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INTRODUCTION: Aggressive hydration using lactated Ringer's solution prevents postendoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). Concerns of this strategy are large volume and lengthy hydration. Our study aimed to evaluate the efficacy of tailored aggressive hydration (TAH) for PEP prevention. METHODS: In this prospective, multicenter, double-blinded, randomized trial conducted across 3 tertiary Korean hospitals, patients who underwent ERCP for the first time were randomly assigned (1:1) to the tailored standard hydration (TSH) and TAH groups. The TSH group received 1.5 mL/kg/hr lactated Ringer's solution during and after ERCP, whereas the TAH group was administered a 20 mL/kg bolus post-ERCP and 3 mL/kg/hr during and after the procedure. Both groups were assessed for elevated serum amylase levels and pain 4-6 hours after ERCP. If both were absent, hydration was discontinued. If either was present, hydration was continued at the original rate until 8 hours. The primary end point was PEP development and was analyzed on an intention-to-treat analysis. RESULTS: A total of 344 patients were randomly assigned to treatment groups (171 to the TSH group and 172 to the TAH group). PEP was observed in 9.4% (16/171) in the TSH group and 3.5% (6/172) in the TAH group (relative risk 0.37, 95% confidence interval 0.15-0.93, P = 0.03). No difference was identified between the 2 groups in PEP severity ( P = 0.80) and complications related to volume overload ( P = 0.32). DISCUSSION: TAH according to the presence of abdominal pain or elevated serum amylase levels at 4-6 hours after ERCP is safe and prevents PEP development.
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BACKGROUND: Pancreatic neuroendocrine neoplasms (PNENs) show heterogeneous biological behavior, and most small PNENs show indolent features. Consequently, selected cases can be considered for observation only, according to the National Comprehensive Cancer Network guideline, however, supporting clinical evidence is lacking. We investigated the clinical course of small PNENs and their risk factors for malignant potential. METHODS: A total of 158 patients with small pathologically confirmed PNENs ≤2 cm in initial imaging were retrospectively enrolled from 14 institutions. The primary outcome was any metastasis or recurrence event during follow-up. RESULTS: The median age was 57 years (range, 22-82 years), and 86 patients (54%) were female. The median tumor size at initial diagnosis was 13 mm (range, 7-20 mm). PNENs were pathologically confirmed by surgery in 137 patients and by EUS-guided fine needle aspiration biopsy (EUS-FNAB) in 21 patients. Eight patients underwent EUS-FNAB followed by surgical resection. The results of WHO grade were available in 150 patients, and revealed 123 grade 1, 25 grade 2, and 2 neuroendocrine carcinomas. A total of 145 patients (92%) underwent surgical resection, and three patients had regional lymph node metastasis. During the entire follow-up of median 45.6 months, 11 metastases or recurrences (7%) occurred. WHO grade 2 (HR 13.97, 95% CI 2.60-75.03, p = 0.002) was the only predictive factor for malignant potential in multivariable analysis. CONCLUSIONS: WHO grade is responsible for the malignant potential of small PNENs ≤2 cm. Thus, EUS-FNAB could be recommended in order to provide early treatment strategies of small PNENs.
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Tumores Neuroendócrinos/epidemiologia , Tumores Neuroendócrinos/patologia , Neoplasias Pancreáticas/epidemiologia , Neoplasias Pancreáticas/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha Fina , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Tumores Neuroendócrinos/cirurgia , Pancreatectomia , Neoplasias Pancreáticas/cirurgia , Intervalo Livre de Progressão , República da Coreia/epidemiologia , Inquéritos e Questionários , Adulto JovemRESUMO
BACKGROUND: Endoscopic transpapillary gallbladder stenting (ETGBS) has been used as an alternative to percutaneous cholecystostomy in patients with acute cholecystitis who are considered unfit for surgery. However, there are few data on the efficacy and safety of ETGBS replacement of percutaneous cholecystostomy in high-risk surgical patients. This study aimed to evaluate the feasibility, efficacy, and safety of ETGBS to replace percutaneous cholecystostomy in high-risk surgical patients. METHODS: This single center retrospective study reviewed the data of patients who attempted ETGBS to replace percutaneous cholecystostomy between January 2017 and September 2019. The technical success, clinical success, adverse events, and stent patency were evaluated. RESULTS: ETGBS was performed in 43 patients (24 male, mean age 80.7 ± 7.4 years) to replace percutaneous cholecystostomy due to high surgical risk. The technical success rate and clinical success rate were 97.7% (42/43) and 90.5% (38/42), respectively. Procedure-related adverse events and stent-related late adverse events occurred in 7.0% (3/43) and 11.6% (5/43), respectively. Of the patients who successfully underwent ETGBS (n = 42), only one had recurrent acute cholecystitis during follow-up. The median stent patency was 415 days (interquartile range 240-528 days). CONCLUSIONS: ETGBS, as a secondary intervention for the purpose of internalizing gallbladder drainage in patients following placement of a percutaneous cholecystostomy, is safe, effective, and technically feasible. Thus, conversion of percutaneous cholecystostomy to ETGBS may be considered as a viable option in high-risk surgical patients.
