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Original Article
Development of colonic stent simulator using three-dimensional printing technique: a simulator development study in Korea
Hyundam Gu, Suyoung Lee, Sol Kim, Hye-Lim Jang, Da-Woon Choi, Kyu Seok Kim, Yu Ri Shin, Dae Young Cheung, Bo-In Lee, Jin Il Kim, Han Hee Lee
Clin Endosc 2024;57(6):790-797.   Published online September 23, 2024
DOI: https://doi.org/10.5946/ce.2024.110
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Colonic stenting plays a vital role in the management of acute malignant colonic obstruction. The increasing use of self-expandable metal stents (SEMS) and the diverse challenges posed by colonic obstruction at various locations underscore the importance of effective training for colonic stent placement.
Methods
All the components of the simulator were manufactured using silicone molding techniques in conjunction with three-dimensional (3D) printing. 3D images sourced from computed tomography scans and colonoscopy images were converted into a stereolithography format. Acrylonitrile butadiene styrene copolymers have been used in fused deposition modeling to produce moldings.
Results
The simulator replicated the large intestine from the rectum to the cecum, mimicking the texture and shape of the human colon. It enables training for colonoscopy insertion, cecum intubation, loop reduction, and stenting within stenotic areas. Interchangeable stenotic modules for four sites (rectum, sigmoid colon, descending colon, and ascending colon) were easily assembled for training. These modules integrate tumor contours and blood vessel structures with a translucent center, allowing real-time visualization during stenting. Successful and repeatable demonstrations of stent insertion and expansion using the reusable SEMS were consistently achieved.
Conclusions
This innovative simulator offers a secure colonic stenting practice across various locations, potentially enhancing clinical outcomes by improving operator proficiency during actual procedures.
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  • 93 Download
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Review
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
Clin Endosc 2024;57(5):588-594.   Published online July 9, 2024
DOI: https://doi.org/10.5946/ce.2023.169
AbstractAbstract PDFPubReaderePub
Endoscopic ultrasound (EUS)-guided interventions have evolved rapidly in recent years, with dedicated metal stents playing a crucial role in this process. Specifically, the invention of biflanged short metal-covered stents, including lumen-apposing metal stents (LAMS), and modifications in a variety of tubular self-expandable metal stents (SEMS), have led to innovations in EUS-guided interventions. LAMS or non-LAMS stents are commonly used in the EUS-guided drainage of pancreatic fluid collections, especially in cases of walled-off necrosis. Additionally, LAMS is commonly considered for drainage of the EUS-guided gallbladder or dilated common bile duct and EUS-guided gastroenterostomy. Fully or partially covered tubular SEMS with several new designs are being considered for EUS-guided biliary drainage. This review focuses on advances in SEMS for EUS-guided interventions and discusses related research results.
  • 2,867 View
  • 255 Download
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Original Article
Outcomes of partially covered self-expandable metal stents with different uncovered lengths in endoscopic ultrasound-guided hepaticogastrostomy: a Japanese retrospective study
Takeshi Okamoto, Takashi Sasaki, Tsuyoshi Takeda, Tatsuki Hirai, Takahiro Ishitsuka, Manabu Yamada, Hiroki Nakagawa, Takafumi Mie, Takaaki Furukawa, Akiyoshi Kasuga, Masato Ozaka, Naoki Sasahira
Clin Endosc 2024;57(4):515-526.   Published online May 10, 2024
DOI: https://doi.org/10.5946/ce.2023.142
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: The optimal length of the uncovered portion of partially covered self-expandable metal stents (PCSEMSs) used in endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) remains unclear. This study investigated the safety and efficacy of PCSEMSs with different uncovered lengths, with a focus on stent migration and time to recurrent biliary obstruction (RBO).
Methods
Outcomes of patients undergoing EUS-HGS using PCSEMSs with 5-mm and 20-mm uncovered portions at our institution from January 2016 to December 2021 were compared.
Results
Sixty-two patients underwent EUS-HGS using PCSEMS (5/20-mm uncovered portions: 32/30). Stent migration occurred only in the 5-mm group. There were no differences in RBO rates (28.1% vs. 40.0%) or median time to RBO (6.8 vs. 7.1 months) between the two groups. Median overall survival (OS) was longer in the 20-mm group (3.1 vs. 4.9 months, p=0.037) due to the higher number of patients that resumed chemotherapy after EUS-HGS (56.7% vs. 28.1%, p=0.029). Good performance status, absence of hepatic metastases, and chemotherapy after EUS-HGS were independent predictors of longer OS.
Conclusions
No migration was observed in patients treated with PCSEMS with 20-mm uncovered portions. Patients treated with PCSEMS with 20-mm uncovered portions performed at least as well as those treated with 5-mm uncovered portions in all material respects.

Citations

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  • Migration of covered expandable metal stents after endoscopic ultrasound-guided hepaticogastrostomy: stent covering versus stent design?
    Todd H. Baron
    Clinical Endoscopy.2024; 57(4): 471.     CrossRef
  • 2,334 View
  • 192 Download
  • 1 Web of Science
  • 1 Crossref
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Review
Endoscopic stenting for malignant gastric outlet obstruction: focusing on comparison of endoscopic stenting and surgical gastrojejunostomy
Sun Gyo Lim, Chan Gyoo Kim
Clin Endosc 2024;57(5):571-580.   Published online February 23, 2024
DOI: https://doi.org/10.5946/ce.2023.160
AbstractAbstract PDFPubReaderePub
Malignant gastric outlet obstruction (GOO) is a condition characterized by blockage or narrowing where the stomach empties its contents into the small intestine due to primary malignant tumors or metastatic diseases. This condition leads to various symptoms such as nausea, vomiting, abdominal pain, and weight loss. To manage malignant GOO, different treatment options have been employed, including surgical gastrojejunostomy (SGJ), gastroduodenal stenting (GDS) using self-expandable metallic stent (SEMS), and endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ). This review focuses on comparing the clinical outcomes of endoscopic stenting (GDS and EUS-GJ) with SGJ for malignant GOO. Studies have shown that GDS with SEMS provides comparable clinical outcomes and safety for the palliation of obstructive symptoms. The choice between covered and uncovered SEMS remains controversial, as different studies have reported varying results. EUS-GJ, performed via endoscopic ultrasound guidance, has shown promising efficacy and safety in managing malignant GOO, but further studies are needed to establish it as the primary treatment option. Comparative analyses suggest that GDS has higher recurrence and reintervention rates compared to EUS-GJ and SGJ, with similar overall procedural complications. However, bleeding rates were lower with GDS than with SGJ. Randomized controlled trials are required to determine the optimal treatment approach for malignant GOO.
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Systematic Review and Meta-analysis
Stricturing Crohn's disease: what is the role of endoscopic stenting? A systematic review
Giorgia Burrelli Scotti, Roberto Lorenzetti, Annalisa Aratari, Antonietta Lamazza, Enrico Fiori, Claudio Papi, Stefano Festa
Clin Endosc 2023;56(6):726-734.   Published online October 24, 2023
DOI: https://doi.org/10.5946/ce.2023.059
Graphical AbstractGraphical Abstract AbstractAbstract PDFPubReaderePub
Background
/Aims: Endoscopic stenting for stricturing Crohn's disease (CD) is an emerging treatment that achieves more persistent dilatation of the stricture over time than endoscopic balloon dilatation (EBD). We aimed to explore the efficacy and safety of stenting for the treatment of CD strictures.
Methods
A systematic electronic literature search was performed (PROSPERO; no. CRD42022308033). The primary outcomes were technical success, efficacy, complication rate, and the need for further interventions due to reobstruction. The outcomes of partially covered self-expanding metal stents (PCSEMS) with scheduled retrieval after seven days were also analyzed.
Results
Eleven eligible studies were included in the review. Overall, 173 patients with CD were included in this study. Mean percentage of technical success was 95% (range, 80%–100%), short-term efficacy was 100% in all studies, and long-term efficacy was 56% (range, 25%–90%). In patients with a scheduled PCSEMS retrieval, the long-term efficacy was 76% (range, 59%–90%), the mean complication rate was 35% (range, 15%–57%), and the major complication rate was 11% (range, 0%–29%).
Conclusions
Endoscopic stenting with scheduled PCSEMS retrieval may be considered a feasible second-line treatment for short CD strictures to postpone surgery. However, larger head-to-head prospective studies are needed to understand the role of stenting as an alternative or additional treatment to EBD in CD.

