The Experts below are selected from a list of 32175 Experts worldwide ranked by ideXlab platform
Hiroyuki Isayama - One of the best experts on this subject based on the ideXlab platform.
-
Antireflux Metal Stent for biliary obstruction: Any benefits?
Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society, 2020Co-Authors: Tsuyoshi Hamada, Hiroyuki Isayama, Yousuke Nakai, Kazuhiko KoikeAbstract:Endoscopic retrograde cholangiopancreatography with Stent placement has been utilized as standard palliative management of distal malignant biliary obstruction (MBO). Compared to plastic Stents, Metal Stents can provide longer-term relief of symptoms. When a large-bore Metal Stent is placed across the ampulla, patients are predisposed to the risk of cholangitis or Stent dysfunction due to reflux of duodenal contents. To mitigate the risk of adverse events associated with the duodenobiliary reflux, efforts have been directed to development of antireflux Metal Stents (ARMSs). The antireflux property has been introduced through adding of an antireflux valve to the duodenal Stent end. Evidence from clinical studies indicates that ARMSs may not only reduce the risk of ascending cholangitis during follow-up but also prolong Stent patency time. However, the results of clinical studies testing ARMSs are inconsiStent owing to heterogeneous designs of antireflux valves and Stent bodies. Metal Stents are increasingly indicated for benign biliary strictures and MBO in the setting of neoadjuvant chemotherapy, and therefore, research is warranted to evaluate ARMSs for those indications. Given that endoscopic ultrasound (EUS)-guided transmural biliary drainage has gained popularity, the optimal timing of placing an ARMS in relation to EUS-guided and percutaneous drainage should be investigated. Development and evaluation of ARMSs require an integrative approach utilizing phantom and animal models, measurements of Stent mechanical properties, and in vivo functional study after Stent placement. In this review article, we summarize updated evidence on ARMSs for MBO and discuss issues that should be addressed in future studies.
-
Retrospective Comparative Study of Side-by-Side and Stent-in-Stent Metal Stent Placement for Hilar Malignant Biliary Obstruction
Digestive Diseases and Sciences, 2020Co-Authors: Kazunaga Ishigaki, Hiroyuki Isayama, Yousuke Nakai, Tsuyoshi Hamada, Naminatsu Takahara, Tatsuya Sato, Ryunosuke Hakuta, Kei Saito, Tomotaka Saito, Suguru MizunoAbstract:Background In patients with unresectable hilar malignant biliary obstruction (MBO), bilateral Metal Stent placement is recommended. However, treatment selection between partially Stent-in-Stent (SIS) and side-by-side (SBS) methods is still controversial. Study Clinical outcomes of bilateral Metal Stent placement by SBS and SIS methods for hilar MBO were retrospectively studied in four Japanese centers. While large-cell-type uncovered Metal Stents were placed above the papilla in SIS, braided-type uncovered Metal Stents were placed across the papilla in SBS. Results A total of 64 patients with hilar MBO (40 SIS and 24 SBS) were included in the analysis. Technical success rate was 100% in SIS and 96% in SBS. Functional success rate was 93% in SIS and 96% in SBS. Early adverse event rates were higher in SBS (46%) than in SIS (23%), though not statistically significant ( P = 0.09). Post-procedure pancreatitis was exclusively observed in SBS group (29%). Recurrent biliary obstruction rates were 48% and 43%, and the median time to recurrent biliary obstruction was 169 and 205 days in SIS and SBS, respectively. Conclusions Other than a trend to higher adverse event rates including post-procedure pancreatitis in SBS, clinical outcomes of SIS and SBS methods were comparable in patients with unresectable hilar MBO.
-
Antireflux Metal Stent as a First-Line Metal Stent for Distal Malignant Biliary Obstruction: A Pilot Study.
