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The outcomes and safety of patients undergoing endoscopic retrograde cholangiopancreatography combining a single-use cholangioscope and a single-use duodenoscope:A multicenter retrospective international study

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Hepatobiliary & Pancreatic Diseases International 2024年第1期23卷 71-76页

作者： Alessandro Fugazza Matteo Colombo michel kahaleh V.Raman Muthusamy Bick Benjamin Wim Laleman Carmelo Barbera Carlo Fabbri Jose Nieto Abed Al-Lehibi Mohan Ramchandani Amy Tyberg Haroon Shahid Avik Sarkar Dean Ehrlich Stuart Shermand Cecilia Binda Marco Spadaccini Andrea Iannone Kareem Khalaf Nageshwar Reddy Andrea Anderloni Alessandro Repici Division of Gastroenterology and Digestive Endoscopy Humanitas Research Hospital-IRCCSVia Manzoni 5620089RozzanoMilanoItaly Gastroenterology Rutgers Robert Wood JohnsonNew BrunswickNew JerseyUSA Vatche and Tamar Manoukian Division of Digestive Diseases University of CaliforniaLos Angeles School of Medicine at UCLALos AngelesCaliforniaUSA Division of Digestive and Liver Disorders Indiana University School of MedicineIndianapolisINUSA Department of Gastroenterology and Hepatology University Hospitals LeuvenKU Leuven3000 LeuvenBelgium U.O.C.di Gastroenterologia ed Endoscopia Digestiva Ospedale Giuseppe MazziniASL TeramoItaly Gastroenterology and Digestive Endoscopy Unit Forlì-Cesena HospitalsAUSL RomagnaForlì-CesenaItaly Borland Groover Clinic JacksonvilleFloridaUSA Department of Gastroenterology and Hepatology King Fahad Medical CityRiyadhSaudi Arabia Asian Institute of Gastroenterology HyderabadIndia Section of Gastroenterology Department of Emergency and Organ TransplantationUniversity of BariBari 70124Italy Department of Biomedical Sciences Humanitas UniversityVia Rita Levi Montalcini 420090Pieve EmanueleMilanItaly

Background: Duodenoscope-related multidrug-resistant organism(MDRO) infections raise concerns. Disposable duodenoscopes have been recently introduced in the market and approved by regulatory agencies with the aim to reduce the risk of endoscopic retrograde cholangiopancreatography(ERCP) associated infections. The aim of this study was to evaluate the outcome of procedures performed with single-use duodenoscopes in patients with clinical indications to single-operator cholangiopancreatoscopy. Methods: This is a multicenter international, retrospective study combining all patients who underwent complex biliopancreatic interventions using the combination of a single-use duodenoscope and a single-use cholangioscope. The primary outcome was technical success defined as ERCP completion for the intended clinical indication. Secondary outcomes were procedural duration, rate of cross-over to reusable duodenoscope, operator-reported satisfaction score(1 to 10) on performance rating of the single-use duodenoscope, and adverse event(AE) rate. Results: A total of 66 patients(26, 39.4% female) were included in the study. ERCP was categorized according to ASGE ERCP grading system as 47(71.2%) grade 3 and 19(28.8%) grade 4. The technical success rate was 98.5%(65/66). Procedural duration was 64(interquartile range 15-189) min, cross-over rate to reusable duodenoscope was 1/66(1.5%). The satisfaction score of the single-use duodenoscope classified by the operators was 8.6 ± 1.3 points. Four patients(6.1%) experienced AEs not directly related to the single-use duodenoscope, namely 2 post-ERCP pancreatitis(PEP), 1 cholangitis and 1 ***: Single-use duodenoscope is effective, reliable and safe even in technically challenging procedures with a non-inferiority to reusable duodenoscope, making these devices a viable alternative to standard reusable equipment.

