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Burhan Sahin - One of the best experts on this subject based on the ideXlab platform.
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ERCP experience in patients with Choledochoduodenostomy: diagnostic findings and therapeutic management.
Surgical endoscopy, 2010Co-Authors: Bilge Tunc Demirel, Erkan Parlak, Sabite Kacar, Nurgul Sasmaz, Murat Kekilli, Ibrahim Koral Onal, Selçuk Dişibeyaz, Zeki Mesut Yalın Kiliç, Burhan SahinAbstract:Background Endoscopic retrograde cholangiopancreatography (ERCP), besides reducing the need for surgery in a wide spectrum of biliary disease, is increasingly be used for the treatment of biliary complications of surgery. In this paper, we review our experience with postoperative ERCPs required after biliary surgery with a special focus on side-to-side Choledochoduodenostomy (CD).
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Bile reflux index after therapeutic biliary procedures
BMC Gastroenterology, 2008Co-Authors: Sedef Kuran, Erkan Parlak, Gulden Aydog, Sabite Kacar, Nurgul Sasmaz, Ali Ozden, Burhan SahinAbstract:Background Therapeutic biliary procedures disrupt the function of the sphincter of Oddi. Patients are potential "bile refluxers". The aim of this study was to assess how these procedures affect the histology-based bile reflux index (BRI), which can be used to reflect duodenogastric reflux (DGR). Methods Gastric antrum and corpus biopsies were collected from 131 subjects (56 men, 75 women; mean age, 55.9 ± 15.6 years). Group 1 (Biliary group-BG; n = 66) had undergone endoscopic sphincterotomy, endoscopic stenting, or Choledochoduodenostomy for benign pathology; Group 2 (n = 20) had undergone cholecystectomy alone; and Group 3 (n = 6) Billroth II gastroenterostomy. Group 4 (no cholecystectomy; n = 39) had upper endoscopy with normal findings and served as controls. BRI > 14 indicated DGR (BRI [+]). To eliminate confounding effects of Helicobacter pylori ( Hp ) infection, comparisons were made according to Hp colonization. Results Fifty-nine subjects (45%) were Hp (+). The frequencies of BRI (+) status in antrum and corpus specimens from Hp (-) BG patients were 74.3% and 71.4%, respectively (85.7% for both antrum and corpus for Choledochoduodenostomy). Corresponding results were 60% and 60% for Group 2, 100% (only corpus) for Group 3, and 57.1% and 38.1% for controls (BG, Group 2, and Group 3 vs controls – p > 0.05 antrum, p < 0.05 corpus). Fifty-four BG patients had previously undergone cholecystectomy. Excluding those, the rates of BRI (+) in Hp (-) BG patients were 75% antrum and 62.5% corpus (p > 0.05 for both vs. Group 2). Conclusion Patients who had undergone biliary procedures showed similar bile-related histological changes in both corpus and antrum biopsies, but the changes seen in controls were more prominent in the antrum than corpus. Therapeutic biliary procedures increase the rate of BRI (+) especially in the case of Choledochoduodenostomy. Therapeutic biliary procedures without cholecystectomy also increase the rate of BRI (+) similar to that observed in patients with cholecystectomy.
Takao Itoi - One of the best experts on this subject based on the ideXlab platform.
