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World Journal of Gastroenterology 2006年第45期12卷 7299-7303页

作者： Osamu Takasawa Naotaka Fujita Go Kobayashi Yutaka Noda Kei Ito Jun Horaguchi Sendai City Medical Center Gastroenterology 5-22-1 Tsurugaya Miyaginoku Sendai Miyagi 983-0824 Japan

AIM: To assess optimum endoscopic biliary drainage (EBD) in cases with unresectable pancreatic cancer in the era of gemcitabine (GEM). METHODS: Thirty patients with unresectable pancreatic cancer, who presented with jaundice and underwent chemotherapy using GEM after EBD were included in this study (GEM group). Fifteen cases with the same clinical manifestation and stage of pancreatic cancer treated with EBD alone were also included as controls. A covered metallic stent (CMS) or a plastic stent (PS) was used for EBD. The mean survival time (MST) in each group, risk factors of survival time, type of stent used and associated survival time, occlusion rate of stent, patency period of stent, and risk factors of stent occlusion were evaluated. RESULTS: MST in the GEM group was longer than that in the control (9.9 mo vs 6.2 mo). In the GEM group, the survival time was not different between those who underwent metallic stenting and those who underwent plastic stenting. Stent occlusion occurred in 60% of the PS group and 7% of the CMS group. The median stent patency in the PS-GEM group and the CMS-GEM group was 5 mo and 7.5 mo, respectively. Use of a PS was the only risk factor of stent occlusion. CONCLUSION: A CMS is recommended in cases presenting with jaundice due to unresectable pancreatic cancer, since the use of a CMS makes it possible to continue chemotherapy using GEM without repetition of stent replacement.

关键词： Gemcitabine chemotherapy endoscopic biliary drainage Covered metallic stent Pancreatic cancer Unresectable pancreatic cancer Obstructive jaundice

endoscopic or percutaneous biliary drainage in hilar cholangiocarcinoma:When and how?

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World Journal of Gastrointestinal Oncology 2021年第12期13卷 2050-2063页

作者： Tudor Mocan Adelina Horhat Emil Mois Florin Graur Cristian Tefas Rares Craciun Iuliana Nenu Mihaela Spârchez Zeno Sparchez Third Medical Department "Iuliu Hatieganu"University of Medicine and PharmacyCluj-Napoca 400162Romania Institute for Gastroenterology and Hepatology Cluj-Napoca 400162Romania Second Pediatric Department University of Medicine and Pharmacy"Iuliu Hatieganu"Cluj-Napoca 400162Romania

Hilar cholangiocarcinoma (hCCA) is a primary liver tumor associated with a dimprognosis. The role of preoperative and palliative biliary drainage has long beendebated. The most common techniques are endoscopic retrograde cholangiopancreatography(ERCP) and percutaneous transhepatic biliary drainage (PTBD);however, recently developed endoscopic ultrasound-assisted methods are gainingmore atention. Selecting the best available method in any specific scenario iscrucial, yet sometimes challenging. Thus, this review aimed to discuss theavailable techniques, indications, perks, pitfalls, and timing-related issues in themanagement of hCCA. In a preoperative setting, PTBD appears to have someadvantages: low risk of postprocedural complications (namely cholangitis) andbetter priming for surgery. For palliative purposes, we propose ERCP/PTBDdepending on the experience of the operators, but also on other factors: the levelof bilirubin (if very high, rather PTBD), length of the stenosis and the presence ofcholangitis (PTBD), ERCP failure, or altered biliary anatomy.

