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1.
Artigo em Inglês | MEDLINE | ID: mdl-38389803

RESUMO

Objective: Few reports have explored the application of urinary trypsinogen-2 measurement in the early diagnosis of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis, and none have demonstrated the benefits of noninvasive testing. This study aimed to evaluate the clinical application of the rapid urinary trypsinogen-2 dipstick test (Nipro, Japan) compared with serum amylase and lipase levels for the early diagnosis of post-ERCP pancreatitis (PEP). Methods: A total of 100 consecutive patients (54 men and 46 women) who were admitted and underwent ERCP at Tokyo Medical University Hospital from August 2021 to December 2021 were recruited. All patients underwent rapid urinary trypsinogen-2 measurement using the dipstick test before and after ERCP. Measurements were taken 24 h before ERCP for pre-ERCP and 1-4 h after ERCP for post-ERCP. Additionally, serum amylase and lipase levels were measured at 8:00 a.m. of the day after ERCP (at least 8 h after ERCP), and their diagnostic abilities for PEP were compared and evaluated. Results: PEP occurred in 5/100 patients (5%). The sensitivity, specificity, positive predictive value, and negative predictive value of the dipstick test for diagnosing PEP were 100%, 83.2%, 23.8%, and 100%, respectively. These results were comparable to the diagnostic performance of serum amylase and lipase levels at 8:00 a.m. on the day after ERCP (at least 8 h after ERCP). However, false positives must be considered. Conclusion: The dipstick test may be useful in clinical practice as a noninvasive screening test for the early prediction of PEP.

4.
Artigo em Inglês | MEDLINE | ID: mdl-38212938

RESUMO

BACKGROUND: Endoscopic ultrasound-guided tissue acquisition is vital for diagnosing pancreatic and peridigestive tract lesions. A new three-prong asymmetry tip needle has been developed for this procedure. In this study, we retrospectively assessed the diagnostic ability, tissue collection volume, and procedural adverse events of the three-prong asymmetry tip needle for solid pancreatic, subepithelial, and other organ lesions. METHODS: We analyzed the data of 58 consecutive patients who underwent endoscopic ultrasound-guided tissue acquisition using a three-prong asymmetry tip needle between August 2022 and April 2023 at a single care center. RESULTS: The tissue collection rate was 91.4% with 89.7% accuracy, 89.3% sensitivity, 100% specificity, 100% positive predictive value, and 25% negative predictive value. No significant differences in collection rates or diagnostic performance were observed based on the target organ, puncture route, or lesion size. Using our original assessment method, the average histological core tissue score was 3.1 ± 0.8, whereas the blood contamination volume was 2.5 ± 0.8. Only one of 58 patients (1.7%) developed a pancreatic fistula of moderate severity as an adverse event. CONCLUSIONS: The three-prong asymmetry tip needle demonstrated good diagnostic capability and adequate sample volume with safety for pancreatic, subepithelial, and other organ lesions.

6.
J Hepatobiliary Pancreat Sci ; 31(2): 120-132, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37907717

RESUMO

BACKGROUND/PURPOSE: Afferent loop syndrome (ALS) is a rare adverse event after gastrointestinal surgery requiring appropriate early decompression treatment. Several endoscopic interventions have been attempted for treatment, including endoscopic enteral metal stent placement (EMSP), endoscopic ultrasound (EUS)-guided entero-enterostomy (EUS-EE), and EUS-guided hepaticogastrostomy (EUS-HGS). However, there are limited data on outcomes, including duration of stent patency. In this study, we evaluated the usefulness of each endoscopic intervention for malignant ALS. METHODS: We retrospectively investigated nine patients with malignant ALS who underwent EMSP, EUS-EE, or EUS-HGS. Information on technical success, clinical efficacy, adverse events, stent dysfunction, and overall survival was collected and analyzed. RESULTS: The most common symptoms were abdominal pain and cholangitis. ALS was treated by EMSP in three patients, EUS-EE in three patients, and EUS-HGS in three patients. Stent placement was successful and clinically effective in all patients with no adverse events. During follow-up, stent dysfunction occurred in two patients treated by EUS-HGS. Eight patients died of primary disease during a median follow-up of 157 days. CONCLUSIONS: Each of the available endoscopic interventions for malignant ALS can be expected to produce similar outcomes, including duration of stent patency. The choice of endoscopic intervention should be made based on the characteristics of each treatment.


