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Y Nimura - One of the best experts on this subject based on the ideXlab platform.
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percutaneous transhepatic biliary Drainage Catheter tract recurrence in cholangiocarcinoma
British Journal of Surgery, 2010Co-Authors: Yu Takahashi, Tomoki Ebata, Masato Nagino, Hideki Nishio, Tsuyoshi Igami, Y NimuraAbstract:Background: The aim of the study was to clarify the incidence, risk factors and treatment of percutaneous transhepatic biliary Drainage (PTBD) Catheter tract recurrence in patients with resected cholangiocarcinoma. Methods: The medical records of 445 patients with perihilar and distal cholangiocarcinoma who underwent resection following PTBD were reviewed retrospectively. Results: PTBD Catheter tract recurrence was detected in 23 patients (5·2 per cent). The mean(s.d.) interval between surgery and onset of the recurrence was 14·4(13·8) months. On multivariable analysis, duration of PTBD (60 days or more), multiple PTBD Catheters and macroscopic papillary tumour type were identified as independent risk factors. In four patients with synchronous metastasis, the PTBD sinus tract was resected simultaneously, at the time of initial surgery. Of 19 patients with metachronous metastasis, 15 underwent surgical resection of the metastasis. Survival of the 23 patients with PTBD Catheter tract recurrence was poorer than that of the 422 patients without recurrence (median 22·8 versus 27·3 months; P = 0·095). Even after surgical resection of PTBD Catheter tract recurrence, survival was poor. Conclusion: PTBD Catheter tract recurrence is not unusual. The prognosis for these patients is generally poor, even after resection. To prevent this troublesome complication, endoscopic biliary Drainage is first recommended when Drainage is indicated. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
Shyam Varadarajulu - One of the best experts on this subject based on the ideXlab platform.
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EUS 2008 Working Group document: evaluation of EUS-guided hepaticogastrostomy
Gastrointestinal Endoscopy, 2009Co-Authors: Thomas J. Savides, Shyam Varadarajulu, Laurent PalazzoAbstract:Drainage of a biliary obstruction can be accomplished in several ways: (1) placement of an internal biliary stent at ERCP, (2) placement of percutaneous transhepatic biliary Drainage Catheter (PTBD), and (3) surgical anastomosis (ie, hepaticogastrostomy or choledochojejunostomy). Recently, the role of EUS was evaluated in several studies as an alternative treatment modality for the management of patients with obstructive jaundice. This section of the EUS 2008 Working Group Proceedings evaluates the current evidence and potential role of EUS-guided hepaticogastrostomy in the management of patients with obstructive jaundice.
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modified technique for eus guided Drainage of pelvic abscess with video
Gastrointestinal Endoscopy, 2008Co-Authors: Jessica Trevino, Ernesto R Drelichman, Shyam VaradarajuluAbstract:Background We previously described a technique for EUS-guided Drainage of pelvic abscess by means of transrectal Catheter placement. However, Drainage Catheters are prone to accidental dislodgement, and their management has mandated a prolonged inpatient hospital stay. Objective To evaluate the effectiveness of a combined technique by using EUS-guided transrectal Drainage Catheter and stent placement for management of patients with pelvic abscesses. Design An observational study. Setting Academic tertiary-referral center. Patients Four patients underwent EUS-guided Drainage of pelvic abscesses that were not amenable for Drainage by US and/or CT guidance. Interventions A 10F Drainage Catheter and one or two 7F double-pigtail stents were deployed in the abscess cavity under EUS guidance. Subsequently, the Drainage Catheter was periodically flushed and aspirated for 36 hours until improvement in size of the abscess was confirmed by CT imaging. The Drainage Catheter was then discontinued, and the patients were discharged from the hospital. If resolution of the abscess was noted on outpatient CT at 2 weeks, then the stents were retrieved by sigmoidoscopy. Main Outcomes Measurements Short-term treatment success was defined as improvement in clinical symptoms and a decrease in size of the pelvic abscess on postprocedure CT obtained at 36 hours. Medium-term treatment success was defined as resolution of clinical symptoms and pelvic abscess on follow-up CT at 2 weeks. Results The procedure was technically successful in all 4 patients. The mean size of the abscess was 93 × 61 mm. No procedural complications were encountered. Treatment was successful both in the short and medium term in all 4 patients, and the mean duration of the postprocedure hospital stay was 2 days. At a mean follow-up of 221 days (range, 65-416 days), all 4 patients were doing well, without any symptoms of pelvic-abscess recurrence. Limitations The small number of patients and the absence of a comparative treatment group. Conclusions The combined placement of a transrectal Drainage Catheter and a stent under EUS guidance was a technically feasible, safe, and effective technique for management of patients with pelvic abscess. This technique minimized the possibility of accidental dislodgement of the Drainage Catheter and facilitated earlier patient discharge from the hospital.
