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Yokode M, Matsumori T, Uza N, Kuwada T, Shiokawa M, Maruno T, Seno H. Usefulness of a circumferential argon plasma coagulation probe in trimming a dislocated distal biliary metal stent. Endoscopy 2022; 54:E802-E803. [PMID: 35523223 PMCID: PMC9735302 DOI: 10.1055/a-1816-7903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Masataka Yokode
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tomoaki Matsumori
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Norimitsu Uza
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takeshi Kuwada
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masahiro Shiokawa
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takahisa Maruno
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroshi Seno
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Kitagawa S, Ishikawa S, Okamura K. Recanalization of a completely occluded biliary metal stent using argon plasma coagulation and electrohydraulic lithotripsy. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2022; 29:e95-e96. [PMID: 35000277 DOI: 10.1002/jhbp.1110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 11/25/2021] [Accepted: 12/14/2021] [Indexed: 11/07/2022]
Affiliation(s)
- Sho Kitagawa
- Department of Gastroenterology, Sapporo Kosei General Hospital, Sapporo, Japan
| | - Shori Ishikawa
- Department of Gastroenterology, Sapporo Kosei General Hospital, Sapporo, Japan
| | - Keiya Okamura
- Department of Gastroenterology, Sapporo Kosei General Hospital, Sapporo, Japan
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Tringali A, Margagnoni G, Brighi S, Costamagna G. Endoscopic "cutting" of a trapped Dormia basket. Endoscopy 2021; 53:E79-E80. [PMID: 32590855 DOI: 10.1055/a-1196-1095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Andrea Tringali
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italia.,Centre for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore di Roma, Roma, Italia
| | | | - Stefano Brighi
- Digestive Endoscopy Unit, Ospedale "F. Spaziani", Frosinone, Italia
| | - Guido Costamagna
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italia.,Centre for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore di Roma, Roma, Italia
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Chua T, Fukami N. Revision of migrated self-expandable metal stent by the remOVE device. Endoscopy 2018; 50:1129-1130. [PMID: 30107627 DOI: 10.1055/a-0666-4462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Tiffany Chua
- Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Phoenix Arizona, United States
| | - Norio Fukami
- Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Phoenix Arizona, United States
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Shimizu K, Takamori H, Baba H. Usefulness of surgical closure following intraoperative endoscopic additional stenting of duodenal perforation by stent: Report of a case. Int J Surg Case Rep 2016; 25:21-3. [PMID: 27289171 PMCID: PMC4908309 DOI: 10.1016/j.ijscr.2016.05.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 05/30/2016] [Accepted: 05/31/2016] [Indexed: 12/02/2022] Open
Abstract
Perforation of duodenum rarely occurs after stenting, but it could be life threatening. Reduced the force of the existing stent to the injury site, which could make it possible to perform simple closure. Surgical closure following intraoperative endoscopic additional stenting could be one of the useful options for duodenal perforation by stent.
Introduction Malignant duodenal stenosis occurs in patients with advanced periampullary cancer. Insertion of a self-expanding metal stent for the treatment of this condition carries the risk of subsequent perforation of the duodenum. We report successful treatment of duodenal perforation induced by a stent. Presentation of case An 80-year-old woman suffering from stenosis caused by advanced periampullary cancer underwent metallic stent placement and her symptoms improved. While attempting biliary re-stenting to prevent restenosis after 4 months, the proximal end of the duodenal metallic stent migrated into the abdominal cavity. Using a laparotomy intraoperative endoscope, duodenal stents were placed into the prolapsed stent in the form of stent-in-stent to reduce the axial force of the stent, after which the puncture site was closed by suturing. No leakage or stenosis was observed at the duodenum, and the patient was able to eat normally until her death 4 months after surgery. Conclusion Surgical closure following intraoperative endoscopic additional stenting is a viable option for duodenal perforation caused by a stent.