Gut and liver, 2017Co-Authors: Tsuyoshi Hamada, Hiroyuki Isayama, Yousuke Nakai, Osamu Togawa, Naminatsu Takahara, Rie Uchino, Suguru Mizuno, Dai Mohri, Hiroshi Yagioka, Hirofumi KogureAbstract:Background/Aims In distal malignant biliary obstruction, an antireflux Metal Stent (ARMS) with a funnel-shaped valve is effective as a reintervention for Metal Stent occlusion caused by reflux. This study sought to evaluate the feasibility of this ARMS as a first-line Metal Stent. Methods Patients with nonresectable distal malignant biliary obstruction were identified between April and December 2014 at three Japanese tertiary centers. We retrospectively evaluated recurrent biliary obstruction and adverse events after ARMS placement. Results In total, 20 consecutive patients were included. The most common cause of biliary obstruction was pancreatic cancer (75%). Overall, recurrent biliary obstruction was observed in seven patients (35%), with a median time to recurrent biliary obstruction of 246 days (range, 11 to 246 days). Stent occlusion occurred in five patients (25%), the causes of which were sludge and food impaction in three and two patients, respectively. Stent migration occurred in two patients (10%). The rate of adverse events associated with ARMS was 25%: pancreatitis occurred in three patients, cholecystitis in one and liver abscess in one. No patients experienced nonocclusion cholangitis. Conclusions The ARMS as a first-line biliary drainage procedure was feasible. Because the ARMS did not fully prevent Stent dysfunction due to reflux, further investigation is warranted.
-
Simultaneous Duodenal Metal Stent Placement and EUS-Guided Choledochoduodenostomy for Unresectable Pancreatic Cancer
2016Co-Authors: Kazumichi Kawakubo, Hiroyuki Isayama, Yousuke Nakai, Naoki Sasahira, Hirofumi Kogure, Takashi Sasaki, Kenji Hirano, Minoru Tada, Kazuhiko KoikeAbstract:Patients with pancreatic cancer frequently suffer from both biliary and duodenal obstruction. For such patients, both bili-ary and duodenal self-expandable Metal Stent placement is necessary to palliate their symptoms, but it was difficult to cross two Metal Stents. Recently, endoscopic ultrasonogra-phy-guided choledochoduodenostomy (EUS-CDS) was report-ed to be effective for patients with an inaccessible papilla. We report two cases of pancreatic cancer with both biliary and duodenal obstructions treated successfully with simul-taneous duodenal Metal Stent placement and EUS-CDS. The first case was a 74-year-old man with pancreatic cancer. Duodenoscopy revealed that papilla had been invaded with tumor and duodenography showed severe stenosis in the horizontal portion. After a duodenal uncovered Metal Stent was placed across the duodenal stricture, EUS-CDS was per-formed. The second case was a 63-year-old man who previ-ously had a covered Metal Stent placed for malignant biliary obstruction. After removing the previously placed Metal Stent, EUS-CDS was performed. Then, a duodenal covered Metal Stent was placed across the duodenal stenosis. Both patients could tolerate a regular diet and did not suffer from Stent occlusion. EUS-CDS combined with duodenal Metal Stent placement may be an ideal treatment strategy in pa-tients with pancreatic cancer with both duodenal and biliary malignant obstruction. (Gut Liver 2012;6:399-402) Key Words: Endoscopic ultrasonography-guided choledocho-duodenostomy; Duodenal Stent; Malignant biliary obstructio
-
a japanese prospective multicenter study of self expandable Metal Stent placement for malignant colorectal obstruction short term safety and efficacy within 7 days of Stent procedure in 513 cases
Gastrointestinal Endoscopy, 2015Co-Authors: Takeaki Matsuzawa, Hiroyuki Isayama, Hideyuki Ishida, Shuntaro Yoshida, Toshio Kuwai, Iruru Maetani, Mamoru Shimada, Tomonori Yamada, Shuji Saito, Masafumi TomitaAbstract:Background Endoscopic self-expandable Metal Stent placement has been used as an alternative to surgery for malignant colorectal obstruction; however, factors affecting its clinical outcome are unclear. Objective To clarify the short-term safety and efficacy of endoscopic self-expandable Metal Stent placement for malignant colorectal obstruction and to identify factors associated with its clinical and technical failure. Design Prospective clinical cohort study. Setting Fourteen academic centers and 32 community hospitals. Patients A total of 513 consecutive patients with malignant colorectal obstruction. Intervention Endoscopic self-expandable Metal Stent placement, sharing of Stent placement methods among participating facilities. Main Outcome Measurements The primary endpoint was clinical success, defined as symptom and radiological finding resolution within 24 hours. Secondary endpoints were technical success and adverse events. The follow-up period was 7 days. Results The clinical and technical success rates were 95.5% and 97.9%, respectively. Major adverse events included perforation (2.1%), Stent migration (1.0%), and Stent occlusion (0.8%). The main causes of perforation were the procedure itself (0.8%) and comorbidities (obstructive colitis and impending perforation) not apparent before Stent placement (0.6%). Extrinsic tumor origin was independently associated with the clinical failure after Stent placement (odds ratio 4.23; 95% confidence interval, 1.21-14.79; P = .02). Stricture marking trended toward a negative association with technical failure ( P = .09). Limitations Noncomparative study. Conclusion Strict inclusion criteria and stricture marking may improve the technical and clinical success of Stent placement.
