophe Duvoux, Aurélien Amiot, Charlotte Gagniere, Nicolas Mongardon, Julien Calderaro, Daniele Sommacale, Alain Luciani, Iradj Sobhani
Journal of Clinical Medicine.2023; 12(4): 1453. CrossRef
Endoskopisches Management von Gallengangskomplikationen nach Leberchirurgie
Martha M. Kirstein, Torsten Voigtländer
Zentralblatt für Chirurgie - Zeitschrift für Allgemeine, Viszeral-, Thorax- und Gefäßchirurgie.2022; 147(04): 398. CrossRef
Intraductal fully covered self-expanding metal stents in the management of post-liver transplant anastomotic strictures: a UK wide experience
Wafaa Ahmed, Dave Kyle, Amardeep Khanna, John Devlin, David Reffitt, Zeino Zeino, George Webster, Simon Phillpotts, Robert Gordon, Gareth Corbett, William Gelson, Manu Nayar, Haider Khan, Matthew Cramp, Jonathan Potts, Waleed Fateen, Hamish Miller, Bharat
Therapeutic Advances in Gastroenterology.2022; 15: 175628482211224. CrossRef
Incidents and risk factors of biliary complications after orthotropic liver transplantation
Samir Zeair, Robert Stasiuk, Labib Zair, Marta Wawrzynowicz-Syczewska, Anita Rybicka, Elżbieta Grochans, Arkadiusz Kazimierczak
Medicine.2021; 100(34): e26994. CrossRef
Biliary complications in recipients of living donor liver transplantation: A single-centre study
Reginia Nabil Guirguis, Ehab Hasan Nashaat, Azza Emam Yassin, Wesam Ahmed Ibrahim, Shereen A Saleh, Mohamed Bahaa, Mahmoud El-Meteini, Mohamed Fathy, Hany Mansour Dabbous, Iman Fawzy Montasser, Manar Salah, Ghada Abdelrahman Mohamed
World Journal of Hepatology.2021; 13(12): 2081. CrossRef
Management of Post-Transplant Anastomotic Stricture Using Self-Expandable Metal Stent
Dong Wook Lee, Kazuo Hara
Clinical Endoscopy.2020; 53(3): 261. CrossRef
A unique type of fully covered metal stent for the management of post liver transplant biliary anastomotic strictures
Ben Warner, Phillip Harrison, Muhammad Farman, John Devlin, David Reffitt, Yasser El-Sherif, Shirin E. Khorsandi, Andreas Prachalias, Miriam Cortes Cerisuelo, Krish Menon, Wayel Jassem, Parthi Srinivasan, Hector Vilca-Melendez, Michael Heneghan, Nigel Hea
BMC Gastroenterology.2020;[Epub] CrossRef
The first experience with the fully-covered self-expandable nitinol stents in the management of anastomotic biliary strictures after orthotopic liver transplantation
A. V. Shabunin, I. Yu. Korzheva, G. M. Chechenin, S. S. Lebedev, P. A. Drozdov, O. S. Zhuravel, S. A. Astapovich
Almanac of Clinical Medicine.2020; 48(3): 171. CrossRef
Endoscopic Management of Biliary Issues in the Liver Transplant Patient
James F. Crismale, Jawad Ahmad
Gastrointestinal Endoscopy Clinics of North America.2019; 29(2): 237. CrossRef
Endoscopic management of anastomotic stricture after living-donor liver transplantation
Dong Wook Lee, Jimin Han
The Korean Journal of Internal Medicine.2019; 34(2): 261. CrossRef
Efficacy of Nasobiliary Tubes and Biliary Stents in Management of Patients with Bile Leak after Liver Transplantation: A Systematic Review
Ali Raza, Anam Omer, Sara Iqbal, Vineet Gudsoorkar, Pramoda Koduru, Kumar Krishnan
Clinical Endoscopy.2019; 52(2): 159. CrossRef
Endoscopic management of biliary strictures post-liver transplantation
Ahmed Akhter, Patrick Pfau, Mark Benson, Anurag Soni, Deepak Gopal
World Journal of Meta-Analysis.2019; 7(4): 120. CrossRef
Liver transplant–related anastomotic biliary strictures: a novel, rapid, safe, radiation-sparing, and cost-effective management approach
Monique T. Barakat, Robert J. Huang, Nirav C. Thosani, Abhishek Choudhary, Mohit Girotra, Subhas Banerjee
Gastrointestinal Endoscopy.2018; 87(2): 501. CrossRef
Long‐term outcomes of early compared to late onset choledochocholedochal anastomotic strictures after orthotopic liver transplantation
Sanjaya K. Satapathy, Imran Sheikh, Bilal Ali, Fazal Yahya, Mehmet Kocak, Laxmi Babu Parsa, James D. Eason, Jason M. Vanatta, Satheesh P. Nair
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Challenges of Endoscopic Management of Pancreaticobiliary Complications in Surgically Altered Gastrointestinal Anatomy
Tin Moe Wai, Eun Young Kim
Clinical Endoscopy.2016; 49(6): 502. CrossRef