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Affiliation(s)
- Kenji Shimizu
- Department of Surgery, Saiseikai Kumamoto Hospital, 5-3-1 Chikami, Minami-ku, Kumamoto 861-4193, Japan
| | - Hiroshi Takamori
- Department of Surgery, Saiseikai Kumamoto Hospital, 5-3-1 Chikami, Minami-ku, Kumamoto 861-4193, Japan.
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
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Argon Plasma Coagulation for Extraction of an Impacted Trapezoid Basket in the Pancreatic Duct. ACG Case Rep J 2015; 2:139-41. [PMID: 26157943 PMCID: PMC4435397 DOI: 10.14309/crj.2015.34] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 02/10/2015] [Indexed: 12/02/2022] Open
Abstract
We performed endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy for pancreatic stent placement on a 55-year-old woman with a dilated pancreatic duct, pancreatic duct stone, and chronic pancreatitis. During follow-up ERCP, the lithotripter traction wire fractured during electrohydraulic lithotripsy and mechanical lithotripsy. Multiple attempts using standard techniques to clear the lithotripter and stone failed. Argon plasma coagulation (APC) was used to ablate 2 of the lithotripter wires, and the lithotripter was disengaged from the stone and removed.
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Ching YH, Geck RD, Andrews AD, Rumbak MJ, Camporesi EM. Argon plasma coagulation in the management of uncovered tracheal stent fracture. Respir Med Case Rep 2014; 13:37-8. [PMID: 26029557 PMCID: PMC4246352 DOI: 10.1016/j.rmcr.2014.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Endotracheal and endobronchial stenting, particularly with uncovered stents, can be complicated by stent fracture, granulation tissue formation, direct airway injury, and airway obstruction. While stent removal is possible, it can result in significant complications and long-term benefit is not guaranteed. Argon plasma coagulation can be employed to trim fractured stent fragments and remove granulation tissue simultaneously. In this manuscript, we report a case and describe our experience with using this technique.
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Affiliation(s)
- Yiu-Hei Ching
- Department of Surgery, University of South Florida Morsani College of Medicine, 1 Tampa General Circle, Tampa, FL 33606, USA
| | - Robert D Geck
- Department of Medicine, Division of Pulmonary Critical Care and Sleep Medicine, Section of Interventional Pulmonary, James A Haley Veterans Hospital and University of South Florida Morsani College of Medicine, 2 Tampa General Circle, Tampa, FL 33606, USA
| | - Arthur D Andrews
- Department of Medicine, Division of Pulmonary Critical Care and Sleep Medicine, Section of Interventional Pulmonary, James A Haley Veterans Hospital and University of South Florida Morsani College of Medicine, 2 Tampa General Circle, Tampa, FL 33606, USA
| | - Mark J Rumbak
- Department of Medicine, Division of Pulmonary Critical Care and Sleep Medicine, Section of Interventional Pulmonary, James A Haley Veterans Hospital and University of South Florida Morsani College of Medicine, 2 Tampa General Circle, Tampa, FL 33606, USA
| | - Enrico M Camporesi
- Florida Gulf-to-Bay Anesthesiology Associates, 1 Tampa General Circle, Tampa, FL 33606, USA
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Hamada T, Isayama H, Nakai Y, Kogure H, Yamamoto N, Koike K. Tips and troubleshooting for transpapillary metal stenting for distal malignant biliary obstruction. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2013; 21:E12-8. [DOI: 10.1002/jhbp.51] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Tsuyoshi Hamada
- Department of Gastroenterology; Graduate School of Medicine; The University of Tokyo; 7-3-1 Hongo Bunkyo-ku Tokyo 113-8655 Japan
| | - Hiroyuki Isayama
- Department of Gastroenterology; Graduate School of Medicine; The University of Tokyo; 7-3-1 Hongo Bunkyo-ku Tokyo 113-8655 Japan
| | - Yousuke Nakai
- Department of Gastroenterology; Graduate School of Medicine; The University of Tokyo; 7-3-1 Hongo Bunkyo-ku Tokyo 113-8655 Japan
| | - Hirofumi Kogure