Yousuke Nakai - One of the best experts on this subject based on the ideXlab platform.
-
Antireflux Metal Stent for biliary obstruction: Any benefits?
Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society, 2020Co-Authors: Tsuyoshi Hamada, Hiroyuki Isayama, Yousuke Nakai, Kazuhiko KoikeAbstract:Endoscopic retrograde cholangiopancreatography with Stent placement has been utilized as standard palliative management of distal malignant biliary obstruction (MBO). Compared to plastic Stents, Metal Stents can provide longer-term relief of symptoms. When a large-bore Metal Stent is placed across the ampulla, patients are predisposed to the risk of cholangitis or Stent dysfunction due to reflux of duodenal contents. To mitigate the risk of adverse events associated with the duodenobiliary reflux, efforts have been directed to development of antireflux Metal Stents (ARMSs). The antireflux property has been introduced through adding of an antireflux valve to the duodenal Stent end. Evidence from clinical studies indicates that ARMSs may not only reduce the risk of ascending cholangitis during follow-up but also prolong Stent patency time. However, the results of clinical studies testing ARMSs are inconsiStent owing to heterogeneous designs of antireflux valves and Stent bodies. Metal Stents are increasingly indicated for benign biliary strictures and MBO in the setting of neoadjuvant chemotherapy, and therefore, research is warranted to evaluate ARMSs for those indications. Given that endoscopic ultrasound (EUS)-guided transmural biliary drainage has gained popularity, the optimal timing of placing an ARMS in relation to EUS-guided and percutaneous drainage should be investigated. Development and evaluation of ARMSs require an integrative approach utilizing phantom and animal models, measurements of Stent mechanical properties, and in vivo functional study after Stent placement. In this review article, we summarize updated evidence on ARMSs for MBO and discuss issues that should be addressed in future studies.
-
Retrospective Comparative Study of Side-by-Side and Stent-in-Stent Metal Stent Placement for Hilar Malignant Biliary Obstruction
Digestive Diseases and Sciences, 2020Co-Authors: Kazunaga Ishigaki, Hiroyuki Isayama, Yousuke Nakai, Tsuyoshi Hamada, Naminatsu Takahara, Tatsuya Sato, Ryunosuke Hakuta, Kei Saito, Tomotaka Saito, Suguru MizunoAbstract:Background In patients with unresectable hilar malignant biliary obstruction (MBO), bilateral Metal Stent placement is recommended. However, treatment selection between partially Stent-in-Stent (SIS) and side-by-side (SBS) methods is still controversial. Study Clinical outcomes of bilateral Metal Stent placement by SBS and SIS methods for hilar MBO were retrospectively studied in four Japanese centers. While large-cell-type uncovered Metal Stents were placed above the papilla in SIS, braided-type uncovered Metal Stents were placed across the papilla in SBS. Results A total of 64 patients with hilar MBO (40 SIS and 24 SBS) were included in the analysis. Technical success rate was 100% in SIS and 96% in SBS. Functional success rate was 93% in SIS and 96% in SBS. Early adverse event rates were higher in SBS (46%) than in SIS (23%), though not statistically significant ( P = 0.09). Post-procedure pancreatitis was exclusively observed in SBS group (29%). Recurrent biliary obstruction rates were 48% and 43%, and the median time to recurrent biliary obstruction was 169 and 205 days in SIS and SBS, respectively. Conclusions Other than a trend to higher adverse event rates including post-procedure pancreatitis in SBS, clinical outcomes of SIS and SBS methods were comparable in patients with unresectable hilar MBO.
-
Antireflux Metal Stent as a First-Line Metal Stent for Distal Malignant Biliary Obstruction: A Pilot Study.