关键词： Hilar cholangiocarcinoma endoscopic biliary drainage Percutaneous biliary drainage endoscopic ultrasound biliary drainage Surgical oncology

Redefining endoluminal biliary drainage:Challenges and innovations in endosonography-guided techniques

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World Journal of Gastroenterology 2025年第1期31卷 146-151页

作者： Marcel Razpotnik Department of Gastroenterology and Hepatology Campus Virchow/Campus MitteCharitéBerlinBerlin 10117Germany

endoscopic retrograde cholangiopancreatography is considered the gold standard for treating benign and malignant biliary ***,its use in complex biliary obstructions is *** the past decades,therapeutic endosonography(EUS)and emerging technologies such as lumen-apposing metal stents have enabled endoscopic treatment of conditions previously requiring nonendoscopic or surgical *** show that EUS-guided choledochoduodenostomy is a reliable alternative to endoscopic retrograde cholangiopancreatography in the treatment of distal malignant biliary obstructions and can be considered a primary drainage modality in centers with adequate *** malignant hilar biliary obstructions,draining at least 50%of viable liver tissue often requires combining different *** treatment strategy in these patients should be individualized,depending on the Bismuth classification,patient physical status,and intended systemic *** to the lack of evidence,general recommendations cannot be made for EUS-guided hepaticoduodenostomy or combined procedures with transhepatic bridging *** novel techniques should be limited to selected palliative cases where conventional methods have failed and conducted within clinical trials to generate evidence before broader application.

关键词： endoscopic biliary drainage Interventional endosonography Lumen-apposing metal stent Malignant hilar biliary obstruction Malignant distal biliary obstruction

Surgical site infection following pancreaticoduodenectomy in a referral cancer center in Mexico

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Hepatobiliary & Pancreatic Diseases International 2024年第5期23卷 502-508页

作者： Rodrigo Villaseñor-Echavarri Javier Melchor-Ruan Mercedes Aranda-Audelo Gabriela Arredondo-Saldaña Patricia Volkow-Fernandez Maria del Carmen Manzano-Robleda Alejandro E Padilla-Rosciano Diana Vilar-Compte Department of Infectious Diseases Instituto Nacional de CancerologíaAv.San Fernando 22Belisario Domínguez Secc 16TlalpanMexico CityMexico School of Medicine Universidad PanamericanaAugusto Rodin No.498Insurgentes MixcoacBenito JuárezMexico CityMexico Department of Digestive Tube and Hepatopancreatobiliary Tumors Instituto Nacional de CancerologíaAv.San Fernando 22Belisario Domínguez Secc 16TlalpanMexico CityMexico Department of Infectious Diseases Hospital Manuel Gea GonzálezCalz.de Tlalpan 4800Belisario Domínguez Secc 16TlalpanMexico CityMexico Gastrointestinal and Endoscopy Department Instituto Nacional de CancerologíaAv.San Fernando 22Belisario Domínguez Secc 16TlalpanMexico CityMexico

Background: Pancreaticoduodenectomy is the standard treatment for resectable periampullary cancer. Surgical site infections(SSI) are common complications with increased morbidity. The study aimed to describe the prevalence, risk factors, microbiology, and outcomes of SSI among patients undergoing pancreaticoduodenectomy. Methods: We conducted a retrospective study in a referral cancer center between January 2015 and June 2021. We analyzed baseline patient characteristics and SSI occurrence. Culture results and susceptibility patterns were described. Multivariate logistic regression was used to determine risk factors, proportional hazards model to evaluate mortality, and Kaplan-Meier analysis to assess long-term survival. Results: A total of 219 patients were enrolled in the study;101(46%) developed SSI. Independent factors for SSI were diabetes mellitus, preoperative albumin level, biliary drainage, biliary prostheses, and clinically relevant postoperative pancreatic fistula. The main pathogens were Enterobacteria and Enterococci. Multidrug-resistance rate in SSI was high but not associated with increased mortality. Infected patients had higher odds of sepsis, longer hospital stay and intensive care unit stay, and readmission rate. Neither 30-day mortality nor long-term survival was significantly different between infected and non-infected patients. Conclusions: SSI prevalence among patients undergoing pancreaticoduodenectomy was high and largely caused by resistant microorganisms. Most risk factors were related to preoperative instrumentation of the biliary tree. SSI was associated with greater risk of unfavorable outcomes;however, survival was unaffected.

