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Mai HD, Panicker L, Stone JJ, Brahmbhatt MN. LAMS use in malignant stricture of duodenal apex with synchronous malignant biliary obstruction: a potentially effective and simpler endoscopic approach. Clin J Gastroenterol 2024; 17:52-56. [PMID: 37981629 DOI: 10.1007/s12328-023-01885-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 10/19/2023] [Indexed: 11/21/2023]
Abstract
We report the first case of lumen apposing metal stent (LAMS) use in malignant stricture of the duodenal apex to treat gastric outlet obstruction (GOO) and to facilitate endoscopic retrograde management of synchronous malignant biliary obstruction due to pancreatic head adenocarcinoma. This technique may be an effective alternative and a simpler approach than current methodology to this endoscopically challenging condition.
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Affiliation(s)
- Hugh D Mai
- EUS and Advanced Endoscopy, Gastroenterology, Department of Veterans Affairs, Health Care System, West Palm Beach, FL, USA.
| | - Linoj Panicker
- Gastroenterology, Department of Veteran Affairs, Health Care System, West Palm Beach, FL, USA
| | - James J Stone
- General Surgery, Department of Veteran Affairs, Health Care System, West Palm Beach, FL, USA
| | - Mihir N Brahmbhatt
- Gastroenterology Fellow, Department of Veterans Affairs, Health Care System, West Palm Beach, FL, USA
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2
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Chittajallu V, Omar YA, Simons-Linares CR, Chahal P. Endoscopic balloon dilation management for benign duodenal stenosis. Surg Endosc 2023; 37:3610-3618. [PMID: 36624215 DOI: 10.1007/s00464-022-09844-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND AIMS Benign duodenal stenosis (BDS) is most commonly caused by peptic ulcer disease (PUD). Endoscopic balloon dilation (EBD) is the recommended initial management despite limited supporting literature. Our study investigated the etiologic spectrum of BDS and its response to endoscopic dilation. METHODS We performed a cohort study of a prospectively maintained database of BDS at our large tertiary academic center between 2002 and 2018. All patients who underwent EBD were analyzed. Dilation was performed using through-the-scope balloons. Technical and clinical successes of initial and repeat EBD were compared. Descriptive statistics, univariate, and multivariate analysis were performed. RESULTS The study included 86 patients with 54.7% female gender. Etiologies included 39 patients with PUD (45.3%), 19 patients with Crohn's disease (22.1%), 23 patients had idiopathic etiologies (26.7%), and 5 patients were listed as other etiologies (5.8%). Proximal stricture location (1st part of duodenum) occurred in 66% of females, whereas distal duodenal involvement was seen in 63.6% of males (p value 0.007). Usage of PPI was associated with 3.6 times higher clinical success rate (p value 0.04). Technical (97.4%) and clinical (77.8%) successes for index dilations in PUD were not significantly better than those of non-PUD patients (p values 0.99, 0.52). CONCLUSION EBD has both a high technical and clinical success for BDS regardless of etiology and should be considered over initial surgical intervention due to low risk profile. Males tend to have more distal duodenal involvement, and PPI usage is an independent predictor for clinical success.
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Affiliation(s)
- Vibhu Chittajallu
- Digestive Health Institute, University Hospitals Cleveland, Cleveland, OH, USA.