Gut and liver, 2017Co-Authors: Tsuyoshi Hamada, Hiroyuki Isayama, Yousuke Nakai, Osamu Togawa, Naminatsu Takahara, Rie Uchino, Suguru Mizuno, Dai Mohri, Hiroshi Yagioka, Hirofumi KogureAbstract:Background/Aims In distal malignant biliary obstruction, an antireflux Metal Stent (ARMS) with a funnel-shaped valve is effective as a reintervention for Metal Stent occlusion caused by reflux. This study sought to evaluate the feasibility of this ARMS as a first-line Metal Stent. Methods Patients with nonresectable distal malignant biliary obstruction were identified between April and December 2014 at three Japanese tertiary centers. We retrospectively evaluated recurrent biliary obstruction and adverse events after ARMS placement. Results In total, 20 consecutive patients were included. The most common cause of biliary obstruction was pancreatic cancer (75%). Overall, recurrent biliary obstruction was observed in seven patients (35%), with a median time to recurrent biliary obstruction of 246 days (range, 11 to 246 days). Stent occlusion occurred in five patients (25%), the causes of which were sludge and food impaction in three and two patients, respectively. Stent migration occurred in two patients (10%). The rate of adverse events associated with ARMS was 25%: pancreatitis occurred in three patients, cholecystitis in one and liver abscess in one. No patients experienced nonocclusion cholangitis. Conclusions The ARMS as a first-line biliary drainage procedure was feasible. Because the ARMS did not fully prevent Stent dysfunction due to reflux, further investigation is warranted.
-
Simultaneous Duodenal Metal Stent Placement and EUS-Guided Choledochoduodenostomy for Unresectable Pancreatic Cancer
2016Co-Authors: Kazumichi Kawakubo, Hiroyuki Isayama, Yousuke Nakai, Naoki Sasahira, Hirofumi Kogure, Takashi Sasaki, Kenji Hirano, Minoru Tada, Kazuhiko KoikeAbstract:Patients with pancreatic cancer frequently suffer from both biliary and duodenal obstruction. For such patients, both bili-ary and duodenal self-expandable Metal Stent placement is necessary to palliate their symptoms, but it was difficult to cross two Metal Stents. Recently, endoscopic ultrasonogra-phy-guided choledochoduodenostomy (EUS-CDS) was report-ed to be effective for patients with an inaccessible papilla. We report two cases of pancreatic cancer with both biliary and duodenal obstructions treated successfully with simul-taneous duodenal Metal Stent placement and EUS-CDS. The first case was a 74-year-old man with pancreatic cancer. Duodenoscopy revealed that papilla had been invaded with tumor and duodenography showed severe stenosis in the horizontal portion. After a duodenal uncovered Metal Stent was placed across the duodenal stricture, EUS-CDS was per-formed. The second case was a 63-year-old man who previ-ously had a covered Metal Stent placed for malignant biliary obstruction. After removing the previously placed Metal Stent, EUS-CDS was performed. Then, a duodenal covered Metal Stent was placed across the duodenal stenosis. Both patients could tolerate a regular diet and did not suffer from Stent occlusion. EUS-CDS combined with duodenal Metal Stent placement may be an ideal treatment strategy in pa-tients with pancreatic cancer with both duodenal and biliary malignant obstruction. (Gut Liver 2012;6:399-402) Key Words: Endoscopic ultrasonography-guided choledocho-duodenostomy; Duodenal Stent; Malignant biliary obstructio
-
simultaneous duodenal Metal Stent placement and eus guided choledochoduodenostomy for unresectable pancreatic cancer
Gut and Liver, 2012Co-Authors: Kazumichi Kawakubo, Hiroyuki Isayama, Yousuke Nakai, Naoki Sasahira, Hirofumi Kogure, Takashi Sasaki, Kenji Hirano, Minoru Tada, Kazuhiko KoikeAbstract:Patients with pancreatic cancer frequently suffer from both biliary and duodenal obstruction. For such patients, both biliary and duodenal self-expandable Metal Stent placement is necessary to palliate their symptoms, but it was difficult to cross two Metal Stents. Recently, endoscopic ultrasonography-guided choledochoduodenostomy (EUS-CDS) was reported to be effective for patients with an inaccessible papilla. We report two cases of pancreatic cancer with both biliary and duodenal obstructions treated successfully with simultaneous duodenal Metal Stent placement and EUS-CDS. The first case was a 74-year-old man with pancreatic cancer. Duodenoscopy revealed that papilla had been invaded with tumor and duodenography showed severe stenosis in the horizontal portion. After a duodenal uncovered Metal Stent was placed across the duodenal stricture, EUS-CDS was performed. The second case was a 63-year-old man who previously had a covered Metal Stent placed for malignant biliary obstruction. After removing the previously placed Metal Stent, EUS-CDS was performed. Then, a duodenal covered Metal Stent was placed across the duodenal stenosis. Both patients could tolerate a regular diet and did not suffer from Stent occlusion. EUS-CDS combined with duodenal Metal Stent placement may be an ideal treatment strategy in patients with pancreatic cancer with both duodenal and biliary malignant obstruction.