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Colecistite Aguda , Colecistostomia , Idoso , Idoso de 80 Anos ou mais , Colecistite Aguda/diagnóstico por imagem , Colecistite Aguda/cirurgia , Colecistostomia/efeitos adversos , Drenagem/efeitos adversos , Vesícula Biliar/diagnóstico por imagem , Vesícula Biliar/cirurgia , Humanos , Masculino , Estudos Retrospectivos , Stents , Resultado do TratamentoAssuntos
Neoplasias dos Ductos Biliares , Colangiocarcinoma , Colangite Esclerosante , Tumor de Klatskin , Humanos , Tumor de Klatskin/diagnóstico por imagem , Tumor de Klatskin/patologia , Colangite Esclerosante/diagnóstico , Colangite Esclerosante/patologia , Imunoglobulina G , Vesícula Biliar/patologia , Colangiocarcinoma/diagnóstico , Colangiocarcinoma/patologia , Neoplasias dos Ductos Biliares/diagnóstico por imagem , Neoplasias dos Ductos Biliares/patologia , Ductos Biliares Intra-Hepáticos/patologia , Diagnóstico DiferencialRESUMO
BACKGROUND: The incidence of post-endoscopic sphincterotomy (ES) bleeding is reportedly 2.0-5.0 %. Among various hemostatic methods, endoclip therapy is an effective modality in gastrointestinal bleeding. However, endoclip application for post-ES hemorrhage has not been widely studied, partly because of the difficulty in placing of clips using a duodenoscope. A cap-fitted forward-viewing gastroscope can easily visualize the major papilla and overcome the technical difficulty in applying endoclips. We aimed to determine the efficacy and safety of endoclips for the treatment of post-ES hemorrhage using a cap-fitted forward-viewing gastroscope. METHODS: From January 2011 to December 2015, a total of 1448 endoscopic retrograde cholangiopancreatography procedures with ES were retrospectively assessed and followed-up. Patients with post-ES hemorrhage who did not respond to balloon compression or to spray or injection of a diluted epinephrine solution at the bleeding focus underwent endoclip therapy using a cap-fitted forward-viewing gastroscope. Bleeding patterns (oozing, pulsatile, and exposed vessel) were recorded. RESULTS: ES-induced uncontrolled hemorrhage occurred in 57 patients (3.93 %). The mean age was 68.9 ± 14.5 years, and the sex ratio (male/female) was 37 (64.9 %):20 (35.1 %) in 57 patients. Of the 57 cases of hemorrhage, early uncontrolled and delayed hemorrhage occurred in 45 (3.1 %) and 12 (0.82 %), respectively. Visible bleeding patterns following ES were: 50 oozing (57.7 %), 6 pulsatile (10.5 %), and 1 exposed vessel (1.8 %). Hemostasis was achieved by endoclipping using a cap-fitted forward-viewing gastroscope in 57 of 57 patients (100 %). The median number of clips used was 1.8 (range 1-3). No evidence of further bleeding or procedure-related complications was seen. CONCLUSIONS: We concluded that endoclip application using a cap-fitted forward-viewing gastroscope is feasible and safe and may be an effective technique for the treatment and/or prevention of post-ES hemorrhage.