| | - Yazan Abu Omar
- Department of Hospital Medicine, Cleveland Clinic, Cleveland, OH, USA
| | | | - Prabhleen Chahal
- Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
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3
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Mangiavillano B, Moon JH, Facciorusso A, Di Matteo F, Paduano D, Bulajic M, Ofosu A, Auriemma F, Lamonaca L, Yoo HW, Rea R, Massidda M, Repici A. EUS-guided biliary drainage with a novel electrocautery-enhanced lumen apposing metal stent as first approach for distal malignant biliary obstruction: a prospective study. Endosc Int Open 2022; 10:E998-E1003. [PMID: 35845026 PMCID: PMC9286767 DOI: 10.1055/a-1838-2683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) represents the gold standard for jaundice palliation in malignant biliary obstruction (MBO) patients. Biliary drainage using electrocautery lumen apposing metal stent (EC-LAMS) is currently a well-established procedure when ERCP fails. We aimed to assess the technical and clinical success of a new EC-LAMS as the first approach to the palliation of malignant jaundice due to MBO in patients unfit for surgery. Patients and methods Twenty-five consecutive patients undergoing endoscopic-guided biliary drainage with the new EC-LAMS were prospectively enrolled. Clinical success was defined as bilirubin level decrease > 15 % 24 hours after EC-LAMS placement. Results Mean age was 76.6 ± 11.56 years, and male patients were 10 (40 %). EC-LAMS placement was technically feasible in 24 patients (96 %) and clinical success rate was 100 %. Only one patient (4 %) experienced a misplacement rescued by an immediate second EC-LAMS placement. The mean duration of hospital stay was 4.66 ± 4.22 days. The median overall survival was 7 months (95 % CI 1-7). Conclusions In this preliminary study, the new EC-LAMS seems to allow a single-step palliative endoscopic therapy in patients affected by jaundice due to MBO, with high technical and clinical success and low adverse events. Further large prospective studies are warranted to validate these results.
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Affiliation(s)
- Benedetto Mangiavillano
- Gastrointestinal Endoscopy Unit – Humanitas Mater Domini – Castellanza (VA), Italy,Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan, Italy
| | - Jong Ho Moon
- Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon, Korea
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | | | - Danilo Paduano
- Gastrointestinal Endoscopy Unit – Humanitas Mater Domini – Castellanza (VA), Italy
| | | | - Andrew Ofosu
- Division of Digestive Diseases, University of Cincinnati, Cincinnati, Ohio, United States
| | - Francesco Auriemma
- Gastrointestinal Endoscopy Unit – Humanitas Mater Domini – Castellanza (VA), Italy
| | - Laura Lamonaca
- Gastrointestinal Endoscopy Unit – Humanitas Mater Domini – Castellanza (VA), Italy
| | - Hae Won Yoo
- Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon, Korea
| | - Roberta Rea
- Digestive Endoscopy, Campus-Bio Medico University, Rome, Italy
| | | | - Alessandro Repici
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan, Italy,Humanitas Clinical and Research Center – IRCCS, Rozzano (MI), Italy
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4
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Mangiavillano B, Moon JH, Crinò SF, Larghi A, Pham KD, Teoh AYB, Paduano D, Lee YN, Yoo HW, Shin IS, Rizzatti G, Robles-Medranda C, Oleas R, Conti Bellocchi MC, Auriemma F, Lamonaca L, Spatola F, Conigliaro R, Facciorusso A, Gabbrielli A, Repici A. Safety and efficacy of a novel electrocautery-enhanced lumen-apposing metal stent in interventional EUS procedures (with video). Gastrointest Endosc 2022; 95:115-22. [PMID: 34339667 DOI: 10.1016/j.gie.2021.07.021] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/22/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Electrocautery-tip lumen-apposing metal stents (EC-LAMSs) have extended the indications of therapeutic EUS. We aimed to retrospectively evaluate safety and technical and clinical success of a newly developed EC-LAMS, the Hot-Spaxus (Taewoong Medical Co, Gimpo, Korea), for various EUS-guided procedures. METHODS We included and retrospectively analyzed consecutive patients at 8 tertiary care referral centers who had undergone EUS interventional procedures using the Hot-Spaxus between October 2018 and February 2021. RESULTS Of 58 included patients (male-to-female, 36:22; mean age, 63.5 ± 14.9 years), 29 had undergone pancreatic fluid collection drainage (50%), 22 (37.9%) biliary drainage for malignant distal obstruction, 3 (5.1%) gallbladder drainage for acute cholecystitis, 3 gastroenteroanastomoses, and 1 (1.7%) pelvic collection drainage. Technical success was achieved in 54 of 58 patients (93.1%) and clinical success in all 58. Adverse events occurred in 6 patients (11.1%): 2 early (3.7%), 1 late (1.8%), and 3 long term (5.6%). The outcomes were similar to those observed in a control group of patients treated with the Hot-Axios (Boston Scientific, Marlborough, Mass, USA), the other available EC-LAMS. CONCLUSIONS Our study showed that the novel EC-LAMS has high technical and clinical success rates for various interventional EUS indications. Future multicenter prospective studies will better clarify the role of this new EC-LAMS for different indications.
