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The Role of Therapeutic Endoscopic Ultrasound in Management of Malignant Double Obstruction (Biliary and Gastric Outlet): A Comprehensive Review with Clinical Scenarios.
J Clin Med
December 2024
Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy.
Endoscopic ultrasound (EUS)-guided interventions have revolutionized the management of malignant biliary obstruction (MBO) and gastric outlet obstruction (GOO), providing minimally invasive alternatives with improved outcomes. These procedures have significantly reduced the need for high-risk surgical interventions or percutaneous alternatives and have provided effective palliative care for patients with advanced gastrointestinal and bilio-pancreatic malignancies. EUS-guided biliary drainage (EUS-BD) techniques, including hepaticogastrostomy (EUS-HGS), choledochoduodenostomy (EUS-CDS), and antegrade stenting (EUS-AS), offer high technical and clinical success rates, with a good safety profile particularly when Endoscopic Retrograde Cholangiopancreatography (ERCP) is not feasible.
View Article and Find Full Text PDFEvolving Endoscopic Approaches to Pancreatic Pseudocysts and Walled-Off Necrosis: Case Series and Review of Evidence.
J Investig Med High Impact Case Rep
December 2024
Imaging followed by endoscopic ultrasound (EUS)-guided therapy has become the preferred modality for treating pancreatic pseudocysts over surgical or radiological interventions. However, there continues to be a lack of consensus regarding the utility of endoscopic retrograde cholangiopancreatography (ERCP) before and after cyst drainage. We describe 4 cases of large pancreatic pseudocyst causing extrinsic biliary obstruction treated successfully with endoscopic cystogastrostomy decompression using a lumen-apposing self-expandable metal stent (LAMS) without ERCP.
View Article and Find Full Text PDFOptimizing EUS-guided choledochoduodenostomy with lumen-apposing metal stents for primary drainage of malignant distal biliary obstruction (SCORPION-IIp): a prospective pilot study.
Gastrointest Endosc
October 2024
Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands; Cancer Center Amsterdam, Amsterdam, The Netherlands; Department of Gastroenterology and Hepatology, Amsterdam UMC, location Vrije Universiteit, Amsterdam, The Netherlands.
Background And Aims: Biliary drainage by ERCP in patients with malignant distal bile duct obstruction (MBO) is frequently associated with adverse events, such as pancreatitis, hampering patient outcomes. EUS-guided choledochoduodenostomy (EUS-CDS) with a lumen-apposing metal stent (LAMS) is a promising alternative in patients with MBO but is associated with a worrisome risk of stent dysfunction. Placement of a fully covered self-expandable metal stent (FCSEMS) through the LAMS, thereby changing the axis of biliary drainage toward the descending duodenum, may decrease the risk of stent dysfunction while maintaining high technical success and low adverse event rates.
View Article and Find Full Text PDFAmerican Society for Gastrointestinal Endoscopy guideline on the role of endoscopy in the diagnosis and management of solid pancreatic masses: summary and recommendations.
Gastrointest Endosc
November 2024
Department of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, Florida, USA.
Article Synopsis
- This clinical practice guideline from the ASGE offers evidence-based recommendations for using endoscopy to diagnose and manage pancreatic masses, focusing on needle selection and sample processing.
- It advises the use of fine-needle biopsy (FNB) needles, particularly 22-gauge over 25-gauge, and recommends fork-tip or Franseen needle types, while suggesting against routine rapid on-site evaluation (ROSE) for initial tissue acquisitions.
- For managing biliary obstructions and pain in unresectable cases, it recommends self-expandable metal stents (SEMSs) over plastic stents, with covered SEMSs preferred when malignancy is confirmed, and celiac plexus neurolysis (CPN) for abdominal pain.
Technical feasibility of EUS-guided liver abscess drainage for the right hepatic lobe using a novel metal stent as first-line treatment (with video).
Gastrointest Endosc
September 2024
2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan.
Article Synopsis
- This study aimed to evaluate the feasibility of using endoscopic ultrasound-guided liver abscess drainage (EUS-LAD) specifically for abscesses located in the right hepatic lobe, a technique that has not been previously established.
- The study involved 19 patients, primarily dealing with abscesses in segment 6 of the liver, with a technical success rate of 78.9% for the drainage procedure, and high clinical success (93.3%) without recurrence of abscesses.
- Results indicate that using a novel partially covered self-expandable metal stent (PCSEMS) for EUS-LAD is both a viable and safe option for treating right liver lobe abscesses, with manageable adverse events.
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