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Takao Itoi,
D Nageshwar Reddy,
Atsushi Sofuni,
Mohan Ramchandani,
Fumihide Itokawa,
Rajesh Gupta, Toshio Kurihara,
Takayoshi Tsuchiya,
Kentaro Ishii,
Nobuhito Ikeuchi,
Fuminori Moriyasu,
Jong Ho Moon
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ABSTRACT: BACKGROUND: Although peroral direct cholangioscopy (PDCS) is emerging as an alternative to traditional mother-daughter cholangioscopy, it is associated with high failure rates. The aim of the present study was to evaluate the ability to insert and carry out interventions using a prototype multi-bending PDCS. PATIENTS AND METHODS: Prospective, observational clinical feasibility study was done in 41 patients with a variety of biliary diseases. A multi-bending PDCS prototype was inserted using a free-hand technique, a guidewire alone, or with a 5-Fr diameter anchoring balloon. Diagnostic and therapeutic procedures were carried out. RESULTS: The free-hand direct insertion technique failed in all attempted cases (n = 7). Of the remaining 34 cases, successful rate of PDCS insertion into the distal bile duct was achieved by passing the PDCS over a guidewire alone (n = 6) and/or with a guidewire plus anchoring balloon (n = 28) for an overall successrate of 88.2% (30/34). In 13 (92.9%) patients without an underlying biliary stricture, PDCS insertion proximal to the bifurcation was possible. In 25 cases, biliary interventions were attempted including biopsy (n = 13), stone removal (n = 6), stent removal (n = 1), and intraductal electrohydraulic lithotripsy (n = 2) and were successful in 22 (88%). Other than two patients with procedure-related cholangitis with a mild grade of severity, no complications were observed. CONCLUSIONS: Using a novel multi-bending prototype peroral direct cholangioscope, cholangioscopy had a high diagnostic and therapeutic success rate only when passed over a guidewire and anchoring balloon but not with the free-hand insertion technique. Comparative studies of direct cholangioscopy are warranted.
Digestive Endoscopy 04/2013; · 1.19 Impact Factor
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ABSTRACT: Endoscopic ultrasonography-guided (EUS)-guided pancreatic interventions have gained increasing attention. Here we review EUS-guided pancreatic duct (PD) access techniques and outcomes. EUS-guided PD intervention is divided into two types, antegrade and rendezvous techniques, following EUS-guided pancreatography. In the antegrade technique, pancreaticoenterostomy is carried out by stent placement between the PD and the stomach, duodenum, or jejunum. Transenteric antegrade PD stenting is conducted by stent placement, advancing anteriorly into the PD through the pancreatic tract. The rendezvous technique is carried out by using a guidewire through the papilla or anastomotic site for retrograde stent insertion. In terms of EUS-guided PD stenting, 11 case reports totaling 75 patients (35 normal anatomy, 40 altered anatomy) have been published. The technical success rate was greater than 70%. Early adverse events, including severe hematoma and severe pancreatitis,occurred in seven (63.6%) of 11 reports. Regarding the rendezvous technique, 12 case reports totaling 52 patients (22 normal anatomy, 30 altered anatomy) have been published. The technical success rate ranged from 25% to 100%. It was 48% in one report that involved more than 20 cases. Once stents were placed, all patients became free of symptoms. Early mild adverse events occurred in four (36.4%) of 11 reports. In conclusion, although it can be risky because of possible serious or even fatal adverse events, including pancreatic juice leakage, perforation and severe acute pancreatitis, EUS-PD access seems to be promising for treating symptomatic pancreatic diseases caused by PD stricture and pancreaticoenterostomy stricture.
Digestive Endoscopy 03/2013; · 1.19 Impact Factor
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Takao Itoi,
Kenneth F Binmoeller,
Janak Shah,
Atsushi Sofuni,
Fumihide Itokawa, Toshio Kurihara,
Takayoshi Tsuchiya,
Kentaro Ishii,
Shujiro Tsuji,
Nobuhito Ikeuchi,
Fuminori Moriyasu
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ABSTRACT: Tubular plastic and metal stents have inherent shortcomings when used for transenteric drainage of fluid collections.
To evaluate a novel lumen-apposing, self-expandable metal stent for EUS-guided drainage of pancreatic pseudocysts and the gallbladder.
Retrospective case series.
Tertiary-care academic medical center.