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Sundaram S, Harindranath S, Rao PK, Ramani N, Kale A, Patkar S. Concomitant endoscopic biliary, duodenal and colonic stent placement for advanced carcinoma of gall bladder. Int J Gastrointest Interv 2021. [DOI: 10.18528/ijgii210020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Sridhar Sundaram
- Department of Gastroenterology, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, India
| | - Sidharth Harindranath
- Department of Gastroenterology, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, India
| | - Praveen Kumar Rao
- Department of Gastroenterology, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, India
| | - Nitin Ramani
- Department of Gastroenterology, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, India
| | - Aditya Kale
- Department of Gastroenterology, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, India
| | - Shraddha Patkar
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India
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Wu CH, Lee MH, Tsou YK, Lin CH, Sung KF, Pan KT, Liu NJ. Risk Factors of Duodenobiliary Reflux-Related Dysfunction of Covered Biliary Metal Stents after Treatment of Duodenal Stricture in Patients with Malignant Biliary and Duodenal Obstruction. Curr Oncol 2021; 28:3738-3747. [PMID: 34677237 PMCID: PMC8534963 DOI: 10.3390/curroncol28050319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 02/05/2023] Open
Abstract
Duodenal obstruction is often accompanied with unresectable malignant distal biliary obstruction in patients who have undergone biliary self-expandable metal stent (SEMS) placement. Duodenobiliary reflux (DBR) is a major cause of recurrent biliary obstruction (RBO) after covered biliary SEMS placement. We analyzed the risk factors for DBR-related SEMS dysfunction following treatment for malignant duodenal obstruction. Sixty-one patients with covered SEMS who underwent treatment for duodenal obstruction were included. We excluded patients with tumor-related stent dysfunction (n = 6) or metal stent migration (n = 1). Fifty-four patients who underwent covered biliary SEMS placement followed by duodenal metal stenting or surgical gastrojejunostomy were included. Eleven patients had DBR-related biliary SEMS dysfunction after treatment of duodenal obstruction. There was no difference between the duodenal metal stenting group and the surgical gastrojejunostomy group. Duodenal obstruction below the papilla of Vater and a score of ≤2 on the Gastric Outlet Obstruction Scoring System after treatment for duodenal obstruction were associated with DBR-related covered biliary SEMS dysfunction. Thus, creating a reliable route for ensuring good oral intake and avoiding DBR in patients with duodenal obstruction below the papilla of Vater are both important factors in preventing DBR-related covered biliary SEMS dysfunction.
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Affiliation(s)
- Chi-Huan Wu
- Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (C.-H.W.); (M.-H.L.); (Y.-K.T.); (C.-H.L.); (K.-F.S.)
| | - Mu-Hsien Lee
- Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (C.-H.W.); (M.-H.L.); (Y.-K.T.); (C.-H.L.); (K.-F.S.)
| | - Yung-Kuan Tsou
- Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (C.-H.W.); (M.-H.L.); (Y.-K.T.); (C.-H.L.); (K.-F.S.)
| | - Cheng-Hui Lin
- Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (C.-H.W.); (M.-H.L.); (Y.-K.T.); (C.-H.L.); (K.-F.S.)
| | - Kai-Feng Sung
- Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (C.-H.W.); (M.-H.L.); (Y.-K.T.); (C.-H.L.); (K.-F.S.)
| | - Kuang-Tse Pan
- Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
- Correspondence: (K.-T.P.); (N.-J.L.); Tel.: +886-3-328-1200 (ext. 8107) (N.-J.L.)
| | - Nai-Jen Liu
- Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (C.-H.W.); (M.-H.L.); (Y.-K.T.); (C.-H.L.); (K.-F.S.)