Citations

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  • Perioperative Considerations for the Surgical Treatment of Crohn’s Disease with Discussion on Surgical Antibiotics Practices and Impact on the Gut Microbiome
    Shelbi Olson, Lindsay Welton, Cyrus Jahansouz
    Antibiotics.2024; 13(4): 317.     CrossRef
  • 3,320 View
  • 191 Download
  • 1 Web of Science
  • 1 Crossref
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Original Articles
Self-expandable metallic stent-induced esophagorespiratory fistulas in patients with advanced esophageal cancer
Iatagan R. Josino, Bruno C. Martins, Andressa A. Machado, Gustavo R. de A. Lima, Martin A. C. Cordero, Amanda A. M. Pombo, Rubens A. A. Sallum, Ulysses Ribeiro Jr, Todd H. Baron, Fauze Maluf-Filho
Clin Endosc 2023;56(6):761-768.   Published online July 25, 2023
DOI: https://doi.org/10.5946/ce.2022.297
Graphical AbstractGraphical Abstract AbstractAbstract PDFPubReaderePub
Background
/Aims: Self-expandable metallic stents (SEMSs) are widely adopted for the palliation of dysphagia in patients with malignant esophageal strictures. An important adverse event is the development of SEMS-induced esophagorespiratory fistulas (SEMS-ERFs). This study aimed to assess the risk factors related to the development of SEMS-ERF after SEMS placement in patients with esophageal cancer.
Methods
This retrospective study was performed at the Instituto do Cancer do Estado de São Paulo. All patients with malignant esophageal strictures who underwent esophageal SEMS placement between 2009 and 2019 were included in the study.
Results
Of the 335 patients, 37 (11.0%) developed SEMS-ERF, with a median time of 129 days after SEMS placement. Stent flare of 28 mm (hazard ratio [HR], 2.05; 95% confidence interval [CI], 1.15–5.51; p=0.02) and post-stent chemotherapy (HR, 2.0; 95% CI, 1.01–4.00; p=0.05) were associated with an increased risk of developing SEMS-ERF, while lower-third tumors were a protective factor (HR, 0.5; 95% CI, 0.26–0.85; p=0.01). No difference was observed in overall survival.
Conclusions
The incidence of SEMS-ERFs was 11%, with a median time of 129 days after SEMS placement. Post-stent chemotherapy and a 28 mm stent flare were associated with a higher risk of SEMS-ERF.

Citations

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  • Clinical Implications of Circulating Tumor Cells in Patients with Esophageal Squamous Cell Carcinoma: Cancer-Draining Blood Versus Peripheral Blood
    Dong Chan Joo, Gwang Ha Kim, Hoseok I, Su Jin Park, Moon Won Lee, Bong Eun Lee
    Cancers.2024; 16(16): 2921.     CrossRef
  • How to reduce fistula formation after self-expandable metallic stent insertion for treating malignant esophageal stricture?
    Kwang Bum Cho
    Clinical Endoscopy.2023; 56(6): 735.     CrossRef
  • 2,502 View
  • 115 Download
  • 2 Web of Science
  • 2 Crossref
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Impact of sarcopenia on biliary drainage during neoadjuvant therapy for pancreatic cancer
Kunio Kataoka, Eizaburo Ohno, Takuya Ishikawa, Kentaro Yamao, Yasuyuki Mizutani, Tadashi Iida, Hideki Takami, Osamu Maeda, Junpei Yamaguchi, Yukihiro Yokoyama, Tomoki Ebata, Yasuhiro Kodera, Hiroki Kawashima
Clin Endosc 2024;57(1):112-121.   Published online July 18, 2023
DOI: https://doi.org/10.5946/ce.2022.278
Graphical AbstractGraphical Abstract AbstractAbstract PDFPubReaderePub
Background
/Aims: Since the usefulness of neoadjuvant chemo(radiation) therapy (NAT) for pancreatic cancer has been demonstrated, recurrent biliary obstruction (RBO) in patients with pancreatic cancer with a fully covered self-expandable metal stent (FCSEMS) during NAT is expected to increase. This study investigated the impact of sarcopenia on RBO in this setting.
Methods
Patients were divided into normal and low skeletal muscle index (SMI) groups and retrospectively analyzed. Patient characteristics, overall survival, time to RBO (TRBO), stent-related adverse events, and postoperative complications were compared between the two groups. A Cox proportional hazard model was used to identify the risk factors for short TRBO.
Results
A few significant differences were observed in patient characteristics, overall survival, stent-related adverse events, and postoperative complications between 38 patients in the normal SMI group and 17 in the low SMI group. The median TRBO was not reached in the normal SMI group and was 112 days in the low SMI group (p=0.004). In multivariate analysis, low SMI was the only risk factor for short TRBO, with a hazard ratio of 5.707 (95% confidence interval, 1.148–28.381; p=0.033).
Conclusions
Sarcopenia was identified as an independent risk factor for RBO in patients with pancreatic cancer with FCSEMS during NAT.

Citations

Citations to this article as recorded by  
  • Endeavors to prevent stent malfunction: new insights into the risk factors for recurrent biliary obstruction
    Sung-Jo Bang
    Clinical Endoscopy.2024; 57(1): 56.     CrossRef
  • Skeletal muscle status and survival among patients with advanced biliary tract cancer
    Shinya Takaoka, Tsuyoshi Hamada, Naminatsu Takahara, Kei Saito, Go Endo, Ryunosuke Hakuta, Kota Ishida, Kazunaga Ishigaki, Sachiko Kanai, Kohei Kurihara, Hiroki Oyama, Tomotaka Saito, Tatsuya Sato, Tatsunori Suzuki, Yukari Suzuki, Shuichi Tange, Yurie Tok
    International Journal of Clinical Oncology.2024; 29(3): 297.     CrossRef
  • 2,849 View
  • 138 Download
  • 2 Web of Science
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Clinical outcomes of permanent stenting with endoscopic ultrasound gallbladder drainage
Eisuke Suzuki, Yuji Fujita, Kunihiro Hosono, Yuji Koyama, Seitaro Tsujino, Takuma Teratani, Atsushi Nakajima, Nobuyuki Matsuhashi
Clin Endosc 2023;56(5):650-657.   Published online April 5, 2023
DOI: https://doi.org/10.5946/ce.2022.190
Graphical AbstractGraphical Abstract AbstractAbstract PDFPubReaderePub
Background
/Aims: Endoscopic ultrasound gallbladder drainage (EUS-GBD) is gaining attention as a treatment method for cholecystitis. However, only a few studies have assessed the outcomes of permanent stenting with EUS-GBD. Therefore, we evaluated the clinical outcomes of permanent stenting using EUS-GBD.
Methods
This was a retrospective, single-center cohort study. The criteria for EUS-GBD at our institution are a high risk for surgery, inability to perform surgery owing to poor performance status, and inability to obtain consent for emergency surgery. EUS-GBD was performed using a 7-Fr double-pigtail plastic stent with a dilating device. The primary outcomes were the recurrence-free rate of cholecystitis and the late-stage complication-avoidance rate. Secondary outcomes were technical success, clinical success, and procedural adverse events.
Results
A total of 41 patients were included in the analysis. The median follow-up period was 168 (range, 10–1,238) days. The recurrence-free and late-stage complication-avoidance rates during the follow-up period were 95% (38 cases) and 90% (36 cases), respectively. There were only two cases of cholecystitis recurrence during the study period.
Conclusions
EUS-GBD using double-pigtail plastic stent was safe and effective with few complications, even in the long term, in patients with acute cholecystitis.