This study involved 15 patients (median age 54 years) with symptomatic pancreatic pseudocysts who underwent 12 transgastric and 3 transduodenal pseudocyst drainage procedures. Five patients (median age 69.5 years) with acute cholecystitis underwent 4 cholecystoduodenostomies and 1 cholecystogastostomy.
Stent deployment under EUS guidance, passage of an endoscope through the stent lumen for pseudocystoscopy or cholecystoscopy, transenteric endoscopy-guided interventions including biopsy, necrosectomy, and stone removal.
Technical and clinical success.
All stents were successfully deployed without complication, with a median time to removal of 35 days. All pseudocysts resolved after a single drainage procedure. One stent migrated into the stomach, and the remaining 14 were found to be patent at the time of removal. There was no pseudocyst recurrence during the 11.4-month median follow-up period. One gallbladder stent remains indwelling and fully patent at 12 months. Resolution of acute cholecystitis was observed immediately after stent implantation. No recurrence of symptoms was observed during a median follow-up period of 9 months.
Retrospective study, small sample size, lack of control patients.
Transenteric drainage of pancreatic pseudocysts and the gallbladder by using a novel, lumen-apposing, metal stent was accomplished with high technical and clinical success in this pilot observational study. Further studies are warranted.
Gastrointestinal endoscopy 01/2012; 75(4):870-6. · 6.71 Impact Factor
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Takao Itoi,
Atsushi Sofuni,
Fumihide Itokawa, Toshio Kurihara,
Takayoshi Tsuchiya,
Kentaro Ishii,
Nobuhito Ikeuchi,
Fuminori Moriyasu,
Kazuhiko Kasuya,
Akihiko Tsuchida,
Terumi Kamisawa,
Todd H Baron
Gastrointestinal endoscopy 12/2011; 75(2):441-9. · 6.71 Impact Factor
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ABSTRACT: ERCP-related procedures involve radiation exposure of patients and medical staff. We developed a novel protective lead shield which is attached around the fluoroscopy generator. Here we examine levels of radiation exposure to patients, endoscopists and assistants, and evaluate the usefulness of the newly designed protective shield.
Four-hundred and seventy-one ERCP procedures were performed from April 2006 to April 2007. At first, we compared the radiation dose of consecutive fluoroscopy conditions with pulse fluoroscopy of 15 per second and then the radiation dose with and without the protective shield. Next, we measured the radiation exposure of endoscopists and assistants in the clinical setting monitored by digital dosimeter during ERCP procedure.
The radiation dose was the most at the 45° direction. Using pulse fluoroscopy of 15 per second the radiation dose of patients and endoscopists decreased by about half. Using both pulse fluoroscopy of 15 per second and the protective shield, the radiation dose at the endoscopist's position was reduced up to 97%. The total fluoroscopy time was 5851 minutes in the 471 ERCP cases. Using pulse 15 and the protective lead shield, the radiation exposure dose of one endoscopist and two assistants were 2430.8, 2673.9 and 1375.0µSv, respectively.
Novel protective lead shield in combination with pulse fluoroscopy can significantly reduce the radiation exposure leading to avoid unnecessary radiation exposure to patients and medical staff.
Hepato-gastroenterology 12/2011; 59(115):709-12. · 0.66 Impact Factor
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ABSTRACT: Recently, controllable biopsy forceps (MTW, D°sseldorf, Germany) have been developed. This biopsy forceps were 90° adjustable. In the present study, the feasibility and efficacy of the controllable biopsy forceps were compared with those of conventional biopsy forceps in patients with biliary tract disease.
A total of 27 patients with biliary tract lesions were enrolled. We evaluated the procedure time, the sample tissue size and the diagnostic accuracy. In addition, the physicians performing the procedure rated their impressions about operability into 3 classes: excellent, fair and poor.
The sensitivity in distinguishing benign from malignant lesions was 71.4% (15/21) for the 90° adjustable type and 66.7% (14/21) for the conventional type. The accuracy rate was 77.8% (21/27) for the 90° adjustable type and 74.0% (20/27) for the conventional type. In terms of operability as rated by each physician, the 'excellent' rate was given more frequently to the 90° adjustable type 25.9% than for the conventional type 11.1% (p=0.047).
This preliminary study showed that controllable biopsy forceps compared to conventional type biopsy forceps, despite a larger diameter, enables biopsy in a similar procedure time and its ease of use was rated better.
