Background: In this prospective case series, endoscopic management of pancreatic pseudocysts and Abscesses was investigated following an EUS-guided 1- step procedure for initial transmural access. Methods: Endoscopic ...Background: In this prospective case series, endoscopic management of pancreatic pseudocysts and Abscesses was investigated following an EUS-guided 1- step procedure for initial transmural access. Methods: Endoscopic drainage of pancreatic pseudocysts and Abscesses was performed in 35 patients (mean age, 51 years; range, 21- 81 years) by using interventional echoendoscopes (FG38UX and EG3830UT; Pentax-Hitachi, Lü bbecke, Germany). Interventions were performed by using a 1- step device consisting of a needle-wire suitable for cutting current, a 5.5F dilator, and an 8.5F plastic endoprosthesis (Giovannini Needle Wire Oasis, Cook Endoscopy,Winston-Salem, NC). Results: Endoscopic stent placement was successful in 33 of 35 patients (94% ), whereas repeated needle passages were unsuccessful in 2 cases (pancreatic pseudocystwall, 7 mm). No procedure-related complications, such as bleeding, perforation, or pneumoperitoneum, were observed. All subsequent complications, such as ineffective drainage (9% ), stent occlusion (12% ), or cyst infection (12% ), were managed endoscopically. Fourteen patients (43% ) demonstrated sustained clinical improvement and cyst resolutio upon placement of the initial 8.5F transmural drain. Ten patients (30% ) did not reveal a 50% reduction in cyst size on day 3, but cyst resolution was achieved by additional endoscopic cyst irrigation. Nine patients (27% ) with primary or secondary cyst infection underwent endoscopic balloon dilation and prolonged endoscopic drainage procedures to achieve cyst resolution. The overall resolution rate was 88% , with a recurrence rate of 12% , based on a mean follow-up period of 24 months. Conclusion: This 1- step EUS-guided technique with a needle-wire device provides safe transmural access and allows subsequent effective endoscopic management of pancreatic pseudocysts and Abscesses.展开更多
目的评估内镜闭合诊断性超声内镜相关十二指肠穿孔的安全性以及疗效。方法通过PubMed、Web of Science搜索引擎,以及国内万方、知网和维普数据库,以关键词检索国内外文献,纳入相关病例,加以综合分析。结果共纳入27例,均为女性,患者平均...目的评估内镜闭合诊断性超声内镜相关十二指肠穿孔的安全性以及疗效。方法通过PubMed、Web of Science搜索引擎,以及国内万方、知网和维普数据库,以关键词检索国内外文献,纳入相关病例,加以综合分析。结果共纳入27例,均为女性,患者平均年龄为74.6岁(范围54~93岁),穿孔部位多见于球降交界处(81.5%),其次为降部(4例,14.8%)以及降部与水平部交界处(1例,3.7%)。穿孔大小5~25 mm。27例患者中16例采用OTSC(over-the-scope-clips)吻合夹系统闭合,6例单纯采用金属夹闭合,4例采用金属夹联合尼龙绳行荷包闭合,1例放置全覆膜金属支架闭合,27例患者均成功闭合穿孔,未追加外科手术。结论内镜闭合诊断性超声内镜相关十二指肠穿孔是一种安全、可行且疗效确切的治疗方法,可有效的避免外科手术。展开更多
Background: Diagnosing primary sclerosing cholangitis (PSC) is problematic and requires meeting a burden of proof through clinical, biochemical, radiologic, and histological features. Endoscopic ultrasound yields deta...Background: Diagnosing primary sclerosing cholangitis (PSC) is problematic and requires meeting a burden of proof through clinical, biochemical, radiologic, and histological features. Endoscopic ultrasound yields detailed images of the extrahepatic biliary tree, but its value in contributing to the diagnosis of this condition is unknown. Objectives: To determine the potential for transduodenal EUS to detect common bile duct wall thickening in PSC.Design: A prospective, controlled study with retrospective, blinded data analysis. Setting: Single tertiary referral center for inflammatory bowel disease and EUS. Patients: Four groups of patients were assessed with radial endosonography: PSC (n = 9); inflammatory bowel disease (IBD) with abnormal liver blood tests (n = 21); choledocholithiasis (n = 15); and normal controls (n = 50). Measurements were made of the common bile duct diameter and wall thickness. Interventions: Transduodenal radial EUS of the biliary tree. Main Outcome Measurements: Common bile duct diameter and wall thickness. Results: The mean diameter (SD) of the common bile duct for the PSC, IBD, choledocholithiasis, and normal control groups measured 8.9 mm (2.8), 5.4 mm (1.7), 7.2 mm (2.2), and 5.0 mm (1.9), respectively (PSC and chole-docholithiasis groups compared to the IBD group, P < .05 for a single test of hypothesis, but correction for the multiple