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Treating bilio-duodenal obstruction: Combining new endoscopic technique with 6 Fr stent introducer

World Journal of Gastroenterology 2010年第22期16卷 2828-2831页

作者： Iruru Maetani Tomoko Nambu shigefumi omuta Takeo Ukita Hiroaki Shigoka Division of Gastroenterology Department of Internal Medicine Toho University Ohashi Medical Center

Periampullary cancer may cause not only biliary but also duodenal obstructions. In patients with concomitant duodenal obstructions, endoscopic biliary stenting remains technically difficult and may often require percutaneous transhepatic biliary drainage. We describe a method of metal stent placement via a thin forwardviewing endoscope in patients with simultaneous biliary and duodenal obstruction. In two consecutive patients with biliary and duodenal obstruction due to pancreatic cancer, a new biliary metal stent mounted in a slim delivery catheter was placed via a thin forward viewing endoscope after passage across the duodenal stenosis without balloon dilation. In both patients, with our new placement technique, metallic stents were successfully placed in a short time without adverse events. After biliary stenting, one patient received curative resection and the other received duodenal stenting for palliation. Metallic stent placement with a forward-viewing thin endoscope is a beneficial technique, which can avoid percutaneous drainage in patients with bilio-duodenal obstructions due to periampullary cancer.

关键词： Biliary obstruction Duodenal obstruction Pancreatic cancer Self-expandable metallic stent Stent placement Thin forward-viewing endoscope

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Direct peroral cholangioscopy using an ultraslim upper endoscope for biliary lesions

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Hepatobiliary & Pancreatic Diseases International 2014年第1期13卷 60-64页

作者： shigefumi omuta Iruru Maetani Takeo Ukita Tomoko Nambu Katsushige Gon Hiroaki Shigoka Yoshinori Saigusa Michihiro Saito Division of Gastroenterology Department of Internal Medicine Toho University Ohashi Medical Center

BACKGROUND: The development of direct peroral cholangioscopy(DPOC) using an ultraslim endoscope simplifies biliary cannulation. The conventional techniques are cumbersome to perform and require advanced skills. The recent introduction of the guidewires and balloons has improved the therapeutic outcomes. Here we describe an effective and easier method for performing DPOC using an ultraslim upper endoscope. METHODS: Indications for DPOC were the presence of stones on follow-up of patients who had previously undergone complete sphincteroplasty, including endoscopic sphincterotomy or endoscopic papillary large balloon dilatation. Fifteen patients underwent DPOC. An ultraslim endoscope was inserted perorally and was advanced into the major papilla. The ampulla of Vater was visualized by retroflexing the endoscope in the distal second portion of the duodenum, and then DPOC was performed using a wire-guided cannulation technique with an anchored intraductal balloon catheter. RESULTS: One patient failed in the treatment due to looping of the endoscope in the fornix of the stomach. Fourteen(93.3%) were successfully treated with our modified DPOC technique. Only one patient(6.7%) experienced an adverse event(pancreatitis) who responded well to conservative management. Residual stones of the common bile duct were completely removed in 3 patients. CONCLUSION: The modified method of DPOC is simple, safe and easy to access the bile duct.

关键词： direct peroral cholangioscopy ultraslim upper endoscope endoscopic retrograde cholangioscopy biliary tract

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Is endoscopic papillary large balloon dilatation without endoscopic sphincterotomy effective?

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World Journal of Gastroenterology 2015年第23期21卷 7289-7296页

作者： shigefumi omuta Iruru Maetani Michihiro Saito Hiroaki Shigoka Katsushige Gon Junya Tokuhisa Mieko Naruki Division of Gastroenterology and Hepatology Department of Internal Medicine Toho University Ohashi Medical Center

AIM: To evaluate the safety and efficacy of endoscopic papillary large balloon dilatation(EPLBD) without endoscopic sphincterotomy in a prospective ***: From July 2011 to August 2013, we performed EPLBD on 41 patients with nae papillae prospectively. For sphincteroplasty of EPLBD,endoscopic sphincterotomy(EST) was not performed,and balloon diameter selection was based on the distal common bile duct diameter. The balloon was inflated to the desired pressure. If the balloon waist did not disappear, and the desired pressure was satisfied, we judged the dilatation as complete. We used a retrieval balloon catheter or mechanical lithotripter(ML) to remove stones and assessed the rates of complete stone removal, number of sessions, use of ML and adverse events. Furthermore, we compared the presence or absence of balloon waist disappearance with clinical characteristics and endoscopic ***: The mean diameters of the distal and maximum common bile duct were 13.5 ± 2.4 mm and16.4 ± 3.1 mm, respectively. The mean maximum transverse-diameter of the stones was 13.4 ± 3.4mm, and the mean number of stones was 3.0 ± *** stone removal was achieved in 97.5%(40/41)of cases, and ML was used in 12.2%(5/41) of *** mean number of sessions required was 1.2 ± *** developed in two patients and perforation in one. The rate of balloon waist disappearance was73.1%(30/41). No significant differences were noted in procedure time, rate of complete stone removal(100% vs 100%), number of sessions(1.1 vs 1.3, P= 0.22), application of ML(13% vs 9%, P = 0.71),or occurrence of pancreatitis(3.3% vs 9.1%, P =0.45) between cases with and without balloon waist ***: EST before sphincteroplasty may be unnecessary in EPLBD. Further investigations are needed to verify the relationship between the presence or absence of balloon waist disappearance.

关键词： Endoscopic papillary large balloon dilatation Difficult bile duct stone Endoscopic sphincterotomy Distal common bile duct Perforation

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Newly designed J-shaped tip guidewire: A preliminary feasibility study in wire-guided cannulation

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World Journal of Gastroenterology 2013年第28期19卷 4531-4536页

作者： shigefumi omuta Iruru Maetani Hiroaki Shigoka Katsushige Gon Michihiro Saito Junya Tokuhisa Mieko Naruki Division of Gastroenterology Department of Internal Medicine Toho University Ohashi Medical Center Tokyo 153-8515 Japan

AIM: To perform wire-guided cannulation using a newly designed J-shaped tip guidewire, and to verify feasibility and safety for use. METHODS: The study was conducted on endoscopic retrograde cholangiopancreatography (ERCP) patients with na ve papilla undergoing diagnosis and treatment of biliary diseases between September 2011 and July 2012. We performed ERCP in a succession of 50 cases with a J-shaped tip guidewire. The first insertion attempt began with a trainee who had 5 min to complete cannulation, followed if necessary by the trainer for another 5 min. We assessed the primary success rate of selective biliary cannulation within 10 min and adverse events such as post-ERCP pancreatitis (PEP), bleeding or ***: The primary success rate was 90% (45/50) within 10 min, the initial success rate within 5 min by trainee staff was 76% (38/50). The rate of PEP was 6% (3/50), but all 3 cases were mild pancreatitis. All patients were managed successfully with conservative treatment. There was no bleeding or perforation. CONCLUSION: A newly designed J-shaped tip guidewire has the possibility to facilitate selective biliary cannulation for ERCP and appears to be safe.

关键词： J-shaped tip guidewire Wire-guided cannulation Endoscopic retrograde cholangiopancreatography Biliary tract Cannulation technique Perforation

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