AIM: To determine the optimal method of endoscopic preoperative biliary drainage for malignant distal biliary obstruction.METHODS: Multicenter retrospective study was conducted in patients who underwent plastic stent ...AIM: To determine the optimal method of endoscopic preoperative biliary drainage for malignant distal biliary obstruction.METHODS: Multicenter retrospective study was conducted in patients who underwent plastic stent (PS) or nasobiliary catheter (NBC) placement for resectable malignant distal biliary obstruction followed by surgery between January 2010 and March 2012. Procedure-related adverse events, stent/catheter dysfunction (occlusion or migration of PS/NBC, development of cholangitis, or other conditions that required repeat endoscopic biliary intervention), and jaundice resolution (bilirubin level < 3.0 mg/dL) were evaluated. Cumulative incidence of jaundice resolution and dysfunction of PS/NBC were estimated using competing risk analysis. Patient characteristics and preoperative biliary drainage were also evaluated for association with the time to jaundice resolution and PS/NBC dysfunction using competing risk regression analysis.RESULTS: In total, 419 patients were included in the study (PS, 253 and NBC, 166). Primary cancers included pancreatic cancer in 194 patients (46%), bile duct cancer in 172 (41%), gallbladder cancer in three (1%), and ampullary cancer in 50 (12%). The median serum total bilirubin was 7.8 mg/dL and 324 patients (77%) had ≥ 3.0 mg/dL. During the median time to surgery of 29 d [interquartile range (IQR), 30-39 d]. PS/NBC dysfunction rate was 35% for PS and 18% for NBC [Subdistribution hazard ratio (SHR) = 4.76; 95%CI: 2.44-10.0, P < 0.001]; the pig-tailed tip was a risk factor for PS dysfunction. Jaundice resolution was achieved in 85% of patients and did not depend on the drainage method (PS or NBC).CONCLUSION: PS has insufficient patency for preoperative biliary drainage. Given the drawbacks of external drainage via NBC, an alternative method of internal drainage should be explored.展开更多
AIM To study the safety of insertion of metallic stents in elderly patients with unresectable distal malignant biliary obstruction.METHODS Of 272 patients with unresectable distal malignant biliary obstruction,184 pat...AIM To study the safety of insertion of metallic stents in elderly patients with unresectable distal malignant biliary obstruction.METHODS Of 272 patients with unresectable distal malignant biliary obstruction,184 patients under the age of 80 were classified into Group A,and 88 subjects aged 80 years or more were classified into Group B.The safety of metallic stent insertion,metal stent patency period,and the obstruction rate were examined in each group.RESULTS In Group B,patients had a significantly worse per-formance status,high blood pressure,heart disease,cerebrovascular disease,and dementia;besides the rate of patients orally administered antiplatelet drugs or anticoagulants tended to be higher(P<0.05).Metallic stents were successfully inserted in all patients.The median patency period was 265.000±26.779(1-965)d;252.000±35.998(1-618)d in Group A and 269.000±47.885(1-965)d in Group B,with no significant difference between the two groups.Metallic stent obstruction occurred in 82 of the 272(30.15%)patients;in 53/184(28.80%)patients in Group A and in 29/88(32.95%)of those in Group B,showing no significant difference between the two groups.Procedural accidents due to metal stent insertion occurred in 24/272(8.8%)patients;in 17/184(9.2%)of patients in Group A and in 7/88(8.0%)of those in Group B,with no significant difference between the two groups,either.CONCLUSION These results suggested that metallic stents can be safely inserted to treat unresectable distal malignant biliary obstruction even in elderly patients aged 80 years or more.展开更多