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Hemorragia Gastrointestinal/terapia , Gastroscópios , Hemostase Endoscópica/instrumentação , Hemorragia Pós-Operatória/terapia , Esfinterotomia Endoscópica/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Colangiopancreatografia Retrógrada Endoscópica , Feminino , Seguimentos , Hemorragia Gastrointestinal/etiologia , Hemostase Endoscópica/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do TratamentoRESUMO
With the introduction of endoscopic retrograde cholangiopancreatography and linear endoscopic ultrasound, interventional pancreaticobiliary (PB) endoscopy has had an enormous impact in the management of pancreatic and biliary diseases. Continuous efforts to improve various devices and techniques have revolutionized these treatment modalities as viable alternatives to surgery. In recent years, trends toward combining endoscopic techniques with other modalities, such as laparoscopic and radiological interventions, for complex PB diseases have emerged using a multidisciplinary approach. Ongoing research and clinical experience will lead to refinements in interventional PB endoscopic techniques and subsequently improve outcomes and reduce complication rates.
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Doenças Biliares , Colangiopancreatografia Retrógrada Endoscópica , Endossonografia , Pancreatopatias , Humanos , Colangiopancreatografia Retrógrada Endoscópica/métodos , Pancreatopatias/cirurgia , Pancreatopatias/diagnóstico por imagem , Doenças Biliares/cirurgia , Doenças Biliares/diagnóstico por imagem , Endossonografia/métodos , História do Século XX , História do Século XXI , Endoscopia do Sistema Digestório/métodos , Endoscopia do Sistema Digestório/instrumentaçãoRESUMO
Background/Aims: There are no consensus guidelines for patients with acute cholecystitis undergoing percutaneous cholecystostomy who are unfit for interval cholecystectomy. The current study aimed to compare the clinical outcomes of endoscopic gallbladder drainage, i.e. conversion from percutaneous cholecystostomy (including endoscopic transpapillary gallbladder stenting and endoscopic ultrasound-guided gallbladder drainage), and conservative treatment after percutaneous cholecystostomy tube removal. Methods: This retrospective review included patients who underwent percutaneous cholecystostomy for acute cholecystitis between January 2017 and December 2020. Consecutive patients who underwent endoscopic gallbladder drainage or percutaneous cholecystostomy tube removal without interval cholecystectomy were included. Outcome measures included recurrent acute cholecystitis and unplanned readmission due to gallstone-related diseases. Results: During the study period, 238 patients were selected (63 underwent endoscopic gallbladder drainage conversion and 175 underwent conservative treatment). Patients who underwent endoscopic gallbladder drainage conversion had lower rates of recurrent acute cholecystitis (3 [4.76%] vs 31 [17.71%], p=0.012) and unplanned readmission due to gallstone-related diseases (6 [9.52%] vs 40 [22.86%], p=0.022) than those who underwent conservative treatment following percutaneous cholecystostomy tube removal. In the univariate and multivariate analyses, calculus cholecystitis (odds ratio, 13.75; 95% confidence interval, 1.83 to 102.83; p=0.011) and conversion of endoscopic gallbladder drainage (odds ratio, 0.23; 95% confidence interval, 0.06 to 0.78; p=0.019) were significant predictive factors for recurrent acute cholecystitis. Conclusions: Endoscopic gallbladder drainage conversion led to more favorable outcomes than conservative treatment after percutaneous cholecystostomy tube removal. Therefore, endoscopic gallbladder drainage conversion may be considered a promising treatment option for patients undergoing percutaneous cholecystostomy who are at a high surgical risk.
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Colecistite Aguda , Colecistostomia , Cálculos Biliares , Humanos , Vesícula Biliar/cirurgia , Colecistostomia/efeitos adversos , Tratamento Conservador , Cálculos Biliares/cirurgia , Drenagem/efeitos adversos , Colecistite Aguda/cirurgia , Colecistite Aguda/etiologia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Since its development, the use of endoscopic ultrasonography (EUS) in the pancreas and the biliary tract has become increasingly important. The accuracy of EUS varies depending on the experience of the endoscopist. Hence, quality control measures using appropriate indicators are required to reduce these variations. American Society for Gastrointestinal Endoscopy and European Society of Gastrointestinal Endoscopy have announced the EUS quality indicators. Here, we reviewed the quality indicators of the EUS procedure in the current published guidelines.
