Late-onset severe biliary bleeding after endoscopic pigtail plastic stent insertion

Yasuda, Muneji; Sato, Hideki; Koyama, Y; Sakakida, Tomoki; Kawakami, Takumi; Nishimura, Takeshi; Fujii, Hideki; Nakatsugawa, Yoshikazu; Yamada, Shinya; Tomatsuri, Naoya; Okuyama, Yûsuke; Kimura, Hiroyuki; Ito, Takaaki; Morishita, Hiroyuki; Yoshida, Norimasa

doi:10.3748/wjg.v23.i4.735

Cited by 8 publications

(6 citation statements)

References 16 publications

(7 reference statements)

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“…Complications of ERCP are divided into those related to sedation, endoscopy, cannulation and contrast medium injection and therapeutic procedures[ 6 ]. Pseudoaneurysms developing from the branches of hepatic artery following ERCP are rarely reported[ 3 - 5 ], in those cases, one patient had a history of plastic stent implantation, the author consider hepatic pseudoaneurysm might have formed as a result of traumatic stimulation related to the stent placement, because it had been placed improperly and its tip located at the site of the aneurysm[ 4 ]. Another patient had cholangitis and underwent a open cholecystectomy, which might be implicated in the information of the false aneurysm[ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…Rarely[ 1 ], significant bleeding may occur secondary to the injury to the branches of the gastroduodenal artery. Although secondary hemorrhage from pseudoaneurysms developed in the branches of the gastroduodenal artery or pancreatoduodenal artery have been reported[ 2 - 4 ], Pseudoaneurysms developing from the branches of hepatic artery following ERCP are rarely reported[ 3 - 5 ], and most pseudoaneurysms are suspected associated with stent insertion or endoscopic sphincterotomy or inflammatory etiologies such as pancreatitis. We report one case of a 73-year-old man who underwent ERCP for relieving cholangitis and stone removal, and subsequently developed intra-abdominal hemorrhage secondary to a left hepatic artery pseudoaneurysm, which was managed successfully with embolization.…”

Section: Introductionmentioning

confidence: 99%

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Left hepatic artery pseudoaneurysm complicating endoscopic retrograde cholangiopancreatography: A case report

Li,

Ye,

Yang

et al. 2023

World J Clin Cases

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Alzheimer’s disease (AD) is a progressive and neurodegenerative illness which results in alterations in cognitive development. It is characterized by loss/dysfunction of cholinergic neurons, and formation of amyloid plaques, and formation of neurofibrillary tangles, among other changes, due to hyperphosphorylation of tau-protein. Exposure to pesticides in humans occurs frequently due to contact with contaminated food, water, or particles. Organochlorines, organophosphates, carbamates, pyrethroids and neonicotinoids are associated with the most diagnosed incidents of severe cognitive impairment. The aim of this study was to determine the effects of these pesticides on the phosphorylation of tau protein, and its cognitive implications in the development of AD. It was found that exposure to pesticides increased the phosphorylation of tau protein at sites Ser198, Ser199, Ser202, Thr205, Ser396 and Ser404. Contact with these chemicals altered the enzymatic activities of cyclin-dependent kinase 5 and glycogen synthase kinase 3 beta, and protein phosphatase-2A. Moreover, it altered the expression of the microtubule associated protein tau gene, and changed levels of intracellular calcium. These changes affected tau protein phosphorylation and neuroinflammation, and also increased oxidative stress. In addition, the exposed subjects had poor level of performance in tests that involved evaluation of novelty, as test on verbal, non-verbal, spatial memory, attention, and problem-solving skills.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Left hepatic artery pseudoaneurysm complicating endoscopic retrograde cholangiopancreatography: A case report

Li,

Ye,

Yang

et al. 2023

World J Clin Cases

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show abstract

“…There are a few reported cases, indwelling stent made bile duct erosion and formed a fistula with hepatic artery. [7][8][9] There is another report where a plastic stent penetrates CBD after 5 weeks from ERCP, and it was suggested that weakened and vulnerable bile duct due to cholecystectomy prior to ERCP, has contributed to stent migration and CBD penetration. The migrated stent was surgically removed and primary repair of CBD penetration was performed.…”