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Case Report

Long-Term Palliative Effect of Stenting in Gastric Outlet Obstruction Due to Transarterial Chemoembolization with Yttrium-90 in a Patient with Metastatic Neuroendocrine Tumor: Erkan Caglar, Gulen Doğusoy, Levent Kabasakal, Ahmet Dobrucali; Clin Endosc 2016;49(5):479-482. Published online June 29, 2016; DOI: https://doi.org/10.5946/ce.2015.149

Abstract PDF PubReader ePub: Internal radioembolization with yttrium-90 is a promising treatment method, predominantly for liver tumors. However, the shifting of yttrium-90-loaded spherules into the arteries and veins that supply the duodenum and stomach, leading to ulceration, hemorrhage, perforation, and outlet obstruction of these organs, is one of the major undesirable consequences of this technique. We report a case of gastric outlet obstruction (GOO) due to antropyloric stenosis with ulceration, edema, and inflammation following transarterial yttrium-90 treatment for a metastatic neuroendocrine tumor in a 58-year-old man. Stenting was used for palliation in this case. GOO improved after stenting and recovery of oral intake was permanent after stent removal.

7,219 View
109 Download
1 Web of Science

Focused Review Series: Past, present and future of gastrointestinal stents

Current Status of Biliary Metal Stents: Hyeong Seok Nam, Dae Hwan Kang; Clin Endosc 2016;49(2):124-130. Published online February 25, 2016; DOI: https://doi.org/10.5946/ce.2016.023

Abstract PDF PubReader ePub

Many advances have been achieved in biliary stenting over the past 30 years. Endoscopic stent placement has become the primary management therapy to relieve obstruction in patients with benign or malignant biliary tract diseases. Compared with plastic stents, a self-expandable metallic stent (SEMS) has been used for management in patients with malignant strictures because of a larger lumen and longer stent patency. Recently, SEMS has been used for various benign biliary strictures and leaks. In this article, we briefly review the characteristics of SEMS as well as complications of stent placement. We review the current guidelines for managing malignant and benign biliary obstructions. Recent developments in biliary stenting are also discussed.

Citations

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Yuechuan Li, Kunshan Yuan, Chengchen Deng, Hui Tang, Jinxuan Wang, Xiaozhen Dai, Bing Zhang, Ziru Sun, Guiying Ren, Haijun Zhang, Guixue Wang
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Safety and efficacy of self-expandable metallic stent combined with 125I brachytherapy for the treatment of malignant obstructive jaundice
Ye Sheng, Xiaobo Fu, Guobao Wang, Maoyuan Mu, Weiwei Jiang, Zixiong Chen, Han Qi, Fei Gao
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Hamza ÖZER, Bige SAYIN, İlkay AKMANGİT
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EUS-guided antegrade stenting using a braided metal stent with a 6-Fr novel slim delivery system for malignant biliary stricture following Roux-en-Y reconstruction (with video)
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Endoscopic management of anastomotic stricture after living-donor liver transplantation
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300 Download
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Focused Review Series: Updates on Gastrointestinal and Pancreaticobiliary Stents

Update on Pancreatobiliary Stents: Stent Placement in Advanced Hilar Tumors: Sung Ill Jang, Dong Ki Lee; Clin Endosc 2015;48(3):201-208. Published online May 29, 2015; DOI: https://doi.org/10.5946/ce.2015.48.3.201