Assuntos
Síndrome da Alça Aferente , Colestase , Humanos , Estudos Retrospectivos , Síndrome da Alça Aferente/diagnóstico por imagem , Síndrome da Alça Aferente/etiologia , Síndrome da Alça Aferente/cirurgia , Endoscopia , Fígado/patologia , Resultado do Tratamento , Endossonografia , Stents/efeitos adversos , Drenagem , Colestase/etiologia
7.
Gastrointest Endosc ; 99(1): 50-60, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37562548

RESUMO

BACKGROUND AND AIMS: Bilioenteric anastomotic stricture (BES) is a well-known adverse event after bilioenterostomy. Recently, EUS-guided antegrade intervention (EUS-AI) has been developed for cases that are difficult to treat by balloon enteroscopy-assisted ERCP. However, no data are available on the long-term outcomes after EUS-AI. The main goal of the present study was to clarify the long-term outcomes of EUS-AI in such patients. METHODS: Between November 2013 and November 2021, 34 patients who were followed for more than 1 year after EUS-AI for BES were identified. The primary endpoint was the rate of stricture resolution. Secondary endpoints were factors associated with stricture resolution, rate of BES recurrence, rate of conversion to surgery, and rate of hepatic fibrosis progression during follow-up. RESULTS: The median follow-up period was 56.7 months. Stricture resolution was achieved in 17 of 34 patients (50%). A multivariate analysis confirmed that the presence of bile duct stones (odds ratio, 9.473; 95% confidence interval, 1.66-53.98; P = .01) was significantly associated with stricture resolution. The stricture recurrence rate was 33%, and the median time from stent removal to recurrence was 31.2 months. Four patients underwent surgery because of recurrent cholangitis. During the median follow-up period of 56.7 months, 25% progressed to hepatic fibrosis based on the Fibrosis-4 index grade. Interestingly, patients without cholangitis during follow-up did not show progression of hepatic fibrosis. CONCLUSIONS: EUS-AI has achieved acceptable long-term clinical outcomes. EUS-AI can be a viable alternative treatment of choice before surgical treatment in patients who are difficult to treat by conventional approaches.


Assuntos
Colangite , Humanos , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Estudos Retrospectivos , Colangite/etiologia , Stents/efeitos adversos , Cirrose Hepática , Colangiopancreatografia Retrógrada Endoscópica , Resultado do Tratamento
9.
J Hepatobiliary Pancreat Sci ; 30(12): e81-e83, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37907833

RESUMO

Transpapillary endoscopic biliary drainage is the gold standard for resolving malignant biliary obstruction. Stent migration occasionally occurs and is troublesome to retrieve. Yamamoto and colleagues report with accompanying video on the successful retrieval of a proximally migrated stent using biopsy forceps through a guiding sheath cannula.


Assuntos
Cânula , Stents Metálicos Autoexpansíveis , Humanos , Stents , Biópsia , Instrumentos Cirúrgicos
10.
Medicine (Baltimore) ; 102(44): e35701, 2023 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-37933064