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Modified technique for EUS-guided Drainage of pelvic abscess (with video).
Gastrointestinal endoscopy, 2008Co-Authors: Jessica Trevino, Ernesto R Drelichman, Shyam VaradarajuluAbstract:Background We previously described a technique for EUS-guided Drainage of pelvic abscess by means of transrectal Catheter placement. However, Drainage Catheters are prone to accidental dislodgement, and their management has mandated a prolonged inpatient hospital stay. Objective To evaluate the effectiveness of a combined technique by using EUS-guided transrectal Drainage Catheter and stent placement for management of patients with pelvic abscesses. Design An observational study. Setting Academic tertiary-referral center. Patients Four patients underwent EUS-guided Drainage of pelvic abscesses that were not amenable for Drainage by US and/or CT guidance. Interventions A 10F Drainage Catheter and one or two 7F double-pigtail stents were deployed in the abscess cavity under EUS guidance. Subsequently, the Drainage Catheter was periodically flushed and aspirated for 36 hours until improvement in size of the abscess was confirmed by CT imaging. The Drainage Catheter was then discontinued, and the patients were discharged from the hospital. If resolution of the abscess was noted on outpatient CT at 2 weeks, then the stents were retrieved by sigmoidoscopy. Main Outcomes Measurements Short-term treatment success was defined as improvement in clinical symptoms and a decrease in size of the pelvic abscess on postprocedure CT obtained at 36 hours. Medium-term treatment success was defined as resolution of clinical symptoms and pelvic abscess on follow-up CT at 2 weeks. Results The procedure was technically successful in all 4 patients. The mean size of the abscess was 93 × 61 mm. No procedural complications were encountered. Treatment was successful both in the short and medium term in all 4 patients, and the mean duration of the postprocedure hospital stay was 2 days. At a mean follow-up of 221 days (range, 65-416 days), all 4 patients were doing well, without any symptoms of pelvic-abscess recurrence. Limitations The small number of patients and the absence of a comparative treatment group. Conclusions The combined placement of a transrectal Drainage Catheter and a stent under EUS guidance was a technically feasible, safe, and effective technique for management of patients with pelvic abscess. This technique minimized the possibility of accidental dislodgement of the Drainage Catheter and facilitated earlier patient discharge from the hospital.
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eus guided Drainage of pelvic abscess with video
Gastrointestinal Endoscopy, 2007Co-Authors: Shyam Varadarajulu, Ernesto R DrelichmanAbstract:BACKGROUND: Although pelvic abscesses have traditionally been drained by surgery or under radiologic guidance, a small subset of patients who are not candidates for these interventions require an alternate mode of Drainage. OBJECTIVE: Evaluate the efficacy of EUS for Drainage of pelvic abscesses that could not be drained under US or CT guidance. DESIGN: Prospective case series. SETTING: Tertiary referral center. PATIENTS: Four patients underwent EUS-guided Drainage of pelvic abscesses that were not amenable for Drainage by US and/or CT guidance. INTERVENTIONS: A 10F Drainage Catheter was deployed in the abscess cavity under EUS guidance in all patients. The Catheters were flushed periodically until resolution of the abscess was confirmed by CT imaging. MAIN OUTCOME MEASUREMENTS: Resolution of a pelvic abscess on follow-up CT and improvement in clinical symptoms. RESULTS: A Drainage Catheter was successfully placed in all 4 patients. The mean size of the abscess was 68 x 72 mm. There were no procedure-related complications. One patient died of worsening congestive heart failure 48 hours after the procedure. The abscesses resolved in the remaining 3 patients within a mean duration of 6 days, with complete symptom relief. LIMITATIONS: A small number of patients and short duration of follow-up. CONCLUSIONS: EUS-guided placement of Drainage Catheter is a minimally invasive technique for draining pelvic abscesses that are within the reach of the echoendoscope.