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doi:10.3748/wjg.14.6078
2014Co-Authors: Fumihide Itokawa, Atsushi Sofuni, Toshio Kurihara, Takayoshi Tsuchiya, Kentaro Ishii, Shujiro Tsuji, Nobuhito Ikeuchi, Fuminori Moriyasu, Takao ItoiAbstract:CASE REPORT Endoscopic ultrasound-guided Choledochoduodenostomy in patients with failed endoscopic retrograde cholangiopancreatograph
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endoscopic ultrasound guided Choledochoduodenostomy in patients with failed endoscopic retrograde cholangiopancreatography
World Journal of Gastroenterology, 2008Co-Authors: Takao Itoi, Fumihide Itokawa, Atsushi Sofuni, Toshio Kurihara, Takayoshi Tsuchiya, Kentaro Ishii, Shujiro Tsuji, Nobuhito Ikeuchi, Fuminori MoriyasuAbstract:Endoscopic ultrasonography (EUS)-guided biliary drainage was performed for treatment of patients who have obstructive jaundice in cases of failed endoscopic retrograde cholangiopancreatography (ERCP). In the present study, we introduced the feasibility and outcome of EUS-guided Choledochoduodenostomy in four patients who failed in ERCP. We performed the procedure in 2 papilla of Vater, including one resectable case, and 2 cases of cancer of the head of pancreas. Using a curved linear array echoendoscope, a 19 G needle or a needle knife was punctured transduodenally into the bile duct under EUS visualization. Using a biliary catheter for dilation, or papillary balloon dilator, a 7-Fr plastic stent was inserted through the Choledochoduodenostomy site into the extrahepatic bile duct. In 3 (75%) of 4 cases, an indwelling plastic stent was placed, and in one case in which the stent could not be advanced into the bile duct, a naso-biliary drainage tube was placed instead. In all cases, the obstructive jaundice rapidly improved after the procedure. Focal peritonitis and bleeding not requiring blood transfusion was seen in one case. In this case, pancreatoduodenectomy was performed and the surgical findings revealed severe adhesion around the Choledochoduodenostomy site. Although further studies and development of devices are mandatory, EUS-guided Choledochoduodenostomy appears to be an effective alternative to ERCP in selected cases.
Kazuo Hara - One of the best experts on this subject based on the ideXlab platform.
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Prospective clinical study of EUS-guided Choledochoduodenostomy for malignant lower biliary tract obstruction.
The American journal of gastroenterology, 2011Co-Authors: Kazuo Hara, Kenji Yamao, Yasumasa Niwa, Akira Sawaki, Nobumasa Mizuno, Susumu Hijioka, Masahiro Tajika, Hiroki Kawai, Shinya Kondo, Yuji KobayashiAbstract:Prospective Clinical Study of EUS-Guided Choledochoduodenostomy for Malignant Lower Biliary Tract Obstruction
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endoscopic ultrasound guided Choledochoduodenostomy
Digestive Endoscopy, 2010Co-Authors: Kazuo Hara, Kenji Yamao, Akira Sawaki, Nobumasa Mizuno, Tadayuki Takagi, Vikram BhatiaAbstract:Endoscopic biliary drainage (EBD) may be unsuccessful in some patients, because of failed biliary cannulation or tumor infiltration, limiting endoscopic access to major papilla. The alternative method of percutaneous transhepatic biliary drainage carries a risk of complications, such as bleeding, portal vein thrombus, portal vein occlusion and intra- or extra-abdominal bile leakage. Recently, endoscopic ultrasonography (EUS)-guided biliary stent placement has been described in patients with malignant biliary obstruction. Technically, EUS-guided biliary drainage is possible via transgastric or transduodenal routes or through the small intestine using a direct access or rendezvous technique. We describe herein a technique for direct stent insertion from the duodenal bulb for the management of patients with jaundice caused by malignant obstruction of the lower extrahepatic bile duct. We think transduodenal direct access is the best treatment in patients with jaundice caused by inoperable malignant obstruction of the lower extrahepatic bile duct when EBD fails.
Rastislav Kunda - One of the best experts on this subject based on the ideXlab platform.