Citations

Citations to this article as recorded by  
  • Revolutionizing outcomes: endoscopic ultrasound-guided gallbladder drainage using innovative electrocautery enhanced-lumen apposing metal stents for high-risk surgical patients
    Hyung Ku Chon, Yun Chae Lee, Tae Hyeon Kim, Seung Ok Lee, Seong-Hun Kim
    Scientific Reports.2024;[Epub]     CrossRef
  • 2,328 View
  • 106 Download
  • 1 Web of Science
  • 1 Crossref
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Systematic Review and Meta-analysis
Influence of biliary stents on the diagnostic outcome of endoscopic ultrasound–guided tissue acquisition from solid pancreatic lesions: a systematic review and meta-analysis
Suprabhat Giri, Shivaraj Afzalpurkar, Sumaswi Angadi, Jijo Varghese, Sridhar Sundaram
Clin Endosc 2023;56(2):169-179.   Published online February 15, 2023
DOI: https://doi.org/10.5946/ce.2022.282
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: This meta-analysis analyzed the effect of an indwelling biliary stent on endoscopic ultrasound (EUS)–guided tissue acquisition from pancreatic lesions.
Methods
A literature search was performed to identify studies published between 2000 and July 2022 comparing the diagnostic outcomes of EUS-TA in patients with or without biliary stents. For non-strict criteria, samples reported as malignant or suspicious for malignancy were included, whereas for strict criteria, only samples reported as malignant were included in the analysis.
Results
Nine studies were included in this analysis. The odds of an accurate diagnosis were significantly lower in patients with indwelling stents using both non-strict (odds ratio [OR], 0.68; 95% confidence interval [CI], 0.52–0.90) and strict criteria (OR, 0.58; 95% CI, 0.46–0.74). The pooled sensitivity with and without stents were similar (87% vs. 91%) using non-strict criteria. However, patients with stents had a lower pooled sensitivity (79% vs. 88%) when using strict criteria. The sample inadequacy rate was comparable between groups (OR, 1.12; 95% CI, 0.76–1.65). The diagnostic accuracy and sample inadequacy were comparable between plastic and metal biliary stents.
Conclusions
The presence of a biliary stent may negatively affect the diagnostic outcome of EUS-TA for pancreatic lesions.

Citations

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  • Role of Endoscopic Ultrasound in Diagnosis of Pancreatic Ductal Adenocarcinoma
    Abhirup Chatterjee, Jimil Shah
    Diagnostics.2023; 14(1): 78.     CrossRef
  • 2,592 View
  • 117 Download
  • 1 Crossref
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Review
Optimal endoscopic drainage strategy for unresectable malignant hilar biliary obstruction
Itaru Naitoh, Tadahisa Inoue
Clin Endosc 2023;56(2):135-142.   Published online January 5, 2023
DOI: https://doi.org/10.5946/ce.2022.150
AbstractAbstract PDFPubReaderePub
Endoscopic biliary drainage strategies for managing unresectable malignant hilar biliary obstruction differ in terms of stent type, drainage area, and deployment method. However, the optimal endoscopic drainage strategy remains unclear. Uncovered self-expandable metal stents (SEMS) are the preferred type because of their higher functional success rate, longer time to recurrent biliary obstruction (RBO), and fewer cases of reintervention than plastic stents (PS). Other PS subtypes and covered SEMS, which feature a longer time to RBO than PS, can be removed during reintervention for RBO. Bilateral SEMS placement is associated with a longer time to RBO and a longer survival time than unilateral SEMS placement. Unilateral drainage is acceptable if a drainage volume of greater than 50% of the total liver volume can be achieved. In terms of deployment method, no differences were observed in clinical outcomes between side-by-side (SBS) and stent-in-stent deployment. Simultaneous SBS boasts a shorter procedure time and higher technical success rate than sequential SBS. This review of previous studies aimed to clarify the optimal endoscopic biliary drainage strategy for unresectable malignant hilar biliary obstruction.

Citations

Citations to this article as recorded by  
  • Comparison of unilateral and bilateral intraductal plastic stent placement for unresectable malignant hilar biliary obstruction: A propensity score‐matched cohort analysis
    Mitsuru Okuno, Keisuke Iwata, Tsuyoshi Mukai, Yuhei Iwasa, Shinya Uemura, Kensaku Yoshida, Akinori Maruta, Takuji Iwashita, Ichiro Yasuda, Masahito Shimizu
    Journal of Hepato-Biliary-Pancreatic Sciences.2024; 31(4): 284.     CrossRef
  • Preoperative endoscopic biliary drainage by metal versus plastic stents for resectable perihilar cholangiocarcinoma
    David M. de Jong, Timothy M. Gilbert, Lynn E. Nooijen, Eva Braunwarth, Marijana Ninkovic, Florian Primavesi, Hassan Z. Malik, Nick Stern, Richard Sturgess, Joris I. Erdmann, Rogier P. Voermans, Marco J. Bruno, Bas Groot Koerkamp, Lydi M.J.W. van Driel
    Gastrointestinal Endoscopy.2024; 99(4): 566.     CrossRef
  • TOKYO criteria 2024 for the assessment of clinical outcomes of endoscopic biliary drainage
    Hiroyuki Isayama, Tsuyoshi Hamada, Toshio Fujisawa, Mitsuharu Fukasawa, Kazuo Hara, Atsushi Irisawa, Shigeto Ishii, Ken Ito, Takao Itoi, Yoshihide Kanno, Akio Katanuma, Hironari Kato, Hiroshi Kawakami, Hirofumi Kawamoto, Masayuki Kitano, Hirofumi Kogure,
    Digestive Endoscopy.2024; 36(11): 1195.     CrossRef
  • Trisectoral Metal Stenting Using Combined Stent-by-Stent and Stent-in-Stent Method for Malignant Hilar Biliary Obstruction: A Prospective Pilot Study
    Tadahisa Inoue, Rena Kitano, Mayu Ibusuki, Tomoya Kitada, Kazumasa Sakamoto, Satoshi Kimoto, Jun Arai, Kiyoaki Ito
    Digestive Diseases and Sciences.2024; 69(11): 4283.     CrossRef
  • Suprapapillary trisectoral deployment of slim fully covered metal stents with ultra-stiff high-sliding guidewires for malignant hilar biliary obstruction
    Tadahisa Inoue, Rena Kitano, Tomoya Kitada, Kazumasa Sakamoto, Satoshi Kimoto, Jun Arai, Kiyoaki Ito
    Endoscopy.2024; 56(S 01): E996.     CrossRef
  • Efficacy and safety of covered self-expandable metal stents for malignant hilar biliary obstruction: systematic review and meta-analysis
    Kwang Hyun Chung, Kyong Joo Lee, Abel A. Joseph, Robert J. Huang, Andrew Li, Joo Ha Hwang, Seung Bae Yoon
    Gastrointestinal Endoscopy.2024;[Epub]     CrossRef
  • Evaluating safety and efficacy of plastic versus metal stenting in malignant hilar biliary obstruction: a systematic review and meta-analysis of randomized controlled trials
    Xinjie Luo, Zhicheng Huang, Kamran Ali, Khizar Hayat
    Postgraduate Medical Journal.2024;[Epub]     CrossRef
  • Research progress on biliary stents
    Qi Zhang, Haipo Cui, Yan Zhang, Hexuan Jiang
    Progress in Medical Devices.2023;[Epub]     CrossRef
  • 3,733 View
  • 367 Download
  • 6 Web of Science
  • 8 Crossref
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Original Articles
A prospective study of fully covered self-expandable metal stents for refractory benign pancreatic duct strictures
Bhavik Bharat Shah, Gajanan Ashokrao Rodge, Usha Goenka, Shivaraj Afzalpurkar, Mahesh Kumar Goenka
Clin Endosc 2022;55(6):793-800.   Published online April 4, 2022
DOI: https://doi.org/10.5946/ce.2021.211
AbstractAbstract PDFPubReaderePub
Background
/Aims: Fully covered self-expanding metal stents (FCSEMSs) are a relatively novel option for treating painful main pancreatic duct refractory strictures in patients with chronic pancreatitis. Herein, we aimed to assess the efficacy, feasibility, and safety of FCSEMSs in this patient group.
Methods
This prospective single-center study included patients who underwent endoscopic retrograde pancreatography with FCSEMS placement. The primary endpoints were the technical and clinical success rates. A reduction in visual analog scale pain score of >50% compared with that before stent placement was defined as clinical success. Secondary endpoints were resolution of pancreatic strictures on fluoroscopy during endoscopic retrograde pancreatography and the development of stent-related adverse events.
Results
Thirty-six patients were included in the analysis. The technical success rate was 100% (n=36) and the clinical success rate was 86.1% (n=31). There was a significant increase in stricture diameter from 1.7 mm to 3.5 mm (p<0.001) after stent removal. The mean visual analog scale pain score showed statistically significant improvement. At 19 months of follow-up, 55.6% of the patients were asymptomatic. Stent migration (16.7%), intolerable abdominal pain (8.3%), development of de novo strictures (8.3%), and mild pancreatitis (2.8%) were the most common adverse events.
Conclusions
FCSEMS placement showed good technical and clinical success rates for achieving pain relief in patients with refractory main pancreatic duct strictures.