关键词： Single-operator cholangioscopy Single-use duodenoscope Endoscopic retrograde cholangiopancreatography Indeterminate biliary stricture Difficult biliary stones

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Endoscopic palliation of malignant biliary obstruction

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World Journal of Gastrointestinal Endoscopy 2022年第10期14卷 581-596页

作者： Andrew Canakis michel kahaleh Department of Gastroenterology and Hepatology University of Maryland School of MedicineBaltimoreMD 21201United States Department of Gastroenterology and Hepatology Robert Wood Johnson Medical CenterNew BrunswickNJ 08901United States

Malignant biliary obstruction often presents with challenges requiring the endoscopist to assess the location of the lesion,the staging of the disease,the eventual resectability and patient preferences in term of biliary *** review will focus on the different modalities available in order to offer the most appropriate palliation,such as conventional endoscopic retrograde cholangiopancreatography,endoscopic ultrasound guided biliary drainage as well as ablative therapies including photodynamic therapy or radiofrequency ablation.

关键词： Biliary obstruction Endoscopic retrograde cholangiopancreatography Endoscopic ultrasonography Stenting Ablation therapy

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Endoscopic management of chronic pancreatitis

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World Journal of Gastrointestinal Endoscopy 2013年第1期5卷 19-28页

作者： Veeral M Oza michel kahaleh Division of Gastroenterology and Hepatology Weill Cornell Medical CenterNew York Presbyterian HospitalNew YorkNY 10021United States

Chronic pancreatitis (CP) is a common gastrointestinal illness, which affects the quality of life with substantial morbidity and mortality. The management includes medical, endoscopic and surgical approaches with the need for interaction between various specialties, calling for a concerted multidisciplinary approach. However, at the time of this publication, guidelines to establish care of these patients are lacking. This review provides the reader with a comprehensive overview of the studies summarizing the various treatment options available, including medical, surgical and endoscopic options. In addition, technological advances such as endoscopic retrograde cholangiopancreatogrophy, endoscopic shock wave lithotripsy and endoscopic ultrasound can now be offered with reasonable success for pancreatic decompression, stricture dilatation with stent placement, stone fragmentation, pseudocyst drainage, and other endoscopic interventions such as celiac plexus block for pain relief. We emphasize the endoscopic op-tions in this review, and attempt to extract the most up to date information from the current literature. The treatment of CP and its complications are discussed extensively. Complications such as biliary strictures. pancreatic pseudocysts, and chronic pain are common issues that arise as long-term complications of CP. These often require endoscopic or surgical management and possibly a combination of approaches, however choosing amongst the various therapeutic and palliative modalities while weighing the risks and benefits, makes the management of CP challenging. Treatment goals should be not just to control symptoms but also to prevent disease progression. Our aim in this paper is to advocate and emphasize an evidence based approach for the management of CP and associated long term complications.

关键词： Chronic Pancreatitis Biliary strictures Pseudocysts Endoscopic management Pain Pancreatic stones

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Endoscopic palliation of malignant biliary stricture

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World Journal of Gastrointestinal Oncology 2016年第3期8卷 240-247页

作者： Sanjay M Salgado Monica Gaidhane michel kahaleh Division of Gastroenterology and Hepatology Weill Cornell Medical College

Malignant biliary strictures often present late after the window for curative resection has elapsed. In such patients, the goal of therapy is typically focused on palliation. While historically, palliative measures were performed surgically, the advent of endoscopic intervention offers minimally invasive options to provide relief of symptoms, improve quality of life, and in some cases, increase survival of these patients. Some of these therapies, such as endoscopic biliary decompression, have become mainstays of treatment for decades, whereas newer modalities, including radiofrequency ablation, and photodynamic therapy offer additional options for patients with incurable biliary malignancies.