- Correspondence: (K.-T.P.); (N.-J.L.); Tel.: +886-3-328-1200 (ext. 8107) (N.-J.L.)
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Kongkam P, Luangsukrerk T, Harinwan K, Vanduangden K, Plaidum S, Rerknimitr R, Kullavanijaya P. Combination of endoscopic-ultrasound guided choledochoduodenostomy and gastrojejunostomy resolving combined distal biliary and duodenal obstruction. Endoscopy 2021; 53:E355-6. [PMID: 33212523 DOI: 10.1055/a-1294-9399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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8
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Mangiavillano B, Auriemma F, Lamonaca L, Repici A. A Novel Lumen-Apposing Metal Stent with an Electrocautery Tip for Different Indications: Initial Experience in a Referral Center. Dig Dis 2021; 40:526-529. [PMID: 34348270 PMCID: PMC8450863 DOI: 10.1159/000518539] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 07/19/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND STUDY AIMS Recently, a new electrocautery lumen-apposing metal stent (EC-LAMS) has been launched. The primary aim of our study was to assess the feasibility of the freehand placement with intra-channel release of the new EC-LAMS. The secondary aims were to assess technical and clinical outcomes and rates of adverse events. PATIENTS AND METHODS We retrospectively evaluated 5 patients (3 F; mean age: 75.6 ± 14.6 years) who underwent new EC-LAMS placement for different indications (cholecystitis, malignant biliary obstruction, and malignant gastric outlet obstruction). We described all the procedures of EC-LAMS placement, providing also a video of one of them (see online suppl. material; for all online suppl. material, see www.karger.com/doi/10.1159/000518539). RESULTS Technical and clinical success was achieved in all patients who underwent new EC-LAMS placement, and no AEs were experienced. All of the EC-LAMS were placed using the freehand technique with intra-channel release. CONCLUSIONS Our initial experience with the new EC-LAMS showed a good performance of this device for different indications, especially if the stents are placed freehand and with intra-channel release. Further studies are needed to confirm our preliminary data and first impression about this new EC-LAMS.
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Affiliation(s)
- Bendetto Mangiavillano
- *Benedetto Mangiavillano, MD, Gastrointestinal Endoscopy Unit, Humanitas - Mater Domini, Via Gerenzano n.2, 21053- Castellanza (VA), Tel: 0039 0331 476205 - 381, Email address:
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9
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Due-Petersson R, Hansen LB. Lumen-apposing metal stent for treatment of malignant biliary obstruction, placed through an uncovered duodenal self-expanding metal stent. BMJ Case Rep 2021; 14:14/4/e238599. [PMID: 33858881 PMCID: PMC8055135 DOI: 10.1136/bcr-2020-238599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The development and refinement of endoscopic stenting techniques in recent years have made endoscopic treatment an important part of palliative care for irresectable malignant disease in the gastrointestinal tract. We present the case of a 82-year-old man with biliary obstruction and duodenal stenosis on the basis of disseminated pancreatic cancer. He was bothered by jaundice and reduced oral intake. This is typically alleviated using stents; however, the placement of a duodenal stent can limit the possibility of subsequent placement of a biliary stent. This therapeutic challenge was solved using a combination of lumen-apposing metal stents (LAMS) and self-expanding uncovered metal stents (SEMS). LAMS is a relatively novel type of stent intended for endoscopic ultrasonography-guided placement. First, we placed a SEMS in the duodenum, a LAMS was subsequently placed through the mesh of the duodenal SEMS, alleviating the biliary system. The patient was able to resume oral intake and his jaundice subsided.