关键词： Surgical site infection Pancreaticoduodenectomy Pancreatic cancer endoscopic biliary drainage biliary prosthesis

Verification of the Tokyo guidelines for acute cholangitis secondary to benign and malignant biliary obstruction:experience from a Chinese tertiary hospital

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Hepatobiliary & Pancreatic Diseases International 2013年第4期12卷 400-407页

作者： Gang Sun Lu Han Yun-Sheng Yang En-Qiang Linghu Wen Li Feng-Chun Cai Jin-Yan Kong Xiang-Dong Wang Jiang-Yun Meng Hong Du Hong-Bin Wang Qi-Yang Huang Quratulain Hyder Xiu-Li Zhang Department of Gastroenterology and Hepatology Chinese PLA General Hospital Department of General Oncology Chinese PLA General Hospital Department of Gastroenterology Pakistan Institute of Medical SciencesG-8-3 Islamabad Pakistan

BACKGROUND: The lack of widely-accepted guidelines for acute cholangitis largely lags behind the progress in medical and surgical technology and science for the management of acute cholangitis. This study aimed to verify the Tokyo guidelines for the management of acute cholangitis and cholecystitis of 2007 edition (TG07) in patients with obstructive cholangitis due to benign and malignant diseases. METHODS: The patients were retrieved from our existing ERCP database. Final diagnosis of acute cholangitis was made by detecting purulent bile during biliary drainage. We examined and compared the guidelines concerning benign and malignant obstruction. RESULTS: In 120 patients in our study, 82 and 38 had benign and malignant biliary obstruction, respectively. Guidelines based diagnosis was made in 68 (82.9%), 36 (94.7%), and 104 (86.7%) patients with benign, malignant, and overall biliary obstruction, respectively, which were significantly higher than 44 (53.7%), 17 (44.7%), and 61 (50.8%) diagnosed by Charcot’s triad (P<0.001). Treatment consistent with the guidelines was offered to 58 (70.7%) patients with benign obstruction and15 (39.5%) patients with malignant obstruction (P=0.001). No significant association was observed between clinical compliance, guidelines-based severity grades and clinical outcomes. In the multivariate model, intrahepatic obstruction (OR=11.2, 95% CI: 1.55-226.9) and hypoalbuminemia (≤25.0 g/L; OR=17.3, 95% CI: 3.5-313.6) were independent risk factors for a 30-day mortality. CONCLUSIONS: The TG07 are more reliable than Charcot’s triad for the diagnosis of acute cholangitis albeit with limited prognostic values. Intrahepatic obstruction and hypoalbuminemia are new predictors of poor prognosis and need further assessment.

关键词： acute cholangitis the Tokyo guidelines endoscopic biliary drainage diagnosis

Cholangiopancreatography troubleshooting:the usefulness of endoscopic retrieval of migrated biliary and pancreatic stents

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Hepatobiliary & Pancreatic Diseases International 2009年第6期8卷 632-637页

作者： Yuji Sakai Toshio Tsuyuguchi Takeshi Ishihara Harutoshi Sugiyama Reiko Eto Tatsuya Fujimoto Shin Yasui Ryo Tamura Seiko Togo Motohisa Tada Osamu Yokosuka Department of Medicine and Clinical Oncology Graduate School of MedicineChiba University

BACKGROUND:Stent migration in the hepatopancreatic duct might arise as one of the rare complications associated with biliary or pancreatic *** there are some procedures to retrieve the migrated stent,including surgical,percutaneous,and endoscopic approaches,endoscopy should be attempted first because it is least *** study set out to evaluate the usefulness of endoscopic retrieval of migrated biliary and pancreatic ***:Plastic stents that migrated in the bile duct(35 patients)or pancreatic duct(2)were retrieved with endoscopic retrograde *** used were snare forceps,a basket catheter,grasping forceps,biopsy forceps,a balloon catheter,and the Soehendra stent ***:endoscopic retrieval of migrated stents was performed successfully in 36(97.0%)of the 37 *** devices utilized for successful treatment were basket catheter(13 patients),grasping forceps(10),snare forceps(8),balloon catheter(3),biopsy forceps(1),and the Soehendra stent retriever(1).The unsuccessfully treated patient with chronic pancreatitis underwent surgery since the guide wire did not move forward due to bile duct stenosis,and there was also duodenal *** patient developed mild pancreatitis after withdrawal of the stent;the pancreatitis was relieved with conservative ***:endoscopic retrieval of migrated biliary and pancreatic stents appears to be useful because of its safety and low ***,various forceps should be prepared for the retrieval of a migrated stent.