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Early pancreatic cancer diagnosis is crucial for timely intervention and better outcomes. The coronavirus disease 2019 (COVID-19) pandemic has disrupted routine health care globally. The COVID-19 pandemic has disrupted routine health care globally. This study aimed to evaluate the impact of COVID-19 on the diagnosis and treatment of pancreatic cancer. This retrospective study compared pancreatic cancer patients from 2 tertiary hospitals in pre and COVID-19 periods. Pre-COVID-19 period spanned from January 1, 2018, to January 19, 2020, while the COVID-19 period extended from January 20, 2020, to December 31, 2021. Results: A total of 542 patients were included. In the pre-COVID-19 period, 280 new cases of pancreatic cancer were enrolled, compared to 262 during COVID-19. The annual incidence rates were 136.63 and 134.50 patients, respectively. The median age was significantly lower during COVID-19 (71.5 years) compared to pre-COVID-19 (77 years) (P < .001). In subgroup analyses for stage 3 and 4, the proportion of stage 4 pancreatic cancer increased during COVID-19 (χ2 = 5.53, P = .019), and the COVID-19 group had younger diagnoses, better performance status, more surgery, higher use of FOLFIRINOX chemotherapy, fewer hospital referrals, and better median overall survival compared to the pre-COVID-19 group. This study revealed changes in the characteristics and treatment of patients diagnosed with pancreatic cancer during the COVID-19 pandemic. Although further large-scale research is necessary, the findings of this study can function as foundational data for formulating policies for the management of patients with pancreatic cancer during future pandemics of other infectious diseases.
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COVID-19 , Neoplasias Pancreáticas , Humanos , Neoplasias Pancreáticas/terapia , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/epidemiologia , COVID-19/epidemiologia , COVID-19/diagnóstico , COVID-19/terapia , Masculino , Feminino , Idoso , Estudos Retrospectivos , Pessoa de Meia-Idade , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , SARS-CoV-2 , Fluoruracila/uso terapêutico , Fluoruracila/administração & dosagem , Estadiamento de Neoplasias , Incidência , Irinotecano/uso terapêutico , Oxaliplatina/uso terapêutico , Idoso de 80 Anos ou mais , Leucovorina/uso terapêutico , Turquia/epidemiologiaRESUMO
This study retrospectively evaluated the outcomes of endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) using novel electrocautery-enhanced lumen-apposing metal stents (LAMS) in high-risk patients with acute cholecystitis (AC). Between January 1, 2021, and November 30, 2022, 58 high-risk surgical patients with AC underwent EUS-GBD with the novel electrocautery-enhanced LAMS. The technical success rate was 94.8% (55/58), with one case of duodenal perforation requiring surgery with complete stent migration and two of partial stent migration into the gallbladder. However, the clinical success rate was 100% (55/55). Recurrent AC occurred in 3.6% of the cases (2/55), managed with double pigtail plastic stents through the LAMS. Early AEs observed in 1.8% (1/55) due to stent obstruction. Late AEs occurred in 5.4% (3/55), including two cases of cholangitis and one of stent obstruction. For 33 patients followed over 6 months, LAMS maintenance was sustained in 30 cases. Two patients underwent double-pigtail plastic stent replacement after LAMS removal, and one underwent LAMS removal during surgery following tumor stage regression after chemotherapy for cholangiocarcinoma. The novel electrocautery-enhanced LAMS demonstrated high technical and clinical success rates in high-risk surgical patients with AC, maintaining effective gallbladder drainage with minimal AEs during long-term follow-up, thus highlighting its efficacy and safety in challenging patients.