AIM: Inflammatory pseudotumor (IPT) of the liver is a rare benign lesion, the etiology of which remains obscure.It is not associated with any particular diseases apart from phlebitis and Crohn's disease.METHODS: A...AIM: Inflammatory pseudotumor (IPT) of the liver is a rare benign lesion, the etiology of which remains obscure.It is not associated with any particular diseases apart from phlebitis and Crohn's disease.METHODS: A middle-aged male with hepatic IPT and peripheral eosinophilia associated with autoimmune pancreatitis (AIP) was selected for this study and review of literature.RESULTS: A 59-year-old male was admitted with obstructive jaundice, marked eosinophilia (1 343/mm3)and hypergammaglobulinemia (4 145 mg/dL). Imaging techniques revealed dilatation of the intrahepatic bile duct,stenosis of the common bile duct with diffuse wall thickening, gallbladder wall thickening, irregular narrowing of the pancreatic duct, and swelling of the pancreatic parenchyma. Multiple liver masses were also demonstrated and diagnosed as IPT by biopsy specimens. Six months later, the abnormal features of the biliary tree remarkably improved by the oral administration of prednisolone, and the liver masses disappeared. The swelling of the pancreatic head also improved. The peripheral eosinophil count normalized. IPT associated with AIP, as we know,has not been reported in the literature. The clinical features of the present case mimicked those of pancreatic cancer with liver metastasis. This case deserves to be documented to prevent misdiagnosis of similar cases.展开更多
AIM To examine the result of the use of 0.025-inch guidewire(GW)Visi Glide2 TM as the first choice in the endoscopic retrograde cholangiopancreatography(ERCP)-related procedures without selecting the patient in a mult...AIM To examine the result of the use of 0.025-inch guidewire(GW)Visi Glide2 TM as the first choice in the endoscopic retrograde cholangiopancreatography(ERCP)-related procedures without selecting the patient in a multicenter prospective study.METHODS ERCP using 0.025-inch GW VisiGlide2^(TM)as the first choice was conducted in patients who have needed ERCP,and its accomplishment rate of procedure,procedural time,incidence of accidental symptoms were compared with those of ERCP using 0.025-inch GW VisiG lideTM.RESULTS The accomplishment rate of procedure was 97.5%(197/202),and procedural time was 23.930±16.207 min.The accomplishment rate of procedure using 0.025-inch GW Visi GlideTM was 92.3%(183/195),and procedural time was 31.285±19.122 min,thus the accomplishment rate of procedure was significantly improved and procedural time was significantly shortened(P<0.05).Accidental symptoms by ERCPrelated procedures were observed in 3.0%(6/202),and all were conservatively alleviated.CONCLUSION When 0.025-inch GW VisiG lide2 TM was used for ERCPrelated procedure as the first choice,it showed high accomplishment rate of procedure and low incidence of accidental symptoms,suggesting it can be used as the universal GW.Clinical Trial Registry(UMIN0000016042).展开更多
基金Supported by The grant from the Japanese Foundation for Research and Promotion of Endoscopy,No.12-042
文摘AIM: To determine the optimal method of endoscopic preoperative biliary drainage for malignant distal biliary obstruction.METHODS: Multicenter retrospective study was conducted in patients who underwent plastic stent (PS) or nasobiliary catheter (NBC) placement for resectable malignant distal biliary obstruction followed by surgery between January 2010 and March 2012. Procedure-related adverse events, stent/catheter dysfunction (occlusion or migration of PS/NBC, development of cholangitis, or other conditions that required repeat endoscopic biliary intervention), and jaundice resolution (bilirubin level < 3.0 mg/dL) were evaluated. Cumulative incidence of jaundice resolution and dysfunction of PS/NBC were estimated using competing risk analysis. Patient characteristics and preoperative biliary drainage were also evaluated for association with the time to jaundice resolution and PS/NBC dysfunction using competing risk regression analysis.RESULTS: In total, 419 patients were included in the study (PS, 253 and NBC, 166). Primary cancers included pancreatic cancer in 194 patients (46%), bile duct cancer in 172 (41%), gallbladder cancer in three (1%), and ampullary cancer in 50 (12%). The median serum total bilirubin was 7.8 mg/dL and 324 patients (77%) had ≥ 3.0 mg/dL. During the median time to surgery of 29 d [interquartile range (IQR), 30-39 d]. PS/NBC dysfunction rate was 35% for PS and 18% for NBC [Subdistribution hazard ratio (SHR) = 4.76; 95%CI: 2.44-10.0, P < 0.001]; the pig-tailed tip was a risk factor for PS dysfunction. Jaundice resolution was achieved in 85% of patients and did not depend on the drainage method (PS or NBC).CONCLUSION: PS has insufficient patency for preoperative biliary drainage. Given the drawbacks of external drainage via NBC, an alternative method of internal drainage should be explored.