- Department of Gastroenterology; Graduate School of Medicine; The University of Tokyo; 7-3-1 Hongo Bunkyo-ku Tokyo 113-8655 Japan
| | - Natsuyo Yamamoto
- Department of Gastroenterology; Graduate School of Medicine; The University of Tokyo; 7-3-1 Hongo Bunkyo-ku Tokyo 113-8655 Japan
| | - Kazuhiko Koike
- Department of Gastroenterology; Graduate School of Medicine; The University of Tokyo; 7-3-1 Hongo Bunkyo-ku Tokyo 113-8655 Japan
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Ito K, Ogawa T, Horaguchi J, Koshita S, Fujita N. Reintervention for occluded biliary metal stent for patients with malignant distal biliary stricture. Dig Endosc 2013; 25 Suppl 2:126-31. [PMID: 23617663 DOI: 10.1111/den.12092] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 02/14/2013] [Indexed: 02/08/2023]
Abstract
A metal stent has a longer stent patency than a plastic stent in patients with unresectable malignant distal biliary stricture. However, treatment for stent dysfunction of a metal stent remains unresolved. A review of reported articles regarding reintervention for metal stent dysfunction showed that causes of stent dysfunction included tumor ingrowth/overgrowth, stone/sludge/food impaction, and stent migration. Cleaning of the stent is associated with an early relapse of stent dysfunction. Additional placement of a covered metal stent is expected to have a longer stent patency than that of other stents such as uncovered metal stents or plastic stents. It is recommended that occluded covered metal stents be removed if possible. Stent trimming with argon plasma coagulation is sometimes useful for the treatment of stent displacement. No strategy for occluded metal stents has been established yet. Further clinical trials regarding proper treatments are necessary.
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Affiliation(s)
- Kei Ito
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan.
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Itoi T, Sofuni A, Itokawa F, Tonozuka R, Ishii K. Current status and issues regarding biliary stenting in unresectable biliary obstruction. Dig Endosc 2013; 25 Suppl 2:63-70. [PMID: 23617652 DOI: 10.1111/den.12062] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 01/05/2013] [Indexed: 12/14/2022]
Abstract
In the present review, we describe the current status of biliary stenting in patients with unresectable malignant biliary strictures. Self-expandable metallic stents (SEMS) are the ideal biliary stent for both distal and hilar biliary strictures, although in terms of distal biliary strictures, there is still some debate as to the selection of covered or uncovered SEMS, suprapapillary or transpapillary stent placement, side-by-side or stent-in-stent placement, unilateral or bilateral stent placement and the necessity for sphincterotomy. Further high-quality randomized controlled trials for these procedures are warranted.
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Affiliation(s)
- Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan.
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Setoyma T, Miyamoto S, Horimatsu T, Morita S, Ezoe Y, Muto M, Watanabe G, Tanaka E, Chiba T. Multimodal endoscopic treatment for delayed severe esophageal stricture caused by incomplete stent removal. Dis Esophagus 2013; 27:112-5. [PMID: 23441591 DOI: 10.1111/dote.12041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The usefulness of a covered self-expandable metallic stent for benign esophageal stricture and perforation was well established. In case of benign disease, early stent removal was recommended within 6-8 weeks after placement. A case with severe esophageal stricture caused by incomplete stent removal 7 years after stent placement for spontaneous esophageal rupture was reported. Residual stent fragments could be removed by step-by-step multimodal endoscopic treatment, producing satisfactory luminal diameter of the esophagus. In particular, stent trimming with argon plasma coagulation was safe and effective strategy. The endoscopic stent removal is minimally invasive and should be attempted before surgical intervention; however, it is most important to ensure early stent removal before tissue ingrowth or overgrowth can develop.