Kazumichi Kawakubo - One of the best experts on this subject based on the ideXlab platform.
-
Simultaneous Duodenal Metal Stent Placement and EUS-Guided Choledochoduodenostomy for Unresectable Pancreatic Cancer
2016Co-Authors: Kazumichi Kawakubo, Hiroyuki Isayama, Yousuke Nakai, Naoki Sasahira, Hirofumi Kogure, Takashi Sasaki, Kenji Hirano, Minoru Tada, Kazuhiko KoikeAbstract:Patients with pancreatic cancer frequently suffer from both biliary and duodenal obstruction. For such patients, both bili-ary and duodenal self-expandable Metal Stent placement is necessary to palliate their symptoms, but it was difficult to cross two Metal Stents. Recently, endoscopic ultrasonogra-phy-guided choledochoduodenostomy (EUS-CDS) was report-ed to be effective for patients with an inaccessible papilla. We report two cases of pancreatic cancer with both biliary and duodenal obstructions treated successfully with simul-taneous duodenal Metal Stent placement and EUS-CDS. The first case was a 74-year-old man with pancreatic cancer. Duodenoscopy revealed that papilla had been invaded with tumor and duodenography showed severe stenosis in the horizontal portion. After a duodenal uncovered Metal Stent was placed across the duodenal stricture, EUS-CDS was per-formed. The second case was a 63-year-old man who previ-ously had a covered Metal Stent placed for malignant biliary obstruction. After removing the previously placed Metal Stent, EUS-CDS was performed. Then, a duodenal covered Metal Stent was placed across the duodenal stenosis. Both patients could tolerate a regular diet and did not suffer from Stent occlusion. EUS-CDS combined with duodenal Metal Stent placement may be an ideal treatment strategy in pa-tients with pancreatic cancer with both duodenal and biliary malignant obstruction. (Gut Liver 2012;6:399-402) Key Words: Endoscopic ultrasonography-guided choledocho-duodenostomy; Duodenal Stent; Malignant biliary obstructio
-
simultaneous duodenal Metal Stent placement and eus guided choledochoduodenostomy for unresectable pancreatic cancer
Gut and Liver, 2012Co-Authors: Kazumichi Kawakubo, Hiroyuki Isayama, Yousuke Nakai, Naoki Sasahira, Hirofumi Kogure, Takashi Sasaki, Kenji Hirano, Minoru Tada, Kazuhiko KoikeAbstract:Patients with pancreatic cancer frequently suffer from both biliary and duodenal obstruction. For such patients, both biliary and duodenal self-expandable Metal Stent placement is necessary to palliate their symptoms, but it was difficult to cross two Metal Stents. Recently, endoscopic ultrasonography-guided choledochoduodenostomy (EUS-CDS) was reported to be effective for patients with an inaccessible papilla. We report two cases of pancreatic cancer with both biliary and duodenal obstructions treated successfully with simultaneous duodenal Metal Stent placement and EUS-CDS. The first case was a 74-year-old man with pancreatic cancer. Duodenoscopy revealed that papilla had been invaded with tumor and duodenography showed severe stenosis in the horizontal portion. After a duodenal uncovered Metal Stent was placed across the duodenal stricture, EUS-CDS was performed. The second case was a 63-year-old man who previously had a covered Metal Stent placed for malignant biliary obstruction. After removing the previously placed Metal Stent, EUS-CDS was performed. Then, a duodenal covered Metal Stent was placed across the duodenal stenosis. Both patients could tolerate a regular diet and did not suffer from Stent occlusion. EUS-CDS combined with duodenal Metal Stent placement may be an ideal treatment strategy in patients with pancreatic cancer with both duodenal and biliary malignant obstruction.