Citations

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  • Citric Acid Loaded Hydrogel-Coated Stent for Dissolving Pancreatic Duct Calculi
    Jing Li, Yanwei Lv, Zheng Chen, Jiulong Zhao, Shige Wang
    Gels.2024; 10(2): 125.     CrossRef
  • Fully Covered Self-expandable Metallic Stents for Refractory Benign Pancreatic Duct Strictures: A Systematic Review and Meta-analysis
    Gajanan Rodge, Suprabhat Giri, Kailash Kolhe, Shivaraj Afzalpurkar, Sidharth Harindranath, Sridhar Sundaram, Aditya Kale
    Surgical Laparoscopy, Endoscopy & Percutaneous Techniques.2024; 34(5): 529.     CrossRef
  • Self-expanding metallic stent for refractory pancreatic duct stricture in chronic pancreatitis: A prospective follow-up study
    Praveer Rai, Pankaj Kumar, Ashok Kumar, Sana Asari, Kartik Agarwal, Mayank, Ravi V. Krishna Kishore, Prabhaker Mishra
    Indian Journal of Gastroenterology.2023;[Epub]     CrossRef
  • Quality of life after endoscopic procedures for chronic pancreatitis: A multicentre study
    Mikael Parhiala, Camilla Nøjgaard, Andreas Bartholdy, Anne Waage, Povilas Ignatavičius, Trond Engjom, Georg Dimcevski, Ingrid Kvåle Nordaas, Evangelos Kalaitzakis, Asbjørn M. Drewes, Amer Hadi, Søren S. Olesen, Jakob L. Poulsen, Johanna Laukkarinen
    United European Gastroenterology Journal.2023; 11(9): 884.     CrossRef
  • Pancreatic duct stents
    Jin Hui Yi, Zhao Shen Li, Liang Hao Hu
    Journal of Digestive Diseases.2022; 23(12): 675.     CrossRef
  • 3,255 View
  • 288 Download
  • 5 Web of Science
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Endoscopic internal drainage with double pigtail stents for upper gastrointestinal anastomotic leaks: suitable for all cases?
Bin Chet Toh, Jingli Chong, Baldwin PM Yeung, Chin Hong Lim, Eugene KW Lim, Weng Hoong Chan, Jeremy TH Tan
Clin Endosc 2022;55(3):401-407.   Published online January 6, 2022
DOI: https://doi.org/10.5946/ce.2021.197
AbstractAbstract PDFPubReaderePub
Background
/Aims: Surgeons and endoscopists have started to use endoscopically inserted double pigtail stents (DPTs) in the management of upper gastrointestinal (UGI) leaks, including UGI anastomotic leaks. We investigated our own experiences in this patient population.
Methods
From March 2017 to June 2020, 12 patients had endoscopic internal drainage of a radiologically proven anastomotic leak after UGI surgery in two tertiary UGI centers. The primary outcome measure was the time to removal of the DPTs after anastomotic healing. The secondary outcome measure was early oral feeding after DPT insertion.
Results
Eight of the 12 patients (67%) required only one DPT, whereas four (33%) required two DPTs. The median duration of drainage was 42 days. Two patients required surgery due to inadequate control of sepsis. Of the remaining 10 patients, nine did not require a change in DPT before anastomotic healing. Nine patients were allowed oral fluids within the 1st week and a soft diet in the 2nd week. One patient was allowed clear oral feeds on the 8th day after DPT insertion.
Conclusions
Endoscopic internal drainage is becoming an established minimally invasive technique for controlling anastomotic leak after UGI surgery. It allows for early oral nutritional feeding and minimizes discomfort from conventional external drainage.

Citations

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  • Endoscopic Intervention for Anastomotic Leakage After Gastrectomy
    Ji Yoon Kim, Hyunsoo Chung
    Journal of Gastric Cancer.2024; 24(1): 108.     CrossRef
  • Endoscopic Management of Post-Sleeve Gastrectomy Complications
    Muaaz Masood, Donald E. Low, Shanley B. Deal, Richard A. Kozarek
    Journal of Clinical Medicine.2024; 13(7): 2011.     CrossRef
  • Endoscopic Internal Drainage Achieving Successful Closure of Iatrogenic Pharyngoesophageal Fistula
    Ahmad Rimawi, Yahia Al-Turk, Abdul Monem Swied
    ACG Case Reports Journal.2023; 10(10): e01191.     CrossRef
  • 3,892 View
  • 272 Download
  • 4 Web of Science
  • 3 Crossref
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Laser-cut-type versus braided-type covered self-expandable metallic stents for distal biliary obstruction caused by pancreatic carcinoma: a retrospective comparative cohort study
Koh Kitagawa, Akira Mitoro, Takahiro Ozutsumi, Masanori Furukawa, Yukihisa Fujinaga, Kenichiro Seki, Norihisa Nishimura, Yasuhiko Sawada, Kosuke Kaji, Hideto Kawaratani, Hiroaki Takaya, Kei Moriya, Tadashi Namisaki, Takemi Akahane, Hitoshi Yoshiji
Clin Endosc 2022;55(3):434-442.   Published online October 28, 2021
DOI: https://doi.org/10.5946/ce.2021.161
AbstractAbstract PDFPubReaderePub
Background
/Aims: Covered self-expandable metallic stents (CMSs) are widely used for malignant distal biliary obstructions (MDBOs) caused by pancreatic carcinoma. This study compared the efficacy and safety of the laser-cut-type and braided-type CMSs.
Methods
To palliate MDBOs caused by pancreatic carcinoma, the laser-cut-type CMSs was used from April 2014 to March 2017, and the braided-type CMSs was used from April 2017 to March 2019. The tested self-expandable metallic stents were equipped with different anti-migration systems.
Results
In total, 47 patients received CMSs for MDBOs (24 laser-cut type, 23 braided-type). The time to recurrent biliary obstruction (TRBO) was significantly longer in the braided-type CMSs (p=0.0008), and the median time to stent dysfunction or patient death was 141 and 265 days in the laser-cut-type CMSs and braided-type CMSs, respectively (p=0.0023). Stent migration was the major cause of stent dysfunction in both groups, which occurred in 37.5% of the laser-cut-type CMSs and 13.0% of the braidedtype CMSs. There were no differences in the survival duration between the groups.
Conclusions
The TRBO was significantly longer for the braided-type CMSs with an anti-migration system than for the laser-cuttype. Stent migration tended to be less frequent with the braided-type CMSs than with the laser-cut-type CMSs.

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Endoscopic Management of Anastomotic Leakage after Esophageal Surgery: Ten Year Analysis in a Tertiary University Center
Nader El-Sourani, Sorin Miftode, Maximilian Bockhorn, Alexander Arlt, Christian Meinhardt
Clin Endosc 2022;55(1):58-66.   Published online October 14, 2021
DOI: https://doi.org/10.5946/ce.2021.099
AbstractAbstract PDFPubReaderePub
Background
/Aims: Anastomotic leakage after esophageal surgery remains a feared complication. During the last decade, management of this complication changed from surgical revision to a more conservative and endoscopic approach. However, the treatment remains controversial as the indications for conservative, endoscopic, and surgical approaches remain non-standardized.
Methods
Between 2010 and 2020, all patients who underwent Ivor Lewis esophagectomy for underlying malignancy were included in this study. The data of 28 patients diagnosed with anastomotic leak were further analyzed.
Results
Among 141 patients who underwent resection, 28 (19.9%) developed an anastomotic leak, eight (28.6%) of whom died. Thirteen patients were treated with endoluminal vacuum therapy (EVT), seven patients with self-expanding metal stents (SEMS) four patients with primary surgery, one patient with a hemoclip, and three patients were treated conservatively. EVT achieved closure in 92.3% of the patients with a large defect and no EVT-related complications. SEMS therapy was successful in clinically stable patients with small defect sizes.
Conclusions
EVT can be successfully applied in the treatment of anastomotic leakage in critically ill patients, while SEMS should be limited to clinically stable patients with a small defect size. Surgery is only warranted in patients with sepsis with graft necrosis.

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Focused Review Series: Endoscopic Management of Postoperative Gastrointestinal Complication: What’s New?
Endoscopic Management of Staple Line Leak after Bariatric Surgery: Surgeon’s Perspective
Yoona Chung, Dae Geun Park, Yong Jin Kim
Clin Endosc 2021;54(6):805-809.   Published online May 12, 2021
DOI: https://doi.org/10.5946/ce.2020.298
AbstractAbstract PDFPubReaderePub
Laparoscopic sleeve gastrectomy (LSG) has become a standalone primary procedure as a bariatric metabolic surgery since the early 2000s. The overall complication rate of LSG is reported to range from 2% to 15%. Staple line leakage (SLL) remains a major adverse event and occurs in approximately 1–6% of patients. Choosing the optimal treatment modality is a complex process. Clinicians must understand that nutritional support and drainage of fluid collection are essential for initial management. Conservative endoscopic management and sufficient drainage can resolve approximately 70% of SLLs. Endoscopic management of bariatric complications has been rapidly evolving in recent years and can be considered in all patients who are hemodynamically stable. We will review the available endoscopic management techniques, including stent placement (self-expanding stents and bariatric-specific stents), clipping, tissue sealant application, and internal drainage (double-pigtail stents [DPS] placement, endoscopic vacuum therapy, and septotomy). Stent placement remains the mainstream treatment for SLLs. However, healing with stents requires multiple sessions/stents and a long course of recovery. Endoscopic internal drainage is gaining popularity and has the potential to be a superior method. The importance of early intervention and combined endoscopic methods should be recognized.