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Drenagem , Eletrocoagulação , Endossonografia , Vesícula Biliar , Stents , Humanos , Masculino , Feminino , Drenagem/métodos , Idoso , Eletrocoagulação/métodos , Endossonografia/métodos , Pessoa de Meia-Idade , Estudos Retrospectivos , Vesícula Biliar/cirurgia , Idoso de 80 Anos ou mais , Resultado do Tratamento , Colecistite Aguda/cirurgia , AdultoRESUMO
Background: Endoscopic ultrasound-guided biliary drainage (EUS-BD), classified as choledochoduodenostomy (CDS) and hepaticogastrostomy (HGS), is a feasible and effective alternative for distal malignant biliary obstruction (MBO) in failed endoscopic retrograde cholangiopancreatography. However, the preferred technique for better outcomes has not yet been evaluated. Objectives: We compared the long-term outcomes between the techniques. Design: Retrospective comparative study. Methods: We reviewed consecutive patients who underwent EUS-CDS or EUS-HGS with transmural stent placement for distal MBO between 2009 and 2022. The primary outcome was the stent patency. The secondary outcomes were technical and clinical success, adverse events (AEs) of each technique, and independent risk factors for stent dysfunction. Results: In all, 115 patients were divided into EUS-CDS (n = 56) and EUS-HGS (n = 59) groups. Among them, technical success was achieved in 98.2% of EUS-CDS and 96.6% of EUS-HGS groups. Furthermore, clinical success was 96.4% in EUS-CDS and 88.1% in EUS-HGS groups, without significant difference (p = 0.200). The mean duration of stent patency for EUS-CDS was 770.3 days while that for EUS-HGS was 164.9 days (p = 0.010). In addition, the only independent risk factor for stent dysfunction was systematic treatment after EUS-BD [hazard ratio and 95% confidence interval 0.238 (0.066-0.863), p = 0.029]. The incidence of stent dysfunction of EUS-HGS was higher than EUS-CDS (35.1% versus 18.2%, 0.071), despite no significant differences even in late AEs. Conclusion: In distal MBO, EUS-CDS may be better than EUS-HGS with longer stent patency and fewer AEs. Furthermore, systematic treatment after EUS-BD is recommended for the improvement of stent patency.
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Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure that requires significant experiences and skills and has various procedure-related complications, some of which can be severe and even result in the death of patients. Expanding ERCP availability has the advantage of increasing accessibility for patients. However, ERCP poses a substantial risk if performed without proper quality management. ERCP quality management is essential for both ensuring safe and successful procedures and meeting the social demands for enhanced healthcare competitiveness and quality assurance. To address these concerns, the Korean Pancreatobiliary Association established a task force to develop ERCP quality indicators (QIs) tailored to the Korean medical environment. Key questions for five pre-procedure, three intra-procedure, and four post-procedure measures were formulated based on a literature search related to ERCP QIs and a comprehensive clinical review conducted by experts. The statements and recommendations regarding each QI item were selected through peer review. The developed ERCP QIs were reviewed by external experts based on the latest available evidence at the time of development. These domestically tailored ERCP QIs are expected to contribute considerably to improving ERCP quality in Korea.
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Colangiopancreatografia Retrógrada Endoscópica , Indicadores de Qualidade em Assistência à Saúde , Colangiopancreatografia Retrógrada Endoscópica/normas , Colangiopancreatografia Retrógrada Endoscópica/métodos , Humanos , República da CoreiaRESUMO
Autoimmune pancreatitis (AIP) is a rare disease clinically characterized by obstructive jaundice, unintentional weight loss, acute pancreatitis, focal pancreatic mass, and diabetes. AIP is classified into two subtypes - type 1 and type 2 - according to pathological findings, clinical features, and serology test results, but some cases may be defined as type not otherwise in the absence of pathological findings and inflammatory bowel disease. To address the differences in diagnostic criteria by country, standard diagnostic criteria for AIP were proposed in 2011 by an international consensus of expert opinions. Differential diagnosis of AIP from pancreatic ductal adenocarcinoma is important but remains challenging for clinicians. Fortunately, all subtypes of AIP show dramatic response to steroid treatment. This review discusses the current perspectives on the diagnosis and management of AIP in clinical practice.
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Background/Aims: Most guidelines recommend surgical resection of all main duct (MD) and mixed-type (MT) intraductal papillary mucinous neoplasms (IPMNs) in suitable patients. However, there is little evidence regarding the malignancy risk of enhancing mural nodules (EMNs) that are present only in the main pancreatic duct (MPD) in patients with MD- and MT-IPMNs. Therefore, this study aimed to identify the clinical and morphological features associated with malignancy in MD- and MT-IPMNs with EMNs only in the MPD. Methods: We retrospectively enrolled 50 patients with MD- and MT-IPMNs with EMNs only in the MPD on contrast-enhanced magnetic resonance imaging. We evaluated the clinical characteristics and preoperative radiologic imaging results of MPD morphology and EMN size and analyzed the risk factors associated with malignancy. Results: Histological findings of EMNs were low-grade dysplasia (38%), malignant lesions (62%), high-grade dysplasia (34%), and invasive carcinoma (28%). On the receiver operating characteristic curve, the cutoff value of EMN size on magnetic resonance imaging for best predicting malignancy was 5 mm (sensitivity, 93.5%; specificity, 52.6%; area under the curve, 0.753). Multivariate analysis showed that only EMN >5 mm (odds ratio, 27.69; confidence interval, 2.75 to 278.73; p=0.050) was an independent risk factor for malignancy. Conclusions: EMNs of >5 mm are associated with malignancy in patients with MD- and MT-IPMNs with EMNs that are present only in the MPD, in accordance with the international consensus guidelines.
