|
1
|
Hasegawa S, Kurita Y, Yamazaki Y, Nihei S, Iizuka T, Misawa N, Hosono K, Endo I, Kobayashi N, Kubota K, Nakajima A. Post-endoscopic sphincterotomy delayed bleeding occurs in patients with just 1-day interruption of direct oral anticoagulants or hemodialysis. DEN OPEN 2025; 5:e70060. [PMID: 39822950 PMCID: PMC11736286 DOI: 10.1002/deo2.70060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2024] [Revised: 12/10/2024] [Accepted: 12/31/2024] [Indexed: 01/19/2025]
Abstract
Objective Endoscopic sphincterotomy (EST), especially when anticoagulants are used, carries a significant risk of delayed bleeding. However, the relationship between the use of antithrombotic agents, including direct oral anticoagulants, and post-EST bleeding remains unclear. This study aimed to identify the risk factors for post-EST delayed bleeding when antithrombotic agents were administered according to the guidelines. Methods We analyzed cases of patients who underwent endoscopic retrograde cholangiopancreatography and EST between January 2018 and August 2022, focusing on those with normal anatomy and naïve papillae. We examined the incidence of post-EST bleeding, endoscopic retrograde cholangiopancreatography procedure details, severity and timing of post-EST delayed bleeding, hemostatic interventions, and factors related to post-EST delayed bleeding. Results Among the 502 patients included, 76 (15%) were taking antithrombotic agents. Post-endoscopic retrograde cholangiopancreatography delayed bleeding was noted in seven patients (1.4%). Mild, moderate, and severe delayed bleeding occurred in four, one, and two cases, respectively. Hemostatic injection completely controlled cases of delayed bleeding. Multivariate analysis identified a 1-day direct oral anticoagulants interruption (odds ratio: 20.5, 95% confidence interval: 3.33-125, p = 0.0011) and dialysis (odds ratio: 38.7, 95% confidence interval: 2.4-624, p = 0.0099) as significant risk factors for delayed bleeding. No thromboembolic events related to the discontinuation of antithrombotic drugs were observed. Conclusion A 1-day direct oral anticoagulants interruption and dialysis are independent risk factors for post-EST delayed bleeding, necessitating careful consideration.
Collapse
Affiliation(s)
- Sho Hasegawa
- Department of Gastroenterology and HepatologyYokohama City University Graduate School of MedicineKanagawaJapan
| | - Yusuke Kurita
- Department of Gastroenterology and HepatologyYokohama City University Graduate School of MedicineKanagawaJapan
| | - Yuma Yamazaki
- Department of Gastroenterology and HepatologyYokohama City University Graduate School of MedicineKanagawaJapan
| | - Shinichi Nihei
- Department of Gastroenterology and HepatologyYokohama City University Graduate School of MedicineKanagawaJapan
| | - Takeshi Iizuka
- Department of Gastroenterology and HepatologyYokohama City University Graduate School of MedicineKanagawaJapan
| | - Noboru Misawa
- Department of Gastroenterology and HepatologyYokohama City University Graduate School of MedicineKanagawaJapan
| | - Kunihiro Hosono
- Department of Gastroenterology and HepatologyYokohama City University Graduate School of MedicineKanagawaJapan
| | - Itaru Endo
- Department of Gastroenterological SurgeryYokohama City University Graduate School of MedicineKanagawaJapan
| | - Noritoshi Kobayashi
- Department of OncologyYokohama City University Graduate School of MedicineKanagawaJapan
| | - Kensuke Kubota
- Department of Gastroenterology and HepatologyYokohama City University Graduate School of MedicineKanagawaJapan
| | - Atsushi Nakajima
- Department of Gastroenterology and HepatologyYokohama City University Graduate School of MedicineKanagawaJapan
| |
Collapse
|
|
2
|