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    Georgios-Ioannis Verras, Francesk Mulita, Charalampos Lampropoulos, Dimitrios Kehagias, Oliver Curwen, Andreas Antzoulas, Ioannis Panagiotopoulos, Vasileios Leivaditis, Ioannis Kehagias
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Original Article
Outcomes of Dilation of Recalcitrant Pancreatic Strictures Using a Wire-Guided Cystotome
Sridhar Sundaram, Dhaval Choksi, Aditya Kale, Suprabhat Giri, Biswaranjan Patra, Shobna Bhatia, Akash Shukla
Clin Endosc 2021;54(6):903-908.   Published online March 4, 2021
DOI: https://doi.org/10.5946/ce.2020.297
AbstractAbstract PDFPubReaderePub
Background
/Aims: Pancreatic strictures in chronic pancreatitis are treated using endoscopic retrograde cholangiopancreatography (ERCP) with plastic stent placement. The management of recalcitrant strictures remains a challenge, with the use of a Soehendra stent retriever or a needle knife described in case reports. Here, we discuss our experience with dilation of dominant pancreatic strictures with a 6-Fr cystotome.
Methods
A retrospective review of an endoscopy database was performed to search for patients with pancreatic strictures recalcitrant to conventional methods of dilation in which a cystotome was used. Technical success was defined as the successful dilation of the stricture with plastic stent placement. Functional success was defined as substantial pain relief or resolution of pancreatic fistulae.
Results
Ten patients (mean age, 30.8 years) underwent dilation of a dominant pancreatic stricture secondary to chronic pancreatitis, with a 6-Fr cystotome. Seven patients presented with pain. Three patients had pancreatic fistulae (two had pancreatic ascites and one had a pancreaticopleural fistula). The median stricture length was 10 mm (range, 5–25 mm). The head of the pancreas was the most common location of the stricture (60%). Technical and functional success was achieved in all patients. One patient had self-limiting bleeding, whereas another patient developed mild post-ERCP pancreatitis.
Conclusions
The use of a 6-Fr cystotome (diathermy catheter) can be an alternative method for dilation of recalcitrant pancreatic strictures after the failure of conventional modalities.

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  • Fully Covered Self-expandable Metallic Stents for Refractory Benign Pancreatic Duct Strictures: A Systematic Review and Meta-analysis
    Gajanan Rodge, Suprabhat Giri, Kailash Kolhe, Shivaraj Afzalpurkar, Sidharth Harindranath, Sridhar Sundaram, Aditya Kale
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    Jonghyun Lee, Dong Uk Kim, Sung Yong Han
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    Vaneet Jearth, Suprabhat Giri, Sridhar Sundaram
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Case Reports
Early Lumen-Apposing Metal Stent Dysfunction Complicating Endoscopic Ultrasound-Guided Gastroenterostomy: A Report of Two Cases
Janine B. Kastelijn, Veronique Van der Voort, Alderina Bijlsma, Leon M. G. Moons, Matthijs P. Schwartz, Frank P. Vleggaar
Clin Endosc 2021;54(4):603-607.   Published online January 13, 2021
DOI: https://doi.org/10.5946/ce.2020.201
AbstractAbstract PDFPubReaderePub
Endoscopic ultrasonography-guided gastroenterostomy using a lumen-apposing metal stent has emerged as a novel technique in the palliative treatment of malignant gastric outlet obstruction. Endoscopic ultrasonography-guided gastroenterostomy seems to have the potential to provide long-lasting patency in a minimally invasive manner. Low reintervention rates have been described. We report two cases with early lumen-apposing metal stent dysfunction, compromising patency. One case showed food impaction after three weeks, and hyperplastic tissue overgrowth with a buried distal flange six weeks after stent placement. The latter was successfully treated by argon plasma coagulation, stent removal, and deployment of a larger-diameter lumen-apposing metal stent. The second case showed a narrowed luminal diameter of the stent and jejunal pressure ulcerations after three weeks. The narrowing was successfully treated by balloon dilation. Eight weeks later, hyperplastic tissue overgrowth at the distal flange of the stent and a gastro-colonic fistula were diagnosed, followed by extensive reconstructive surgery.

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    Sebastian Stefanovic, Douglas G. Adler, Alexander Arlt, Todd H. Baron, Kenneth F. Binmoeller, Michiel Bronswijk, Marco J. Bruno, Jean-Baptiste Chevaux, Stefano Francesco Crinò, Helena Degroote, Pierre H. Deprez, Peter V. Draganov, Pierre Eisendrath, Marc
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    Schalk W. van der Merwe, Roy L. J. van Wanrooij, Michiel Bronswijk, Simon Everett, Sundeep Lakhtakia, Mihai Rimbas, Tomas Hucl, Rastislav Kunda, Abdenor Badaoui, Ryan Law, Paolo G. Arcidiacono, Alberto Larghi, Marc Giovannini, Mouen A. Khashab, Kenneth F.
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Practical Experiences of Unsuccessful Hemostasis with Covered Self-Expandable Metal Stent Placement for Post-Endoscopic Sphincterotomy Bleeding
Michihiro Yoshida, Tadahisa Inoue, Itaru Naitoh, Kazuki Hayashi, Yasuki Hori, Makoto Natsume, Naoki Atsuta, Hiromi Kataoka
Clin Endosc 2022;55(1):150-155.   Published online November 19, 2020
DOI: https://doi.org/10.5946/ce.2020.217
AbstractAbstract PDFPubReaderePub
We reviewed 7 patients with unsuccessful endoscopic hemostasis using covered self-expandable metal stent (CSEMS) placement for post-endoscopic sphincterotomy (ES) bleeding. ES with a medium incision was performed in 6 and with a large incision in 1 patient. All but 1 of them (86%) showed delayed bleeding, warranting second endoscopic therapies followed by CSEMS placement 1–5 days after the initial ES. Subsequent CSEMS placement did not achieve complete hemostasis in any of the patients. Lateral-side incision lines (3 or 9 o’clock) had more frequent bleeding points (71%) than oral-side incision lines (11–12 o’clock; 29%). Additional endoscopic hemostatic procedures with hemostatic forceps, hypertonic saline epinephrine, or hemoclip achieved excellent hemostasis, resulting in complete hemostasis in all patients. These experiences provide an alert: CSEMS placement is not an ultimate treatment for post-ES bleeding, despite its effectiveness. The lateral-side of the incision line, as well as the oral-most side, should be carefully examined for bleeding points, even after the CSEMS placement.

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    Jinpei Dong, Qiushi Feng, Guigen Teng, Haixia Niu, Dapeng Bian
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    Atsushi Yamaguchi, Hiroki Kamada, Shigeaki Semba, Naohiro Kato, Yasuhiro Okuda, Yuji Teraoka, Takeshi Mizumoto, Yuzuru Tamaru, Tsuyoshi Hatakeyama, Hirotaka Kouno, Shigeto Yoshida
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Original Article
Cholecystitis after Placement of Covered Self-Expandable Metallic Stents in Patients with Distal Malignant Biliary Obstructions
Masafumi Watanabe, Kosuke Okuwaki, Jun Woo, Mitsuhiro Kida, Hiroshi Imaizumi, Tomohisa Iwai, Hiroshi Yamauchi, Toru Kaneko, Rikiya Hasegawa, Takahiro Kurosu, Naoki Minato, Hiroki Haradome, Wasaburo Koizumi
Clin Endosc 2021;54(4):589-595.   Published online November 17, 2020
DOI: https://doi.org/10.5946/ce.2020.136
AbstractAbstract PDFPubReaderePub
Background
/Aims: Cholecystitis can occur after the placement of covered self-expandable metallic stents for distal malignant biliary obstructions. We aimed to identify risk factors for cholecystitis following covered self-expandable metallic stent placement.
Methods
We investigated risk factors related to cholecystitis following covered self-expandable metallic stent placement in 118 patients with distal malignant biliary obstructions between January 1, 2015 and April 30, 2019. Endoscopic assessments and tumor invasion to the arteries feeding the gallbladder were determined by a pancreaticobiliary endoscopist and a radiologist, respectively.
Results
The median patient age was 72 years (men, 61.0%). The flow of the contrast agent into the gallbladder and tumor involvement in the orifice of the cystic duct were observed in 35 (29.7%) and 35 (29.7%) patients, respectively. During the observation period (median, 179 days), cholecystitis occurred in 18 (15.3%) patients. Multivariate analysis revealed the flow of the contrast agent into the gallbladder (p=0.023) and tumor involvement in the orifice of the cystic duct (p=0.005) as significant independent risk factors associated with cholecystitis.
Conclusions
The flow of the contrast agent into the gallbladder and tumor involvement in the orifice of the cystic duct are potential independent risk factors for cholecystitis following the placement of covered self-expandable metallic stents. A follow-up prospective study is warranted to validate their influence.