Hepato-gastroenterology 11/2011; 59(117):1350-3. · 0.66 Impact Factor
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Takao Itoi,
Atsushi Sofuni,
Fumihide Itokawa, Toshio Kurihara,
Takayoshi Tsuchiya,
Kentaro Ishii,
Shujiro Tsuji,
Nobuhito Ikeuchi,
Reina Tanaka,
Junko Umeda,
Fuminori Moriaysu
Gastrointestinal endoscopy 11/2011; 76(2):454-7. · 6.71 Impact Factor
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Shujiro Tsuji,
Atsushi Sofuni,
Fuminori Moriyasu,
Fumihide Itokawa,
Kentaro Ishii, Toshio Kurihara,
Takayoshi Tsuchiya,
Nobuhito Ikeuchi,
Junko Umeda,
Reina Tanaka,
Takao Itoi
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ABSTRACT: Background/Aims: The aim of our study was to evaluate the enhancement patterns of gallbladder disease using contrast-enhanced ultrasonography (CE-US) with the contrast agent levovist. Methodology: The subjects were 42 patients, of whom 25 had gallbladder cancer, 2 had adenoma, 5 had adenomyomatosis, 5 had cholesterol polyps and 5 had debris. We assessed the enhancement patterns of each case using CE-US with levovist and classified these patterns into 6 types: diffuse, scattered, branched, linear, homogeneous and unenhanced. Results: The enhancement of gallbladder cancer revealed various patterns. Only 4 malignant cases showed branched patterns. We speculated that branched patterns in the present study were possibly the characteristic of malignancy. CE-US easily distinguished a small polypoid lesion from debris. Using CE-US, we visualized the shape of the gallbladder cancer lesions and some areas of direct invasion to the liver, as well as metastasis. Conclusions: CE-US is a minimally invasive diagnostic technique that is useful in visualizing not only the shape of the lesion and some areas of the direct invasion to the liver, but also metastasis. The above findings suggest that imaging using a contrast agent could lead to improvements in the diagnosis of gallbladder lesions.
Hepato-gastroenterology 08/2011; 59(114):336-40. · 0.66 Impact Factor
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Takao Itoi,
Hiroyuki Isayama,
Atsushi Sofuni,
Fumihide Itokawa, Toshio Kurihara,
Takayoshi Tsuchiya,
Shujiro Tsuji,
Kentaro Ishii,
Nobuhito Ikeuchi,
Reina Tanaka,
Junko Umeda,
Fuminori Moriyasu,
Hiroshi Kawakami
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ABSTRACT: Endoscopic ultrasonography-guided biliary drainage (EUS-BD) has been carried out as an alternative to the percutaneous or surgical approach when endoscopic retrograde cholangiopancreatography fails. However, there is no standard technique or device for EUS-BD. In this review, we focus on how we choose the stents and described our tips on this EUS-BD technique. The plastic stent (PS) and the self-expandable metallic stent (SEMS) are used for EUS-BD. The latter is further divided into the fully covered SEMS (FCSEMS), partially covered SEMS (PCSEMS), and uncovered SEMS (UCSEMS) types. Although PS is not expensive, the duration of stent patency is short. SEMS is expensive but the duration of stent patency is long. With UCSEMS, basically there is no stent malpositioning; however, if the gap between the bile duct and the GI tract becomes displaced, bile leakage from the mesh of the stent is likely to occur. Though there is no bile leakage with FCSEMS, the side branch of the bile duct may become occluded, and migration and dislocation sometimes occur. PCSEMS is basically similar to FCSEMS. When EUS-BD was first developed, drainage by PS was common, although reports on drainage by SEMS have increased recently.
Journal of hepato-biliary-pancreatic sciences. 06/2011; 18(5):664-72.
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Kentaro Ishii,
Takao Itoi,
Atsushi Sofuni,
Fumihide Itokawa,
Takayoshi Tsuchiya, Toshio Kurihara,
Shujiro Tsuji,
Nobuhito Ikeuchi,
Junko Umeda,
Fuminori Moriyasu,
Akihiko Tsuchida
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ABSTRACT: To evaluate the efficacy and safety of endoscopic removal and trimming of self-expandable metallic stents (SEMS).