Fukuma T, Ishii S, Fujisawa T, Takahashi K, Nakamura T, Shibata F, Tomishima K, Takasaki Y, Suzuki A, Takahashi S, Ito K, Ushio M, Ikemura M, Kabemura D, Ota H, Nakai Y, Kogure H, Takahara N, Isayama H. Development of a Dedicated X-Ray Fluoroscopic Apparatus for Therapeutic Pancreatobiliary Endoscopy: A Review. J Clin Med 2025; 14:1214. [PMID: 40004745 PMCID: PMC11856850 DOI: 10.3390/jcm14041214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2024] [Revised: 01/30/2025] [Accepted: 02/07/2025] [Indexed: 02/27/2025] Open
Abstract
In recent years, pancreaticobiliary endoscopy (PBE) has evolved to include a wide range of endoscopic procedures used to treat various diseases. Several interventional endoscopic ultrasonography procedures have been developed for conditions that cannot be treated with conventional endoscopic methods. As PBE continues to advance, it is crucial to improve fluoroscopic systems to enhance image quality, ensure patient safety, reduce radiation exposure, and ensure the operation of video-recording systems. The difficult procedures require the precise imaging of thin pancreatic/biliary branch devices, including guidewires, catheters, and stents. It is crucial to reduce noise caused by patient breathing and movement, while retaining the necessary movement in the image on the screen. A stable table is effective for ensuring the safety of patients during the procedure. A reduction in radiation exposure is important, and the flame rate conversion technique is effective. Ensuring high-quality recording is useful for the video presentation of PBE procedures. In collaboration with Fujifilm (Tokyo, Japan), we researched and developed various functions in fluoroscopic systems for PBE. In this review, we outline the requirements for fluoroscopic procedures in PBE, the evolution of technology to date, and its prospects, while also presenting the commercial equipment currently available.
Collapse
Affiliation(s)
- Taito Fukuma
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo 113-8431, Japan; (T.F.); (S.I.); (T.F.); (K.T.); (Y.T.); (A.S.); (S.T.); (K.I.); (M.U.); (M.I.); (D.K.); (H.O.)
| | - Shigeto Ishii
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo 113-8431, Japan; (T.F.); (S.I.); (T.F.); (K.T.); (Y.T.); (A.S.); (S.T.); (K.I.); (M.U.); (M.I.); (D.K.); (H.O.)
| | - Toshio Fujisawa
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo 113-8431, Japan; (T.F.); (S.I.); (T.F.); (K.T.); (Y.T.); (A.S.); (S.T.); (K.I.); (M.U.); (M.I.); (D.K.); (H.O.)
| | - Keiko Takahashi
- Medical System Research & Development Center, MS R&D Department, FUJIFILM Corporation, Chiba 277-0804, Japan; (K.T.); (T.N.)
| | - Tadashi Nakamura
- Medical System Research & Development Center, MS R&D Department, FUJIFILM Corporation, Chiba 277-0804, Japan; (K.T.); (T.N.)
| | - Futoshi Shibata
- Modality Solution Division, Medical System Business Division, XR Product Marketing Group, FUJIFILM Corporation, Tokyo 107-0052, Japan;
| | - Ko Tomishima
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo 113-8431, Japan; (T.F.); (S.I.); (T.F.); (K.T.); (Y.T.); (A.S.); (S.T.); (K.I.); (M.U.); (M.I.); (D.K.); (H.O.)
| | - Yusuke Takasaki
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo 113-8431, Japan; (T.F.); (S.I.); (T.F.); (K.T.); (Y.T.); (A.S.); (S.T.); (K.I.); (M.U.); (M.I.); (D.K.); (H.O.)
| | - Akinori Suzuki
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo 113-8431, Japan; (T.F.); (S.I.); (T.F.); (K.T.); (Y.T.); (A.S.); (S.T.); (K.I.); (M.U.); (M.I.); (D.K.); (H.O.)
| | - Sho Takahashi
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo 113-8431, Japan; (T.F.); (S.I.); (T.F.); (K.T.); (Y.T.); (A.S.); (S.T.); (K.I.); (M.U.); (M.I.); (D.K.); (H.O.)
| | - Koichi Ito
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo 113-8431, Japan; (T.F.); (S.I.); (T.F.); (K.T.); (Y.T.); (A.S.); (S.T.); (K.I.); (M.U.); (M.I.); (D.K.); (H.O.)
| | - Mako Ushio
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo 113-8431, Japan; (T.F.); (S.I.); (T.F.); (K.T.); (Y.T.); (A.S.); (S.T.); (K.I.); (M.U.); (M.I.); (D.K.); (H.O.)