文摘AIM To study the safety of insertion of metallic stents in elderly patients with unresectable distal malignant biliary obstruction.METHODS Of 272 patients with unresectable distal malignant biliary obstruction,184 patients under the age of 80 were classified into Group A,and 88 subjects aged 80 years or more were classified into Group B.The safety of metallic stent insertion,metal stent patency period,and the obstruction rate were examined in each group.RESULTS In Group B,patients had a significantly worse per-formance status,high blood pressure,heart disease,cerebrovascular disease,and dementia;besides the rate of patients orally administered antiplatelet drugs or anticoagulants tended to be higher(P<0.05).Metallic stents were successfully inserted in all patients.The median patency period was 265.000±26.779(1-965)d;252.000±35.998(1-618)d in Group A and 269.000±47.885(1-965)d in Group B,with no significant difference between the two groups.Metallic stent obstruction occurred in 82 of the 272(30.15%)patients;in 53/184(28.80%)patients in Group A and in 29/88(32.95%)of those in Group B,showing no significant difference between the two groups.Procedural accidents due to metal stent insertion occurred in 24/272(8.8%)patients;in 17/184(9.2%)of patients in Group A and in 7/88(8.0%)of those in Group B,with no significant difference between the two groups,either.CONCLUSION These results suggested that metallic stents can be safely inserted to treat unresectable distal malignant biliary obstruction even in elderly patients aged 80 years or more.
文摘AIM: Inflammatory pseudotumor (IPT) of the liver is a rare benign lesion, the etiology of which remains obscure.It is not associated with any particular diseases apart from phlebitis and Crohn's disease.METHODS: A middle-aged male with hepatic IPT and peripheral eosinophilia associated with autoimmune pancreatitis (AIP) was selected for this study and review of literature.RESULTS: A 59-year-old male was admitted with obstructive jaundice, marked eosinophilia (1 343/mm3)and hypergammaglobulinemia (4 145 mg/dL). Imaging techniques revealed dilatation of the intrahepatic bile duct,stenosis of the common bile duct with diffuse wall thickening, gallbladder wall thickening, irregular narrowing of the pancreatic duct, and swelling of the pancreatic parenchyma. Multiple liver masses were also demonstrated and diagnosed as IPT by biopsy specimens. Six months later, the abnormal features of the biliary tree remarkably improved by the oral administration of prednisolone, and the liver masses disappeared. The swelling of the pancreatic head also improved. The peripheral eosinophil count normalized. IPT associated with AIP, as we know,has not been reported in the literature. The clinical features of the present case mimicked those of pancreatic cancer with liver metastasis. This case deserves to be documented to prevent misdiagnosis of similar cases.
文摘AIM To examine the result of the use of 0.025-inch guidewire(GW)Visi Glide2 TM as the first choice in the endoscopic retrograde cholangiopancreatography(ERCP)-related procedures without selecting the patient in a multicenter prospective study.METHODS ERCP using 0.025-inch GW VisiGlide2^(TM)as the first choice was conducted in patients who have needed ERCP,and its accomplishment rate of procedure,procedural time,incidence of accidental symptoms were compared with those of ERCP using 0.025-inch GW VisiG lideTM.RESULTS The accomplishment rate of procedure was 97.5%(197/202),and procedural time was 23.930±16.207 min.The accomplishment rate of procedure using 0.025-inch GW Visi GlideTM was 92.3%(183/195),and procedural time was 31.285±19.122 min,thus the accomplishment rate of procedure was significantly improved and procedural time was significantly shortened(P<0.05).Accidental symptoms by ERCPrelated procedures were observed in 3.0%(6/202),and all were conservatively alleviated.CONCLUSION When 0.025-inch GW VisiG lide2 TM was used for ERCPrelated procedure as the first choice,it showed high accomplishment rate of procedure and low incidence of accidental symptoms,suggesting it can be used as the universal GW.Clinical Trial Registry(UMIN0000016042).