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Carcinoma Ductal Pancreático , Neoplasias Císticas, Mucinosas e Serosas , Neoplasias Pancreáticas , Humanos , Carcinoma Ductal Pancreático/diagnóstico por imagem , Carcinoma Ductal Pancreático/cirurgia , Carcinoma Ductal Pancreático/patologia , Estudos Retrospectivos , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/cirurgia , Neoplasias Pancreáticas/patologia , Ductos Pancreáticos/diagnóstico por imagem , Ductos Pancreáticos/patologia , Neoplasias Císticas, Mucinosas e Serosas/patologiaRESUMO
Background/Aims: This study aimed to investigate the patterns of preferred endoscopic procedure types and techniques for managing difficult common bile duct (CBD) stones in South Korea. Methods: The Committee of Policy and Quality Management of Korean Pancreatobiliary Association (KPBA) conducted a survey containing 19 questions. Both paper and online surveys were carried out; with the paper survey being conducted during the 2019 Annual Congress of KPBA and the online survey being conducted through Google Forms from April 2020 to February 2021. Results: The response rate was approximately 41.3% (86/208). Sixty-two (73.0%) worked at tertiary hospitals or academic medical centers, and 60 (69.7%) had more than 5 years of endoscopic retrograde cholangiopancreatography experience. The preferred size criteria for large CBD stones were 15 mm (40.6%), 20 mm (31.3%), and 30 mm (4.6%). For managing of large CBD stones, endoscopic papillary large balloon dilation after endoscopic sphincterotomy was the most preferred technique (74.4%). When performing procedures in those with bleeding diathesis, 64 (74.4%) respondents favored endoscopic papillary balloon dilation (EPBD) alone or EPBD with small endoscopic sphincterotomy. Fifty-five respondents (63.9%) preferred the doubleguidewire technique when faced with difficult bile duct cannulation in patients with periampullary diverticulum. In surgically altered anatomies, cap-fitted forward viewing endoscopy (76.7%) and percutaneous transhepatic cholangioscopy (48.8%) were the preferred techniques for Billroth-II anastomosis and total gastrectomy with Roux-en-Y anastomosis, respectively. Conclusions: Most respondents showed unifying trends for the management of difficult CBD stones. The current practice patterns could be used as basic data for clinical quality improvements in the management of difficult CBD stones.
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Cálculos Biliares , Humanos , Cálculos Biliares/cirurgia , Resultado do Tratamento , Colangiopancreatografia Retrógrada Endoscópica/métodos , Esfinterotomia Endoscópica/métodos , República da CoreiaRESUMO
Background/Aims: Although endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) and fine needle biopsy (FNB) are widely used for tissue acquisition of pancreatic solid mass, the optimal strategy of this procedure has not been established yet. The aim of this nationwide study was to investigate the current practice patterns of EUS-FNA/FNB for pancreatic solid mass in Korea. Methods: The Policy-Quality Management of the Korean Pancreatobiliary Association (KPBA) developed a questionnaire containing 22 questions. An electronic survey consisting of the questionnaire was distributed by e-mail to members registered to the KPBA. Results: A total of 101 respondents completed the survey. Eighty respondents (79.2%) performed preoperative EUS-FNA/FNB for operable pancreatic solid mass. Acquire needles (60.4%) were used the most, followed by ProCore needles (47.5%). In terms of need size, most respondents (>80%) preferred 22-gauge needles regardless of the location of the mass. Negative suction with a 10-mL syringe (71.3%) as sampling technique was followed by stylet slow-pull (41.6%). More than three needle passes for EUS-FNA/FNB was performed by most respondents (>80%). The frequency of requiring repeated procedure was significantly higher in respondents with a low individual volume (<5 per month, p=0.001). Prophylactic antibiotics were routinely used in 39 respondents (38.6%); rapid on-site pathologic evaluation was used in 6.1%. Conclusions: According to this survey, practices of EUS-FNA/FNB for pancreatic solid mass varied substantially, some of which differed considerably from the recommendations present in existing guidelines. These results suggest that the development of evidence-based quality guidelines fitting Korean clinical practice is needed to establish the optimal strategy for this procedure.
