Hideyuki Shiomi1, Kentaro Yamao2, Noriyuki Hoki3, Takeshi Hisa4, Takeshi Ogura5, Kosuke Minaga2,6, Atsuhiro Masuda1, Kazuya Matsumoto7, Hironari Kato8, Hideki Kamada9, Daisuke Goto10, Hajime Imai2, Mamoru Takenaka1,2, Chishio Noguchi11, Hidefumi Nishikiori12, Yasutaka Chiba13, Hiromu Kutsumi14, Masayuki Kitano15. 1. Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan. 2. Department of Gastroenterology and Hepatology, Kinki University Faculty of Medicine, Osaka-sayama, 589-8511, Japan. 3. Department of Gastroenterology, Bellland General Hospital, Sakai, Osaka, 599-8247, Japan. 4. Department of Internal Medicine, Saku Central Hospital Advanced Care Center, Nagano, 384-0301, Japan. 5. Second Department of Internal Medicine, Osaka Medical College, Takatsuki, 569-8686, Japan. 6. Department of Gastroenterology and Hepatology, Japanese Red Cross Society Wakayama Medical Center, Wakayama, 640-8558, Japan. 7. Department of Gastroenterology, Tottori University Hospital, Yonago, 683-8504, Japan. 8. Departments of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, 700-8558, Japan. 9. Department of Gastroenterology and Neurology, Kagawa University Faculty of Medicine, Kagawa, 761-0793, Japan. 10. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tottori Red Cross Hospital, Tottori, 680-8517, Japan. 11. Department of Gastroenterology, Shinbeppu Hospital, 3898 Tsurumi, Beppu-shi, Oita, 874-0833, Japan. 12. Department of Gastroenterology, Oita Sanai Medical Center, Oita, 870-1151, Japan. 13. Clinical Research Center, Kinki University Hospital, Osaka-sayama, 589-8511, Japan. 14. Center for Clinical Research and Advanced Medicine Establishment, Shiga University of Medical Science, Otsu, 520-2192, Japan. 15. Second Department of Internal Medicine, Wakayama Medical University School of Medicine, 811-1 Kimiidera, Wakayama, 641-8509, Japan. kitano@wakayama-med.ac.jp.
Abstract
BACKGROUND: Endoscopic ultrasound-guided rendezvous technique (EUS-RV) has emerged as an effective salvage method for unsuccessful biliary cannulation. However, its application for benign and resectable malignant biliary disorders has not been fully evaluated. AIMS: To assess the efficacy and safety of EUS-RV for benign and resectable malignant biliary disorders. METHODS: This was a multicenter prospective study from 12 Japanese referral centers. Patients who underwent EUS-RV after failed biliary cannulation for biliary disorder were candidates for this study. Inclusion criteria were unsuccessful biliary cannulation for therapeutic endoscopic retrograde cholangiopancreatography with benign and potentially resectable malignant biliary obstruction. Exclusion criteria included unresectable malignant biliary obstruction, inaccessible papillae due to surgically altered upper gastrointestinal anatomy or duodenal stricture, and previous sphincterotomy and/or biliary stent placement. The primary outcome was the technical success rate of biliary cannulation; procedure time, adverse events, and clinical outcomes were secondary outcomes. RESULTS: Twenty patients were prospectively enrolled. The overall technical success rate and median procedure time were 85% and 33 min, respectively. Guidewire manipulation using a 4-Fr tapered tip catheter contributed to the success in advancing the guidewire into the duodenum. Adverse events were identified in 15% patients, including 2 with biliary peritonitis and 1 mild pancreatitis. EUS-RV did not affect surgical maneuvers or complications associated with surgery, or postoperative course. CONCLUSIONS: EUS-RV may be a safe and feasible salvage method for unsuccessful biliary cannulation for benign or resectable malignant biliary disorders. Use of a 4-Fr tapered tip catheter may improve the overall EUS-RV success rate.
BACKGROUND: Endoscopic ultrasound-guided rendezvous technique (EUS-RV) has emerged as an effective salvage method for unsuccessful biliary cannulation. However, its application for benign and resectable malignant biliary disorders has not been fully evaluated. AIMS: To assess the efficacy and safety of EUS-RV for benign and resectable malignant biliary disorders. METHODS: This was a multicenter prospective study from 12 Japanese referral centers. Patients who underwent EUS-RV after failed biliary cannulation for biliary disorder were candidates for this study. Inclusion criteria were unsuccessful biliary cannulation for therapeutic endoscopic retrograde cholangiopancreatography with benign and potentially resectable malignant biliary obstruction. Exclusion criteria included unresectable malignant biliary obstruction, inaccessible papillae due to surgically altered upper gastrointestinal anatomy or duodenal stricture, and previous sphincterotomy and/or biliary stent placement. The primary outcome was the technical success rate of biliary cannulation; procedure time, adverse events, and clinical outcomes were secondary outcomes. RESULTS: Twenty patients were prospectively enrolled. The overall technical success rate and median procedure time were 85% and 33 min, respectively. Guidewire manipulation using a 4-Fr tapered tip catheter contributed to the success in advancing the guidewire into the duodenum. Adverse events were identified in 15% patients, including 2 with biliary peritonitis and 1 mild pancreatitis. EUS-RV did not affect surgical maneuvers or complications associated with surgery, or postoperative course. CONCLUSIONS:EUS-RV may be a safe and feasible salvage method for unsuccessful biliary cannulation for benign or resectable malignant biliary disorders. Use of a 4-Fr tapered tip catheter may improve the overall EUS-RV success rate.
Authors: Peter B Cotton; Glenn M Eisen; Lars Aabakken; Todd H Baron; Matt M Hutter; Brian C Jacobson; Klaus Mergener; Albert Nemcek; Bret T Petersen; John L Petrini; Irving M Pike; Linda Rabeneck; Joseph Romagnuolo; John J Vargo Journal: Gastrointest Endosc Date: 2010-03 Impact factor: 9.427
Authors: P C Robson; N Heffernan; M Gonen; R Thornton; L A Brody; R Holmes; K T Brown; A M Covey; D Fleischer; G I Getrajdman; W Jarnagin; C Sofocleous; L Blumgart; M D'Angelica Journal: Ann Surg Oncol Date: 2010-04-01 Impact factor: 5.344
Authors: Do Hyun Park; Seung Uk Jeong; Byung Uk Lee; Sang Soo Lee; Dong-Wan Seo; Sung Koo Lee; Myung-Hwan Kim Journal: Gastrointest Endosc Date: 2013-03-21 Impact factor: 9.427