RESUMO

INTRODUCTION: In median arcuate ligament syndrome (MALS), the celiac artery is compressed, causing an arcade to develop in the pancreatic head, leading to ischemic symptoms and aneurysms. PATIENT CONCERNS: The patient was diagnosed with borderline resectable pancreatic cancer (PC) and MALS. Endoscopic biliary drainage with a covered metal stent (CMS) was performed for the obstructive jaundice. After the jaundice improved, a modified FOLFIRINOX regimen was initiated. Several days later, cardiopulmonary arrest occurred after hematemesis occurred. Cardiopulmonary resuscitation was performed, his blood pressure stabilized, and emergent upper endoscopy was performed. The CMS was dislodged and active bleeding was observed in the papillae. The CMS was replaced, and temporary hemostasis was achieved. Contrast-enhanced computed tomography revealed a diagnosis of extravasation from the posterior superior pancreaticoduodenal artery (PSPDA) into the biliary tract. Transcatheter arterial embolization was performed. However, the patient was subsequently diagnosed with hypoxic encephalopathy and died on day 14 of hospitalization. DIAGNOSIS: Biliary hemorrhage due to invasion of pancreatic cancer from the PSPDA associated with MALS. INTERVENTION: None. OUTCOMES: Biliary hemorrhage from the PSPDA was fatal in the patient with invasive PC with MALS. LESSONS: Since MALS associated with PC is not a rare disease, the purpose of this study was to keep in mind the possibility of fatal biliary hemorrhage.


Assuntos
Hemobilia , Síndrome do Ligamento Arqueado Mediano , Neoplasias Pancreáticas , Humanos , Protocolos de Quimioterapia Combinada Antineoplásica , Hemobilia/etiologia , Hemorragia/complicações , Síndrome do Ligamento Arqueado Mediano/diagnóstico , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas
11.
Endosc Ultrasound ; 12(2): 251-258, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37148137

RESUMO

Background and Objectives: EUS-guided tissue acquisition is routinely performed for the diagnosis of gastrointestinal tract and adjacent organ lesions. Recently, various types of needles have been developed. However, how the shape of the needle tip and echoendoscope tip angle affect puncturability, has not been clarified. The aim of this experimental study was to compare the puncturability of several 22-gauge EUS-FNA and EUS-guided fine-needle biopsy (EUS-FNB) needles, and to evaluate the effects of the needle tip shape and echoendoscope tip angle on tissue puncturability. Materials and Methods: The following six major FNA and FNB needles were evaluated: SonoTip® ProControl, EZ Shot 3 Plus, Expect™ Standard Handle, SonoTip® TopGain, Acquire™, and SharkCore™. The mean maximum resistance force against needle advancement was evaluated and compared under several conditions using an echoendoscope. Results: The mean maximum resistance force of the needle alone was higher for the FNB needles than for the FNA needles. The mean maximum resistance force of the needle in the echoendoscope with free angle demonstrated that the resistance forces were between 2.10 and 2.34 Newton (N). The mean maximum resistance force increased upon increases in angle of the tip of echoendoscope, particularly in the FNA needles. Among the FNB needles, SharkCore™ had the lowest resistance force (2.23 N). The mean maximum resistance force of the needle alone, the needle in the echoendoscope with free angle, and the needle in the echoendoscope with full-up angle for SonoTip® TopGain were all similar to that of Acquire™. Conclusion: SonoTip® TopGain had similar puncturability to Acquire™ in all tested situations. Regarding the puncturability, SharkCore™ is most suitable for insertion into target lesions, when tight echoendoscope tip angle is necessary.

13.
J Hepatobiliary Pancreat Sci ; 30(3): 351-359, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35918909

RESUMO

BACKGROUND/PURPOSE: Shear wave elastography (SWE) is a clinical method used to evaluate liver hardness. In this study, we assessed its applicability in assessing the pancreas and its potential for diagnosing chronic pancreatitis. METHODS: We performed SWE on 59 patients who underwent abdominal ultrasound, and measured the computed tomography (CT) values of the pancreas. Patients were classified as having a normal pancreas (NP), early chronic pancreatitis (ECP), or chronic pancreatitis (CP). SW elasticity (SWe), SW dispersion (SWd), and CT values between groups were analyzed. RESULTS: SWe significantly differed between the CP and NP/ECP groups (NP vs CP; P = 0.001, ECP vs CP; P = 0.026,), while SWd showed a significant difference only between the NP and CP group (NP vs CP; P = 0.001). The CT values were significantly different between the CP and NP/ECP groups (NP vs CP; P = 0.0006, ECP vs CP; P = 0.0027). CONCLUSION: Pancreatic SWE and CT values were helpful in the diagnosis of chronic pancreatitis. SWd may reveal status changes in ECP.