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Neoplasias Pancreáticas , Humanos , Neoplasias Pancreáticas/patologia , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Endossonografia , Sucção , República da CoreiaRESUMO
EUS-guided drainage for gallbladder, bile duct, pancreatic duct, and peripancreatic fluid collection has been performed more frequently in the last decade. The development of dedicated stents and delivery systems for EUS-guided interventions have improved the efficacy and safety of these procedures. Furthermore, the introduction of lumen-apposing metal stents has reduced the complication significantly of endoscopic transmural drainage of pancreatic collections and gallbladder. Recent studies show that EUS-guided drainage of pancreaticobiliary ducts and peripancreatic fluid collection produces good results and low complication rates. This review describes the current position and role of interventional EUS for pancreatobiliary disease in clinical practice.
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Endossonografia , Ultrassonografia de Intervenção , Ductos Biliares/cirurgia , Drenagem/métodos , Vesícula Biliar/diagnóstico por imagem , Humanos , Stents , Resultado do Tratamento , Ultrassonografia de Intervenção/métodosRESUMO
BACKGROUND/AIMS: : Percutaneous transhepatic cholangioscopy (PTCS) is used for the diagnosis and treatment of biliary diseases in patients with failed endoscopic retrograde cholangiopancreatography, particularly those with surgically altered anatomy. However, few studies are available on the clinical use of Spyglass DS direct visualization system (SpyDS)-assisted PTCS. This study aimed to assess the efficacy and safety of SpyDS-assisted PTCS in patients with surgically altered anatomy, particularly those with a Roux-en-Y reconstruction. METHODS: Thirteen patients (six women, median age 71.4 years [range, 53 to 83 years]) with surgically altered anatomy (four Roux-en-Y choledochojejunostomies, seven Roux-en-Y hepaticojejunostomies, and two Roux-en-Y esophagojejunostomies) who underwent SpyDS-assisted PTCS between January 2019 and August 2020 were included and the data was acquired by retrospectively reviewing electronic medical record. RESULTS: A total of 19 SpyDS-assisted PTCS procedures were performed in the 13 patients: eight had bile-duct stones, and five had biliary strictures. All SpyDS-assisted PTCS procedures were successfully performed. The total procedure time was 42.42±18.0 minutes (mean±standard deviation). Bile duct clearance was achieved in all bile duct stone cases after a median of 2 (range, 1 to 3) procedures. In the five biliary stricture cases, the results of SpyBite forceps-guided targeted biopsy were consistent with adenocarcinoma (100% accuracy). The median hospitalization duration was 20 days (range, 14 to 30 days). No procedure-related morbidity or mortality occurred. CONCLUSIONS: SpyDS-assisted PTCS may be a safe, feasible, and effective procedure for the diagnosis and treatment of biliary diseases in patients with surgically altered anatomy, particularly in those with the Roux-en-Y reconstruction requiring a percutaneous approach. However, our findings need to be validated in further studies.
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Procedimentos Cirúrgicos do Sistema Biliar , Colangiopancreatografia Retrógrada Endoscópica , Idoso , Idoso de 80 Anos ou mais , Anastomose em-Y de Roux/efeitos adversos , Anastomose em-Y de Roux/métodos , Colangiopancreatografia Retrógrada Endoscópica/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Projetos Piloto , Estudos RetrospectivosRESUMO
Procedural sedation has become increasingly common in endoscopy. Sedatives and analgesics induce anxiolysis and amnesia. In addition, an appropriate level of sedation is necessary for safe procedures including therapeutic endoscopy. Midazolam and propofol are the most commonly used drugs in sedative endoscopy. In recent years, the need to ascertain the safety and effectiveness of sedation has increased in practice. Therefore, new sedatives and analgesic drugs for optimal sedative endoscopy, have recently emerged. This article reviews the characteristics of sedatives and analgesics, and describes their clinical use in gastrointestinal endoscopy.