| | - Muneo Ikemura
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo 113-8431, Japan; (T.F.); (S.I.); (T.F.); (K.T.); (Y.T.); (A.S.); (S.T.); (K.I.); (M.U.); (M.I.); (D.K.); (H.O.)
| | - Daishi Kabemura
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo 113-8431, Japan; (T.F.); (S.I.); (T.F.); (K.T.); (Y.T.); (A.S.); (S.T.); (K.I.); (M.U.); (M.I.); (D.K.); (H.O.)
| | - Hiroto Ota
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo 113-8431, Japan; (T.F.); (S.I.); (T.F.); (K.T.); (Y.T.); (A.S.); (S.T.); (K.I.); (M.U.); (M.I.); (D.K.); (H.O.)
| | - Yousuke Nakai
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (Y.N.); (N.T.)
- Department of Internal Medicine, Institute of Gastroenterology, Tokyo Women’s Medical University, Tokyo 162-8666, Japan
| | - Hirofumi Kogure
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo 101-8309, Japan;
| | - Naminatsu Takahara
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (Y.N.); (N.T.)
| | - Hiroyuki Isayama
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo 113-8431, Japan; (T.F.); (S.I.); (T.F.); (K.T.); (Y.T.); (A.S.); (S.T.); (K.I.); (M.U.); (M.I.); (D.K.); (H.O.)
| |
Collapse
|
|
3
|
Ishida Y, Hisa T, Matsumoto R, Nishiyama S, Kudo A, Yamada T, Osera S, Tomori A, Fukushima H. Utility and safety of endoscopic papillary balloon dilation with small-incision sphincterotomy for small bile duct stones: A randomized controlled trial. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2025; 32:160-167. [PMID: 39663138 DOI: 10.1002/jhbp.12097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2024]
Abstract
BACKGROUND Endoscopic sphincterotomy (ES) for bile duct stones (BDS) can cause basket impaction with stone, complicating the procedure. In this study, we evaluated the utility and safety of small incision ES combined with endoscopic papillary balloon dilation (sES + EPBD) (balloon dilated up to the stone size), compared with ES alone for BDS <12 mm. METHODS The primary endpoint was the frequency of mechanical lithotripsy (ML), indicating the risk of basket impaction with stone; however, the secondary endpoints were procedure time, successful stone removal, and early adverse events. RESULTS A total of 100 patients were randomized into the ES and sES + EPBD groups (n = 50 for each). Significantly fewer cases required ML (20.0% vs. 4.0%, p = .028) in the sES + EPBD group. The maximum short-axis diameter of the stones in all patients requiring ML in the ES group ranged from 8 to 11 mm. The median procedure time was significantly shorter (18.5 min vs. 17 min, p = .047) in the sES + EPBD group. Both groups showed similar frequencies of successful stone removal in one session (88.0% vs. 98.0%, p = .112) and early adverse events (4.0% vs. 2.0%, p = .62). CONCLUSION In cases of small BDS, sES + EPBD exhibits a low frequency of ML, which shortens procedure time and prevents basket impaction with stones.