All SEMS had been placed for distal biliary strictures. Twenty-seven endoscopic procedures were performed in 19 patients in whom SEMS (one uncovered and 18 covered) removal had been attempted, and 8 patients in whom stent trimming using argon plasma coagulation (APC) had been attempted at Tokyo Medical University Hospital. The APC settings were: voltage 60-80 W and gas flow at 1.5 L/min.
The mean stent indwelling period for all patients in whom stent removal had been attempted was 113.7 ± 77.6 d (range, 8-280 d). Of the 19 patients in whom removal of the SEMS had been attempted, the procedure was successful in 14 (73.7%) without procedure-related adverse events. The indwelling period in the stent removable group was shorter than that in the unremovable group (94.9 ± 71.5 d vs 166.2 ± 76.2 d, P = 0.08). Stent trimming was successful for all patients with one minor adverse event consisting of self-limited hemorrhage. Trimming time ranged from 11 to 16 min.
Although further investigations on larger numbers of cases are necessary to accumulate evidence, the present data suggested that stent removal and stent trimming is feasible and effective for stent-related complications.
World Journal of Gastroenterology 06/2011; 17(21):2652-7. · 2.47 Impact Factor
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Fumihide Itokawa,
Takao Itoi,
Atsushi Sofuni, Toshio Kurihara,
Takayoshi Tsuchiya,
Kentaro Ishii,
Shujiro Tsuji,
Nobuhito Ikeuchi,
Junko Umeda,
Reina Tanaka,
Naoyuki Yokoyama,
Fuminori Moriyasu,
Kazuhiko Kasuya,
Toshitaka Nagao,
Terumi Kamisawa,
Akihiko Tsuchida
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ABSTRACT: Recently, the usefulness of endoscopic ultrasound (EUS) elastography has been reported for the diagnosis of pancreatic lesions. In the present study, we retrospectively assessed EUS elastography as a diagnostic tool by evaluating tissue elasticity distribution and elasticity semiquantification, using the strain ratio (SR) of tissue elasticity, in patients with pancreatic masses.
One hundred and nine patients who underwent EUS elastography between September 2006 and May 2009 were retrospectively evaluated. The final diagnosis was chronic pancreatitis (CP) in 20 patients [6 with non-mass-forming pancreatitis, 7 with mass-forming pancreatitis (MFP), and 7 with autoimmune pancreatitis (AIP)], pancreatic cancer (PC) in 72, pancreatic neuroendocrine tumor (PNET) in 9, and normal pancreas in 8. The tissue elasticity distribution calculation was performed in real time, and the results were represented in color in fundamental B-mode imaging. In addition, we performed quantification using the SR (non-mass area/mass area).
Elastography for all PC patients showed intense blue coloration, indicating malignant lesions. In contrast, MFP presented with a mixed coloration pattern of green, yellow, and low-intensity blue. Normal controls showed an even distribution of green to red. The mean SR was 23.66 ± 12.65 for MFP and 39.08 ± 20.54 for PC (P < 0.05).
Endoscopic ultrasound elastography is a promising diagnostic tool for defining the tissue characteristics of pancreatic masses. In addition, semiquantitative analysis of elasticity using the SR may allow the differentiation of MFP from PC.
Journal of Gastroenterology 06/2011; 46(6):843-53. · 4.16 Impact Factor
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ABSTRACT: There are few reports on the histological diagnostic ability of endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) in a large-series of pancreatic masses. In the present study therefore we retrospectively evaluated the histological diagnostic ability of EUS-FNA in pancreatic masses without on-site cytopathologist. In 355 patients with pancreatic solid masses, EUS-FNA was carried out. EUS-FNA histology showed accuracy, 90.7%; sensitivity, 89.5%; specificity, 95.6%; positive predict value, 98.8%; negative predict value, 68.8% by intention-to-treat analysis. Except for 10 with inadequate materials, EUS-FNA histology showed accuracy, 93.3%; sensitivity, 91.8%; specificity, 100%; positive predict value, 100%; negative predict value, 77.6%. The mean number of puncture was 2.88 (range 1 to 8). There was two (0.6%) procedure-related bleeding. In conclusion, diagnostic ability of EUS-FNA by histological materials was similar to previous literature on the EUS-FNA without on-site cytopathologist.