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element trial study protocol for a randomized controlled trial on endoscopic ultrasound guided biliary drainage of first intent with a lumen apposing metal stent vs endoscopic retrograde cholangio pancreatography in the management of malignant distal
Trials, 2019Co-Authors: Yen I Chen, Kashi Callichurn, Avijit Chatterjee, Etienne Desilets, Donnellan Fergal, Nauzer Forbes, Ian Gan, Sana Kenshil, Mouen A Khashab, Rastislav KundaAbstract:Endoscopic ultrasound guided-biliary drainage (EUS-BD) is a promising alternative to endoscopic retrograde cholangiopancreatography (ERCP); however, its growth has been limited by a lack of multicenter randomized controlled trials (RCT) and dedicated devices. A dedicated EUS-BD lumen- apposing metal stent (LAMS) has recently been developed with the potential to greatly facilitate the technique and safety of the procedure. We aim to compare a first intent approach with EUS-guided Choledochoduodenostomy with a dedicated biliary LAMS vs. standard ERCP in the management of malignant distal biliary obstruction. The ELEMENT trial is a multicenter single-blinded RCT involving 130 patients in nine Canadian centers. Patients with unresectable, locally advanced, or borderline resectable malignant distal biliary obstruction meeting the inclusion and exclusion criteria will be randomized to EUS-Choledochoduodenostomy using a LAMS or ERCP with traditional metal stent insertion in a 1:1 proportion in blocks of four. Patients with hilar obstruction, resectable cancer, or benign disease are excluded. The primary endpoint is the rate of stent dysfunction needing re-intervention. Secondary outcomes include technical and clinical success, interruptions in chemotherapy, rate of surgical resection, time to stent dysfunction, and adverse events. The ELEMENT trial is designed to assess whether EUS-guided Choledochoduodenostomy using a dedicated LAMS is superior to conventional ERCP as a first-line endoscopic drainage approach in malignant distal biliary obstruction, which is an important and timely question that has not been addressed using an RCT study design. Registry name: ClinicalTrials.gov. Registration number: NCT03870386. Date of registration: 03/12/2019.
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eus guided Choledochoduodenostomy for malignant distal biliary obstruction using a lumen apposing fully covered metal stent after failed ercp
Surgical Endoscopy and Other Interventional Techniques, 2016Co-Authors: Rastislav Kunda, Manuel Perezmiranda, Uwe Will, Sebastian Ullrich, Dirk Brenke, Markus Dollhopf, Michelle Meier, Alberto LarghiAbstract:Background A novel lumen-apposing, self-expanding metal stent to perform EUS-guided drainage procedures has been recently developed. The aim of this study was to analyze the safety, technical and clinical effectiveness of this device for EUS-guided Choledochoduodenostomy (EUS-CD) with palliative intent.
Fuminori Moriyasu - One of the best experts on this subject based on the ideXlab platform.
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doi:10.3748/wjg.14.6078
2014Co-Authors: Fumihide Itokawa, Atsushi Sofuni, Toshio Kurihara, Takayoshi Tsuchiya, Kentaro Ishii, Shujiro Tsuji, Nobuhito Ikeuchi, Fuminori Moriyasu, Takao ItoiAbstract:CASE REPORT Endoscopic ultrasound-guided Choledochoduodenostomy in patients with failed endoscopic retrograde cholangiopancreatograph
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endoscopic ultrasound guided Choledochoduodenostomy in patients with failed endoscopic retrograde cholangiopancreatography
World Journal of Gastroenterology, 2008Co-Authors: Takao Itoi, Fumihide Itokawa, Atsushi Sofuni, Toshio Kurihara, Takayoshi Tsuchiya, Kentaro Ishii, Shujiro Tsuji, Nobuhito Ikeuchi, Fuminori MoriyasuAbstract:Endoscopic ultrasonography (EUS)-guided biliary drainage was performed for treatment of patients who have obstructive jaundice in cases of failed endoscopic retrograde cholangiopancreatography (ERCP). In the present study, we introduced the feasibility and outcome of EUS-guided Choledochoduodenostomy in four patients who failed in ERCP. We performed the procedure in 2 papilla of Vater, including one resectable case, and 2 cases of cancer of the head of pancreas. Using a curved linear array echoendoscope, a 19 G needle or a needle knife was punctured transduodenally into the bile duct under EUS visualization. Using a biliary catheter for dilation, or papillary balloon dilator, a 7-Fr plastic stent was inserted through the Choledochoduodenostomy site into the extrahepatic bile duct. In 3 (75%) of 4 cases, an indwelling plastic stent was placed, and in one case in which the stent could not be advanced into the bile duct, a naso-biliary drainage tube was placed instead. In all cases, the obstructive jaundice rapidly improved after the procedure. Focal peritonitis and bleeding not requiring blood transfusion was seen in one case. In this case, pancreatoduodenectomy was performed and the surgical findings revealed severe adhesion around the Choledochoduodenostomy site. Although further studies and development of devices are mandatory, EUS-guided Choledochoduodenostomy appears to be an effective alternative to ERCP in selected cases.