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Sugimoto M, Takagi T, Suzuki R, Konno N, Asama H, Sato Y, Irie H, Nakamura J, Takasumi M, Hashimoto M, Kato T, Kobashi R, Hikichi T, Ohira H. The Dramatic Haemostatic Effect of Covered Self-expandable Metallic Stents for Duodenal and Biliary Bleeding. Intern Med 2021; 60:883-889. [PMID: 33087676 PMCID: PMC8024959 DOI: 10.2169/internalmedicine.6018-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Bilio-duodenal bleeding, such as post-endoscopic sphincterotomy (EST) bleeding, common bile duct (CBD) bleeding after endoscopic retrograde cholangiopancreatography (ERCP), and duodenal bleeding due to malignant tumour invasion, can sometimes become severe. Six cases of refractory bilio-duodenal bleeding were stanched via covered self-expandable metallic stent (CSEMS) insertion, even though three of the patients had a history of gastrectomy. The dumbbell-shaped CSEMS was useful for managing post-EST bleeding. Additional duodenal CSEMS insertion was useful for the patient who had previously undergone uncovered SEMS insertion, and no migration of the CSEMS was observed. CSEMS insertion was useful for treating refractory bilio-duodenal haemorrhaging.
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Affiliation(s)
- Mitsuru Sugimoto
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Japan
| | - Tadayuki Takagi
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Japan
| | - Rei Suzuki
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Japan
| | - Naoki Konno
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Japan
| | - Hiroyuki Asama
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Japan
| | - Yuki Sato
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Japan
| | - Hiroki Irie
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Japan
| | - Jun Nakamura
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Japan
- Department of Endoscopy, Fukushima Medical University Hospital, Japan
| | - Mika Takasumi
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Japan
| | - Minami Hashimoto
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Japan
- Department of Endoscopy, Fukushima Medical University Hospital, Japan
| | - Tsunetaka Kato
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Japan
- Department of Endoscopy, Fukushima Medical University Hospital, Japan
| | - Ryoichiro Kobashi
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Japan
| | - Takuto Hikichi
- Department of Endoscopy, Fukushima Medical University Hospital, Japan
| | - Hiromasa Ohira
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Japan
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Mangiavillano B, Kunda R, Robles-Medranda C, Oleas R, Anderloni A, Sportes A, Fabbri C, Binda C, Auriemma F, Eusebi LH, Frazzoni L, Fuccio L, Colombo M, Fugazza A, Bianchetti M, Repici A. Lumen-apposing metal stent through the meshes of duodenal metal stents for palliation of malignant jaundice. Endosc Int Open 2021; 9:E324-E330. [PMID: 33655029 PMCID: PMC7899809 DOI: 10.1055/a-1333-1053] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) is the gold standard procedure for malignant jaundice palliation; however, it can be challenging when a duodenal self-expandable metal stent (SEMS) is already in place. Patients and methods The primary aim of our study was to evaluate the technical feasibility of the placement of a lumen apposing metal stent (LAMS) through the mesh (TTM) of duodenal stents. The secondary aims were to evaluate clinical outcomes and adverse events (AEs) related to the procedures. Results Data from 23 patients (11 F and 12 M; mean age: 69.5 ± 11 years old) were collected. In 17 patients (73.9 %) TTM LAMS placement was performed as first intention, while in six patients (26.1 %) it was performed after a failed ERCP. Thirteen patients (56.5 %) underwent the procedure due to advanced pancreatic head neoplasia. One technical failure was experienced (4.3 %). The TTM LAMS placement led to a significant decrease in the serum levels of bilirubin, ALP, GGT, WBC and CRP. No cases of duodenal SEMS occlusion occurred and no other AEs were observed during the follow-up. Conclusions Concomitant malignant duodenal and biliary obstruction is a challenging condition. Palliation of jaundice using TTM LAMS in patients already treated with duodenal stent is associated to promising technical and clinical outcomes.