Digestive Endoscopy 05/2011; 23 Suppl 1:34-8. · 1.19 Impact Factor
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ABSTRACT: Endoscopic ultrasonography-guided fine needle aspiration biopsy (EUS-FNA) is a safe and accurate procedure for the diagnosis of pancreatic lesions. However, in general, surgically altered anatomy excluding Billroth I gastrectomy is considered a relative contraindication to EUS-FNA. Herein, we described a successful case of EUS-FNA in a patient with prior Billroth II gastrectomy. A 78-year-old man, who had previously undergone Billroth II gastrectomy for duodenal ulcer, undertook EUS-FNA using a curved linear echoendoscope. An echoendoscope was advanced into the duodenum and EUS-FNA could be carried out using a 22-gauge needle without procedure-related adverse event.
Digestive Endoscopy 05/2011; 23 Suppl 1:162-3. · 1.19 Impact Factor
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ABSTRACT: Traditionally, either surgical or percutaneous drainage is recommended for liver abscess. Recently, several endoscopists have reported the endoscopic ultrasound (EUS)-guided liver abscess drainage. Herein, we report a case of tuberculous liver abscess in which endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) was useful for the diagnosis and therapy. A 78-year-old woman suffered from continuous epigastric pain and fever up. Computed tomography (CT) showed a 70 mm multilocular and multiseptate cystic lesion around the head of pancreas and caudate lobe of the liver. After confirming liver abscess by EUS-FNA, EUS-guided liver abscess drainage was carried out. Finally, a 7 Fr straight stent and a 5 Fr nasocystic catheter were inserted into the cyst. Four weeks later, we found that cultured microorganism obtained using drainage catheter was Mycobacterium tuberculosis. Although he was doing well during 5 days after the procedure, CT showed the size of another abscess increased. Then, additional EUS-guided abscess drainage was carried out at the body of the stomach into the abscess of the left lobe. Two weeks later, CT showed disappearance of abscesses. Then, she discharged with the internal stent still in place.
Digestive Endoscopy 05/2011; 23 Suppl 1:158-61. · 1.19 Impact Factor
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ABSTRACT: Pancreatic carcinoma has one of the poorest prognoses among malignant tumors. Many pancreatic carcinoma patients who undergo common treatments, such as surgery, radio-chemotherapy and chemotherapy, gained little benefit because of the histological characteristics.
HIFU is a new technique of noninvasive treatment for unresectable pancreatic carcinoma. HIFU has the ability to ablate the deep tissues inside body from an external source using high-intensity focused ultrasound. The effects of HIFU can result in cell destruction and tissue necrosis.
Results from study in China in 251 patients with advanced pancreatic carcinoma suggested that HIFU treatment could reduce the size of tumors without causing complications and prolong survival. Moreover, according to some reports from China, HIFU treatment is suggested to be useful as the one of palliative treatments for unresectable pancreatic carcinoma. Our case of HIFU therapy for pancreatic carcinoma is presented including pathological findings in this paper. The results suggested that HIFU treatment might be effective in controlling local tumor.
HIFU therapy may have the possibility of becoming one of the combination therapies for treating pancreatic carcinoma in the future.
Journal of hepato-biliary-pancreatic sciences. 03/2011; 18(3):295-303.
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ABSTRACT: Endoscopic ultrasonography-guided gallbladder drainage (EUS-GBD) has been developed as an alternative drainage method in patients with acute cholangitis. Here, we describe two successful EUS-GBD cases and review the literature on this topic.
EUS-GBD was conducted using a curved linear array echoendoscope and a 19-gauge needle.
A 7-Fr double pigtail stent was successfully placed transgastrically in one patient and transduodenally in the other patient, without any serious early adverse events in either patient. No late complications or relapse of acute cholecystitis have been seen during the 3- to 6-month follow-up period.
EUS-GBD holds high potential as an alternative gallbladder decompression procedure. However, because current experience is limited, multicenter trials for the accurate evaluation of this procedure appear to be necessary in the near future.
Journal of hepato-biliary-pancreatic sciences. 03/2011; 18(2):282-6.
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Takayoshi Tsuchiya,
Takao Itoi,
Takuji Gotoda,
Kensuke Kuraoka,
Atsushi Sofuni,
Fumihide Itokawa, Toshio Kurihara,
Kentaro Ishii,
Shujiro Tsuji,
Nobuhito Ikeuchi,
Reina Tanaka,
Junko Umeda,
Fuminori Moriyasu
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ABSTRACT: Self-expandable metallic stent (SEMS) placement is a widely used, effective therapy for unresectable malignant stricture of the lower bile duct.