-
risk factors for pancreatitis following transpapillary self expandable Metal Stent placement
Surgical Endoscopy and Other Interventional Techniques, 2012Co-Authors: Kazumichi Kawakubo, Hiroyuki Isayama, Yousuke Nakai, Naoki Sasahira, Hirofumi Kogure, Takashi Sasaki, Osamu Togawa, Saburo Matsubara, Natsuyo Yamamoto, Kenji HiranoAbstract:Background Pancreatitis is one of complications after self-expandable Metal Stent (SEMS) placement. The purpose of this study was to evaluate risk factors for pancreatitis after endoscopic SEMS placement for malignant biliary obstruction (MBO).
Kenji Hirano - One of the best experts on this subject based on the ideXlab platform.
-
Simultaneous Duodenal Metal Stent Placement and EUS-Guided Choledochoduodenostomy for Unresectable Pancreatic Cancer
2016Co-Authors: Kazumichi Kawakubo, Hiroyuki Isayama, Yousuke Nakai, Naoki Sasahira, Hirofumi Kogure, Takashi Sasaki, Kenji Hirano, Minoru Tada, Kazuhiko KoikeAbstract:Patients with pancreatic cancer frequently suffer from both biliary and duodenal obstruction. For such patients, both bili-ary and duodenal self-expandable Metal Stent placement is necessary to palliate their symptoms, but it was difficult to cross two Metal Stents. Recently, endoscopic ultrasonogra-phy-guided choledochoduodenostomy (EUS-CDS) was report-ed to be effective for patients with an inaccessible papilla. We report two cases of pancreatic cancer with both biliary and duodenal obstructions treated successfully with simul-taneous duodenal Metal Stent placement and EUS-CDS. The first case was a 74-year-old man with pancreatic cancer. Duodenoscopy revealed that papilla had been invaded with tumor and duodenography showed severe stenosis in the horizontal portion. After a duodenal uncovered Metal Stent was placed across the duodenal stricture, EUS-CDS was per-formed. The second case was a 63-year-old man who previ-ously had a covered Metal Stent placed for malignant biliary obstruction. After removing the previously placed Metal Stent, EUS-CDS was performed. Then, a duodenal covered Metal Stent was placed across the duodenal stenosis. Both patients could tolerate a regular diet and did not suffer from Stent occlusion. EUS-CDS combined with duodenal Metal Stent placement may be an ideal treatment strategy in pa-tients with pancreatic cancer with both duodenal and biliary malignant obstruction. (Gut Liver 2012;6:399-402) Key Words: Endoscopic ultrasonography-guided choledocho-duodenostomy; Duodenal Stent; Malignant biliary obstructio
-
simultaneous duodenal Metal Stent placement and eus guided choledochoduodenostomy for unresectable pancreatic cancer
Gut and Liver, 2012Co-Authors: Kazumichi Kawakubo, Hiroyuki Isayama, Yousuke Nakai, Naoki Sasahira, Hirofumi Kogure, Takashi Sasaki, Kenji Hirano, Minoru Tada, Kazuhiko KoikeAbstract:Patients with pancreatic cancer frequently suffer from both biliary and duodenal obstruction. For such patients, both biliary and duodenal self-expandable Metal Stent placement is necessary to palliate their symptoms, but it was difficult to cross two Metal Stents. Recently, endoscopic ultrasonography-guided choledochoduodenostomy (EUS-CDS) was reported to be effective for patients with an inaccessible papilla. We report two cases of pancreatic cancer with both biliary and duodenal obstructions treated successfully with simultaneous duodenal Metal Stent placement and EUS-CDS. The first case was a 74-year-old man with pancreatic cancer. Duodenoscopy revealed that papilla had been invaded with tumor and duodenography showed severe stenosis in the horizontal portion. After a duodenal uncovered Metal Stent was placed across the duodenal stricture, EUS-CDS was performed. The second case was a 63-year-old man who previously had a covered Metal Stent placed for malignant biliary obstruction. After removing the previously placed Metal Stent, EUS-CDS was performed. Then, a duodenal covered Metal Stent was placed across the duodenal stenosis. Both patients could tolerate a regular diet and did not suffer from Stent occlusion. EUS-CDS combined with duodenal Metal Stent placement may be an ideal treatment strategy in patients with pancreatic cancer with both duodenal and biliary malignant obstruction.
