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Revista Espanola de Enfermedades... Jan 2024We read with interest the Editorial by Vila et al. on the paradigm shift for endoscopic biliary drainage of malignant distal biliary obstruction (MDBO) which places...
We read with interest the Editorial by Vila et al. on the paradigm shift for endoscopic biliary drainage of malignant distal biliary obstruction (MDBO) which places Endoscopic Ultrasound (EUS) drainage as the first option instead of traditional ERCP drainage. The modern biliary endoscopist must have the duodenoscope in one hand and the therapeutic echoendoscope in the other. ERCP training alone is no longer appropriate because the goal is to drain the obstruction during a single session. That is why in more and more centers the patient signs a single consent for endoscopic biliary drainage, whether by ERCP, EUS or combined. Should EUS drainage be used first for MDBO without attempting ERCP? A possible protocol for endoscopic drainage of MDBO could be to start with the duodenoscope for ERCP. If the papilla of Vater is accessible, try cannulation considering the ESGE criteria for a difficult cannulation: more than 5 contacts with the papilla; more than 5 minutes spent attempting to cannulate following visualization of the papilla; more than one unintended pancreatic duct cannulation or opacification. If biliary cannulation is not achieved, immediately switch to EUS drainage during the same session. Occasionally, the double guidewire technique or even transpancreatic biliary sphincterotomy could be used, but not needle-knife precut.
PubMed: 38258798
DOI: 10.17235/reed.2024.10222/2023 -
Cureus Jul 2023Previous gastric procedures often make endoscopic interventions challenging. Our case study focuses specifically on performing an endoscopic retrograde...
Previous gastric procedures often make endoscopic interventions challenging. Our case study focuses specifically on performing an endoscopic retrograde cholangiopancreatography (ERCP) through a gastroscope (EVIS EXERA III GIF-HQ190, Olympus, Center Valley, USA) in a patient with a history of Billroth II gastrojejunostomy. Successful ERCP in Billroth II using a gastroscope with traditional ERCP instrumentation has been very rarely reported in case reports in the literature review. This case study provides an alternative method of access to the common bile duct (CBD) and treatment of obstruction to prevent the risk of morbidities from an open CBD exploration. The primary diagnosis for this patient was choledocholithiasis. He initially underwent a standard ERCP with a side-viewing duodenoscope (EVIS EXERA II, TJF-Q190V, Olympus, Center Valley, USA); however, due to the difficult anatomy from his previous Billroth II reconstruction, the CBD was very difficult to access. A gastroscope was then used instead to perform the ERCP, providing an innovative endoscopic therapy. Given the patient's multiple comorbidities, he was at high risk for morbidity and mortality with an open CBD exploration. Hence, this case report provides insight into an innovative endoscopic approach to CBD exploration with difficult anatomy.
PubMed: 37575799
DOI: 10.7759/cureus.41793 -
Infection Control and Hospital... Oct 2023We report 2 outbreaks of genetically unrelated carbapenem-resistant New Delhi metallo-β-lactamase-producing caused by contaminated duodenoscopes. Using endoscopes with...
We report 2 outbreaks of genetically unrelated carbapenem-resistant New Delhi metallo-β-lactamase-producing caused by contaminated duodenoscopes. Using endoscopes with disposable end caps, adherence to the manufacturer's reprocessing instructions, routine audits, and manufacturer evaluation are critical in preventing such outbreaks.
Topics: Humans; Escherichia coli; beta-Lactamases; Carbapenem-Resistant Enterobacteriaceae; Duodenoscopes; Disease Outbreaks; Carbapenems; Microbial Sensitivity Tests; Anti-Bacterial Agents
PubMed: 36815278
DOI: 10.1017/ice.2023.21 -
World Journal of Clinical Cases Dec 2023One challenging scenario in the treatment of biliary stricture is that post-liver transplantation (LT) biliary strictures cannot be accessed using endoscopic retrograde...
BACKGROUND
One challenging scenario in the treatment of biliary stricture is that post-liver transplantation (LT) biliary strictures cannot be accessed using endoscopic retrograde cholangiopancreatography (ERCP). Here, we report such a case that was successfully treated using a novel endoscopic technique.
CASE SUMMARY
A 60-year-old man presented with obstructive jaundice caused by a post-LT biliary stricture. He underwent LT for compensated alcoholic liver cirrhosis and hepatocellular carcinoma. Laboratory investigations unveiled a cholestatic pattern of abnormalities in liver function and a total bilirubin level of 16 mg/dL. Magnetic resonance cholangiopancreatography revealed a stricture extending from the right intrahepatic bile duct into the common hepatic duct. Severe postoperative deformities made accessing the ampulla of Vater with a side-viewing duodenoscope impossible. Percutaneous transhepatic biliary drainage (PTBD) was performed to treat biliary obstruction. Moreover, to resolve the stricture completely, a fully covered self-expandable metal stent (FC-SEMS) with a novel proximal retrievable string was deployed into the post-LT biliary stricture through the PTBD tract. Before inserting the stent through the PTBD tract, the stent with the distal string was manually inverted to ensure that the distal part with the string became the proximal part for later endoscopic removal. After 6 mo, the FC-SEMS was successfully removed without complications, as the string was pulled out using a forward-viewing gastroscope.