Assuntos
Técnicas de Imagem por Elasticidade , Pancreatite Crônica , Humanos , Técnicas de Imagem por Elasticidade/métodos , Pancreatite Crônica/diagnóstico por imagem , Pâncreas/diagnóstico por imagem , Ultrassonografia , Fígado
14.
Dig Endosc ; 35(1): 47-57, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35702927

RESUMO

Urgent or emergency endoscopic retrograde cholangiopancreatography (ERCP) is indicated for gallstone-induced acute cholangitis and pancreatitis. The technique and optimal timing of ERCP depend on the disease state, its severity, anatomy, patient background, and the institutional situation. Endoscopic transpapillary biliary drainage within 24 h is recommended for moderate to severe acute cholangitis. The clinical outcomes of biliary drainage with nasobiliary drainage tube placement and plastic stent placement are comparable, and the choice is made on a case-by-case basis considering the advantages and disadvantages of each. The addition of endoscopic sphincterotomy (EST) is basically not necessary when performing drainage alone, but single-session stone removal following EST is acceptable in mild to moderate cholangitis cases without antithrombotic therapy or coagulopathy. For gallstone pancreatitis, early ERCP/EST are recommended in cases with impacted gallstones in the papilla. In some cases of gallstone pancreatitis, a gallstone impacted in the papilla has already spontaneously passed into the duodenum, and early ERCP/EST lacks efficacy in such cases, with unfavorable findings of cholangitis or cholestasis. If it is difficult to diagnose the presence of gallstones impacted in the papilla on imaging, endoscopic ultrasonography can be useful in determining the indication for ERCP.


Assuntos
Colangite , Cálculos Biliares , Pancreatite , Humanos , Colangiopancreatografia Retrógrada Endoscópica/métodos , Cálculos Biliares/diagnóstico , Cálculos Biliares/diagnóstico por imagem , Esfinterotomia Endoscópica/métodos , Colangite/diagnóstico , Colangite/etiologia , Colangite/cirurgia , Pancreatite/complicações , Pancreatite/diagnóstico , Doença Aguda
15.
J Hepatobiliary Pancreat Sci ; 30(6): e38-e40, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-36259175

RESUMO

EUS-guided drainage using a lumen-apposing metal stent (LAMS) has demonstrated promising clinical efficacy for peripancreatic fluid collection. However, intracavitary bleeding has been reported after LAMS placement. Yamamoto et al. reported endoscopic hemostasis using hemostatic gel for intracavitary bleeding.


Assuntos
Endossonografia , Hemostáticos , Humanos , Stents , Hemorragia , Drenagem , Hemostáticos/uso terapêutico
16.
J Hepatobiliary Pancreat Sci ; 30(3): 401-407, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-36043228

RESUMO

BACKGROUND/PURPOSE: A peroral cholangioscope (POCS) can allow direct visualization of the biliary mucosa and its use is becoming more widespread due to improvements in functionality, image quality, and operability, as well as the development of related devices. Recently, a novel mother-baby peroral cholangioscope (nMB-POCS) with a large (2-mm) accessory channel has been developed. In this study, we evaluated the feasibility of this novel POCS in a dry simulation and animal model. METHODS: We evaluated the ease of insertion and maneuverability of the nMB-POCS, the image quality, and the passage of the devices into the accessory channel and into the common bile duct in a dry and live porcine model. RESULTS: In both models, the nMB-POCS could be easily inserted into the duodenoscope and into the distal bile duct and hilum. The image quality was good, and it was possible to observe the surface structure and the vascular network of the bile duct mucosa in detail. CONCLUSIONS: The nMB-POCS with its larger accessory channel is expected to improve the efficiency of diagnosis and  treatment, and reduce the procedure time. Clinical studies in patients are warranted.