Abstract PDF PubReader ePub

Palliative drainage is the main treatment option for inoperable hilar cholangiocarcinoma to improve symptoms, which include cholangitis, pruritus, high-grade jaundice, and abdominal pain. Although there is no consensus on the optimal method for biliary drainage due to the paucity of large-scale randomized control studies, several important aspects of any optimal method have been studied. In this review article, we discuss the liver volume to be drained, stent type, techniques to insert self-expanding metal stents, and approaches for proper and effective biliary drainage based on previous studies and personal experience.

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Unilateral Stent Insertion With High-intensity Focused Ultrasound Ablation for Hilar Cholangiocarcinoma
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Xue Yin, Dong-Mei Li, Fang Yang, Tong-Gang Liu, Feng-Fei Xia, Yu-Fei Fu
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C.H. Jeon, C.J. Yoon, N.J. Seong, H. Lee, J.H. Hwang, J. Kim
Clinical Radiology.2018; 73(4): 412.e9. CrossRef
Placement of a Newly Designed Y-Configured Bilateral Self-Expanding Metallic Stent for Hilar Biliary Obstruction: A Pilot Study
Dechao Jiao, Kai Huang, Ming Zhu, Gang Wu, Jianzhuang Ren, Yanli Wang, Xinwei Han
Digestive Diseases and Sciences.2017; 62(1): 253. CrossRef
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Gang Chang, Feng-Fei Xia, Hong-Fu Li, Su Niu, Yuan-Shun Xu
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Review

Evidence-Based Recommendations on Colorectal Stenting: A Report from the Stent Study Group of the Korean Society of Gastrointestinal Endoscopy: Kwang Jae Lee, Sang Woo Kim, Tae Il Kim, Jong-Hoon Lee, Bo-In Lee, Bora Keum, Dae Young Cheung, Chang Heon Yang, The Stent Study Group of the Korean Society of Gastrointestinal Endoscopy; Clin Endosc 2013;46(4):355-367. Published online July 31, 2013; DOI: https://doi.org/10.5946/ce.2013.46.4.355

Abstract PDF PubReader ePub

Recently, placement of self-expandable metallic stents has been used for the treatment of colorectal obstruction. As domestic awareness of colorectal cancer has increased, the number of colorectal stenting procedures performed has also increased. We aimed to provide evidence-based recommendations for colorectal stenting to aid gastroenterologists in making informed decisions regarding the management of patients who present with colorectal obstruction. The working group consisted of eight gastroenterologists who actively practice and conduct research in the field of colorectal stenting and are the members of the Stent Study Group of the Korean Society of Gastrointestinal Endoscopy. A literature search was conducted using the PubMed, Embase, KoreaMed, and the Cochrane Library databases to identify relevant articles published between January 2001 and June 2012. Based on the modified Delphi process, 10 recommendation statements regarding indications, usefulness, methodology and complications of colorectal stenting, and alternative treatments for malignant colorectal obstruction were determined. The contents will be widely distributed, and periodically revised to reflect the latest knowledge. These evidence-based recommendations for colorectal stenting will provide gastroenterologists and patients with appropriate and balanced information, and will improve the quality of care.

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Spontaneous Biloma Caused by Pancreatic Cancer and Treated by Endoscopic Biliary Stenting: Ji Young Park, M.D., Jin Lee, M.D., Soon Jae Lee, M.D., Se Ah Kwon, M.D., Dong Hee Koh, M.D., Min Ho Choi, M.D., Hyun Joo Jang, M.D. and Sea Hyub Kae, M.D.; Korean J Gastrointest Endosc 2011;42(3):190-194. Published online March 28, 2011

