Background: Endoscopic metallic stenting bilaterally for malignant hilar biliary obstruction has been considered difficult and complex. Difficulties were to pass the stent mesh of delivery system at stent placement and re-intervention. Recently, Niti-Y stent with central wide-open mesh was developed and reported easy to place bilaterally. However, weak points were difficulty of through the mesh other portion than center area and weak radial force around the center portion. We evaluated the newly designed Niti-S stent (large-cell-D type; LCD) with easy to through the mesh and sufficient radial force in all portions. Methods: Between November 2007 and August 2008, 12 patients (m/f: 7/5, mean age 66) with malignant hilar obstruction were received LCD placement endoscopically. Causative diseases were cholangiocarcinoma 3, gallbladder cancer 6, intrahepatic cholangiocarcinoma 1, and lymph node metastasis 2. According to Bismuth classification, there was type I: 1, type II: 5, type III: 5, and type IV: 4. We analyzed technical success, complications and stent patency. Results: LCD placed bilaterally in 6 patients and unilaterally in 6 patients, and successfully in all cases. The median stent patency was 202 days, and occlusion was 4 (33.3%); tumor ingrowth in 3 and sludge in 1. Two patients received successfully by insertion of an additional 2 plastic stent as stent-in-stent both side. One patient underwent percutaneous biliary drainage (PTBD) because of duodenal obstruction. One patient underwent PTBD in another hospital. One of 4 cholangitis without stent occlusion required additional PTBD and remaining cases improved by antibiotics. Two liver abscess drained percutaneously and improved soon. Conclusions: LCD was easy to place bilaterally and manage of occluded stent. Although with large-cell, LCD showed good stent patency without increasing tumor ingrowth.Background: Double balloon enteroscopy (DBE) is a technique that allows for access deep into the small intestine. Indications for DBE are expanding to include using it to perform endoscopic retrograde cholangio-pancreatography (ERCP) in patients with surgical alteration of the upper GI tract. Aims and Methods: The aim of this review was to report safety and feasibility of DBE for ERCP in patients with UGI tract surgical reconstruction. This was a retrospective review of DBE for ERCP in patients that were referred to our institute from February 2007 to November 2008. Results: Twenty patients have undergone a total of twenty nine DBE for ERCPs: mean age 57.9 years (range 26-85), female 10. Indications for DB included: Roux-en-Y hepaticojejunostomy 7 patients, Roux-en-Y gastrojejunostomy 5 patients, Roux-en-Y esophagojejunostomy 1 patient, Whipple's resection with choledochojejunostomy 1 patient and Billroth II gastroenterostomy 6 patients. Twelve patients (12/20, 60%) had previous unsuccessful ERCP with either a sideview duodenoscope (9/12) or a pediatric colonoscope (3/12). Indications for ERCP were choledocholithiasis (10/29, 34.5%), suspicious stricture (8/29, 2...
tients with Roux-en-Y anastomoses. With this method, the same group 3 performed ERCP in 13 such patients, resulting in diagnostic (61.5%) and therapeutic (53.8%) successes. Itoi et al 8 used a single-balloon enteroscope for ERCP in 13 patients with Billroth II or Roux-en-Y anastomoses, and they replaced a single-balloon enteroscope with a conventional endoscope through an overtube, resulting in therapeutic success (10/13). Dellon et al 4 used a single-balloon enteroscope for ERCP with long accessories in 4 patients with Roux-en-Y anastomoses, resulting in diagnostic (3/4) and therapeutic (1/2) successes. Because these enteroscopes have 200-cm working lengths, specialized or very limited accessories are available. [2][3][4][5][6] We first reported a case series of ERCP for surgically altered anatomy with a short, double-balloon enteroscope (Fujinon EC450-BI5, Fujinon, Tokyo, Japan), which has a 152-cm working length, for which all conventional accessories are available. 2 Recently, we reported a large case series of 103 ERCPs with a short double-balloon enteroscope in 68 patients with surgically altered anatomies. 5 Deep insertion (100/103), cholangiography (98/100), and therapeutic interventions (98/98) were highly successful. We therefore recommend the short double-balloon enteroscope for ERCP in patients with surgically altered anatomies because all conventional accessories are available.
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