Assuntos
Procedimentos Cirúrgicos do Sistema Biliar , Laparoscopia , Animais , Suínos , Colangiopancreatografia Retrógrada Endoscópica/métodos , Ductos Biliares , Ducto Colédoco
17.
J Hepatobiliary Pancreat Sci ; 30(4): e20-e21, 2023 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-36048175

RESUMO

This paper discusses a novel tube placement technique; the "spinning lasso method", in EUS-guided drainage for small pancreatic pseudocysts (PC) with video. In general, the placement of a drainage tube can be difficult in a small PC and the tube often deviates during attempted insertions into the cavity. The technique helps to mitigate this problem.


Assuntos
Pseudocisto Pancreático , Humanos , Pseudocisto Pancreático/diagnóstico por imagem , Pseudocisto Pancreático/cirurgia , Endossonografia/métodos , Drenagem/métodos , Stents
18.
J Hepatobiliary Pancreat Sci ; 30(4): e22-e24, 2023 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-36178214

RESUMO

PuraStat is a newly developed self-assembling hemostatic gel which is expected to be applied to bleeding from various lesions of the gastrointestinal tract. Yamamoto and colleagues describe the practical use of this hemostatic gel for delayed bleeding after endoscopic papillectomy, with accompanying video.


Assuntos
Ampola Hepatopancreática , Neoplasias do Ducto Colédoco , Hemostáticos , Humanos , Ampola Hepatopancreática/patologia , Esfinterotomia Endoscópica/métodos , Hemostáticos/uso terapêutico , Resultado do Tratamento , Neoplasias do Ducto Colédoco/patologia
19.
J Hepatobiliary Pancreat Sci ; 30(7): 983-992, 2023 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-36458423

RESUMO

BACKGROUND/PURPOSE: EUS-guided biliary drainage (EUS-BD) has recently been reported to be a useful salvage technique after ERCP fail. However, data on EUS-BD used for preoperative biliary drainage (PBD) are limited. The aim of this study was to verify the clinical feasibility of EUS-BD for PBD. METHODS: PBD was performed for malignant biliary obstruction in 318 patients at our institution between July 2014 and April 2022. Fifteen (4.7%) of these patients underwent surgical resection after preoperative EUS-BD (HGS 13; HDS 1; AGS with HGS 1) and were retrospectively analyzed. RESULTS: The stent was successfully placed in all 15 cases with a median procedure time of 15 min (technical success rate 100%). The median total bilirubin value decreased significantly from 3.7 before drainage to 0.9 after surgery (p < .001) and cholangitis was well managed (clinical success rate 100%). Surgery was performed at a median of 22 days after drainage, and there were no stent-related adverse events or recurrences of biliary obstruction. Severe surgery-related adverse events occurred in three cases, but none were associated with EUS-BD. The stent was removed during surgery in 12 cases. CONCLUSIONS: EUS-BD can be a feasible and safe alternative method of PBD for malignant biliary obstruction after ERCP fail.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Colestase , Humanos , Estudos Retrospectivos , Estudos de Viabilidade , Colangiopancreatografia Retrógrada Endoscópica/métodos , Colestase/diagnóstico por imagem , Colestase/etiologia , Colestase/cirurgia , Drenagem/métodos , Ultrassonografia de Intervenção , Endossonografia/métodos , Stents/efeitos adversos
20.
J Hepatobiliary Pancreat Sci ; 30(3): e9-e11, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-36377345

RESUMO

Yamamoto et al. report two cases of endoscopic closure using an over-the-scope clip for scope-induced perforation encountered during endoscopic ultrasound and endoscopic retrograde cholangiopancreatography, respectively. In a supporting video, they explain how to prepare the over-the-scope clip and clearly show how the actual procedures were performed.


Assuntos
Úlcera Duodenal , Humanos , Endoscopia Gastrointestinal/métodos , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica/métodos , Endossonografia , Instrumentos Cirúrgicos/efeitos adversos
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