A novel approach in benign biliary stricture – balloon dilation combined with cholangioscopy-guided steroid injection

Franzini, Tomazo; Moura, Renata Nobre; Rodela, Gustavo Luis; Andraus, Wellington; Herman, Paulo; D’Albuquerque, Luiz Augusto Carneiro; Moura, Eduardo Guimarães Hourneaux de

doi:10.1055/s-0034-1393370

Cited by 14 publications

(16 citation statements)

References 5 publications

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“…Although the evidence is limited to case reports, steroids (triamcinolone) can be injected directly into strictures refractory to treatment with balloon dilation and indwelling catheters [19]. For cases in which conventional methods for recanalization and/or dilation fail, PTCS can be used to guide the correct placement of magnets into the stricture site.…”

Section: Cholangioscopymentioning

confidence: 99%

Percutaneous Transhepatic Cholangioscopy in Bilioenteric Anastomosis Stricture

2016

Clin Endosc

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Bilioenteric anastomosis strictures are a serious complication of biliary surgery, and often result in recurrent cholangitis, choledocholithiasis, biliary cirrhosis, and hepatic failure. Bilioenteric reconstructive surgery is the standard treatment of choice for such complications. However, percutaneous transhepatic cholangioscopy (PTCS), also known as per-oral endoscopic-guided intervention, is a less invasive procedure that is becoming an increasingly popular alternative. This review describes the PTCS procedure (including the preparation process), as well as the diagnostic and therapeutic role of PTCS in bilioenteric anastomosis strictures.

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Section: Cholangioscopymentioning

confidence: 99%

Percutaneous Transhepatic Cholangioscopy in Bilioenteric Anastomosis Stricture

2016

Clin Endosc

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“…Because of the possibility of direct high-resolution imaging of bile ducts, single-operator cholangioscopy has recently attracted attention in the field of management of biliary complications after LT[13]. However, only a few case reports and small case series have analyzed the role of single-operator cholangioscopy for management of biliary complications after LT[14-16]. Moreover, most of these case series were performed using the earlier generation of the SpyGlass system.…”

Section: Introductionmentioning

confidence: 99%

Single-operator cholangioscopy for biliary complications in liver transplant recipients

Hüsing‐Kabar¹,

Heinzow²,

Schmidt³

et al. 2017

WJG

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AIMTo evaluate cholangioscopy in addition to endoscopic retrograde cholangiopancreatography (ERCP) for management of biliary complications after liver transplantation (LT).METHODSTwenty-six LT recipients with duct-to-duct biliary reconstruction who underwent ERCP for suspected biliary complications between April and December 2016 at the university hospital of Muenster were consecutively enrolled in this observational study. After evaluating bile ducts using fluoroscopy, cholangioscopy using a modern digital single-operator cholangioscopy system (SpyGlass DS™) was performed during the same procedure with patients under conscious sedation. All patients received peri-interventional antibiotic prophylaxis and bile was collected during the intervention for microbial analysis and for antibiotic susceptibility testing.RESULTSThirty-three biliary complications were found in a total of 22 patients, whereas four patients showed normal bile ducts. Anastomotic strictures were evident in 14 (53.8%) patients, non-anastomotic strictures in seven (26.9%), biliary cast in three (11.5%), and stones in six (23.1%). A benefit of cholangioscopy was seen in 12 (46.2%) patients. In four of them, cholangioscopy was crucial for selective guidewire placement prior to planned intervention. In six patients, biliary cast and/or stones failed to be diagnosed by ERCP and were only detectable through cholangioscopy. In one case, a bile duct ulcer due to fungal infection was diagnosed by cholangioscopy. In another case, signs of bile duct inflammation caused by acute cholangitis were evident. One patient developed post-interventional cholangitis. No further procedure-related complications occurred. Thirty-seven isolates were found in bile. Sixteen of these were gram-positive (43.2%), 12 (32.4%) were gram-negative bacteria, and Candida species accounted for 24.3% of all isolated microorganisms. Interestingly, only 48.6% of specimens were sensitive to prophylactic antibiotics.CONCLUSIONSingle-operator cholangioscopy can provide important diagnostic information, helping endoscopists to plan and perform interventional procedures in LT-related biliary complications.

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“…Single‐operator cholangioscopy is useful in the evaluation and treatment of biliary complications after liver surgery . SOC increases the ability to evaluate mucosal changes and presence of fibrosis and provides direct intraductal therapies.…”

Section: Therapeutic Cholangioscopic Proceduresmentioning

confidence: 99%

“…SOC increases the ability to evaluate mucosal changes and presence of fibrosis and provides direct intraductal therapies. The safety and feasibility of D‐SOC‐guided steroids injection has been reported in a patient with refractory anastomotic biliary stricture after liver transplant . The patient underwent two sessions of SOC‐guided steroid injection immediately after biliary balloon dilation, with 40 mg of triamcinolone acetate injected per session.…”

Section: Therapeutic Cholangioscopic Proceduresmentioning

confidence: 99%

“…Single-operator cholangioscopy is useful in the evaluation and treatment of biliary complications after liver surgery. 49 SOC increases the ability to evaluate mucosal changes and presence of fibrosis and provides direct intraductal therapies. The safety and feasibility of D-SOC-guided steroids injection has been reported in a patient with refractory anastomotic biliary stricture after liver transplant.…”

Section: Post Liver-transplant Biliary Stricturementioning

confidence: 99%

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Biliary interventions using single‐operator cholangioscopy

Navaneethan

Moon²,

Itoi

2019

Digestive Endoscopy

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Cholangioscopy provides an opportunity to directly visualize the bile duct for diagnosing biliary lesions and for therapeutic interventions. Although there are different cholangioscopy techniques available, single‐operator cholangioscopy has gained widespread acceptance as the standard technique for interventions in the biliary system because of its ease of use and widespread availability. Single‐operator cholangioscopy can be used for both diagnostic and therapeutic indications in the biliary tract. Diagnostic cholangioscopy is used for direct evaluation of indeterminate bile duct strictures with biopsies, diagnosing filling defects in the bile ducts observed during endoscopic retrograde cholangiography (ERC) imaging, preoperative mapping of the precise location and extension of tumors of the biliary tract, and diagnosis of intraductal neoplasms. Therapeutic cholangioscopy is used for visually guided treatment of biliary stones that have failed extraction with conventional ERC techniques, residual or impacted stones by using intraductal lithotripsy, ablation of biliary tumors and for facilitation of guidewire advancement into selective intrahepatic ducts for adequate biliary drainage. In this review, we will focus on advances in the single‐operator cholangioscopy techniques in the diagnosis and management of biliary disorders.

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A novel approach in benign biliary stricture – balloon dilation combined with cholangioscopy-guided steroid injection

Abstract: SpyGlass cholangioscopy-guided steroid injection at a benign biliary stricture. Franzini Tomazo et al. Balloon dilation plus cholangioscopy-guided steroid injection for benign biliary stricture … Endoscopy 2015; 47: E571-E572 Cases and Techniques Library (CTL) E572

Cited by 14 publications

References 5 publications

Percutaneous Transhepatic Cholangioscopy in Bilioenteric Anastomosis Stricture

Percutaneous Transhepatic Cholangioscopy in Bilioenteric Anastomosis Stricture

Single-operator cholangioscopy for biliary complications in liver transplant recipients

Biliary interventions using single‐operator cholangioscopy

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