We evaluated the short-term outcome of the newly developed WallFlex(®) Biliary RX Partially Covered Stent in patients with malignant lower and middle biliary stricture in five tertiary referral centers.
The subjects of this study were 52 patients in whom WallFlex(®) Biliary RX Stents were inserted into the bile duct for malignant stenosis of the middle and lower bile duct at five medical facilities between April 2009 and November 2009.
The stent placement success rate was 100%. Effective biliary decompression was achieved in all patients. The incidence of early complications was 7.7% (4/52). Stent occlusion occurred in two patients (3.8%) (one dislocation, one migration); cholecystitis occurred in two patients (3.8%). Neither acute pancreatitis nor stent kinking in the bile duct occurred.
The present results revealed that the new WallFlex(®) Biliary RX Partially Covered SEMSs were useful for the short-term relief of biliary obstruction due to unresectable distal biliary malignancies.
Digestive Diseases and Sciences 02/2011; 56(6):1889-95. · 2.12 Impact Factor
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Takao Itoi,
Kazuhiko Kasuya,
Atsushi Sofuni,
Fumihide Itokawa,
Takayoshi Tsuchiya, Toshio Kurihara,
Nobuhito Ikeuchi,
Mami Takeuchi,
Takeshi Nagano,
Hitoshi Iwamoto,
Eigoro Yamanouchi,
Motohide Shimazu,
Akihiko Tsuchida
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ABSTRACT: Magnetic compression anastomosis (MCA) is a revolutionary, minimally invasive method of performing choledochoenterostomy or choledochocholedochostomy without using surgical techniques in patients with biliary stricture or obstruction. Herein, we describe a case series of MCA for severe biliary stricture or obstruction, which could not be treated with conventional therapies.
Two patients with biliary obstruction were treated using MCA for choledochocholedochostomy and choledochoenterostomy at Tokyo Medical University Hospital and Tokyo Medical University Hachioji Medical Center. Endoscopically, a samarium-cobalt (Sm-Co) rare-earth magnet was placed at the superior site of obstruction through the percutaneous transhepatic biliary drainage route and another Sm-Co magnet was placed at the inferior site of obstruction. A comprehensive computer-aided literature search for MCA was performed up to September 2009 by using MEDLINE and EMBASE.
MCA techniques enabled complete anastomosis in both cases without procedure-related complications.
The MCA technique is a revolutionary method of performing choledochocholedochostomy and choledochoenterostomy interventionally in patients with biliary obstruction, for whom the conventional endoscopic procedure is not available, or in candidates who are deemed unsuitable for surgery.
Journal of hepato-biliary-pancreatic sciences. 12/2010; 18(3):357-65.
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Gastrointestinal endoscopy 11/2010; 73(4):841-3. · 6.71 Impact Factor
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Takao Itoi,
Kentaro Ishii,
Atsushi Sofuni,
Fumihide Itokawa, Toshio Kurihara,
Takayoshi Tsuchiya,
Shujiro Tsuji,
Nobuhito Ikeuchi,
Junko Umeda,
Rena Tanaka,
Fuminori Moriyasu
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ABSTRACT: Extraction of bile duct stones in patients who have undergone Roux-en-Y anastomosis can be challenging. Recently, large balloon dilation following endoscopic sphincterotomy has been shown to be useful for the removal of bile duct stones.
We retrospectively evaluated the feasibility and safety of endoscopic sphincterotomy large balloon dilation for the removal of bile duct stones in patients with Roux-en-Y anastomosis.
Large balloon papillary dilation following EST for the removal of bile duct stones was performed on the intact papilla in 15 patients with Roux-en-Y anastomosis at our institution. When we could not use the long-type accessories, a conventional forward-viewing upper endoscope passed through the over tube of the single-balloon or double-balloon enteroscope for the use of short-type accessories. Following endoscopic sphincterotomy, a large balloon catheter was positioned across the main duodenal papilla. The size of large balloon used ranged from 15mm to 20mm.
Complete clearance of bile duct stones was achieved in all cases in the initial session without any adverse events. A mechanical lithotriptor for crushing stones was used in one patient (6.7%).
Large balloon papillary dilation following EST appears to be an effective and safe treatment for difficult-to-remove bile duct stones in patients with Roux-en-Y anastomosis .
Digestive and Liver Disease 10/2010; 43(3):237-41. · 3.05 Impact Factor