关键词： Biliary strictures Malignant Endoscopic retrograde cholangiopancreatography Photodynamic therapy Endoscopy Palliation Endoscopic ultrasound Radiofrequency ablation

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Management of liver transplantation biliary stricture: Results from a tertiary hospital

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World Journal of Gastrointestinal Endoscopy 2015年第7期7卷 747-757页

作者： Fernanda Prata Martins michel kahaleh Angelo P Ferrari Endoscopy Unit Hospital Israelita Albert Einstein Division of Gastroenterology and Hepatology Department of Medicine Weill Cornell Medical College Division of Gastroenterology Universidade Federal de Sao Paulo

AIM: To review results of endoscopic treatment for anastomotic biliary strictures after orthotopic liver transplantation(OLT) during an 8-year period. METHODS: This is a retrospective review of all endoscopic retrograde cholangiopancreatographys(ERCPs) performed between May 2006 and June 2014 in deceased OLT recipients with anastomotic stricture at a tertiary care hospital. Patients were divided into 2 groups, according to the type of stent used(multiple plastic or covered self-expandable metal stents), which was chose on a case-by-case basis and their characteristics. The primary outcome was anastomotic stricture resolution rate determined if there was no more than a minimum waist at cholangiography and a 10 mm balloon could easily pass through the anastomosis with no need for further intervention after final stent removal. Secondary outcomes were technical successrate, number or ERCPs required per patient, number of stents placed, stent indwelling, stricture recurrence rate and therapy for recurrent anastomotic biliary stricture(AS). Stricture recurrence was defined as clinical laboratorial and/or imaging evidence of obstruction at the anastomosis level, after it was considered completely treated, requiring subsequent interventional ***: A total of 195 post-OLT patients were assessed for eligibility. One hundred and sixty-four(164) patients were diagnosed with anastomotic biliary stricture. ERCP was successfully performed in 157/164(95.7%) patients with AS, that were treated with either multiple plastic(n = 109) or metallic billiary stents(n = 48). Mean treatment duration, number of procedures and stents required were lower in the metal stent group. Acute pancreatitis was the most common procedure related complication, occurring in 17.1% in the covered self-expandable metal stents(c SEMS) and 4.1% in the multiple plastic stent(MPS) group. Migration was the most frequent stent related complication, observed in 4.3% and 5.5%(c SEMS and MPS respectively

关键词： Biliary stricture Benign Liver transplant Endoscopic retrograde cholangiopancreatographys Endoscopic treatment Plastic stent Self-expandablemetal stent

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Endoscopic ultrasonography guided drainage:Summary of consortium meeting,May 21,2012,San Diego,California

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World Journal of Gastroenterology 2015年第3期21卷 726-741页

作者： michel kahaleh Everson LA Artifon Manuel Perez-Miranda Monica Gaidhane Carlos Rondon Takao Itoi Marc Giovannini Division of Gastroenterology and Hepatology Department of MedicineWeill Cornell Medical CenterNew YorkNY 10021United States Department of Surgery University of Sao Paulo Medical SchoolSao Paulo 05403-000Brazil Endoscopy Unit Hospital Universitario Rio Hortega47012 ValladolidSpain Department of Gastroenterology and Hematology Tokyo Medical UniversityTokyo 160-0023Japan Department of Gastroenterology PaoliCalmettes Institute13273 MarseilleFrance

Endoscopic retrograde cholangiopancreatography(ERCP) is the preferred procedure for biliary and pancreatic *** ERCP is successful in about 95% of cases,a small subset of cases are unsuccessful due to altered anatomy,peri-ampullary pathology,or malignant *** ultrasound-guided drainage is a promising technique for biliary,pancreatic and recently gallbladder decompression,which provides multiple advantages over percutaneous or surgical biliary *** retrospective and some prospective studies have shown endoscopic ultrasoundguided drainage to be safe and *** on the currently reported literature,regardless of the approach,the cumulative success rate is 84%-93% with an overall complication rate of 16%-35%.endoscopic ultrasoundguided drainage seems a viable therapeutic modality for failed conventional drainage when performed by highly skilled advanced endoscopists at tertiary centers with expertise in both echo-endoscopy and therapeutic

关键词： Endoscopic ultrasound Endoscopic ultrasoundguided

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Management of pancreatic fluid collections: A comprehensive review of the literature

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World Journal of Gastroenterology 2016年第7期22卷 2256-2270页

作者： Amy Tyberg Kunal Karia Moamen Gabr Amit Desai Rushabh Doshi Monica Gaidhane Reem Z Sharaiha michel kahaleh Division of Gastroenterology and Hepatology Weill Cornell Medical College

