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Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HG) is a technique used to access the biliary tree in patients with surgically altered anatomy. Additionally, development of EUS-HG fistula permits intraductal therapy, thereby preventing patients from requiring surgery or percutaneous transhepatic biliary drainage (PTBD), thus decreasing morbid...
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Introduction
Treatment of pancreaticobiliary pathology following Roux-en-Y gastric bypass (RYGB) poses significant technical challenges. Laparoscopic-assisted endoscopic retrograde cholangiopancreatography (LA-ERCP) can overcome those anatomical hurdles, allowing access to the papilla. Our aims were to analyze our 12-year institutional outcomes and...
Citations
... Patients with hepaticojejunal anastomosis strictures or huge intrahepatic stones may require multiple endoscopic inter-ventions. The application of POC through the HGS route has been described in various case reports and it was effective in performing lithotripsy and stone removal [118][119][120][121][122][123][124][125][126] and for the treatment of anastomotic strictures [127][128][129]. POC through HGS also allowed for the removal of migrated biliary stents in two case reports [130,131]. ...
Endoscopy plays a central role in diagnostic and therapeutic approaches to biliary disease in both benign and malignant conditions. A cholangioscope is an endoscopic instrument that allows for the direct exploration of the biliary tree. Over the years, technology has improved endoscopic image quality and allowed for the development of an operative procedure that can be performed during cholangioscopy. Different types of instruments are available in this context, and they can be used in different anatomical access points according to the most appropriate clinical indication. The direct visualization of biliary mucosa is essential in the presence of biliary strictures of unknown significance, allowing for the appropriate allocation of patients to surgery or conservative treatments. Cholangioscopy has demonstrated excellent performance in discriminating malignant conditions (such as colangiocarcinoma) from benign inflammatory strictures, and more recent advances (e.g., artificial intelligence and confocal laser endomicroscopy) could further increase its diagnostic accuracy. Cholangioscopy also plays a primary role in the treatment of benign conditions such as difficult bile stones (DBSs). In this case, it may not be possible to achieve complete biliary drainage using standard ERCP. Therapeutic cholangioscopy-guided lithotripsy allows for stone fragmentation and complete biliary drainage. Indeed, other complex clinical situations, such as patients with intra-hepatic lithiasis and patients with an altered anatomy, could benefit from the therapeutic role of cholangioscopy. The aim of the present review is to explore the most recent diagnostic and therapeutic advances in the roles of cholangioscopy in the management of biliary diseases.
... Patients with hepaticojejunal anastomosis strictures or huge intrahepatic stones may require multiple endoscopic inter-ventions. The application of POC through the HGS route has been described in various case reports and it was effective in performing lithotripsy and stone removal [118][119][120][121][122][123][124][125][126] and for the treatment of anastomotic strictures [127][128][129]. POC through HGS also allowed for the removal of migrated biliary stents in two case reports [130,131]. ...
Aims:
Whipple's disease (WD) is a rare and potentially fatal infectious disease caused by Tropheryma whipplei. It is characterized by a long prodromal phase that mimics a rheumatological disease, often leading to treatment with immunosuppressants. Immune reconstitution inflammatory syndrome (IRIS) is currently the most important complication of WD, requiring prompt recognition and treatment as it can be fatal. However, data on the epidemiology of IRIS are scarce. We aimed to identify clinical and laboratory predictors of IRIS at time of WD diagnosis and to evaluate whether prevalence of IRIS has changed over time.
Methods:
45 patients with WD (10 F, 52±11 years) were followed-up between January-2000 and December-2021. Clinical and laboratory data at diagnosis of WD were retrospectively collected and compared among patients who developed IRIS and those who did not.
Results:
Erythrocyte sedimentation rate (ESR, 33±12 vs. 67±26 mm/h, p<0.01), platelet count (PLT, 234,000±80,000 vs. 363,000±119,000/μL, p<0.01), and body mass index (22±2 vs. 20±3, p=0.04) differed significantly between patients who subsequently developed IRIS and those who did not. ROC analysis identified ESR≤46mm/h (AUC 0.88, 95%CI 0.72-1.00) and PLTs≤327,000/μL (AUC 0.85, 95%CI 0.70-1.00) as the best cut-off values to discriminate WD patients at highest risk of developing IRIS. Prevalence of IRIS remained stable (22.2%) over time.
Conclusions:
Low ESR and PLT count at diagnosis help identify WD patients at high risk of developing IRIS. Instead, a greater inflammatory response suggests a lower risk of IRIS. Prevalence of IRIS did not change over two decades. This article is protected by copyright. All rights reserved.
... In an effort to prolong stent patency, some endoscopists have utilized a technique combining EUS-HGS with EUS-AG stent placement [69]. Imai et al August 16, 2021 Volume 13 Issue 8 [70] performed a retrospective study comparing outcomes in patients with MBO treated with EUS-HGS alone (Group A, n = 42) versus combined EUS-HGS and EUS-AG (Group B, n = 37) [70]. Technical success was higher in Group A (97.6% vs 83.8%) while clinical success was equal in both groups (90.2% vs 90.3%). ...
... In an effort to prolong stent patency, some endoscopists have utilized a technique combining EUS-HGS with EUS-AG stent placement [69]. Imai et al August 16, 2021 Volume 13 Issue 8 [70] performed a retrospective study comparing outcomes in patients with MBO treated with EUS-HGS alone (Group A, n = 42) versus combined EUS-HGS and EUS-AG (Group B, n = 37) [70]. Technical success was higher in Group A (97.6% vs 83.8%) while clinical success was equal in both groups (90.2% vs 90.3%). ...
Endoscopic retrograde cholangiopancreatography (ERCP) is the mainstay procedure of choice for management of obstructive biliary disease. While ERCP is widely performed with high success rates, the procedure is not feasible in every patient such as cases of non-accessible papilla. In the setting of unsuccessful ERCP, endoscopic ultrasound-guided biliary drainage (EUS-BD) has become a promising alternative to surgical bypass and percutaneous biliary drainage (PTBD). A variety of different forms of EUS-BD have been described, allowing for both intrahepatic and extrahepatic approaches. Recent studies have reported high success rates utilizing EUS-BD for both transpapillary and transluminal drainage, with fewer adverse events when compared to PTBD. Advancements in novel technologies designed specifically for EUS-BD have led to increased success rates as well as improved safety profile for the procedure. The techniques of EUS-BD are yet to be fully standardized and are currently performed by highly trained advanced endoscopists. The aim of our review is to highlight the different EUS-guided interventions for achieving biliary drainage and to both assess the progress that has been made in the field as well as consider what the future may hold.
... The Giobor stent is a dedicated biliary stent for HGS and has been reported for use in malignant diseases but not as a temporary stent [1][2][3][4][5]. The recent change in covered design (70 %:30 %) enables its use in a biliary benign scenario as a temporary stent to create a transhepatic mature fistula, allowing subsequent anterograde stenting. ...