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Affiliation(s)
- T Setoyma
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Kida M, Miyazawa S, Iwai T, Ikeda H, Takezawa M, Kikuchi H, Watanabe M, Imaizumi H, Koizumi W. Recent advances of biliary stent management. Korean J Radiol 2012; 13 Suppl 1:S62-6. [PMID: 22563289 PMCID: PMC3341462 DOI: 10.3348/kjr.2012.13.s1.s62] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2011] [Accepted: 12/09/2011] [Indexed: 12/13/2022] Open
Abstract
Recent progress in chemotherapy has prolonged the survival of patients with malignant biliary strictures, leading to increased rates of stent occlusion. Even we employed metallic stents which contributed to higher rates and longer durations of patency, and occlusion of covered metallic stents now occurs in about half of all patients during their survival. We investigated the complication and patency rate for the removal of covered metallic stents, and found that the durations were similar for initial stent placement and re-intervention. In order to preserve patient quality of life, we currently recommend the use of covered metallic stents for patients with malignant biliary obstruction because of their removability and longest patency duration, even though uncovered metallic stents have similar patency durations.
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Affiliation(s)
- Mitsuhiro Kida
- Department of Gastroenterology, Kitasato University East Hospital, Sagamihara, Kanagawa 228-8520, Japan.
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Ishii K, Itoi T, Sofuni A, Itokawa F, Tsuchiya T, Kurihara T, Tsuji S, Ikeuchi N, Umeda J, Moriyasu F, Tsuchida A. Endoscopic removal and trimming of distal self-expandable metallic biliary stents. World J Gastroenterol 2011; 17:2652-7. [PMID: 21677835 PMCID: PMC3110929 DOI: 10.3748/wjg.v17.i21.2652] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Revised: 06/04/2010] [Accepted: 06/11/2010] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the efficacy and safety of endoscopic removal and trimming of self-expandable metallic stents (SEMS).
METHODS: All SEMS had been placed for distal biliary strictures. Twenty-seven endoscopic procedures were performed in 19 patients in whom SEMS (one uncovered and 18 covered) removal had been attempted, and 8 patients in whom stent trimming using argon plasma coagulation (APC) had been attempted at Tokyo Medical University Hospital. The APC settings were: voltage 60-80 W and gas flow at 1.5 L/min.
RESULTS: The mean stent indwelling period for all patients in whom stent removal had been attempted was 113.7 ± 77.6 d (range, 8-280 d). Of the 19 patients in whom removal of the SEMS had been attempted, the procedure was successful in 14 (73.7%) without procedure-related adverse events. The indwelling period in the stent removable group was shorter than that in the unremovable group (94.9 ± 71.5 d vs 166.2 ± 76.2 d, P = 0.08). Stent trimming was successful for all patients with one minor adverse event consisting of self-limited hemorrhage. Trimming time ranged from 11 to 16 min.
CONCLUSION: Although further investigations on larger numbers of cases are necessary to accumulate evidence, the present data suggested that stent removal and stent trimming is feasible and effective for stent-related complications.
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Endoscopic Trimming of an Embedded Distally Migrated Metallic Rectal Stent With Argon Plasma Coagulation. Surg Laparosc Endosc Percutan Tech 2010; 20:e73-5. [DOI: 10.1097/sle.0b013e3181d874a0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Matsubayashi H, Hasuike N, Tanaka M, Takizawa K, Yamaguchi Y, Ono H. Trimming of a Migrated Biliary Nitinol Stent Using Argon Plasma. Case Rep Gastroenterol 2009; 3:202-206. [PMID: 21103276 PMCID: PMC2988958 DOI: 10.1159/000226252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Metallic stent migration is a well-known complication which cannot always be managed by removal or repositioning, especially in case of uncovered stent. We report a patient who developed obstructive jaundice due to migration of an expandable metallic stent (EMS) inserted in the lower bile duct. Trimming of the EMS using argon plasma was performed, with the power setting of 60 W and 2.0 l/min of argon flow. The distal part of the EMS was removed and mechanical cleaning using balloon catheter was performed for remnant EMS. Without additional stent insertion, jaundice was relieved in a few days. No complication was recognized during the procedure and no recurrence of jaundice in the rest of his life.