Pancreatic fluid collections(PFCs) are a frequent complication of pancreatitis. It is important to classify PFCs to guide management. The revised Atlanta criteria classifies PFCs as acute or chronic, with chronic fluid collections subdivided into pseudocysts and walled-off pancreatic necrosis(WOPN). Establishing adequate nutritional support is an essential step in the management of PFCs. Early attempts at oral feeding can be trialed in patients with mild pancreatitis. Enteral feeding should be implemented in patients with moderate to severe pancreatitis. Jejunal feeding remains the preferred route of enteral nutrition. Symptomatic PFCs require drainage; options include surgical, percutaneous, or endoscopic approaches. With the advent of newer and more advanced endoscopic tools and expertise, and an associated reduction in health care costs, minimally invasive endoscopic drainage has become the preferable approach. An endoscopic ultrasonography-guided approach using a seldinger technique is the preferred endoscopic approach. Both plastic stents and metal stents are efficacious and safe; however, metal stents may offer an advantage, especially in infected pseudocysts and in WOPN. Direct endoscopic necrosectomy is often required in WOPN. Lumen apposing metal stents that allow for direct endoscopic necrosectomy and debridement through the stent lumen are preferred in these patients. Endoscopic retrograde cholangio pancreatography with pancreatic duct(PD) exploration should be performed concurrent to PFC drainage. PD disruption is associated with an increased severity of pancreatitis, an increased risk of recurrent attacks of pancreatitis and long-term complications, and a decreased rate of PFC resolution after drainage. Any pancreatic ductal disruption should be bridged with endoscopic stenting.

关键词： Pancreatic fluid collection Pancreatic fluid collection Pseudocyst Walled-off pancreatic necrosis Walled-off pancreatic necrosis Pancreatitis

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Photodynamic therapy:Palliation and endoscopic technique in cholangiocarcinoma

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World Journal of Gastrointestinal Endoscopy 2010年第11期2卷 357-361页

作者： James A Richter michel kahaleh University of Virginia Health System CharlottesvilleVA 22908-0708United States

Cholangiocarcinoma is the primary malignancy arising from the biliary *** disease is marked by jaundice,cholestasis,and *** 50 percent of patients present with advanced stage disease,precluding curative surgical resection as an option of *** is poor,and survival has been limited even after biliary *** management has become the standard of care for unresectable disease and has evolved to include an endoscopic approach. Photodynamic therapy(PDT)consists of administration of a photosensitizer followed by local irradiation with laser *** studies conducted in Europe and the United States have shown a marked improvement in the symptoms of cholestasis,survival,and quality of *** article summarizes the published experience regarding PDT for cholangiocarcinoma and the steps required to administer this therapy safely.

关键词： Cholangiocarcinoma Cholestasis Jaundice Neoplasia Palliation Photodynamic therapy Photofrin

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Endoscopic ultrasonography guided biliary drainage: Summary of consortium meeting, May 7^(th) , 2011, Chicago

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World Journal of Gastroenterology 2013年第9期19卷 1372-1379页

作者： michel kahaleh Everson LA Artifon Manuel Perez-Miranda Kapil Gupta Takao Itoi Kenneth F Binmoeller California Pacific Medical Center San Francisco CA 94115 United States Marc Giovannini Division of Gastroenterology and Hepatology Weill Cornell Medical College New York NY 10021 United States Department of Gastroenterology University of So Paulo Medical School So Paulo 05403-000 Brazil Endoscopy Unit Hospital Universitario Rio Hortega 47012 Valladolid Spain Pancreatic Biliary Department Cedars-Sinai Medical Center Beverly Hills CA 90048 United States Department of Gastroenterology and Hepatology Tokyo Medical University Tokyo 160-0023 Japan Department of Gastroenterology Paolicalmettes Institute 13273 Marseille France