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  • Adverse events of self-expandable metal stent placement for malignant distal biliary obstruction: a large multicenter study
    Takashi Tamura, Takuo Yamai, Norimitsu Uza, Tomoaki Yamasaki, Atsuhiro Masuda, Fumimasa Tomooka, Hirotsugu Maruyama, Minoru Shigekawa, Takeshi Ogura, Katsutoshi Kuriyama, Masanori Asada, Hisakazu Matsumoto, Mamoru Takenaka, Koichiro Mandai, Yui Osaki, Ken
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    Giuseppe Vanella, Chiara Coluccio, Alessandro Cucchetti, Roberto Leone, Giuseppe Dell’Anna, Paolo Giuffrida, Carmela Abbatiello, Cecilia Binda, Carlo Fabbri, Paolo Giorgio Arcidiacono
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    Harishankar Gopakumar, Ritu Raj Singh, Vakya Revanur, Rajanikanth Kandula, Srinivas R. Puli
    American Journal of Gastroenterology.2024; 119(8): 1607.     CrossRef
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    José Miguel Jiménez-Gutiérrez, Félix Téllez-Avila
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    威 刘
    Asian Case Reports in Emergency Medicine.2024; 12(04): 153.     CrossRef
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    Tatsuya Ishii, Tsuyoshi Hayashi, Hajime Yamazaki, Risa Nakamura, Kosuke Iwano, Ryo Ando, Haruka Toyonaga, Toshifumi Kin, Kuniyuki Takahashi, Akio Katanuma
    Journal of Hepato-Biliary-Pancreatic Sciences.2023; 30(10): 1180.     CrossRef
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    Jiangning Gu, Xiaoyi Guo, Yong Sun, Bin Fan, Haoran Li, Ting Luo, Haifeng Luo, Jiao Liu, Feng Gao, Yuan Gao, Guang Tan, Xiaoming Liu, Zhuo Yang
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    Dong Wook Lee, Eun Young Kim
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Focused Review Series: Endoscopic Management for Biliary Stricture after Liver Transplantation
Management of Post-Transplant Anastomotic Stricture Using Self-Expandable Metal Stent
Dong Wook Lee, Kazuo Hara
Clin Endosc 2020;53(3):261-265.   Published online May 29, 2020
DOI: https://doi.org/10.5946/ce.2020.119
AbstractAbstract PDFPubReaderePub
Anastomotic stricture (AS) is one of the complications of liver transplantation (LT) and can occur in up to 40% of living-donor LTs. Endoscopic management has become the first-line treatment of AS, and multiple plastic stents insertion has been mainly used in the past. Recently, many treatments utilizing fully covered self-expandable metal stents (cSEMSs) have been attempted, and results showing adequate treatment outcome have been reported. In this review, we look into the treatment performance and cautionary steps needed when using cSEMS as a treatment for AS.

Citations

Citations to this article as recorded by  
  • Management of biliary complications in liver transplant recipients using a fully covered self-expandable metal stent with antimigration features
    Andrew CANAKIS, Andrew J. GILMAN, Todd H. BARON
    Minerva Gastroenterology.2024;[Epub]     CrossRef
  • Endoscopic Management of Biliary Strictures after Orthotopic Liver Transplantation: A Single Center Experience Study
    Vasile Sandru, Madalina Stan-Ilie, Oana-Mihaela Plotogea, Catalina Vladut, Bogdan Silviu Ungureanu, Gheorghe G. Balan, Dan Ionut Gheonea, Gabriel Constantinescu
    Diagnostics.2022; 12(5): 1221.     CrossRef
  • Efficacy of a modified short fully covered self‐expandable metal stent for perihilar benign biliary strictures
    Tae Hoon Lee, Jong Ho Moon, Yun Nah Lee, Seok Jung Jo, Jae Keun Park, Jae Kook Yang, Sang‐Woo Cha, Young Deok Cho, Sang‐Heum Park
    Journal of Gastroenterology and Hepatology.2021; 36(4): 1057.     CrossRef
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  • 3 Web of Science
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Case Report
A remnant choledochal cyst after choledochal cyst excision treated with a lumen-apposing metal stent: a case report
Bo Kyung Kim, Jung Won Chun, Sang Hyub Lee, Ji Kon Ryu, Yong-Tae Kim, Woo Hyun Paik
Clin Endosc 2022;55(4):564-569.   Published online January 8, 2020
DOI: https://doi.org/10.5946/ce.2019.176
AbstractAbstract PDFPubReaderePub
A lumen-apposing metal stent (LAMS) is a saddle-shaped stent with large flanges at both ends, thereby preventing stent migration and helping with approximation of the adjacent structures. We report the case of a 25-year-old female with remnant choledochal cyst which was successfully treated with LAMS after initial treatment failure with a plastic stent. Although complete excision of the cyst is the definite treatment of choledochal cysts, endoscopic ultrasonography-guided cystoduodenostomy can be considered in cases wherein surgery is not feasible and dysplasia is not present. LAMS may be preferred to plastic stents for effective resolution of remnant choledochal cyst and prevention of ascending infection.

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  • Hepatic multiple hyperintense cystic lesions: a rare caroli disease
    Mohammed H. Alsharif, Nagi M. Bakhit, Abdulaziz Alarifi, Elbagir M. Nassir, Abair A. Mahdi, Juman M. Almasaad, Abubaker Y. Elamin, Khalid M. Taha
    THE NEW ARMENIAN MEDICAL JOURNAL.2023; (1, 17 (202): 41.     CrossRef
  • Hepatic multiple hyperintense cystic lesions: a rare caroli disease.
    Mohammed H. Alsharif, Nagi.M Bakhit, Abdulaziz Alarifi, Elbagir M. Nassir, Abair A. Mahdi, Juman M. Almasaad, Abubaker.Y. Elamin, Khalid M. Taha
    THE NEW ARMENIAN MEDICAL JOURNAL.2023; (1, 17 (202): 41.     CrossRef
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Original Articles
Endoscopic Therapy for Pancreatic Fluid Collections: A Definitive Management Using a Dedicated Algorithm
Ming Ming Xu, Iman Andalib, Aleksey Novikov, Enad Dawod, Moamen Gabr, Monica Gaidhane, Amy Tyberg, Michel Kahaleh
Clin Endosc 2020;53(3):355-360.   Published online December 3, 2019
DOI: https://doi.org/10.5946/ce.2019.113
AbstractAbstract PDFPubReaderePub
Background
/Aims: Endoscopic ultrasonography (EUS)-guided drainage is the preferred approach for infected or symptomatic pancreatic fluid collections (PFCs). Here, we developed an algorithm for the management of pancreatitis complicated by PFCs and report on its effcacy and safety.
Methods
Between September 2011 and October 2017, patients were prospectively managed according to the algorithm. PFCs were classified as poorly organized fluid collections (POFCs), pancreatic pseudocysts (PPs), or walled-off pancreatic necrosis (WOPN). Clinical success was defined as a decrease in PFC size by ≥50% of the maximal diameter or to ≤2 cm.
Results
 A total of 108 patients (62% male; mean age, 53 years) were included: 13 had POFCs, 43 had PPs, and 52 had WOPN. Seventytwo patients (66%) required a pancreatic duct (PD) stent, whereas 65 (60%) received enteral feeding. A total of 103 (95%) patients achieved clinical success. Eight patients experienced complications including bleeding (n=6) and surgical intervention (n=2). Patients with enteral feeding were 3.4 times more likely to achieve resolution within 60 days (p=0.0421), whereas those with PD stenting was five times more likely to achieve resolution within 90 days (p=0.0069).
Conclusions
 A high PFC resolution rate can be achieved when a dedicated algorithm encompassing EUS-guided drainage, PD stenting, and early enteral feeding is adopted.