关键词： endoscopic biliary drainage stent migration endoscopic retrograde cholangiopancreatography endoscopic retrieval troubleshooting

biliary metal stents should be placed near the hilar duct in distal malignant biliary stricture patients

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World Journal of Gastroenterology 2022年第17期28卷 1860-1870页

作者： Mitsuru Sugimoto Tadayuki Takagi Rei Suzuki Naoki Konno Hiroyuki Asama Yuki Sato Hiroki Irie Yoshinori Okubo Jun Nakamura Mika Takasumi Minami Hashimoto Tsunetaka Kato Ryoichiro Kobashi Takumi Yanagita Takuto Hikichi Hiromasa Ohira Department of Gastroenterology Fukushima Medical UniversityFukushima 9601295Japan Department of Endoscopy Fukushima Medical University HospitalFukushima 9601295Japan

BACKGROUND endoscopic biliary drainage using a self-expandable metallic stent(SEMS)has been widely performed to treat distal malignant biliary obstruction(DMBO).However,the optimal position of the stent remains *** To determine the ideal position for SEMS *** In total,135 DMBO patients underwent SEMS(uncovered or covered)placement over a ten-year period.A total of 127 patients with biliary obstruction between the junction of the cystic duct and Vater’s papilla were *** SEMS was placed through the upper common bile duct 2 cm from the biliary hilar duct in 83 patients(Hilar group)or near the top of the biliary obstruction in 44 patients(Lower group).Technical and functional success,adverse events,and risk factors for SEMS dysfunction were *** The stent patency period was significantly longer in the Hilar group than in the Lower group(P valuebiliary hilar duct.

关键词： endoscopic biliary drainage Malignant biliary obstruction Uncovered self-expandable metallic stent Covered self-expandable metallic stent biliary hilar duct Patency period

endoscopic bilateral stent-in-stent placement for malignant hilar obstruction using a large cell type stent

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Hepatobiliary & Pancreatic Diseases International 2016年第6期15卷 633-639页

作者： Jin Myung Park Sang Hyub Lee Kwang Hyun Chung Dong Kee Jang Ji Kon Ryu Yong-Tae Kim Jae Min Lee Woo Hyun Paik Department of Internal Medicine and Liver Research Institute Seoul National University HospitalSeoul National University College of Medicine Department of Internal Medicine Kangwon National University HospitalKangwon National University School of Medicine Department of Internal Medicine Gyeongsang National University HospitalGyeongsang National University College of Medicine Department of Internal Medicine Inje University Ilsan Paik Hospital

BACKGROUND： Bilateral stent-in-stent （SIS） self-expandable metal stent placement is technically chghallenging for palliation of unresectable malignant hilar obstruction. In the SIS technique, the uniform large cell type biliary stent facilitates contralateral stent deployment through the mesh of the first metallic stent. This study aimed to assess the technical success and clinical effectiveness of this technique with a uniform large cell type biliary stent. METHODS： Thirty-one patients who underwentlbilateral SIS placement using a large cell type stent were reviewed retrospectively. All patients showed malignant hilarl obstruction （Bismuth types Ⅱ, Ⅲ, Ⅳ） with different etiologies. RESULTS： Sixteen （51.6%） patients were male. The mean age of the patients was 67.0±14.0 years. Most patients were diagnosed as having hilar cholangiocarcinoma （58.1%） and gallbladder cancer （29.0%）. Technical success rate was 83.9%. Success was achieved more frequently in patients without masses obstructing the biliary confluence （MOC） than those with MOC （95.2% vs 60.0%, P=0.03）. Functional success rate was 77.4%. Complications occurred in 29.0% of the patients. These tended to occur more frequently in patients with MOC （50.0% vs 19.0%, P=0.11）. Median time to recurrent biliary obstruction was 188 days and median survival was 175 days. CONCLUSIONS： The large cell type stent can be used efficiently for bilateral SIS placement in malignant hilar obstruction. However, the risk of technical failure increases in patients with MOC, and caution is needed to prevent complications for these patients.

