Urgent endoscopic nasobiliary drainage without fluoroscopic guidance: A useful treatment for critically ill patients with biliary obstruction

Wang, Hsiu‐Po; Huang, Shih-Pei; Sun, Menghong; Chen, Jiann-Hwa; Wang, Hsih‐Hsi; Lin, Chih-Ta; Chang, Ying-Sen; Yang, Chang-Shyue; Wu, Ming–Shiang; Lin, Jaw–Town

doi:10.1067/mge.2000.109800

Cited by 17 publications

(17 citation statements)

References 8 publications

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“…ERCP without fluoroscopy can be considered an extreme situation (6). On the other hand, because endoscopists can encounter difficulties in using radiologic equipment, some nonfluoroscopic methods to insert stents have been developed (7).…”

Section: Discussionmentioning

confidence: 99%

Use of an Ultrathin Gastroscope to Allow Endoscopic Insertion of Enteral Wallstents Without Fluoroscopic Monitoring

García-Cano

2006

Dig Dis Sci

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Self-expanding metallic stents are useful in relieving tumoral obstruction in the gastrointestinal tract. Endoscopic insertion is usually made through the working channel of a therapeutic endoscope. Fluoroscopy during insertion is thought to be mandatory in most cases. Endoscopists sometimes encounter problems in using or accessing fluoroscopy facilities. This study describes a method to insert, under certain circumstances, enteral Wallstents using only endoscopic control. An ultrathin gastroscope is used to pass severe tumoral strictures and place a guide wire beyond the stenosis. The ultrathin gastroscope is removed leaving the guide wire in place, which is then inserted in a retrograde fashion into a therapeutic colonoscope, allowing insertion of through-the-scope stents. Successful insertion was achieved in 5 malignant gastric outlet obstructions and in 6 rectosigmoid tumoral obstructions. In conclusion, in some cases using an ultrathin endoscope to place a guide wire beyond the stricture can be useful for endoscopic placement of Wallstents without fluoroscopy.

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Section: Discussionmentioning

confidence: 99%

Use of an Ultrathin Gastroscope to Allow Endoscopic Insertion of Enteral Wallstents Without Fluoroscopic Monitoring

García-Cano

2006

Dig Dis Sci

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“…Finally, the IDUS-directed technique can be used without fluoroscopic facilities. Therefore, it can be performed at bed side for severely ill patients who cannot move from the intensive care unit [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison of intraductal ultrasonography-directed and cholangiography-directed endoscopic retrograde biliary drainage in patients with a biliary obstruction

Rew

Lee

Park

et al. 2016

Korean J Intern Med

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Background/Aims:Endoscopic retrograde biliary drainage (ERBD) has become a standard procedure in patients with a biliary obstruction. Intraductal ultrasonography (IDUS) has emerged as a new tool for managing extrahepatic biliary diseases. IDUS-directed ERBD can be performed without conventional cholangiography (CC). The goal of this study was to assess the effectiveness and safety of IDUS-directed ERBD compared to CC-directed ERBD in patients with an extrahepatic biliary obstruction.Methods:A total of 210 patients who had undergone IDUS-directed ERBD (IDUS-ERBD, n = 105) and CC-directed ERBD (CC-ERBD, n = 105) between October 2013 and April 2014 were analyzed retrospectively. The primary outcome measure was the procedural success rate. Secondary outcome measures included clinical outcomes, total procedure time, radiation exposure time, and overall complication rates.Results:The total technical success rate of ERBD was 100% (105/105) in the IDUS-ERBD and CC-ERBD groups. Mean procedure time was slightly prolonged in the IDUS-ERBD group than that in the CC-ERBD group (32.1 ± 9.9 minutes vs. 28.4 ± 11.6 minutes, p = 0.023). Mean radiation exposure time was one-third less in the IDUS-ERBD group than that in the CC-ERBD group (28.0 ± 49.3 seconds vs. 94.2 ± 57.3 seconds, p < 0.001). No significant differences in complication rates were detected between the groups.Conclusions:IDUS-ERBD was equally effective and safe as CC-ERBD in patients with an extrahepatic biliary obstruction. Although IDUS-ERBD increased total procedure time, it significantly decreased radiation exposure.

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“… 5 Radiocontrast cholangiogram is also not able to be performed on critically ill intensive care unit patients in need of ERC, because moving the patients to a critical-care setting with facilities for fluoroscopy presents a formidable obstacle. 14 Therefore, performing ERC without radiocontrast cholangiogram is desirable for both examiners and patients.…”

Section: Discussionmentioning

confidence: 99%

Intraductal Ultrasonography without Radiocontrast Cholangiogramin Patients with Extrahepatic Biliary Disease

et al. 2015

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Background/AimsIntraductal ultrasonography (IDUS) has been performed as an adjunct to endoscopic retrograde cholangiography (ERC) during radiocontrast cholangiography (RC). Radiation exposure during RC poses a health risk to both patients and examiners. We evaluated the feasibility of IDUS without RC in various extrahepatic biliary diseases.MethodsIDUS was performed with the insertion of an IDUS probe from the papilla of Vater to the confluent portion of the common hepatic duct without fluoroscopy. The technical success rate and procedure-related complications were evaluated retrospectively.ResultsWire-guided IDUS without RC was performed in 105 patients. The mean age was 66.5 years, and 50 (47.6%) were male. The IDUS diagnoses included choledocholithiasis (73, 69.5%), benign biliary stricture (11, 10.5%), choledocholithiasis with biliary pancreatitis (9, 8.6%), bile duct cancer (5, 4.8%), pancreatic cancer (1, 0.9%), and others (6, 5.7%). After IDUS, 66 (62.8%) underwent stone removal, 19 (18.1%) underwent biliary drainage, and 7 (6.6%) underwent brush cytology and biopsy. No significant complications such as perforation or severe pancreatitis occurred.ConclusionsIDUS without RC was a feasible and safe approach in patients with various extrahepatic biliary diseases. We anticipate a potentially important role of IDUS in various ERC procedures because it lacks the hazards of RC.

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Urgent endoscopic nasobiliary drainage without fluoroscopic guidance: A useful treatment for critically ill patients with biliary obstruction

Cited by 17 publications

References 8 publications

Use of an Ultrathin Gastroscope to Allow Endoscopic Insertion of Enteral Wallstents Without Fluoroscopic Monitoring

Use of an Ultrathin Gastroscope to Allow Endoscopic Insertion of Enteral Wallstents Without Fluoroscopic Monitoring

Comparison of intraductal ultrasonography-directed and cholangiography-directed endoscopic retrograde biliary drainage in patients with a biliary obstruction

Intraductal Ultrasonography without Radiocontrast Cholangiogramin Patients with Extrahepatic Biliary Disease

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