Masato Nagino - One of the best experts on this subject based on the ideXlab platform.
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Prospective study of biliary cytology in suspected perihilar cholangiocarcinoma
British Journal of Surgery, 2011Co-Authors: M. Hattori, Tomoki Ebata, Kazuhiko Kato, Masato Nagino, K. Okada, Yoshie ShimoyamaAbstract:Background: The diagnostic value of biliary cytology for hilar bile duct stricture is uncertain. This study prospectively examined three methods for the evaluation of biliary cytology in a consecutive group of patients. Methods: Preoperative bile sampling by aspiration through a Drainage Catheter (aspiration samples), saline flush through a Drainage Catheter (saline samples) or direct sampling from a Drainage bag (bag samples) was performed in consecutive patients with suspected perihilar cholangiocarcinoma who underwent resection after endoscopic nasobiliary Drainage or percutaneous transhepatic biliary Drainage. All bile sampling was performed three times on separate days. The accuracy of cytology in the diagnosis of carcinoma was determined. Results: Of 100 consecutive patients with hilar strictures, 97 had histologically proven cholangiocarcinoma. The proportion of these 97 patients who had a positive finding on cytology in at least one of three sampling sessions was 55 per cent for aspiration samples, 48 per cent for bag samples and 38 per cent for saline samples (P = 0·021, aspiration versus saline). Tumour length correlated significantly with overall positivity. For aspiration samples, sensitivity was 55 per cent, specificity was 100 per cent and accuracy 56·0 per cent. Conclusion: For biliary cytology, sampling by Catheter aspiration is more effective than Catheter flushing or sampling from a Drainage bag. Repeated sampling increases sensitivity. Biliary cytology has modest diagnostic yield, but is easy to perform, highly specific, and can provide a definitive diagnosis. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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percutaneous transhepatic biliary Drainage Catheter tract recurrence in cholangiocarcinoma
British Journal of Surgery, 2010Co-Authors: Yu Takahashi, Tomoki Ebata, Masato Nagino, Hideki Nishio, Tsuyoshi Igami, Y NimuraAbstract:Background: The aim of the study was to clarify the incidence, risk factors and treatment of percutaneous transhepatic biliary Drainage (PTBD) Catheter tract recurrence in patients with resected cholangiocarcinoma. Methods: The medical records of 445 patients with perihilar and distal cholangiocarcinoma who underwent resection following PTBD were reviewed retrospectively. Results: PTBD Catheter tract recurrence was detected in 23 patients (5·2 per cent). The mean(s.d.) interval between surgery and onset of the recurrence was 14·4(13·8) months. On multivariable analysis, duration of PTBD (60 days or more), multiple PTBD Catheters and macroscopic papillary tumour type were identified as independent risk factors. In four patients with synchronous metastasis, the PTBD sinus tract was resected simultaneously, at the time of initial surgery. Of 19 patients with metachronous metastasis, 15 underwent surgical resection of the metastasis. Survival of the 23 patients with PTBD Catheter tract recurrence was poorer than that of the 422 patients without recurrence (median 22·8 versus 27·3 months; P = 0·095). Even after surgical resection of PTBD Catheter tract recurrence, survival was poor. Conclusion: PTBD Catheter tract recurrence is not unusual. The prognosis for these patients is generally poor, even after resection. To prevent this troublesome complication, endoscopic biliary Drainage is first recommended when Drainage is indicated. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
Tomoki Ebata - One of the best experts on this subject based on the ideXlab platform.