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Topazian M, Baron TH. Endoscopic fenestration of duodenal stents using argon plasma to facilitate ERCP. Gastrointest Endosc 2009; 69:166-9. [PMID: 19111700 DOI: 10.1016/j.gie.2008.08.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Accepted: 08/18/2008] [Indexed: 12/30/2022]
Abstract
BACKGROUND The presence of a duodenal stent may hinder attempts at ERCP for treatment of malignant biliary obstruction. OBJECTIVE We describe 2 patients in whom endoscopic fenestration of indwelling duodenal stents with an argon plasma coagulator facilitated successful ERCP. DESIGN Single-center retrospective case series. SETTING Tertiary-referral center. PATIENTS Both patients had unresectable biliary malignancy with both duodenal and biliary obstruction. INTERVENTION AND RESULTS Windows were cut into indwelling duodenal stents with argon plasma, which exposed the underlying papilla and allowed successful ERCP and stent placement. LIMITATIONS Retrospective study and the small sample size. CONCLUSIONS Fenestration of duodenal stents using argon plasma is a simple technique that can facilitate ERCP.
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Affiliation(s)
- Mark Topazian
- Miles and Shirley Fiterman Center for Digestive Diseases, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota 55906, USA
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Matsushita M, Uchida K, Takaoka M, Nishio A, Okazaki K. Malfunctioning covered biliary metallic stents: ineffective trimming or effective removal? Gastrointest Endosc 2009; 69:189. [PMID: 19111708 DOI: 10.1016/j.gie.2008.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2008] [Accepted: 05/08/2008] [Indexed: 12/10/2022]
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Coumaros D, Tsesmeli N. Stent-in-stent insertion using argon plasma coagulation for the cannulation of multiple malfunctioning biliary noncovered self-expandable metal stents. Am J Gastroenterol 2008; 103:3215-7. [PMID: 19086981 DOI: 10.1111/j.1572-0241.2008.02161_15.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Manner H, Enderle MD, Pech O, May A, Plum N, Riemann JF, Ell C, Eickhoff A. Second-generation argon plasma coagulation: two-center experience with 600 patients. J Gastroenterol Hepatol 2008; 23:872-8. [PMID: 18565020 DOI: 10.1111/j.1440-1746.2008.05437.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND AIM Second-generation argon plasma coagulation (APC; APC 2/VIO APC) with its modes 'forced', 'pulsed', and 'precise' is a further development of the ICC/APC 300 system (first-generation APC). Until now, only limited data has existed on the use of APC 2. METHODS Fundamental data on the characteristics of the various APC 2 modes and clinical data from more than 600 patients treated in two high-volume endoscopy centers were analyzed. On the basis of these data, recommendations for the use of APC in daily gastroenterological practice were made. RESULTS In comparison to the ICC system, second-generation APC offers a broadened bandwidth of settings including different APC modes and a range of power settings from 1 to 120 W. Using the various modes of APC 2 in a variety of gastrointestinal diseases, minor complications were observed in 9-21% of patients. Major complications occurred in 1-7% of patients. CONCLUSIONS In a two-center experience treating a large group of patients with a wide variety of gastrointestinal conditions, the different APC 2 modes appeared to be safe and effective. Certain preventive measures before and during clinical application are recommended in order to avoid complications.
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Affiliation(s)
- Hendrik Manner
- Department of Internal Medicine II, HSK Wiesbaden, Wiesbaden, Germany.