Abstract PDF: Biloma is a rare disorder, and is defined as an abnormal extrahepatic or intrahepatic collection of bile within a defined capsular space. The common causes of biloma are iatrogenic and trauma. Spontaneous biloma, especially caused by pancreatic cancer, is very rare. An 86-year-old man was admitted with abdominal pain and fever. The patient denied a history of abdominal surgery, endoscopic retrograde cholangiography, or trauma. Abdominal computed tomography demonstrated a huge collection of fluid in the left lobe of the liver, dilatation of the intra and proximal common bile duct, and a heterogeneous enhancing mass in the pancreatic head portion. Percutaneous drainage under ultrasound guidance was performed, and the fluid analysis was compatible with biloma. A plastic stent was endoscopically inserted into the common bile duct to treat continuous drainage of the fluid despite percutaneous drainage. We report a case of biloma developed spontaneously in a patient with pancreatic cancer and successfully treated by endoscopic biliary stenting. (Korean J Gastrointest Endosc 2011;42:190-194)

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A Case of a Removal of Pyloric Stent That Was Partially Embeded in the Mucosa after Temporary Stenting for the Benign Pyloric Stenosis and It Was Removed Using Argon Plasma Coagulation: Joo Yeon Oh, M.D., Jong-Jae Park, M.D., Ja In Park, M.D., Won Woo Lee, M.D., Seung Young Roh, M.D., Hyun-Seok Kang, M.D., Jae Seon Kim, M.D. and Young-Tae Bak, M.D.; Korean J Gastrointest Endosc 2010;40(1):31-35. Published online January 30, 2010

Abstract PDF: Generally, self expandable metallic stents (SEMSs) are widely used for the treatment of malignant gastrointestinal stenosis due to their effectiveness and low complication rate. On the contraty, balloon dilatation or Bougie dilatation is commonly used for treating benign gastrointestinal stenosis as non-invasive methods. However, their such complications such as recurrence, hemorrhage and perforation are problematic when these dilation techniques are used. Temporary placement of a SEMS in a benign gastric outlet obstruction is expected to be a promising therapeutic modality despite of several major complications such as migration. Rarely, stent removal can, on rare occasions, be difficult or cause bleeding or perforation when the stent is embeded in the mucosa due to mucosal hyperplasia at the tips of the stent. We report here on a case of a stent, partially embeded in the mucosa after temporary stenting for treating a benign pyloric stenosis, which was successfully removed using argon plasma coagulation. (Korean J Gastrointest Endosc 2010;40:31-35)

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Percutaneous Transhepatic Gallbladder Stenting for Acute Cholecystitis after Palliative Metallic Biliary Stenting: Hwal Suk Cho, M.D., Sun Mi Lee, M.D., Chan Won Park, M.D., Ji Young Kim, M.D., Do Hoon Kim, M.D., Kee Tae Park, M.D., Tae Oh Kim, M.D., Jeong Heo, M.D., Gwang Ha Kim, M.D., Dae Hwan Kang, M.D., Geun Am Song, M.D. and Mong Cho, M.D.; Korean J Gastrointest Endosc 2006;33(5):322-325. Published online November 30, 2006

Abstract PDF: Metallic biliary stenting to relieve a malignant biliary obstruction can cause a cystic duct obstruction and acute cholecystitis. Percutaneous transhepatic cholecystostomy is often performed in patients with a limited life expectancy but can have a significant impact on the quality of life. Percutaneous transhepatic gallbladder stenting (PTGS) was performed across the cystic duct via the cholecystostomy tube tract to allow the removal of the cholecystostomy tube. The patient remained asymptomatic for 7 months after PTGS. In conclusion, PTGS across the cystic duct may be considered a treatment option in selected patients who develop acute cholecystitis after palliative metallic biliary stenting. (Korean J Gastrointest Endosc 2006;33: 322⁣325)

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췌관 인공도관의 임상적 유용성에 대한 후향적 연구: Korean J Gastrointest Endosc 2003;27(5):485-485. Published online November 20, 2003

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내시경적 췌관 배액관 삽입과 Octreotide에 의한 췌장성 복수의 치료 ( Treatment of Pancreatic Ascites with Endoscopic Pancreatic Duct Stenting and Octreotide Injection ): Korean J Gastrointest Endosc 2000;21(2):662-665. Published online November 30, 1999

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유두부암 환자에서 내시경적 담관 십이지장 누공 형성술의 임상적 유용성 ( Clinical Usefulness of Endoscopic Choledochoduochoduodenal Fistulotomy in Patients with Ampullary Cancer ): Korean J Gastrointest Endosc 2000;21(1):525-533. Published online November 30, 1999

