The Experts below are selected from a list of 249 Experts worldwide ranked by ideXlab platform

Sherban Pavlovici - One of the best experts on this subject based on the ideXlab platform.

Everson L.a. Artifon - One of the best experts on this subject based on the ideXlab platform.

  • Rendez-Vous laparoendoscopic after ERCP failure in patient with Billroth II gastrectomy
    Revista de gastroenterologia del Peru : organo oficial de la Sociedad de Gastroenterologia del Peru, 2018
    Co-Authors: Fernanda Kreve, Francisco S. Loss, Janaina Gatto, Jonas Takada, Juliana Dantas, Karina Inoue, Alfredo Luiz Jacomo, Everson L.a. Artifon
    Abstract:

    Endoscopic retrograde cholangiopancreatography (ERCP) is the treatment of choice in patients with choledocholithiasis. However, despite its high success rate, in some cases it is not successful, requiring alternative therapy. Billroth II partial gastrectomy is a condition associated with an important failure rate of ERCP. When endoscopic treatment fails, surgical exploration of the bile duct is the most common approach. However, the surgery is related to a greater complexity of execution and morbimortality. We describe the case of a patient with choledocholithiasis and Billroth II partial gastrectomy, submitted to the combined treatment called rendez-vous laparoendoscopic, after failure of ERCP, which unites in a single stage the endoscopic treatment of choledocholithiasis and laparoscopic removal of the gallbladder. We conclude that this therapeutic approach was effective, safe, with low cost and without complications.

  • Endoscopic Papillary Large-Balloon Dilatation in Patients with Billroth II Gastrectomy
    Digestive Diseases and Sciences, 2013
    Co-Authors: Juan J Vila, Everson L.a. Artifon
    Abstract:

    Endoscopic sphincterotomy (ES), introduced by Classen et al. [1] as a minimally invasive technique to retrieve common bile duct (CBD) stones in high-surgical-risk patients, has become the foundation of endoscopic therapy for patients with biliary disease, with a *90 % rate of successfully removing CBD stones with basket extraction or balloon sweeping. As an alternative to ES, Staritz et al. [2] described in 1983 endoscopic papillary balloon dilatation (EPBD) with the aim of avoiding complications associated with ES in the short term such as pancreatitis, perforation, bleeding, and infection, or in the long term such as papillary stenosis and bacterial biliary contamination. EPBD is effective for the treatment of CBD stones with retrieval rates of 80–100 % [3]. The efficacy of ES and EPBD in the removal of CBD stones has been compared with multiple prospective studies and with at least two recent meta-analyses [4, 5], which have concluded that EPBD is associated with lower rates of bleeding and perforation than ES [3–6] but with a higher rate of pancreatitis [4, 5, 7, 8]. Moreover, EPBD is also associated with a lower retrieval rate of CBD stones [4, 5] which, combined with higher rates of pancreatitis, are the main reasons why most endoscopists choose ES over EPBD for CBD stone extraction. Thus, EPBD has become second line, mainly used for endoscopic treatment of CBD stones in patients with liver cirrhosis or coagulopathy. Ten years ago, one single-center retrospective study reported that ES followed by endoscopic papillary largeballoon dilation (EPLBD) of the papillary orifice (10–20 mm) improved the extraction rate of large CBD stones [9]. Further studies confirmed that ES followed by EPLBD is an effective and safe technique for retrieving large CBD stones after failure of common extraction techniques using balloon or basket [10–12]. EPLBD performed after ES effectively removed up to 87–95 % of large CBD stones in patients after the failure of balloon or basket extraction attempts [9–11]. EPLBD could also minimize the chances of pancreatitis since the existing sphincterotomy enables the dilation to proceed upward rather than circumferentially [10]. The most common complication described with this technique is bleeding that occurs in 8.3 % of patients. EPLBD after ES has also been successfully used for extraction of large CBD stones in patients with Billroth II gastrectomy [13]. ES in Billroth II gastrectomy patients is more difficult than in patients with normal anatomy due to the need for the inverted papillary approach despite the development of specific sphincterotomes. Thus, EPBD may be particularly suited for Billroth II gastrectomy patients, although the previously mentioned limitations restrict its utility. Since EPLBD alone is effective and safe in patients with normal anatomy [14], performing EPLBD without previous ES in patients with Billroth II gastrectomy is the next challenge. The outcomes of this procedure in 40 patients are described in this issue of Digestive Diseases and Sciences [15]. Jang et al. performed EPLBD alone to treat patients following Billroth II gastrectomy with difficult-toextract CBD stones. Fourteen patients with four or more J. J. Vila Endoscopy Unit, Complejo Hospitalario de Navarra, Pamplona, Spain e-mail: juanjvila@gmail.com

H Abourebyeh - One of the best experts on this subject based on the ideXlab platform.

