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Endoscopic ultrasonography-guided bi-lateral biliary drainage: A case series study
INTRODUCTION: Biliary obstruction is preferentially managed by endoscopic retrograde cholangiopancreatography (ERCP). However, after ERCP failed, alternatives include percutaneous transhepatic drainage, surgery and more recently, endoscopic ultrasonography (EUS)-guided hepaticogastrostomy. The limit...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Medknow Publications & Media Pvt Ltd
2014
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4569919/ https://www.ncbi.nlm.nih.gov/pubmed/26425521 |
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author | Reimão, S. Francioni, E. Bories, E Caillol, F. Pesenti, C. Giovannini, M. |
author_facet | Reimão, S. Francioni, E. Bories, E Caillol, F. Pesenti, C. Giovannini, M. |
author_sort | Reimão, S. |
collection | PubMed |
description | INTRODUCTION: Biliary obstruction is preferentially managed by endoscopic retrograde cholangiopancreatography (ERCP). However, after ERCP failed, alternatives include percutaneous transhepatic drainage, surgery and more recently, endoscopic ultrasonography (EUS)-guided hepaticogastrostomy. The limitation of this technique is that the drainage is restricted to the left side. The aim of this study is to describe a new method of drainage of both hepatic ductal systems by hepaticogastrostomy in patients with hilar obstruction. RESULTS: Nine prospectively patients were included, all with hilar obstruction (metastasis of a pancreatic adenocarcinoma n = 4, cholangiocarcinoma n = 1, gallbladder cancer n = 2 and metastasis from a pancreatic neuroendocrine tumor n = 2). A total of four patients had previously Whipple surgery and the others five had duodenal involvement by the tumor. The topography of the stenosis varied from Bismuth type 2 (n = 7) and hilar infiltration in the others two. All of them were submitted a three-step drainage. The first one consisted in a transgastric EUS-guided puncture of the left-side bile duct with a 19 gauge needle, insertion of a 0.0035 inch guide wire which was positioned at the right biliary tree crossing the bile bifurcation. After a dilatation with 6 Fr cystotome, a non-covered self-expandable metal stent was placed communicating the right and left biliary ducts. Finally, a second stent, partially covered, was inserted at the left biliary duct, with the distal part inside the previously stent and the proximal edge positioned at the stomach. Successful drainage was observed in seven patients, two of them presented abdominal pain during the first 72 h. One patient developed sepsis and death 7 days after the procedure and the other one had drainage failure. Jaundice was reduced significatively in seven patients and a chemotherapy was started in 6/7 patients CONCLUSION: This pilot study shows the feasibility of this new technique to drain the right biliary duct in patients with hilar obstruction, with few major complications rates. |
format | Online Article Text |
id | pubmed-4569919 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | Medknow Publications & Media Pvt Ltd |
record_format | MEDLINE/PubMed |
spelling | pubmed-45699192015-09-30 Endoscopic ultrasonography-guided bi-lateral biliary drainage: A case series study Reimão, S. Francioni, E. Bories, E Caillol, F. Pesenti, C. Giovannini, M. Endosc Ultrasound EURO EUS Meeting INTRODUCTION: Biliary obstruction is preferentially managed by endoscopic retrograde cholangiopancreatography (ERCP). However, after ERCP failed, alternatives include percutaneous transhepatic drainage, surgery and more recently, endoscopic ultrasonography (EUS)-guided hepaticogastrostomy. The limitation of this technique is that the drainage is restricted to the left side. The aim of this study is to describe a new method of drainage of both hepatic ductal systems by hepaticogastrostomy in patients with hilar obstruction. RESULTS: Nine prospectively patients were included, all with hilar obstruction (metastasis of a pancreatic adenocarcinoma n = 4, cholangiocarcinoma n = 1, gallbladder cancer n = 2 and metastasis from a pancreatic neuroendocrine tumor n = 2). A total of four patients had previously Whipple surgery and the others five had duodenal involvement by the tumor. The topography of the stenosis varied from Bismuth type 2 (n = 7) and hilar infiltration in the others two. All of them were submitted a three-step drainage. The first one consisted in a transgastric EUS-guided puncture of the left-side bile duct with a 19 gauge needle, insertion of a 0.0035 inch guide wire which was positioned at the right biliary tree crossing the bile bifurcation. After a dilatation with 6 Fr cystotome, a non-covered self-expandable metal stent was placed communicating the right and left biliary ducts. Finally, a second stent, partially covered, was inserted at the left biliary duct, with the distal part inside the previously stent and the proximal edge positioned at the stomach. Successful drainage was observed in seven patients, two of them presented abdominal pain during the first 72 h. One patient developed sepsis and death 7 days after the procedure and the other one had drainage failure. Jaundice was reduced significatively in seven patients and a chemotherapy was started in 6/7 patients CONCLUSION: This pilot study shows the feasibility of this new technique to drain the right biliary duct in patients with hilar obstruction, with few major complications rates. Medknow Publications & Media Pvt Ltd 2014-04 /pmc/articles/PMC4569919/ /pubmed/26425521 Text en Copyright: © Endoscopic Ultrasound http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | EURO EUS Meeting Reimão, S. Francioni, E. Bories, E Caillol, F. Pesenti, C. Giovannini, M. Endoscopic ultrasonography-guided bi-lateral biliary drainage: A case series study |
title | Endoscopic ultrasonography-guided bi-lateral biliary drainage: A case series study |
title_full | Endoscopic ultrasonography-guided bi-lateral biliary drainage: A case series study |
title_fullStr | Endoscopic ultrasonography-guided bi-lateral biliary drainage: A case series study |
title_full_unstemmed | Endoscopic ultrasonography-guided bi-lateral biliary drainage: A case series study |
title_short | Endoscopic ultrasonography-guided bi-lateral biliary drainage: A case series study |
title_sort | endoscopic ultrasonography-guided bi-lateral biliary drainage: a case series study |
topic | EURO EUS Meeting |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4569919/ https://www.ncbi.nlm.nih.gov/pubmed/26425521 |
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