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Christiaens P, Decock S, Buchel O, Bulté K, Moons V, D'Haens G, Van Olmen G. Endoscopic trimming of metallic stents with the use of argon plasma. Gastrointest Endosc 2008; 67:369-71. [PMID: 18226706 DOI: 10.1016/j.gie.2007.09.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2007] [Accepted: 09/02/2007] [Indexed: 12/13/2022]
Abstract
BACKGROUND The endoscopic placement of metallic stents for palliation of malignant obstruction of the GI or biliary tract is an established practice and as such is often applied. Use of these stents, however, has its problems. Stent migration may cause obstruction of the bowel lumen. Migration of a biliary stent into the contralateral duodenal wall may cause difficulty in gaining access to the biliary tract, as will the placement of a duodenal stent across the ampulla. OBJECTIVE We report on 6 patients in whom trimming of the metallic nitinol stent was performed. DESIGN Single-center, retrospective case series. SETTING Secondary referral center. PATIENTS Of 6 patients included, 2 patients each had an uncovered duodenal stent, 2 had an uncovered biliary stent each, 1 had an uncovered colorectal stent, and 1 had a covered gastroduodenal stent. INTERVENTIONS Under direct endoscopic vision, an argon plasma beam was used to cut self-expandable metallic stents, as appropriate. MAIN OUTCOME MEASUREMENT The main objective was relief of the obstruction to the bowel lumen or bile duct, facilitating successful passage of an endoscope or biliary canulation, respectively. RESULTS In all 5 patients with uncovered metallic stents, we were able to re-establish access to the obstructed bowel lumen or the biliary tree, as indicated. An attempt to tailor the length of a covered metallic gastroduodenal stent failed. No complications were observed and no hemorrhage or perforation occurred. LIMITATIONS The study was limited by retrospective design and small sample size. CONCLUSIONS The endoscopic cutting and tailoring of an uncovered metallic prosthesis, by means of an argon plasma beam, is feasible, effective, and safe. Trimming of covered stents is not advocated.
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Auroux J, Roblin X, Germain E, Berthelet O, Bichard P. Une utilisation peu usuelle mais efficace du plasma d’argon : la section des prothèses métalliques expansives. ACTA ACUST UNITED AC 2008; 32:118-22. [DOI: 10.1016/j.gcb.2008.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Rerknimitr R, Naprasert P, Kongkam P, Kullavanijaya P. Trimming a metallic biliary stent using an argon plasma coagulator. Cardiovasc Intervent Radiol 2007; 30:534-6. [PMID: 16933157 DOI: 10.1007/s00270-006-0013-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Distal migration is one of the common complications after insertion of a covered metallic stent. Stent repositioning or removal is not always possible in every patient. Therefore, trimming using an argon plasma coagulator (APC) may be a good alternative method to solve this problem. METHODS Metallic stent trimming by APC was performed in 2 patients with biliary Wallstent migration and in another patient with esophageal Ultraflex stent migration. The power setting was 60-100 watts with an argon flow of 0.8 l/min. OBSERVATIONS The procedure was successfully performed and all distal parts of the stents were removed. No significant collateral damage to the nearby mucosa was observed. CONCLUSIONS In a patient with a distally migrated metallic stent, trimming of the stent is possible by means of an APC. This new method may be applicable to other sites of metallic stent migration.
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Affiliation(s)
- Rungsun Rerknimitr
- Gastroenterology Unit, Department of Internal Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10310, Thailand.
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Witte TN, Danovitch SH, Borum ML, Irani SK. Endoscopic trimming of a rectal self-expanding metallic stent by use of argon plasma coagulation. Gastrointest Endosc 2007; 66:210-1. [PMID: 17591502 DOI: 10.1016/j.gie.2007.03.1040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2006] [Accepted: 03/12/2007] [Indexed: 02/08/2023]
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25
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Kundu R, Pleskow D. Biliary and Pancreatic Stents: Complications and Management. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2007. [DOI: 10.1016/j.tgie.2007.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Adam LA, Silva RG, Rizk M, Gerke H. Endoscopic argon plasma coagulation of Marlex mesh erosion after vertical-banded gastroplasty. Gastrointest Endosc 2007; 65:337-40. [PMID: 17137859 DOI: 10.1016/j.gie.2006.06.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2006] [Accepted: 06/03/2006] [Indexed: 02/08/2023]
Abstract
BACKGROUND Marlex mesh erosions may occur as late complications after vertical-banded gastroplasty. Experience with the endoscopic treatment is limited. OBJECTIVE To describe the use of argon plasma coagulation in the endoscopic treatment of eroded Marlex mesh. DESIGN Case report. SETTINGS Endoscopy Unit, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA. PATIENTS We describe the endoscopic treatment of eroded Marlex mesh in 2 patients who presented with symptoms of gastric-outlet obstruction. INTERVENTIONS In both cases, argon plasma coagulation was used to break down the eroded Marlex mesh. Fragments were subsequently removed with forceps and electrocautery snares. We did not encounter any complications with this method. RESULTS The endoscopic treatment resulted in lasting symptomatic improvement in both patients. LIMITATIONS Our experience is limited to 2 cases. CONCLUSIONS Argon plasma coagulation appears to be a promising option for the endoscopic treatment of eroded Marlex mesh. It allows the fragmentation of large mesh portions and enables subsequent removal with a snare and a forceps. This method can result in symptomatic improvement and may obviate the need for surgery. Further data are necessary to evaluate the safety and the efficacy of this approach.