Section: Discussionmentioning

confidence: 99%

Delayed Hemobilia Caused by Penetration of Biliary Plastic Stent into Portal Vein

Kang¹,

Kim²,

Kim³

2022

Korean J Pancreas Biliary Tract

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Biliary stent migration is one of the late complications of endoscopic retrograde cholangiopancreatography. Most of the biliary stent migration is asymptomatic and successfully managed by stent removal. A 66-year-old man with unresectable pancreatic cancer, common bile duct obstruction, and duodenal third portion obstruction underwent endoscopic plastic biliary stent placement and duodenal uncovered metallic stent placement in two separate sessions. After 3 weeks from the duodenal stenting, he presented with hematemesis. Urgent esophagogastroduodenoscopy and magnetic resonance imaging showed hemobilia. The patient recovered with conservative managements. Cross-sectional imagings done 2 months later demonstrated the penetration of the biliary stent into portal vein. Here, we present a case of delayed hemobilia caused by penetration of biliary plastic stent into the portal vein.

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“…Several case reports on biliary bleeding after stent placement for malignant biliary obstruction have been published regardless of whether radiotherapy was performed (4,5,(15)(16)(17)(18). Some possible explanations of bleeding that have been reported are adhesion of the stent to the tumor, duodenal ulceration by the distal end of the stent, and mechanical irritation of the adjacent arterial wall by the stent (19).…”

Section: Discussionmentioning

confidence: 99%

Safety of biliary stent placement followed by definitive chemoradiotherapy in patients with pancreatic cancer with bile duct obstruction

Hayakawa

Ito

Murofushi

et al. 2021

J Gastrointest Oncol

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Background: Although patients with malignant bile duct obstruction due to pancreatic cancer are often initially treated with biliary stent placement, concurrent chemoradiotherapy with stents poses a potential risk of increased toxicity. This retrospective study aimed to evaluate the safety of biliary stent placement followed by definitive concurrent chemoradiotherapy in patients with pancreatic cancer.Methods: Patients with pancreatic cancer who underwent either a plastic stent or a self-expanding metallic stent placement for malignant bile duct obstruction before definitive concurrent chemoradiotherapy were retrospectively reviewed. Radiotherapy was delivered in 1.8 Gy per fraction to a total dose of 50.4 Gy.Gemcitabine, TS-1 plus Gemcitabine, or TS-1 was the concurrent chemotherapy/regimen. The primary endpoint was the rate of biliary stent-related toxicities, defined as biliary bleeding, duodenal perforation, or bile duct perforation.Results: Thirty patients were included. Plastic stents were placed in 23 patients and self-expanding metallic stent in seven patients at the start of irradiation. The median follow-up time was 20 (range, 2-63) months, and 27 patients (90%) completed concurrent chemoradiotherapy. Biliary stent-related toxicity (grade 3 biliary bleeding) was confirmed in one patient (3%) with a plastic stent 9 months after concurrent chemoradiotherapy. The median duration of locoregional control, progression-free survival, and overall survival were 31.1, 7.3, and 10.5 months, respectively. Conclusions: Stent placement followed by concurrent chemoradiotherapy was not associated with an apparent increase in toxicity and may be an appropriate treatment for patients with locally advanced pancreatic head cancer with bile duct obstruction.

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Late-onset severe biliary bleeding after endoscopic pigtail plastic stent insertion

Cited by 8 publications

References 16 publications

Left hepatic artery pseudoaneurysm complicating endoscopic retrograde cholangiopancreatography: A case report

Left hepatic artery pseudoaneurysm complicating endoscopic retrograde cholangiopancreatography: A case report

Delayed Hemobilia Caused by Penetration of Biliary Plastic Stent into Portal Vein

Safety of biliary stent placement followed by definitive chemoradiotherapy in patients with pancreatic cancer with bile duct obstruction

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