Citations

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  • Novel classification system for walled-off necrosis: a step toward standardized nomenclature and risk-stratification framework
    Serge Baroud, Vinay Chandrasekhara, Andrew C. Storm, Ryan J. Law, Eric J. Vargas, Michael J. Levy, Tala Mahmoud, Fateh Bazerbachi, Aliana Bofill-Garcia, Rabih Ghazi, Daniel B. Maselli, John A. Martin, Santhi Swaroop Vege, Naoki Takahashi, Bret T. Petersen
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    Liang Chen, Ting Li, Bin Wang, Yunxiao Cheng, Sicong Zhao, Yunxiao Lyu
    Asian Journal of Surgery.2022; 45(8): 1519.     CrossRef
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    A. V. Fedorov, V. N. Ektov, M. A. Khodorkovskiy
    Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery.2022; 27(3): 81.     CrossRef
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    A.V. Fedorov, V.N. Ektov, M.A. Khodorkovsky
    Khirurgiya. Zhurnal im. N.I. Pirogova.2021; (9): 85.     CrossRef
  • Hydrogen peroxide assisted endoscopic necrosectomy for walled-off pancreatic necrosis: A systematic review and meta-analysis
    Rajat Garg, Shradha Gupta, Amandeep Singh, Marian T. Simonson, Tarun Rustagi, Prabhleen Chahal
    Pancreatology.2021; 21(8): 1540.     CrossRef
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    Robert Dorrell, Swati Pawa, Yi Zhou, Neeraj Lalwani, Rishi Pawa
    Diagnostics.2020; 10(5): 337.     CrossRef
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    Seong-Hun Kim, Eun Ji Shin
    Clinical Endoscopy.2020; 53(3): 253.     CrossRef
  • Role of pancreatography in the endoscopic management of encapsulated pancreatic collections – review and new proposed classification
    Igor Mendonça Proença, Marcos Eduardo Lera dos Santos, Diogo Turiani Hourneaux de Moura, Igor Braga Ribeiro, Sergio Eiji Matuguma, Spencer Cheng, Thomas R McCarty, Epifanio Silvino do Monte Junior, Paulo Sakai, Eduardo Guimarães Hourneaux de Moura
    World Journal of Gastroenterology.2020; 26(45): 7104.     CrossRef
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Efficacy and Safety of Lumen-Apposing Stents for Management of Pancreatic Fluid Collections in a Community Hospital Setting
Rajat Garg, Abdelkader Chaar, Susan Szpunar, Babu P. Mohan, Mohammed Barawi
Clin Endosc 2020;53(4):480-486.   Published online October 16, 2019
DOI: https://doi.org/10.5946/ce.2019.116
AbstractAbstract PDFPubReaderePub
Background
/Aims: Endoscopic ultrasound-guided transmural drainage and necrosectomy employing lumen-apposing metal stent (LAMS) are used for treating pancreatic fluid collections (PFCs) with excellent results from academic centers. Herein, we report the efficacy and safety of LAMS in the treatment of PFCs at a community hospital.
Methods
We retrospectively reviewed the etiology of pancreatitis, type and size of PFCs, length of procedure, technical success, clinical success, adverse events, and stent removal. The primary outcome was the rate of clinical success, and secondary outcomes were technical success and adverse events.
Results
Twenty-seven patients with a mean age of 54.1±6.5 years were included, 44% of which were men. The mean size of the PFCs was 9.7±5.0 cm (range, 3–21). The most common etiology of pancreatitis was alcohol (44%) followed by idiopathic causes (30%) and presence of gallstones (22%). The diagnosis was pseudocyst in 44.4% (12/27) and walled off necrosis in 55.6% (15/27) of patients. There was 100% technical success without any complications. Clinical success was achieved in 22 of 27 patients (81.5%) who underwent stent removal.
Conclusions
Our study is the first to report that endoscopic therapy of PFCs using LAMS is safe and effective even in a community hospital setting with limited resources and support compared to large academic centers.

Citations

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    Rongmin Xu, Kai Zhang, Nan Ge, Siyu Sun
    Frontiers in Medicine.2024;[Epub]     CrossRef
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    Giacomo Emanuele Maria Rizzo, Ilaria Tarantino
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    Carlo Fabbri, Chiara Coluccio, Cecilia Binda, Alessandro Fugazza, Andrea Anderloni, Ilaria Tarantino
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    Hussam I. A. Alzeerelhouseini, Muawiyah Elqadi, Mohammad N. Elqadi, Sadi A. Abukhalaf, Hazem A. Ashhab, Yoshifumi Nakayama
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    Jing Li, Qian Zhang, Anni Zhou, Guiping Zhao, Peng Li
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  • Reply
    Kazuki Takeishi, Toru Ikegami, Tomoharu Yoshizumi, Nao Fujimori, Masaki Mori
    Liver Transplantation.2020; 26(5): 727.     CrossRef
  • Safety and efficacy of lumen-apposing metal stents versus plastic stents to treat walled-off pancreatic necrosis: systematic review and meta-analysis
    Vinay Chandrasekhara, Marc Barthet, Jacques Devière, Fateh Bazerbachi, Sundeep Lakhtakia, Jeffrey J. Easler, Joyce A. Peetermans, Edmund McMullen, Ornela Gjata, Margaret L. Gourlay, Barham K. Abu Dayyeh
    Endoscopy International Open.2020; 08(11): E1639.     CrossRef
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Comparison of Clinical Outcomes between Plastic Stent and Novel Lumen-apposing Metal Stent for Endoscopic Ultrasound-Guided Drainage of Peripancreatic Fluid Collections
Ho Cheol Shin, Chang Min Cho, Min Kyu Jung, Seong Jae Yeo
Clin Endosc 2019;52(4):353-359.   Published online March 13, 2019
DOI: https://doi.org/10.5946/ce.2018.154
AbstractAbstract PDFPubReaderePub
Background
/Aims: Endoscopic ultrasound (EUS)-guided transmural drainage for peripancreatic fluid collections (PFCs) has gained wide acceptance as a nonsurgical intervention. Although a lumen-apposing metal stent (LAMS) was recently introduced, there are few data comparing the clinical outcomes between LAMS and plastic stent (PS) drainage.
Methods
Endoscopy databases of all patients who had undergone EUS-guided drainage for PFCs were searched and the clinical outcomes of EUS-guided drainage according to stent-type used were compared.
Results
A total of 27 patients (median age, 56 years) with PFCs underwent EUS-guided transmural drainage between January 2011 and December 2017. Of these, 17 underwent PS placement and 10 underwent LAMS placement. There was no significant difference in the technical success rate between the 2 groups (94.1% vs. 100%, p=1.0). Procedure time was shorter in the LAMS group compared to that in the PS group (10.6±2.5 min vs. 21.4±9.5 min, p=0.002). Among subjects with clinical success, recurrence of PFC after stent removal occurred in 5 of 12 patients with PS and 4 of 10 with LAMS, without statistical difference (41.7% vs. 40.0%, p=1.0).
Conclusions
Although our study showed similar clinical outcomes for LAMS and PS, further prospective trials are required to validate the superiority of LAMS.