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Affiliation(s)
- Benedetto Mangiavillano
- Gastrointestinal Endoscopy Unit – Humanitas Mater Domini – Castellanza (VA), Italy,Humanitas University, Pieve Emanuele (MI), Italy
| | - Rastislav Kunda
- Department of Surgery, Department of Gastroenterology and Hepatology, and Department of Advanced Interventional Endoscopy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium,Department of Surgical Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Roberto Oleas
- Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
| | - Andrea Anderloni
- Endoscopy Unit, Istituto Clinico Humanitas Research Hospital, Milan
| | - Adrien Sportes
- Digestive Endoscopy, Institut Arnault TZANCK Gastroenterology Unit, Saint-Laurent-du-Var, France
| | - Carlo Fabbri
- Digestive Endoscopy Unit, Endoscopy Unit, Morgagni-Pietrantoni Hospital, Forlì, Italy
| | - Cecilia Binda
- Digestive Endoscopy Unit, Endoscopy Unit, Morgagni-Pietrantoni Hospital, Forlì, Italy
| | - Francesco Auriemma
- Gastrointestinal Endoscopy Unit – Humanitas Mater Domini – Castellanza (VA), Italy
| | - Leonardo H. Eusebi
- Endoscopy Unit, Department of Medical and Surgical Sciences, Sant’Orsola University Hospital, Bologna, Italy
| | - Leonardo Frazzoni
- Endoscopy Unit, Department of Medical and Surgical Sciences, Sant’Orsola University Hospital, Bologna, Italy
| | - Lorenzo Fuccio
- Endoscopy Unit, Department of Medical and Surgical Sciences, Sant’Orsola University Hospital, Bologna, Italy
| | - Matteo Colombo
- Endoscopy Unit, Istituto Clinico Humanitas Research Hospital, Milan
| | | | - Mario Bianchetti
- Gastrointestinal Endoscopy Unit – Humanitas Mater Domini – Castellanza (VA), Italy
| | - Alessandro Repici
- Humanitas University, Pieve Emanuele (MI), Italy,Endoscopy Unit, Istituto Clinico Humanitas Research Hospital, Milan
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Mangiavillano B, Carrara S, Eusebi LH, Auriemma F, Bianchetti M, Repici A. Water-filled technique for therapeutic pancreato-biliary EUS in patients with surgically altered anatomy. Endosc Int Open 2021; 9:E487-E489. [PMID: 33655054 PMCID: PMC7899791 DOI: 10.1055/a-1339-0690] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/28/2020] [Indexed: 12/11/2022] Open
Abstract
One of the main challenges encountered by endosonographers is performing diagnostic and interventional pancreato-biliary endoscopic ultrasound (EUS) procedures in the presence of surgically altered upper gastrointestinal anatomy. We describe the water-filled technique (WFT) for EUS examination and treatment of the pancreato-biliary region in patients with surgically altered upper gastrointestinal anatomy. Using the WFT, the scope is advanced up to the gastro-jejunal anastomosis and, after placing the tip of the scope 2 cm beyond it, enlargement of the jejunal lumen is obtained by water instillation of the jejunal loop. An enlargement of more than 1.5 cm allows advancement of the tip of the scope under EUSguidance up to the duodenum, in a retrograde way. The WFT is useful for reaching the ampullary area and performing diagnostic and therapeutic EUS in patients with surgically altered anatomy. The technique is also reproducible and can be easily used by endoscopists who regularly perform EUS.
