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Pancreatic guidewire placement for achieving selective biliary cannulation during endoscopic retrograde cholangio-pancreatography

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World Journal of Gastroenterology 2008年第36期14卷 5595-5600页

作者： Kei Ito Naotaka Fujita Yutaka Noda Go Kobayashi Takashi Obana Jun Horaguchi Osamu Takasawa Shinsuke Koshita yoshihide kanno Department of Gastroenterology Sendai City Medical Center 5-22-1 Tsurugaya Miyagino-ku Sendai Miyagi 983-0824 Japan

AIM: To investigate the frequency and risk factors for acute pancreatitis after pancreatic guidewire placement (P-GW) in achieving cannulation of the bile duct during endoscopic retrograde cholangio-pancreatography (ERCP). METHODS: P-GW was performed in 113 patients in whom cannulation of the bile duct was difficult. The success rate of biliary cannulation, the frequency and risk factors of post-ERCP pancreatitis, and the frequency of spontaneous migration of the pancreatic duct stent were investigated. RESULTS: Selective biliary cannulation with P-GW was achieved in 73% of the patients. Post-ERCP pancreatitis occurred in 12% (14 patients: mild, 13; moderate, 1). Prophylactic pancreatic stenting was attempted in 59% of the patients. Of the 64 patients who successfully underwent stent placement, three developed mild pancreatitis (4.7%). Of the 49 patients without stent placement, 11 developed pancreatitis (22%: mild, 10; moderate, 1). Of the five patients in whom stent placement was unsuccessful, two developed mild pancreatitis. Univariate and multivariate analyses revealed no pancreatic stenting to be the only significant risk factor for pancreatitis. Spontaneous migration of the stent was observed within two weeks in 92% of the patients who had undergone pancreatic duct ***: P-GW is useful for achieving selective biliary cannulation. Pancreatic duct stenting after P-GW can reduce the incidence of post-ERCP pancreatitis, which requires evaluation by means of prospective randomized controlled trials.

关键词： Endoscopic retrograde cholangio-pancreatography Pancreatic duct stenting Acute pancreatitis Post-endoscopic retrograde cholangio-pancreatography pancreatitis Biliary cannulation

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Efficacy of a newly developed dilator for endoscopic ultrasound-guided biliary drainage

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World Journal of Gastrointestinal Endoscopy 2017年第7期9卷 304-309页

作者： yoshihide kanno Kei Ito Shinsuke Koshita Takahisa Ogawa Kaori Masu Yoshiharu Masaki Yutaka Noda Department of Gastroenterology Sendai City Medical CenterSendaiMiyagi 983-0824Japan

To evaluate the efficacy of a newly developed dilator for endoscopic ultrasound (EUS)-guided drainage (ES Dilator). METHODSFourteen consecutive patients who had undergone EUS-guided choledochoduodenostomy (EUS-CDS) with the ES Dilator were identified from a prospectively maintained database and enrolled in the study group. Fourteen other patients who had undergone EUS-CDS without the dilator just prior to its introduction were analyzed as the control group. A historical cohort study was carried out comparing the two groups. The main outcome measurement was the procedure time. The technical success rate and early AE rate were also compared between the two groups. RESULTSThere were no significant differences in age, sex and etiology of biliary obstruction. The utilization rate of a plastic stent was higher in the control group (36% vs 0%). The technical success rate was 100% in both groups. The mean procedure time was significantly shorter in the study group than in the control group (27 ± 7 min vs 44 ± 26 min, P = 0.026). Additionally, there were no patients who required more than 40 min for the procedure in the study group. Early adverse events occurred in 29% (4/14) of the control group whereas none in the study group. The adverse events in all 4 patients was bile peritonitis, including pan-peritonitis in one patient. All patients recovered with conservative treatment by medication. CONCLUSIONThe newly developed dilator was found to be useful for shortening procedure time and would prevent adverse events related to bile leakage in EUS-CDS.

关键词： Endoscopic ultrasound Dilation Adverse event ES Dilator Cautery

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