Abstract PDF: Backgorund/Aims : Endoscopic choledochoduodenal fistulotomy(fistulotomy), using a needle-knife sphin-cterotome as an alternative to failed duct cannulation and subsequent endoscopic drainage in patients with ampullary cancer, can be performed in patients with a suprapapillary bulged or distorted papilla. The purpose of this prospective sutdy was to evaluate the safety and clinical usefulness of endoscopic fistulotomy in patients with ampullary cancer. Methods : Of the 29 patients with ampullary cancer requiring biliary drainage, 13 patients with a suprapapillary bulged papilla underwent fistulotomy either alone or followed by an upward extension of the fistulous orifice using a standard sphincterotome (fistulotomy group). Of the remaing 16 patients, transpapillary biliary stenting was successful in 13 patients (biliary stenting group). In both group, the rate of successful bile duct cannulation and effective biliary drainage were assessed and compared. Results : Bile duct cannulation was successful in 92.3% of the patients in the fistulotomy group and 81.3% of patients in the biliary stenting group, and the only complications were mild bleeding in 1 patient (7.7%) and cholangitis in 1 patient(6.3%). The success rate for initial biliary drainage with the fistulotomy or transpapillary stenting were 100% and 84.6%, respectively. Of the 12 patients in whom biliary drainage was used as the definite treatment, the symptom-free duration was 3.2 months in 6 patients of the fistulotomy group and 3.9 months in 6 patients in the biliary stenting group. Conclusions : Endoscopic fistulotomy is safe and effective for both preoperative and palliative biliary decompression in patients with ampullary cancer and it is suggested that the procedure can be applied primarily to increase the success rate of biliary access and subsequent biliary drainage especially in patients with a bulged papilla. (Korean J Gastrointest Endosc 2000;21:525-533)

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악성 완전 담도협착에서의 경피적 세침천자술에 의한 경피적 내시경적 담도배액술 ( Percutaneous Endoscopic Biliary Stenting (PEBS) Using the Percutaneous Fine Needle Puncture Method in Malignant Complete Biliary Obstruction ): Korean J Gastrointest Endosc 2000;20(2):154-157. Published online November 30, 1999

Abstract PDF: Nonsurgical drainage of malignant obstructive jaundice is an interesting alternative to surgical drainage in the palliative treatment of pancreaticobiliary neoplasms. Biliary drainage by endoprosthesis is as effective and better supported than percutaneous external drainage, but more difficult to control. Endoscopic retograde biliary drainage (ERBD) is a safe and effective biliary drainage procedure, and is indicated with malignant obstructive jaundice in patients on whom endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST) can be performed. A nonoperative method of palliation was used in patients with malignant obstructive jaundice, in whom a biliary endoprosthesis could not be placed endoscopically due to complete obstruction of the bile duct. A guide wire was manipulated through the lesion by a percutaneous transhepatic route, after puncturing the tumor by a fine needle, and retrieved from the duodenum through an endoscope. A stent was then passed through the endoscope over the guide wire across the stricture.

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원저 : 담도 췌장 ; 침형 유두절개술시 체관내인공관의 임상적 유용성 ( Case Reports : Biliary Tract & Pancreas ; The Needle - Knife Sphincterotomy over Pancreatic Stent : A Safe and Effective Technique? ): Korean J Gastrointest Endosc 1998;18(2):183-195. Published online November 30, 1997