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    Fadi Hawa, Jean M. Chalhoub, Ana Vilela, Elit Quingalahua, Carol Shannon, George M. Philips, Richard S. Kwon, Erik-Jan Wamsteker, Allison R. Schulman, Matthew J. DiMagno, Jorge D. Machicado
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    Edson Guzmán‐Calderón, Alfonso Chacaltana, Ramiro Díaz, Bruno Li, Belen Martinez‐Moreno, José Ramón Aparicio
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    Tadahiro Takada, Shuji Isaji, Toshihiko Mayumi, Masahiro Yoshida, Yoshifumi Takeyama, Takao Itoi, Keiji Sano, Yusuke Iizawa, Atsushi Masamune, Morihisa Hirota, Kohji Okamoto, Dai Inoue, Nobuya Kitamura, Yasuhisa Mori, Shuntaro Mukai, Seiki Kiriyama, Kunih
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Review
De-novo Gastrointestinal Anastomosis with Lumen Apposing Metal Stent
Deepanshu Jain, Ankit Chhoda, Abhinav Sharma, Shashideep Singhal
Clin Endosc 2018;51(5):439-449.   Published online September 27, 2018
DOI: https://doi.org/10.5946/ce.2018.077
AbstractAbstract PDFPubReaderePub
Gastric outlet obstruction, afferent or efferent limb obstruction, and biliary obstruction among patients with altered anatomy often require surgical intervention which is associated with significant morbidity and mortality. Endoscopic dilation for benign etiologies requires multiple sessions, whereas self-expandable metal stents used for malignant etiologies often fail due to tumor in-growth. Lumen apposing metal stents, placed endoscopically with the intent of creating a de-novo gastrointestinal anastomosis bypassing the site of obstruction, can potentially achieve similar efficacy, with a much lower complication rate. In our study cohort (n=79), the composite technical success rate and clinical success rate was 91.1% (72/79) and 97.2% (70/72), respectively. Five different techniques were used: 43% (34/79) underwent the balloon-assisted method, 27.9% (22/79) underwent endoscopic ultrasound-guided balloon occluded gastro-jejunostomy bypass, 20.3% (16/79) underwent the direct technique, 6.3% (5/79) underwent the hybrid rendezvous technique, and 2.5% (2/79) underwent natural orifice transluminal endoscopic surgery (NOTES)-assisted procedure. All techniques required an echoendoscope except NOTES. In all, 53.2% (42/79) had non-cautery enhanced Axios stent, 44.3% (35/79) had hot Axios stent, and 2.5% (2/79) had Niti-S spaxus stent. Symptom-recurrence was seen in 2.8%, and 6.3% had a complication (bleeding, abdominal pain or peritonitis). All procedures were performed by experts at centers of excellence with adequate surgical back up.

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Case Reports
Metal Stent Placement in the Afferent Loop Obstructed by Peritoneal Metastases—Experience of Five Cases
Yoshihide Kanno, Tetsuya Ohira, Yoshihiro Harada, Yoshiki Koike, Taku Yamagata, Megumi Tanaka, Tomohiro Shimada, Kei Ito
Clin Endosc 2018;51(3):299-303.   Published online April 18, 2018
DOI: https://doi.org/10.5946/ce.2018.005
AbstractAbstract PDFPubReaderePub
Afferent loop syndrome is often difficult to resolve. Among patients with afferent loop syndrome whose data were extracted from databases, 5 patients in whom metal stent placement was attempted were included and evaluated in this study. The procedure was technically successful without any adverse events in all patients. Metal stent(s) was placed with an endoscope in the through-the-scope manner in 4 patients and via a percutaneous route in 1 patient. Obvious clinical efficacy was observed in all patients. Adverse events related to the procedure and stent occlusion during the follow-up period were not observed. Metal stent placement for malignant obstruction of the afferent loop was found to be safe and feasible.

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Role of Endoscopy in the Management of Boerhaave Syndrome
Juan Ignacio Tellechea, Jean-Michel Gonzalez, Pablo Miranda-García, Adrian Culetto, Xavier Benoit D’Journo, Pascal Alexandre Thomas, Marc Barthet
Clin Endosc 2018;51(2):186-191.   Published online September 20, 2017
DOI: https://doi.org/10.5946/ce.2017.043
AbstractAbstract PDFPubReaderePub
Boerhaave syndrome (BS) is a spontaneous esophageal perforation which carries high mortality. Surgical treatment is well established, but the development of interventional endoscopy has proposed new therapies. We expose our experience in a Gastrointestinal and Endoscopy Unit. With a retrospective, observational, open-label, single center, consecutive case series. All patients diagnosed with BS who were managed in our center were included. Treated conservatively, endoscopically or surgically, according to their clinical condition and lesion presentation. Fourteen patients were included. Ten were treated with primary surgery. One conservatively. In total, 7/14 patients required an endoscopic treatment. All required metallic stents deployment, 3 cases over-the-scope-clips concomitantly and one case a novel technique an internal drain. 6/7 cases endoscopically treated achieved complete esophageal healing. In conclusion, endoscopy is an useful tool at all stages BS management: difficult diagnosis, primary treatment in selected patients and as salvage when surgery fails. With mortality rates and outcomes comparables to surgery.

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    Gastroenterología y Hepatología (English Edition).2019; 42(9): 564.     CrossRef
  • 6,837 View
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Reviews
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
AbstractAbstract PDFPubReaderePub
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.

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    James F. Crismale, Jawad Ahmad
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    Dong Wook Lee, Jimin Han
    The Korean Journal of Internal Medicine.2019; 34(2): 261.     CrossRef
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    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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    Tin Moe Wai, Eun Young Kim
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  • 188 Download
  • 17 Web of Science
  • 15 Crossref
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Endoscopic Ultrasound (EUS)-Guided Pancreatic Duct Drainage: The Basics of When and How to Perform EUS-Guided Pancreatic Duct Interventions
Christopher G. Chapman, Irving Waxman, Uzma D. Siddiqui
Clin Endosc 2016;49(2):161-167.   Published online March 25, 2016
DOI: https://doi.org/10.5946/ce.2016.011
AbstractAbstract PDFPubReaderePub
Despite the advances in endoscopy, endoscopic ultrasound-guided pancreatic duct drainage (EUS-PDD) remains a technically challenging procedure. Technical success rates are greater than 70%; however, the average rate of adverse events is nearly 20%, which increases to 55% when stent migration is included. Until recently, a significant difficulty with this technique was the absence of dedicated devices. Proper patient selection is of utmost importance, and EUS-PDD should be reserved for patients who have failed endoscopic retrograde pancreatography. Furthermore, EUS-PDD must be performed by experienced endoscopists who are familiar with the technique. The most common indications include chronic pancreatitis induced strictures and stones, disconnected pancreatic ducts, inaccessible ampulla, and post-surgical altered anatomy. This manuscript will review the accessories used, techniques employed, and published literature reporting outcomes as well as adverse events regarding EUS-PDD.

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    Jad P AbiMansour, Barham K Abu Dayyeh, Michael J Levy, Andrew C Storm, John A Martin, Bret T Petersen, Ryan J Law, Mark D Topazian, Vinay Chandrasekhara
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    Anthony Y B Teoh, Vinay Dhir, Mitsuhiro Kida, Ichiro Yasuda, Zhen Dong Jin, Dong Wan Seo, Majid Almadi, Tiing Leong Ang, Kazuo Hara, Ida Hilmi, Takao Itoi, Sundeep Lakhtakia, Koji Matsuda, Nonthalee Pausawasdi, Rajesh Puri, Raymond S Tang, Hsiu-Po Wang, A
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    Emmanuel Coronel, Tomas DaVee, Jeffrey H. Lee
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    Tin Moe Wai, Eun Young Kim
    Clinical Endoscopy.2016; 49(6): 502.     CrossRef
  • 9,132 View
  • 179 Download
  • 25 Web of Science
  • 28 Crossref
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Case Report
Delayed Severe Hemobilia after Endoscopic Biliary Plastic Stent Insertion
Sung Hak Lee, Seung Goun Hong, Kyoung yong Lee, Pyung Kang Park, Sung Du Kim, Mahn Lee, Dong Wook Yu, Man Yong Hong
Clin Endosc 2016;49(3):303-307.   Published online March 25, 2016
DOI: https://doi.org/10.5946/ce.2015.081
AbstractAbstract PDFPubReaderePub
Hemobilia is a rare gastrointestinal bleeding, usually caused by injury to the bile duct. Hemobilia after endoscopic retrograde cholangiopancreatography (ERCP) is generally self-limiting and patients will spontaneously recover, but some severe and fatal hemorrhages have been reported. ERCP-related bowel or bile duct perforation should be managed promptly, according to the type of injury and the status of the patient. We recently experienced a case of late-onset severe hemobilia in which the patient recovered after endoscopic biliary stent insertion. The problem was attributable to ERCP-related bile duct perforation during stone removal, approximately 5 weeks prior to the hemorrhagic episode. The removal of the stent was performed 10 days before the onset of hemobilia. The bleeding was successfully treated by two sessions of transarterial coil embolization.

Citations

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  • A rare incidence of a hepatic artery pseudoaneurysm following plastic biliary stent insertion
    Toshihiko Motohara, Kensuke Yamamura, Shigenori Ueno, Hiroshi Takeno, Yasunori Nagayama, Eri Oda, Ryuichi Karashima, Nobuyuki Ozaki, Toshiro Masuda, Toru Beppu
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    Ruchira Mukherji, Manoj Gopinath
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    Jinhyong Kang, Yang Tae Park, Hyo Jung Kim, Jae Seon Kim
    The Korean Journal of Pancreas and Biliary Tract.2022; 27(3): 135.     CrossRef
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