关键词： biliary tract disease cholangiocarcinoma endoscopic biliary drainage stent insertion

Histological changes at an endosonography-guided biliary drainage site:A case report

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World Journal of Gastroenterology 2007年第41期13卷 5512-5515页

作者： Naotaka Fujita Yutaka Noda Go Kobayashi Kei Ito Takashi Obana Jun Horaguchi Osamu Takasawa Kazunari Nakahara Department of Gastroenterology Sendai City Medical CenterSendaiJapan

Endosonography-guided biliary drainage (ESBD) is a new method enabling internal drainage of an obstructed bile duct. However,the histological conditions associated with fistula development via the duodenum to the bile duct have not been reported. We performed ESBD 14 d preoperatively in a patient with an ampullary carcinoma and histologically confirmed changes in and around the fistula. The female patient developed no complications relevant to ESBD. Levels of serum bilirubin and hepatobiliary enzymes declined quickly,and pancreatoduodenectomy was carried out uneventfully. The resected specimen was sliced and stained with hematoxylin-eosin. Histological evaluation of the puncture site in the duodenum and bile-duct wall,and the sinus tract revealed no hematoma,bile leakage,or abscess in or around the sinus tract. Little sign of granulation,fibrosis,and inflammatory cell infiltration was observed. Although further large-scale confirmatory studies are needed,the findings here may encourage more active use of ESBD as a substitute for percutaneous transhepatic drainage in cases with failed/difficult endoscopic biliary stenting.

关键词： Endosonography endoscopic ultrasound-guided fine needle aspiration endoscopic biliary drainage biliary stenting endoscopic retrograde cholang iopancreatography Obstructive jaundice biliary stricture

endoscopic management of acute cholangitis in elderly patients

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World Journal of Gastroenterology 2006年第40期12卷 6551-6555页

作者： Naresh Agarwal Barjesh Chander Sharma Shiv K Sarin Department of Gastroenterology GB Pant Hospital New Delhi India

AIM: To evaluate clinical presentation, etiology, compli-cations and response to treatment in elderly patients with acute ***: Demographics, etiology of biliary obstruc-tion, clinical features, complications and associated systemic diseases of 175 patients with acute cholangitis were recorded. endoscopic biliary drainage was performed using nasobiliary drain or stent. The complications related to ERCP, success of biliary drainage, morbidity, mortality and length of hospital stay were evaluated. RESULTS: Of 175 patients, 52 aged ≥ 60 years (groupⅠ, age biliary obstruction in group Ⅱ (n = 34) and benign diseases in groupⅠ(n = 120). Indications for biliary drainage were any one of the following either singly or in combination: a fever of ≥ 38.0℃ (n = 136), hypotension (n = 18), peritonism (n = 36), altered sensorium (n = 22), and failure to improve within 72 h of conservative management (n = 22). High grade fever was more common indication of biliary drainage in groupⅠand hypotension, altered sensorium, peritonism and failure to improve within 72 h of conservative management were more common indications in group Ⅱ. endoscopic biliary drainage was achieved in 172 patients (nasobiliary drain: 56 groupⅠ, 24 group Ⅱ, stent: 64 groupⅠ, 28 group Ⅱ) without any significant age related difference in the success rate. Abdominalpain, fever, jaundice, hypotension, altered sensorium, peritonism and renal failure improved after median time of 5 d in 120 patients in groupⅠ(2-15 d) compared to 10 d in 47 patien

关键词： Acute cholangitis endoscopic biliary drainage endoscopic retrograde cholangio-pancreatography Common bile duct stones Carcinoma gall bladder