Endoscopic retrograde cholangiopancreatography (ERCP) has become the preferred procedure for biliary or pancreatic drainage in various pancreatico-biliary disorders. With a success rate of more than 90%, ERCP may not achieve biliary or pancreatic drainage in cases with altered anatomy or with tumors obstructing access to the duodenum. In the past those failures were typically managed exclusively by percutaneous approaches by interventional radiologists or surgical intervention. The morbidity associated was significant especially in those patients with advanced malignancy, seeking minimally invasive interventions and improved quality of life. With the advent of biliary drainage via endoscopic ultrasound (EUS) guidance, EUS guided biliary drainage has been used more frequently within the last decade in different countries. As with any novel advanced endoscopic procedure that encompasses various approaches, advanced endoscopists all over the world have innovated and adopted diverse EUS guided biliary and pancreatic drainage techniques. This diversity has resulted in variations and improvements in EUS Guided biliary and pancreatic drainage; and over the years has led to an extensive nomenclature. The diversity of techniques, nomenclature and recent progress in our intrumentation has led to a dedicated meeting on May 7 th , 2011 during Digestive Disease Week 2011. More than 40 advanced endoscopists from United States, Brazil, Mexico, Venezuela, Colombia, Italy, France, Austria, Germany, Spain, Japan, China, South Korea and India attended this pivotal meeting. The meeting covered improved EUS guided biliary access and drainage procedures, terminology, nomenclature, training and credentialing; as well as emerging devices for EUS guided biliary drainage. This paper summarizes the meeting's agenda and the conclusions generated by the creation of this consortium group.

关键词： Endoscopic ultrasound Biliary drainage Endosonography-guided cholangiopancreatography Endoscopic ultrasound guided Pancreatic drainage Endoscopic retrograde cholangiopancreatography

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Safety of endoscopic retrograde cholangiopancreatography in pregnancy: Fluoroscopy time and fetal exposure, does it matter?

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World Journal of Gastrointestinal Endoscopy 2013年第4期5卷 148-153页

作者： Ioana Smith Monica Gaidhane Allen Goode michel kahaleh Department of Medicine University of Alabama Division of Gastroenterology and Hepatology Weill Cornell Medical College Radiology and Medical Imaging University of Virginia

AIM: To estimate the fetal radiation exposure using thermoluminescent dosimeters (TLD's) in pregnant patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) and assess its relevance. METHODS: Data on thirty-five therapeutic ERCPs conducted in pregnant patients from 2001 to 2009 were retrieved from a prospective database. Techniques to minimize fluoroscopy time were implemented and the fluoroscopy times captured. TLD's were placed on the mother to estimate the fetal radiation exposure and the results were compared to the maximum allowed dose of radiation to the fetus [0.005 gray (Gy)]. Obstetrics consultations were obtained and the fetus was monitored before and after the ERCP. Fluoroscopy wasperformed at 75 kVp. ERCP was performed with the patients supine by dedicated biliary endoscopists performing more than 500 cases a year. RESULTS: A total of 35 pregnant patients underwent ERCP and biliary sphincterotomy (14 in first trimester, 11 in second trimester, and 10 in third trimester). Mean maternal age was 25 years (range 16-37 years) and mean gestational age was 18.9 wk (range 4-35 wk). Mean fluoroscopy time was 0.15 min (range 0-1 min). For 23 women, the estimated fetal radiation exposure was almost negligible (< 0.0001 Gy) while for 8 women, it was within the 0.0001-0.0002 Gy range. Three women had an estimated fetal radiation exposure between 0.0002 and 0.0005 Gy and 1 woman had an estimated fetal radiation exposure greater than 0.0005 Gy. Complications included 2 post-sphincterotomy bleeds, 2 post-ERCP pancreatitis, and 1 fatal acute respiratory distress syndrome. One patient developed cholecystitis 2 d after ERCP. CONCLUSION: ERCP with modified techniques is safe during pregnancy, and estimating the fetal radiation exposure from the fluoroscopy time or measuring it via TLD's is unnecessary.

关键词： Endoscopic retrograde cholangiopancreatography Pregnancy Fluoroscopy Fetal exposure Pancreaticobiliary disease

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