  • endoscopic access to the papilla of vater for endoscopic retrograde cholangiopancreatography in patients with Billroth II or roux en y gastrojejunostomy
    Endoscopy, 1997
    Co-Authors: R E Hintze, A Adler, W Veltzke, H Abourebyeh
    Abstract:

    Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) is an established modality for the diagnosis and treatment of pancreaticobiliary disorders. In contrast to ERCP in patients who have not undergone gastrectomy, ERCP in patients with a Billroth II gastrojejunostomy or a Roux-en-Y anastomosis is considerably more difficult. It was nevertheless considered that ERCP might be possible in most patients with gastrectomies, and this hypothesis was tested. Patients and methods A total of 2256 patients were admitted to our hospital for ERCP from 1990 to 1994. Of these, 65 (3%) had gastrojejunostomies, either with Billroth II reconstructions or with the Roux-en-Y procedure. ERCP was always performed with a conventional side-viewing endoscope. Results We examined the 65 patients with gastrojejunostomies. Of these, 91% had Billroth II anastomoses and 9% had received Roux-en-Y reconstructions. We successfully reached the papilla of Vater with the endoscope in 92% of the patients with Billroth II gastrojejunostomies (54 of 59), but in only 33% of the patients with Roux-en-Y reconstructions (two of six). In 8% of the cases of Billroth II anastomosis, it was not possible to advance the endoscope into the duodenal stump, due to intestinal stenoses (5%) or excessive intestinal length (3%). Failure in case of regular Billroth II anatomy occurred only in patients who had not received Braun enteroenterostomies. Failure also occurred in 67% of the Roux-en-Y gastrojejunostomy cases due to excessive intestinal length. Conclusions Most patients with Billroth II gastrojejunostomy (92% of those in the present study) and some patients with Roux-en-Y anastomosis (33% of those in the present study) can be investigated by ERCP and endoscopically treated in cases of pancreaticobiliary disorder. Braun enteroenterostomy has no negative impact on the endoscopic access to the papilla of Vater in patients with Billroth II gastrojejunostomy. Surgical reconstruction of the gastrointestinal tract to perform gastrojejunostomy should also take endoscopic requirements into account. In view of both the potential postoperative complications and endoscopic requirements, the jejunojejunostomy should be placed nearer to the gastrojejunostomy than 60 cm, and the afferent loop should be as short as possible.

Hakan Senturk - One of the best experts on this subject based on the ideXlab platform.

  • Experience of the Endoscopists Matters in Endoscopic Retrograde Cholangiopancreatography in Billroth II Gastrectomy Patients
    'The Korean Society of Gastrointestinal Endoscopy', 2020
    Co-Authors: Erkan Caglar, Deniz Atasoy, Engin Altınkaya, Serkan Dogan, Tozlu Mukaddes, Hakan Senturk
    Abstract:

    Conclusions: FRCP in patients who had undergone Billroth II gastrectomy was time consuming for the inexperienced endoscopist who should beware of the unique adverse events related to ERCP in patients with altered anatomy

  • experience of the endoscopists matters in endoscopic retrograde cholangiopancreatography in Billroth II gastrectomy patients
    Clinical Endoscopy, 2020
    Co-Authors: Erkan Caglar, Deniz Atasoy, Mukaddes Tozlu, Engin Altınkaya, Serkan Dogan, Hakan Senturk
    Abstract:

    BACKGROUND/AIMS Altered anatomy is a challenge in endoscopic retrograde cholangiopancreatography (ERCP) for patients with Billroth II anastomosis. In this study, we investigated the overall success and role of endoscopist experience. METHODS Data of patients who underwent ERCP between 2014 and 2018 after a previous Billroth II operation were retrieved retrospectively from 2 tertiary ERCP centers. The procedures were performed by 2 endoscopists with different levels of experience. Clinical success was defined as extraction of the stone, placement of a stent through a malignant stricture, and clinical and laboratory improvements in patients. RESULTS Seventy-five patients were included. The technical success rate was 83% for the experienced endoscopist and 75% for the inexperienced endoscopist (p=0.46). The mean (±standard deviation) procedure time was 23.8±5.7 min for the experienced endoscopist and 40.68±6.07 min for the inexperienced endoscopist (p<0.001). In total, 3 perforations (4%) were found. The rate of afferent loop perforation was 6.25% (1/16) for the inexperienced endoscopist and 0% (0/59) for the experienced endoscopist (p=0.053). CONCLUSION ERCP in patients who had undergone Billroth II gastrectomy was time consuming for the inexperienced endoscopist who should beware of the unique adverse events related to ERCP in patients with altered anatomy.

  • Experience of the Endoscopists Matters in Endoscopic Retrograde Cholangiopancreatography in Billroth II Gastrectomy Patients.
    Clinical endoscopy, 2019
    Co-Authors: Erkan Caglar, Deniz Atasoy, Mukaddes Tozlu, Engin Altınkaya, Serkan Dogan, Hakan Senturk
    Abstract:

    BACKGROUND/AIMS Altered anatomy is a challenge in endoscopic retrograde cholangiopancreatography (ERCP) for patients with Billroth II anastomosis. In this study, we investigated the overall success and role of endoscopist experience. METHODS Data of patients who underwent ERCP between 2014 and 2018 after a previous Billroth II operation were retrieved retrospectively from 2 tertiary ERCP centers. The procedures were performed by 2 endoscopists with different levels of experience. Clinical success was defined as extraction of the stone, placement of a stent through a malignant stricture, and clinical and laboratory improvements in patients. RESULTS Seventy-five patients were included. The technical success rate was 83% for the experienced endoscopist and 75% for the inexperienced endoscopist (p=0.46). The mean (±standard deviation) procedure time was 23.8±5.7 min for the experienced endoscopist and 40.68±6.07 min for the inexperienced endoscopist (p

Sherwin B Batoon - One of the best experts on this subject based on the ideXlab platform.