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Affiliation(s)
- Laura A Adam
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA
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Chen YK, Jakribettuu V, Springer EW, Shah RJ, Penberthy J, Nash SR. Safety and efficacy of argon plasma coagulation trimming of malpositioned and migrated biliary metal stents: a controlled study in the porcine model. Am J Gastroenterol 2006; 101:2025-30. [PMID: 16848800 DOI: 10.1111/j.1572-0241.2006.00744.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Argon plasma coagulation (APC) has been used to trim uncovered Elgiloy stents, but the extent of thermal damage and bile duct injury is not known. The goal of this study was to evaluate the safety and efficacy of APC for this application. METHODS Eight Elgiloy (covered and uncovered) and four nitinol stents were deployed in the bile duct at ERCP in 12 anesthetized pigs. In nine pigs, the excess distal ends were trimmed in vivo using short bursts of APC. Three pigs served as controls. Bile ducts and stent specimens were then harvested for gross and histological examinations by a single-blinded pathologist. RESULTS APC effectively trimmed all the stents. Seven APC-treated bile ducts and three controls showed epithelial distortion consistent with pressure injury from stent expansion. Two APC-treated bile ducts showed mild thermal injury. The damage was superficial, extending to a maximum depth of 0.1 mm with rare foci involving subepithelial connective tissue. CONCLUSION APC at indicated settings effectively cuts covered and uncovered Elgiloy as well as nitinol stents, but can cause biliary epithelial injury secondary to conduction of heat and electrical energy. Proper technique and settings should be followed and short bursts of energy judiciously applied in order to minimize this danger.
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Affiliation(s)
- Yang K Chen
- Division of Gastroenterology and Hepatology, University of Colorado Health Sciences Center, Denver, Colorado, USA
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28
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Guda NM, Freeman ML. Endoscopic transection of distally migrated biliary self-expanding metallic stents by using argon plasma coagulation: a report of 2 cases (with video). Gastrointest Endosc 2006; 63:512-4. [PMID: 16500412 DOI: 10.1016/j.gie.2005.11.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2005] [Accepted: 11/02/2005] [Indexed: 12/10/2022]
Affiliation(s)
- Nalini M Guda
- GI Consultants, Ltd, St Luke's Medical Center, Milwaukee, Wisconsin, USA
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Familiari P, Bulajic M, Mutignani M, Lee LS, Spera G, Spada C, Tringali A, Costamagna G. Endoscopic removal of malfunctioning biliary self-expandable metallic stents. Gastrointest Endosc 2005; 62:903-10. [PMID: 16301035 DOI: 10.1016/j.gie.2005.08.051] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2004] [Accepted: 08/31/2005] [Indexed: 02/08/2023]
Abstract
BACKGROUND Endoscopic removal of malfunctioning self-expandable metallic biliary stents (SEMS) is difficult and not well described. The aim of this study is to review the indications, the techniques, and the results of SEMS removal in a cohort of patients with malfunctioning stents. METHODS All patients who underwent an attempt at endoscopic removal of biliary SEMS over a 5-year period were retrospectively identified. The main indications for SEMS removal were the following: distal migration of the stent or impaction to the duodenum, impaction into the bile-duct wall, tissue ingrowth, and inappropriate length of the stent causing occlusion of intrahepatic ducts. SEMS were removed by using foreign-body forceps or polypectomy snares. RESULTS Endoscopic removal of 39 SEMS (13 uncovered and 26 covered) was attempted in 29 patients (17 men; mean age, 66 years). SEMS extraction was attempted after a mean of 7.5 months (8.75 months standard deviation) post-SEMS insertion. Removal was