testing of data removed this significance; normal control group P < .005). Mean ductal wall thickness (SD) was 2.5 mm (0.8) for the PSC group, 0.7 mm (0.4) for the IBD group, 0.8 mm (0.4) for the choledocholithiasis group, and 0.8 mm (0.4) for the normal control group, respectively (PSC group compared to the other 3 groups, P < .005). Limitations: Assessment of intrahepatic PSC is problematic. Conclusion: Thickening ( >1.5 mm) of the common bile duct wall is seen in patients with PSC but not in those with aPPArently uncomplicated IBD or choledocholithiasis. The results of this study suggest that standard endosonography contributes to the imaging and potentially to the diagnosis of PSC.展开更多
Background: MRCP and EUS have replaced ERCP in the diagnosis of biliary diseases, but the latter is needed for treatment. This study evaluates a new approach in the management of common bile duct stones, by using an o...Background: MRCP and EUS have replaced ERCP in the diagnosis of biliary diseases, but the latter is needed for treatment. This study evaluates a new approach in the management of common bile duct stones, by using an oblique-viewing echoendoscope. Methods: Nineteen patients with acute abdominal pain associated with increased liver tests entered the study. Evaluation of the biliary tree was performed by using an oblique-viewing echoendoscope (JF-UM20; Olympus Europe GmbH, Hamburg, Germany). When biliary stones or sludge were found, bile duct cannulation and sphincterotomy were performed in the same session. Results: Bile duct stones were diagnosed by EUS in 4 patients and biliary sludge in 12; the subsequent cholangiography and sphincterotomy with stone extraction confirmed the diagnosis in all patients. Bile duct cannulation failed in 1 patient. EUS showed features of chronic pancreatitis in 3 cases. The mean time for the whole procedure (EUS plus endoscopic retrograde cholangiography with biliary treatment) was 27 minutes. No procedure-related complications were observed. Conclusion: This new approach appears to be feasible and safe, providing an accurate diagnosis and, at the same time, an appropriate treatment of common bile duct stones when needed. With technical improvements, this extended EUS technique could be used as the first-line procedure in patients with biliopancreatic diseases.展开更多
文摘Background: In this prospective case series, endoscopic management of pancreatic pseudocysts and Abscesses was investigated following an EUS-guided 1- step procedure for initial transmural access. Methods: Endoscopic drainage of pancreatic pseudocysts and Abscesses was performed in 35 patients (mean age, 51 years; range, 21- 81 years) by using interventional echoendoscopes (FG38UX and EG3830UT; Pentax-Hitachi, Lü bbecke, Germany). Interventions were performed by using a 1- step device consisting of a needle-wire suitable for cutting current, a 5.5F dilator, and an 8.5F plastic endoprosthesis (Giovannini Needle Wire Oasis, Cook Endoscopy,Winston-Salem, NC). Results: Endoscopic stent placement was successful in 33 of 35 patients (94% ), whereas repeated needle passages were unsuccessful in 2 cases (pancreatic pseudocystwall, 7 mm). No procedure-related complications, such as bleeding, perforation, or pneumoperitoneum, were observed. All subsequent complications, such as ineffective drainage (9% ), stent occlusion (12% ), or cyst infection (12% ), were managed endoscopically. Fourteen patients (43% ) demonstrated sustained clinical improvement and cyst resolutio upon placement of the initial 8.5F transmural drain. Ten patients (30% ) did not reveal a 50% reduction in cyst size on day 3, but cyst resolution was achieved by additional endoscopic cyst irrigation. Nine patients (27% ) with primary or secondary cyst infection underwent endoscopic balloon dilation and prolonged endoscopic drainage procedures to achieve cyst resolution. The overall resolution rate was 88% , with a recurrence rate of 12% , based on a mean follow-up period of 24 months. Conclusion: This 1- step EUS-guided technique with a needle-wire device provides safe transmural access and allows subsequent effective endoscopic management of pancreatic pseudocysts and Abscesses.