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Affiliation(s)
- Benedetto Mangiavillano
- Gastrointestinal Endoscopy Unit – Humanitas Mater Domini – Castellanza, Italy,Humanitas University, Rozzano, Italy
| | - Silvia Carrara
- Digestive Endoscopy Unit, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Leonardo H. Eusebi
- Endoscopy Unit, Department of Medical and Surgical Sciences, Sant’Orsola University Hospital, Bologna, Italy
| | - Franceasco Auriemma
- Gastrointestinal Endoscopy Unit – Humanitas Mater Domini – Castellanza, Italy
| | - Mario Bianchetti
- Gastrointestinal Endoscopy Unit – Humanitas Mater Domini – Castellanza, Italy
| | - Alessandro Repici
- Humanitas University, Rozzano, Italy,Digestive Endoscopy Unit, Humanitas Clinical and Research Center, Rozzano, Italy
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Thomaidis T, Kallimanis G, May G, Zhou P, Sivanathan V, Mosko J, Triantafillidis JK, Teshima C, Moehler M. Advances in the endoscopic management of malignant biliary obstruction. Ann Gastroenterol 2020; 33:338-347. [PMID: 32624653 PMCID: PMC7315700 DOI: 10.20524/aog.2020.0497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 04/28/2020] [Indexed: 12/11/2022] Open
Abstract
Biliary obstruction is common in pancreatobiliary malignancies and has a negative impact on the patient’s quality of life, postoperative complications, and survival rates. Particularly in the last decade, there has been enormous progress regarding the diagnostic and therapeutic options in patients with malignant biliary obstruction. Endoscopy has given a new insight in this direction and novel techniques have been developed for the better characterization and treatment of malignant strictures. We herein summarize the available data on the different endoscopic techniques, and clarify their role in the diagnosis and treatment of malignant biliary obstructive disease. Finally, we propose an algorithm that can facilitate management decisions in these patients.
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Affiliation(s)
- Thomas Thomaidis
- 2 Gastroenterology Clinic, Hygeia Hospital, Athens, Greece (Thomas Thomaidis, George Kallimanis).,Johannes Gutenberg University, Mainz, Germany (Thomas Thomaidis, Visvakanth Sivanathan, Markus Moehler)
| | - George Kallimanis
- 2 Gastroenterology Clinic, Hygeia Hospital, Athens, Greece (Thomas Thomaidis, George Kallimanis)
| | - Gary May
- Division of Therapeutic Endoscopy, St. Michael's Hospital, University of Toronto, Toronto, Canada (Gary May, Jeff Mosko, Christopher Teshima)
| | - Pinghong Zhou
- Interventional endoscopy, Zhongshan Hospital, Fudan University, Shanghai, China (Pinghong Zhou)
| | - Visvakanth Sivanathan
- Johannes Gutenberg University, Mainz, Germany (Thomas Thomaidis, Visvakanth Sivanathan, Markus Moehler)
| | - Jeff Mosko
- Division of Therapeutic Endoscopy, St. Michael's Hospital, University of Toronto, Toronto, Canada (Gary May, Jeff Mosko, Christopher Teshima)
| | | | - Christopher Teshima
- Division of Therapeutic Endoscopy, St. Michael's Hospital, University of Toronto, Toronto, Canada (Gary May, Jeff Mosko, Christopher Teshima)
| | - Markus Moehler
- Johannes Gutenberg University, Mainz, Germany (Thomas Thomaidis, Visvakanth Sivanathan, Markus Moehler)
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Mangiavillano B, Auriemma F, Repici A. Left or Right Screen Orientation in Endoscopic Ultrasonography? Dig Dis 2020; 39:75-76. [PMID: 32392563 DOI: 10.1159/000508557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 05/09/2020] [Indexed: 02/02/2023]
Affiliation(s)
- Bendetto Mangiavillano
- Gastrointestinal Endoscopy Unit, Humanitas - Mater Domini, Castellanza, Italy, .,Humanitas University - Hunimed, Pieve Emanuele, Milan, Italy,
| | - Francesco Auriemma
- Gastrointestinal Endoscopy Unit, Humanitas - Mater Domini, Castellanza, Italy
| | - Alessandro Repici
- Humanitas University - Hunimed, Pieve Emanuele, Milan, Italy.,Digestive Endoscopy Unit, Humanitas Research Hospital, Rozzano, Italy
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