-
risk factors for pancreatitis following transpapillary self expandable Metal Stent placement
Surgical Endoscopy and Other Interventional Techniques, 2012Co-Authors: Kazumichi Kawakubo, Hiroyuki Isayama, Yousuke Nakai, Naoki Sasahira, Hirofumi Kogure, Takashi Sasaki, Osamu Togawa, Saburo Matsubara, Natsuyo Yamamoto, Kenji HiranoAbstract:Background Pancreatitis is one of complications after self-expandable Metal Stent (SEMS) placement. The purpose of this study was to evaluate risk factors for pancreatitis after endoscopic SEMS placement for malignant biliary obstruction (MBO).
Kazuhide Higuchi - One of the best experts on this subject based on the ideXlab platform.
-
comparison study between double bare covered and fully covered Metal Stent during endoscopic ultrasound guided choledochoduodenostomy with video
Digestive Diseases, 2020Co-Authors: Takeshi Ogura, Nobu Nishioka, Masanori Yamada, Tadahiro Yamada, Kazuhide HiguchiAbstract:BACKGROUND Endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) is a common technique for biliary drainage. However, EUS-CDS is associated with adverse events such as cystic duct obstruction, Stent dislocation, and Stent kinking caused by powerful axial force. A novel double-bare, covered self-expandable Metal Stent (DBSEMS) has recently become available in Japan. This pilot study evaluated the clinical outcomes of EUS-CDS using DBSEMS. METHOD We retrospectively enrolled patients with malignant lower bile duct obstruction who underwent EUS-CDS due to failed ERCP. EUS-CDS procedures performed between April 2017 and March 2018 used a conventional fully covered self-expandable Metal Stent (FCSEMS), and those performed between April 2018 and April 2019 used DBSEMS. In all Stents, diameter was 10mm and length was 6cm. RESULTS A total 22 patients underwent EUS-CDS, performed using conventional FCSEMS (n=12) and DBSEMS (n=10). Four complications occurred with FCSEMS: cholangitis due to kinking (n=3) and Stent dislocation (n=1). With DBSEMS, there were no instances of kinking, and reflux cholangitis that developed in one patient due to duodenal obstruction was resolved by duodenal Stenting. Elapsed time to recurrent biliary obstruction was longer with DBSEMS than FCSEMS (200 vs. 99 days), although the difference was not significant (P = 0.06). CONCLUSION DBSEMS can help prevent cholangitis due to Stent kinking after EUS-CDS, thus increasing Stent patency.
-
Novel transluminal treatment protocol for hepaticojejunostomy stricture using covered self-expandable Metal Stent
Surgical Endoscopy, 2020Co-Authors: Takeshi Ogura, Nobu Nishioka, Masanori Yamada, Tadahiro Yamada, Saori Ueno, Jyun Matsuno, Kazuya Ueshima, Yoshitaro Yamamoto, Atsushi Okuda, Kazuhide HiguchiAbstract:Background Hepaticojejunostomy anastomotic stricture (HJS) is a rare complication after pancreatoduodenostomy. However, the rate of HJS may be increased with the expansion of operative indications, such as intraductal papillary mucinous neoplasm. Recently, the indications for EUS-guided biliary drainage to treat benign biliary disease have expanded. Recently, novel transluminal treatment protocol has been established in our hospital. The aim of this study was thus to evaluate the technical feasibility and safety of our treatment protocol. Patients and method Consecutive patients with complications of HJS between January and December 2018 were enrolled in this study. EUS-guided hepaticogastrostomy (HGS) is firstly performed. After 7 days to create the fistula, HGS Stent is removed. HJS is transluminally evaluated by a cholangioscope, and antegrade balloon dilation is attempted. After 3 months, if HJS is still presence, antegrade Stent deployment is performed using a covered Metal Stent. Also, after 1 month, antegrade Stent removal is transluminally performed. Results Among total 29 patients, 14 patients were underwent antegrade Metal Stent deployment. The technical success rate of antegrade Stent deployment was 92.9%. Median period of Stent placement was 30.5 days (range 28–38 days), and transluminal Stent removal was successfully performed in all patients. During follow-up (median 278 days; range 171–505 days), recurrence of HJS was seen in 2 patients. Severe adverse events were not seen in any patients during follow-up period. Conclusion Transluminal Stent deployment for HJS under EUS-guidance appears feasible and safe, although further study with a larger sample size and longer follow-up is warranted.