文摘目的评估内镜闭合诊断性超声内镜相关十二指肠穿孔的安全性以及疗效。方法通过PubMed、Web of Science搜索引擎,以及国内万方、知网和维普数据库,以关键词检索国内外文献,纳入相关病例,加以综合分析。结果共纳入27例,均为女性,患者平均年龄为74.6岁(范围54~93岁),穿孔部位多见于球降交界处(81.5%),其次为降部(4例,14.8%)以及降部与水平部交界处(1例,3.7%)。穿孔大小5~25 mm。27例患者中16例采用OTSC(over-the-scope-clips)吻合夹系统闭合,6例单纯采用金属夹闭合,4例采用金属夹联合尼龙绳行荷包闭合,1例放置全覆膜金属支架闭合,27例患者均成功闭合穿孔,未追加外科手术。结论内镜闭合诊断性超声内镜相关十二指肠穿孔是一种安全、可行且疗效确切的治疗方法,可有效的避免外科手术。
文摘Background: Diagnosing primary sclerosing cholangitis (PSC) is problematic and requires meeting a burden of proof through clinical, biochemical, radiologic, and histological features. Endoscopic ultrasound yields detailed images of the extrahepatic biliary tree, but its value in contributing to the diagnosis of this condition is unknown. Objectives: To determine the potential for transduodenal EUS to detect common bile duct wall thickening in PSC.Design: A prospective, controlled study with retrospective, blinded data analysis. Setting: Single tertiary referral center for inflammatory bowel disease and EUS. Patients: Four groups of patients were assessed with radial endosonography: PSC (n = 9); inflammatory bowel disease (IBD) with abnormal liver blood tests (n = 21); choledocholithiasis (n = 15); and normal controls (n = 50). Measurements were made of the common bile duct diameter and wall thickness. Interventions: Transduodenal radial EUS of the biliary tree. Main Outcome Measurements: Common bile duct diameter and wall thickness. Results: The mean diameter (SD) of the common bile duct for the PSC, IBD, choledocholithiasis, and normal control groups measured 8.9 mm (2.8), 5.4 mm (1.7), 7.2 mm (2.2), and 5.0 mm (1.9), respectively (PSC and chole-docholithiasis groups compared to the IBD group, P < .05 for a single test of hypothesis, but correction for the multiple testing of data removed this significance; normal control group P < .005). Mean ductal wall thickness (SD) was 2.5 mm (0.8) for the PSC group, 0.7 mm (0.4) for the IBD group, 0.8 mm (0.4) for the choledocholithiasis group, and 0.8 mm (0.4) for the normal control group, respectively (PSC group compared to the other 3 groups, P < .005). Limitations: Assessment of intrahepatic PSC is problematic. Conclusion: Thickening ( >1.5 mm) of the common bile duct wall is seen in patients with PSC but not in those with aPPArently uncomplicated IBD or choledocholithiasis. The results of this study suggest that standard endosonography contributes to the imaging and potentially to the diagnosis of PSC.
文摘Background: MRCP and EUS have replaced ERCP in the diagnosis of biliary diseases, but the latter is needed for treatment. This study evaluates a new approach in the management of common bile duct stones, by using an oblique-viewing echoendoscope. Methods: Nineteen patients with acute abdominal pain associated with increased liver tests entered the study. Evaluation of the biliary tree was performed by using an oblique-viewing echoendoscope (JF-UM20; Olympus Europe GmbH, Hamburg, Germany). When biliary stones or sludge were found, bile duct cannulation and sphincterotomy were performed in the same session. Results: Bile duct stones were diagnosed by EUS in 4 patients and biliary sludge in 12; the subsequent cholangiography and sphincterotomy with stone extraction confirmed the diagnosis in all patients. Bile duct cannulation failed in 1 patient. EUS showed features of chronic pancreatitis in 3 cases. The mean time for the whole procedure (EUS plus endoscopic retrograde cholangiography with biliary treatment) was 27 minutes. No procedure-related complications were observed. Conclusion: This new approach appears to be feasible and safe, providing an accurate diagnosis and, at the same time, an appropriate treatment of common bile duct stones when needed. With technical improvements, this extended EUS technique could be used as the first-line procedure in patients with biliopancreatic diseases.