successful in 20 patients (68.9%) and in 29 SEMS (74.3%). Covered SEMS were effectively removed more frequently than uncovered ones: 24 of 26 (92.3%) and 5 of 13 (38.4%), respectively (p < 0.05). No major complications were recorded. Multivariate analysis showed that the time interval between insertion and removal, SEMS length, stent-mesh design (zigzag vs. interlaced), and indication for removal were not predictive of success at stent removal. CONCLUSIONS Endoscopic removal of biliary SEMS is feasible and safe in more than 70% of cases. Because only 38% of uncovered SEMS were removable, the presence of a stent covering is the only factor predictive of successful stent extraction. The presence of diffuse and severe ingrowth was the main feature limiting SEMS removal.
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Vanbiervliet G, Demarquay JF, Dumas R, Caroli-Bosc FX, Piche T, Tran A. Endoscopic insertion of biliary stents in 18 patients with metallic duodenal stents who developed secondary malignant obstructive jaundice. ACTA ACUST UNITED AC 2005; 28:1209-13. [PMID: 15671930 DOI: 10.1016/s0399-8320(04)95212-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
AIM The aim of this work was to evaluate the feasibility of endoscopic insertion of biliary stents in patients with duodenal stents who develop secondary malignant obstructive jaundice. PATIENTS AND METHODS The study population included 133 patients with unresectable malignant duodenal obstruction. In 106 patients a biliary stent was inserted before or at the same time as the duodenal stent. Malignant biliary obstruction appeared secondarily in 18 patients; fifteen of these patients already had a biliary stent. We present our experience of biliary stent insertion in these 18 patients with metallic duodenal stents. RESULTS Biliary obstruction was successfully alleviated in 17 out of 18 patients (94%) without complication. Insertion of a new biliary stent failed in one patient because the mesh of the duodenal stent passed over the metallic biliary stent already in place. Mean duration of endoscopic insertion was 95 minutes (range: 60 - 180). All patients remained free of biliary complications to death (57 days, range: 30 - 120). CONCLUSION Our report shows that endoscopic insertion of a biliary stent is feasible in patients who have metallic duodenal stents. Technical difficulties exist especially if the mesh of the duodenal stent passes over the papilla.
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Affiliation(s)
- John J Vargo
- Department of Gastroenterology and Hepatology, The Cleveland Clinic Foundation, Ohio 44195, USA
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Madoff DC, Wallace MJ. Palliative treatment of unresectable bile duct cancer: which stent? which approach? Surg Oncol Clin N Am 2002; 11:923-39. [PMID: 12607580 DOI: 10.1016/s1055-3207(02)00037-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Nonsurgical options for the palliative treatment of unresectable bile duct cancer are discussed. Despite all of the available approaches, the disease remains uniformly fatal. The goal of managing unresectable bile duct cancer is to treat the symptoms that still contribute to significant morbidity and mortality. Further development of new treatment strategies and modalities is needed to improve the quality of life and survival of patients with this disease.
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Affiliation(s)
- David C Madoff
- Vascular and Interventional Radiology Section, Division of Diagnostic Imaging, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030-4009, USA.
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Ginsberg GG, Barkun AN, Bosco JJ, Burdick JS, Isenberg GA, Nakao NL, Petersen BT, Silverman WB, Slivka A, Kelsey PB. The argon plasma coagulator: February 2002. Gastrointest Endosc 2002; 55:807-10. [PMID: 12024132 DOI: 10.1016/s0016-5107(02)70408-2] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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