Collapse
Affiliation(s)
- Yuki Ishida
- Department of Gastroenterology, Saku Central Hospital Advanced Care Center, Nagano, Japan
- Department of Gastroenterology, Matsumoto Kyoritsu Hospital, Nagano, Japan
| | - Takeshi Hisa
- Department of Gastroenterology, Saku Central Hospital Advanced Care Center, Nagano, Japan
| | - Ryusuke Matsumoto
- Department of Gastroenterology, Obihiro Kosei Hospital, Hokkaido, Japan
| | - Shigeru Nishiyama
- Department of Gastroenterology, Saku Central Hospital Advanced Care Center, Nagano, Japan
| | - Akiharu Kudo
- Department of Gastroenterology, Saku Central Hospital Advanced Care Center, Nagano, Japan
| | - Takahiro Yamada
- Department of Gastroenterology, Saku Central Hospital Advanced Care Center, Nagano, Japan
| | - Shozo Osera
- Department of Gastroenterology, Saku Central Hospital Advanced Care Center, Nagano, Japan
| | - Akihisa Tomori
- Department of Gastroenterology, Saku Central Hospital Advanced Care Center, Nagano, Japan
| | - Hideki Fukushima
- Department of Gastroenterology, Saku Central Hospital Advanced Care Center, Nagano, Japan
| |
Collapse
|
|
4
|
Li L, Zeng Z, Li W, Lu J, Li L, Zhang J. PTCD and choledochoscopy for recurrent choledocholithiasis after multiple abdominal surgeries: a case report. Front Med (Lausanne) 2024; 11:1466184. [PMID: 39776841 PMCID: PMC11703660 DOI: 10.3389/fmed.2024.1466184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Accepted: 11/15/2024] [Indexed: 01/11/2025] Open
Abstract
Background Special attention should be given to intra-abdominal adhesions in patients with a history of open cholecystectomy for gallstones or abdominal surgery. Choosing the appropriate surgical approach to remove the stones is crucial. Patient summary A 68-year-old male was admitted due to sudden onset of upper abdominal pain lasting more than 6 h. In 2018, he underwent open Billroth II surgery for gastric cancer at an external hospital, and in 2020, he underwent open cholecystectomy for gallstones. In August 2023, he received gamma knife treatment for recurrent gastric cancer brain metastasis at another hospital with good results. In December of the same year, the patient presented to our hospital due to recurrent common bile duct stones and cholangitis. Given his history of two abdominal surgeries, percutaneous transhepatic cholangiodrainage (PTCD) combined with choledochoscopic stone extraction was chosen, which was successful in completely removing the stones. A PTCD tube was left in place postoperatively. Conclusion For patients with a history of two or more abdominal surgeries who experience recurrent common bile duct stones, PTCD has the advantages of a shorter operative time, less blood loss, earlier postoperative ventilation, earlier resumption of eating, minimal trauma and faster recovery.
Collapse
Affiliation(s)
- Liqiang Li
- Department of General Surgery, The Second People’s Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, China
- Department of General Surgery, Hefei Second People’s Hospital Affiliated to Bengbu Medical University, Bengbu, China
| | - Zihan Zeng
- Department of General Surgery, The Second People’s Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, China
- Department of General Surgery, Hefei Second People’s Hospital Affiliated to Bengbu Medical University, Bengbu, China
| | - Wenbo Li
- Department of General Surgery, The Second People’s Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, China
- Department of General Surgery, Hefei Second People’s Hospital Affiliated to Bengbu Medical University, Bengbu, China
| | - Jun Lu
- Department of General Surgery, The Second People’s Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, China
- Department of General Surgery, Hefei Second People’s Hospital Affiliated to Bengbu Medical University, Bengbu, China
| | - Liang Li
- Department of General Surgery, The Second People’s Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, China
- Department of General Surgery, Hefei Second People’s Hospital Affiliated to Bengbu Medical University, Bengbu, China
| | - Jun Zhang
- Department of General Surgery, The Second People’s Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, China
- Department of General Surgery, Hefei Second People’s Hospital Affiliated to Bengbu Medical University, Bengbu, China
| |
Collapse
|
|
5
|
Yabe K, Yamagata W, Satou M, Oka I, Horike H, Namiki S, Hosoi K. Minimal endoscopic sphincterotomy followed by papillary balloon dilation to relieve choledocholithiasis in a 6-year-old girl with hereditary spherocytosis. Clin J Gastroenterol 2024; 17:782-787. [PMID: 38517593 DOI: 10.1007/s12328-024-01960-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/17/2024] [Indexed: 03/24/2024]
Abstract
A 6-year-old girl previously diagnosed with hereditary spherocytosis was admitted to our hospital with gallstones and cholangitis. Endoscopic retrograde cholangiopancreatography (ERCP) was performed, and fluoroscopy revealed a dilated common bile duct (CBD) without evident stones, possibly due to spontaneous excretion through the papilla of Vater. A 7-French plastic stent was inserted into the CBD. After the procedure, a marked increase in pancreatic enzyme levels was observed, and she was diagnosed with post-ERCP pancreatitis (PEP). Stent placement could have been a cause of pancreatitis; therefore, we removed the stent. Subsequently, recovery from pancreatitis was confirmed, although she suddenly complained of abdominal pain and was diagnosed with choledocholithiasis recurrence. ERCP was repeated, and fluoroscopy revealed a dilated CBD with a stone. A minimal endoscopic sphincterotomy (EST) was performed to reduce the risk of PEP, and a biliary dilation balloon placed across the papilla was gradually inflated until the waist of the balloon disappeared. Stones were extracted using a retrieval balloon catheter. The abdominal pain resolved immediately, and the patient recovered without developing PEP. To our knowledge, this is the first case report of a pediatric patient treated with minimal EST followed by papillary balloon dilation for choledocholithiasis.