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Prospective study of biliary cytology in suspected perihilar cholangiocarcinoma
British Journal of Surgery, 2011Co-Authors: M. Hattori, Tomoki Ebata, Kazuhiko Kato, Masato Nagino, K. Okada, Yoshie ShimoyamaAbstract:Background: The diagnostic value of biliary cytology for hilar bile duct stricture is uncertain. This study prospectively examined three methods for the evaluation of biliary cytology in a consecutive group of patients. Methods: Preoperative bile sampling by aspiration through a Drainage Catheter (aspiration samples), saline flush through a Drainage Catheter (saline samples) or direct sampling from a Drainage bag (bag samples) was performed in consecutive patients with suspected perihilar cholangiocarcinoma who underwent resection after endoscopic nasobiliary Drainage or percutaneous transhepatic biliary Drainage. All bile sampling was performed three times on separate days. The accuracy of cytology in the diagnosis of carcinoma was determined. Results: Of 100 consecutive patients with hilar strictures, 97 had histologically proven cholangiocarcinoma. The proportion of these 97 patients who had a positive finding on cytology in at least one of three sampling sessions was 55 per cent for aspiration samples, 48 per cent for bag samples and 38 per cent for saline samples (P = 0·021, aspiration versus saline). Tumour length correlated significantly with overall positivity. For aspiration samples, sensitivity was 55 per cent, specificity was 100 per cent and accuracy 56·0 per cent. Conclusion: For biliary cytology, sampling by Catheter aspiration is more effective than Catheter flushing or sampling from a Drainage bag. Repeated sampling increases sensitivity. Biliary cytology has modest diagnostic yield, but is easy to perform, highly specific, and can provide a definitive diagnosis. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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percutaneous transhepatic biliary Drainage Catheter tract recurrence in cholangiocarcinoma
British Journal of Surgery, 2010Co-Authors: Yu Takahashi, Tomoki Ebata, Masato Nagino, Hideki Nishio, Tsuyoshi Igami, Y NimuraAbstract:Background: The aim of the study was to clarify the incidence, risk factors and treatment of percutaneous transhepatic biliary Drainage (PTBD) Catheter tract recurrence in patients with resected cholangiocarcinoma. Methods: The medical records of 445 patients with perihilar and distal cholangiocarcinoma who underwent resection following PTBD were reviewed retrospectively. Results: PTBD Catheter tract recurrence was detected in 23 patients (5·2 per cent). The mean(s.d.) interval between surgery and onset of the recurrence was 14·4(13·8) months. On multivariable analysis, duration of PTBD (60 days or more), multiple PTBD Catheters and macroscopic papillary tumour type were identified as independent risk factors. In four patients with synchronous metastasis, the PTBD sinus tract was resected simultaneously, at the time of initial surgery. Of 19 patients with metachronous metastasis, 15 underwent surgical resection of the metastasis. Survival of the 23 patients with PTBD Catheter tract recurrence was poorer than that of the 422 patients without recurrence (median 22·8 versus 27·3 months; P = 0·095). Even after surgical resection of PTBD Catheter tract recurrence, survival was poor. Conclusion: PTBD Catheter tract recurrence is not unusual. The prognosis for these patients is generally poor, even after resection. To prevent this troublesome complication, endoscopic biliary Drainage is first recommended when Drainage is indicated. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
Yu Takahashi - One of the best experts on this subject based on the ideXlab platform.
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percutaneous transhepatic biliary Drainage Catheter tract recurrence in cholangiocarcinoma
British Journal of Surgery, 2010Co-Authors: Yu Takahashi, Tomoki Ebata, Masato Nagino, Hideki Nishio, Tsuyoshi Igami, Y NimuraAbstract:Background: The aim of the study was to clarify the incidence, risk factors and treatment of percutaneous transhepatic biliary Drainage (PTBD) Catheter tract recurrence in patients with resected cholangiocarcinoma. Methods: The medical records of 445 patients with perihilar and distal cholangiocarcinoma who underwent resection following PTBD were reviewed retrospectively. Results: PTBD Catheter tract recurrence was detected in 23 patients (5·2 per cent). The mean(s.d.) interval between surgery and onset of the recurrence was 14·4(13·8) months. On multivariable analysis, duration of PTBD (60 days or more), multiple PTBD Catheters and macroscopic papillary tumour type were identified as independent risk factors. In four patients with synchronous metastasis, the PTBD sinus tract was resected simultaneously, at the time of initial surgery. Of 19 patients with metachronous metastasis, 15 underwent surgical resection of the metastasis. Survival of the 23 patients with PTBD Catheter tract recurrence was poorer than that of the 422 patients without recurrence (median 22·8 versus 27·3 months; P = 0·095). Even after surgical resection of PTBD Catheter tract recurrence, survival was poor. Conclusion: PTBD Catheter tract recurrence is not unusual. The prognosis for these patients is generally poor, even after resection. To prevent this troublesome complication, endoscopic biliary Drainage is first recommended when Drainage is indicated. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