Abstract PDF: Background
/Aims: Needle-knife sphincterotomy (NKS) is an alternative technique to EST when selective bile duct cannulation can not be achieved with a variety of techniques or accessories. The risk of post-procedure pancreatitis is high, however, when papillary edema, sphincter of Oddi spasm, and the resulting restriction of pancreatic juice flow are induced by both mechanical injury associated with repeated cannulation attempts and possible burn injury due to NKS itself. Recently, nasopancreatic drainage and pancreatic stenting were suggested to be effective in preventing pancreatitis in patients with high risk of postprocedure pancreatitis and in patients who underwent NKS, respectively. The purpose of this study is to evaluate the role of pancreatic stenting on the clinical outcomes in patients with high risks of postprocedure pancreatitis who undergo NKS. Methods: Of the 119 patients who had undergone NKS, pancreatic stenting with 2-4 cm, 7Fr polyethylene biliary stent was performed prior to NKS in 13 patients (pancreatic stent group), and an incision was begun without pancreatic stenting at the papillary roop avoiding trauma of the papillary orifice and thus, reducing the risks of pancreatitis in 15 patients (control group). Both groups were at high risks of pancreatitis associated with repeated, unsuccessful bile duct cannulation attempts. In the two groups, the success rate of bile duct cannulation and the incidence of pancreatitis were analyzed and compared. (Korean J Gastroint,est Endosc 18: 183-193, 1998) (continue)

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원저 : 담도 췌장 ; 내시경적 제거가 곤란한 총담관결석 환자에서 영구적 담관배액술의 효과 ( Original Articles : Biliary Tract & Pancreas ; Long-Term Effect of Permanent Biliary Stenting for Endoscopically Unextractable Common Bile Duct Stone(s) ): Korean J Gastrointest Endosc 1998;18(1):40-50. Published online November 30, 1997

Abstract PDF: Background
/Aims: Endoscopic sphincterotomy(EST) has become a well-established therapeutic modality for common bile duct stone(s). EST and subsequent stone extraction, including mechanical lithotripsy, can clear bile duct in 85% to 95% of patients. Other therapeutic modalities which have been developed to enhance bile duct clearance including extracorporeal shock-wave lithotripsy, electrohydraulic or laser lithotripsy, and chemical dissolution are high cost, not yet widely available especially in community hospital, yet to be perfected, or still under clinical evaluation. The use of biliary stenting has been proposed as an alternative therapy for patients at high risk for surgery. We carried out this prospective, controlled study to evaluate the long-term effect of biliary stenting for endoscopically unextractable common bile duct stone(s). Methods: Of the 233 patients with common bile duct stone(s) admitted at Gil Hospital from Jan. 1995 to Dec. 1996, the stent group were 14 patients with retained comrnon bile duct stone(s) in which 7Fr polyethylene biliary stent was placed with the proximal end above the stone and the distal end in the duodenum. The control group were 6 patients with common bile duct stone(s) not treated, because of patients refusal of surgical or endoscopic management. Follow-up was achieved by direct interview and telephone, and consisted of prospective analysis of all complications that occured during long-term follow-up period. Complication rates in the both groups were compared using chi-square test and cumulative complication-free rates were calculated by Kaplan-Meier analysis. (Korean J Gastrointest Kndosc 18: 40-50, 1~998) (continue)

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원저 : 담도 췌장 ; 총담관결석에 의한 급성화농성담관염 환자에서 내시경적 역행성 담관배액술의 치료효과 ( Original Articles : Biliary Tract & Pancreas ; Biliary Stenting as an Altermative to Endoscopic Nasobiliary Drainage in Patients with Acute Calculous Suppurative Cholangitis ): Korean J Gastrointest Endosc 1997;17(6):789-800. Published online November 30, 1996

Abstract PDF: Background
/Aims: Acute calculous suppurative cholangitis(ACSC) is the most severe complication of bile duct stone(s) and carries 100% mortality if left untreated, and emergent decompression is a life-saving procedure. Endoscopic therapy such as endoscopic sphincterotomy(EST) or endoscopic nasobiliary drainage(ENBD) are well-mtablished treat- ment of choice instead of emergent surgieal or percutaneous drainages which have a high mortality or morbity, respectively. However, EST and subsequent stone removal is operator-dependent, time consuming, associated with complication rate of 6-12%, and may be inadequeate in many critically ill patients. Recently, endoscopic retrograde biliary drainage(ERBD) is suggested to be as effective in temporary biliary drainage for retained common duct stone and acute cholangitis as ENBD is, and preferred to ENBD in some reports, because ENBD can be pulled out occasionally by confused patient, more time consuming, unpleasant, a hindrance for the patient, and does not seem to be any more effective than ERBD. So, we performed this study to evaluate the role of ERBD in patient with ACSC. (Korean J Gastrointest Endosc 17: 789-800, 1997) (continue)

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