Collapse
Affiliation(s)
- Kiyoaki Yabe
- Department of Gastroenterology, Tokyo Metropolitan Children's Medical Center, 2-8-29, Musashidai, Fuchu-shi, Tokyo, 183-8561, Japan.
| | - Wataru Yamagata
- Department of Gastroenterology, Tokyo Metropolitan Tama Medical Center, 2-8-29, Musashidai, Fuchu-shi, Tokyo, 183-8524, Japan
| | - Masamichi Satou
- Department of Gastroenterology, Tokyo Metropolitan Children's Medical Center, 2-8-29, Musashidai, Fuchu-shi, Tokyo, 183-8561, Japan
| | - Itsuhiro Oka
- Department of Gastroenterology, Tokyo Metropolitan Children's Medical Center, 2-8-29, Musashidai, Fuchu-shi, Tokyo, 183-8561, Japan
| | - Hideyuki Horike
- Department of Gastroenterology, Tokyo Metropolitan Tama Medical Center, 2-8-29, Musashidai, Fuchu-shi, Tokyo, 183-8524, Japan
| | - Shin Namiki
- Department of Gastroenterology, Tokyo Metropolitan Tama Medical Center, 2-8-29, Musashidai, Fuchu-shi, Tokyo, 183-8524, Japan
| | - Kenji Hosoi
- Department of Gastroenterology, Tokyo Metropolitan Children's Medical Center, 2-8-29, Musashidai, Fuchu-shi, Tokyo, 183-8561, Japan
| |
Collapse
|
|
6
|
Combined rectal indomethacin and intravenous saline hydration in post-ERCP pancreatitis prophylaxis. Arab J Gastroenterol 2022; 23:95-101. [DOI: 10.1016/j.ajg.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/07/2022] [Accepted: 01/22/2022] [Indexed: 11/22/2022]
|
|
7
|
Best Procedure for the Management of Common Bile Duct Stones via the Papilla: Literature Review and Analysis of Procedural Efficacy and Safety. J Clin Med 2020; 9:jcm9123808. [PMID: 33255554 PMCID: PMC7760048 DOI: 10.3390/jcm9123808] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/10/2020] [Accepted: 11/23/2020] [Indexed: 12/22/2022] Open
Abstract
Background: Endoscopic management of common bile duct stones (CBDS) is standard; however, various techniques are performed via the papilla, and the best procedure in terms of both efficacy and safety has not been determined. Methods: Endoscopic procedures were classified into five categories according to endoscopic sphincterotomy (EST) and balloon dilation (BD): (1) EST, (2) endoscopic papillary BD (≤10 mm) (EPBD), (3) EST followed by BD (≤10 mm) (ESBD), (4) endoscopic papillary large BD (≥12 mm) (EPLBD), and (5) EST followed by large BD (≥12 mm) (ESLBD). We performed a literature review of prospective and retrospective studies to compare efficacy and adverse events (AEs). Each procedure was associated with different efficacy and AE profiles. Results: In total, 19 prospective and seven retrospective studies with a total of 3930 patients were included in this study. For EST, the complete stone removal rate at the first session, rate of mechanical lithotripsy (ML), and rate of overall AEs in EST were superior to EPBD, but a higher rate of bleeding was found for EST. Based on one retrospective study, complete stone removal rate at the first session, rate of ML, and rate of overall AEs were superior for ESBD vs. EST, and the rate of bleeding for the former was also lower. Complete stone removal rate at the first session and rate of ML for ESLBD were superior to those for EST, with no significant difference in rate of AEs. For EST vs. EPLBD, complete stone removal rate at the first session and rate of ML were superior for the latter. For EPLBD vs. ESLBD, the efficacy and safety were similar. Conclusions: ESBD is considered the best procedure for the management of small CBDS, but strong evidence is lacking. For large CBDS, both ESLBD and EPLBD are similar.
Collapse
|