CONCLUSION
Deployment and endoscopic removal of an FC-SEMS with a novel proximal string through the PTBD tract may be a viable option for treating post-LT biliary strictures that are inaccessible by ERCP.
PubMed: 38130794
DOI: 10.12998/wjcc.v11.i34.8235 -
Therapeutic Advances in... 2024Endoscopic retrograde cholangiopancreatography (ERCP) in patients who have undergone Billroth II gastroenterostomy (B-II GE) has been challenging, requiring flexibility...
Practical application of the modification in endoscopic retrograde cholangiopancreatography treated common bile duct stones in patients with Billroth II gastroenterostomy in Vietnam.
OBJECTIVE
Endoscopic retrograde cholangiopancreatography (ERCP) in patients who have undergone Billroth II gastroenterostomy (B-II GE) has been challenging, requiring flexibility in technical approaches during execution. The study aims to assess the effectiveness of enhanced techniques in performing ERCP on this patient group in Vietnam.
METHOD
A total of 42 Vietnamese patients with B-II GE performed an ERCP using a duodenoscope or a modification of ERCP equipment (a cap-fitted regular forward-viewing endoscope) if the former failed. The effectiveness and safety of the ERCP technique were assessed, particularly in patients who underwent the forward-viewing endoscope method.
RESULT
A total of 39 out of 42 patients had the Vater's papilla identified, among whom 12 patients (30.8%) achieved successful cannulation into the bile duct using a side-viewing endoscope, significantly lower than the success rate using a forward-viewing endoscope (25/27, counted 92.6%, with < 0.001). After successful cannulation, the rate of stone clearance, the procedural time, and the hospitalization duration of the patients were equivalent between the two methods and were not dependent on the number or size of the stones. On the other hand, post-ERCP complications in patients utilizing forward-viewing endoscopy included acute pancreatitis (22.2%), post-sphincterotomy bleeding (3.7%), septicemia (4.8%), and perforation (0%). These complications were mild and amenable to conservative endoscopic and medical management, and no mortality was observed. The rates of complications and adverse events after ERCP are comparable between the two treatment methods, even though the end-viewing endoscope is used after the failure of the side-viewing endoscope.
CONCLUSION
Alter ERCP utilizing a cap-fitted forward-viewing endoscope can be a primary choice for treating common bile duct stones in patients with a Billroth II gastric resection history because of high efficacy and acceptable complications. It requires a high level of procedural expertise that requires multiple training sessions.
PubMed: 38745753
DOI: 10.1177/26317745241251713 -
Gastrointestinal Endoscopy Mar 2024Duodenoscopes with single-use end caps were introduced to minimize infection risk, but they are unstudied in pediatrics.
BACKGROUND AND AIMS
Duodenoscopes with single-use end caps were introduced to minimize infection risk, but they are unstudied in pediatrics.
METHODS
We collected clinical data and endoscopists' evaluations of duodenoscopes with single-use end caps versus reusable duodenoscopes over 18 months.
RESULTS
A total of 106 ERCPs were performed for patients aged 1 to 18 (mean, 14.2) years. Forty-six involved single-use end caps, with 9 requiring crossover to reusable duodenoscopes. ERCPs involving single-use end caps resulted in more instances of mucosal trauma (10 vs 0; P < .05) and post-ERCP pancreatitis (4 vs 1; P < .05) and accounted for 8 of 9 ERCPs requiring advanced cannulation techniques. No post-ERCP infections occurred. Reported challenges included single-use end cap stiffness and difficulty with their alignment for cannulation.
CONCLUSIONS
We report difficulty with advancement, greater reliance on advanced cannulation techniques, and higher rates of post-ERCP pancreatitis when using duodenoscopes with single-use end caps in pediatric ERCP. This area warrants further study.
PubMed: 38462055
DOI: 10.1016/j.gie.2024.03.009 -
Infection Control and Hospital... Mar 2024
Topics: Humans; Duodenoscopes; Sterilization; Drug Resistance, Multiple, Bacterial; Cholangiopancreatography, Endoscopic Retrograde
PubMed: 37946384
DOI: 10.1017/ice.2023.246 -
Gastroenterology Mar 2024
PubMed: 38442783
DOI: 10.1053/j.gastro.2024.02.040 -
Gastrointestinal Endoscopy Jun 2024
Topics: Humans; Pancreatic Ducts; Cholangiopancreatography, Endoscopic Retrograde; Catheterization; Pancreas; Male; Female; Pancreas Divisum
PubMed: 38141685
DOI: 10.1016/j.gie.2023.12.026 -
Gastrointestinal Endoscopy Feb 2024
Topics: Humans; Colon; Duodenal Ulcer; Intestinal Perforation; Peptic Ulcer Perforation; Surgical Instruments
PubMed: 37748544
DOI: 10.1016/j.gie.2023.09.018