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Pancreatic perforation caused by the Soehendra® retrieval device in a patient with chronic pancreatitis.

Seung Yong SHIN ; Sung Ill JANG ; Joon Seong PARK ; Dong Ki LEE

Gastrointestinal Intervention.2017;6(3):187-190. doi:10.18528/gii170014

SUMMARY OF EVENT: An endoscopic retrograde pancreatic duct (ERPD) stent was inserted in a male patient with chronic pancreatitis via endoscopic retrograde cholangiopancreatography (ERCP) to relieve chronic epigastric pain. After the procedure, an abdominal computed tomography scan showed localized peritonitis with a dislocated ERPD stent. The patient underwent an emergency operation, which revealed that the peritonitis was caused by perforation of the pancreatic parenchyma by the ERPD stent. TEACHING POINT: A hydrophilic guide wire can puncture the pancreas during ERPD stent insertion. Therefore, it is necessary to ensure that the guide wire reaches the main pancreatic duct, especially in patients with chronic pancreatitis.
Cholangiopancreatography, Endoscopic Retrograde ; Emergencies ; Humans ; Male ; Pancreas ; Pancreatic Ducts ; Pancreatitis, Chronic* ; Peritonitis ; Punctures ; Stents

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De novo hepatico-gastric stent placement for biliary stricture via percutaneous transhepatic biliary approach.

Abhimanyu AGGARWAL ; Auh Whan PARK ; Jonathan WEST

Gastrointestinal Intervention.2017;6(3):183-186. doi:10.18528/gii160027

Biliary stricture formation is a known complication of hepatic surgery in cases of adult living donor liver transplant. In our case, successful percutaneous placement of a hepatico-gastric stent was performed for the drainage of an isolated bile duct after right liver transplant with Roux-en-Y biliary anastomosis in a 42-year-old male. The patient initially presented with cholangitis and a percutaneous transhepatic cholangiogram revealed an isolated stricture of the posterior bile duct. Multiple attempts at regaining continuity of the isolated bile duct with the jejunum were unsuccessful. Thus a tract was created via a percutaneous transhepatic and transluminal approach between the isolated duct and the stomach using a covered stent. The patient had no complications at 18-month follow-up.
Adult ; Bile Ducts ; Biliary Tract ; Cholangitis ; Constriction, Pathologic* ; Drainage ; Follow-Up Studies ; Humans ; Jejunum ; Liver ; Liver Transplantation ; Living Donors ; Male ; Stents* ; Stomach

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A successful rendezvous endoscopic ultrasonography-guided gallbladder drainage in malignant cystic duct obstruction.

Hyoung Woo KIM ; Jong Chan LEE ; Jongchan LEE ; Jaihwan KIM ; Jin Hyeok HWANG

Gastrointestinal Intervention.2017;6(3):180-182. doi:10.18528/gii160023

Endoscopic ultrasonography-guided gallbladder drainage (EUS-GBD) has been developed as an alternative drainage method in patients with malignant cystic duct obstruction. However, the procedure of track dilation is difficult in case of severe gallbladder wall thickening with tumor involvement or inflammation. The rendezvous technique via external fistulous track is considered in failed attempts to dilate an internal track between the gallbladder and the stomach/duodenum using conventional approach of EUS-GBD. This report presents a 56-year-old man with pancreatic cancer with malignant cystic duct obstruction who underwent percutaneous transhepatic gallbladder drainage. The patient was successfully treated using rendezvous EUS-GBD technique after he failed the conventional EUS-GBD procedure of internal track dilation.
Cystic Duct* ; Drainage* ; Endosonography ; Gallbladder* ; Humans ; Inflammation ; Methods ; Middle Aged ; Pancreatic Neoplasms

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Percutaneous transhepatic hepatic venous stenting after extracorporeal hepatic resection and autotransplantation: A case report.

Jung Hwan PARK ; Ung Bae JEON ; Ki Seok CHOO ; Tae Un KIM ; Chong Woo CHU ; Je Ho RYU

Gastrointestinal Intervention.2017;6(3):176-179. doi:10.18528/gii160015

We report a case of percutaneous transhepatic stent placement for the treatment of hepatic venous outflow obstruction after extracorporeal hepatic resection and autotransplantation. A 63-year-old woman with a large mass in the liver was asymptomatic with no hepatic virus infection. Because the tumor was unresectable by conventional means, we used extracorporeal hepatic resection and autotransplantation for operation. Two days after surgery, hepatic venous outflow obstruction of the right and right inferior hepatic veins was suspected on computed tomography. After failure of the transjugular approach, hepatic venous stenting was performed successfully via the percutaneoustranshepatic approach.
Autografts* ; Budd-Chiari Syndrome ; Female ; Hepatic Veins ; Humans ; Liver ; Middle Aged ; Stents* ; Transplantation, Autologous*

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Clinical outcomes of biliary and duodenal self-expandable metal stent placements for palliative treatment in patients with periampullary cancer.

Hong Joo KIM

Gastrointestinal Intervention.2017;6(3):171-175. doi:10.18528/gii170013

BACKGROUND: Endoscopic self-expandable metal stent (SEMS) insertions for palliation of malignant biliary and duodenal obstructions have been revealed to be an effective treatment. We present our clinical experience with the use of SEMS for malignant biliary and duodenal obstructions caused by periampullary cancer. METHODS: We performed a retrospective review of all patients who underwent endoscopic biliary and duodenal SEMS insertion for palliation of malignant biliary and duodenal obstruction caused by periampullary cancer between July 2007 and October 2016. The patients received simultaneous or sequential endoscopic biliary stenting and duodenal stenting with COMVITM stents (partially covered; Taewoong, Seoul, Korea). RESULTS: The final diagnoses of our enrolled patients were 15 pancreas head cancer, and 3 distal common bile duct (CBD) cancer. The main stricture site in the duodenum was bulb (n = 4, 22.2%), 2nd portion (n = 9, 50.0%), and 3rd portion (n = 5, 27.8%). The technical success rates of CBD and duodenal stenting were 100% (18/18), and 100% (18/18), respectively. The clinical success rates of CBD and duodenal stenting were 100% (18/18), and 88.9% (16/18), respectively. Median actuarial stent patency for biliary and duodenal SEMS were 6.5 months (range, 1-2 months) and 4.5 months (range, 1-14 months), respectively. Three patients (16.7%) had recurrent biliary obstruction and all of them underwent percutaneous trans-hepatic biliary drainage (PTBD) with biliary SEMS reinsertion. Three other patients (16.7%, totally different from patients with CBD restenosis) had recurrent duodenal obstruction and all of them underwent upper gastrointestinal endoscopy with duodenal SEMS reinsertion. CONCLUSION: Endoscopic SEMS insertions for simultaneous palliation of malignant biliary and duodenal obstruction in patients with periampullary cancer may provide a safe, and less invasive alternative to surgical palliation with a successful clinical outcome.
Common Bile Duct ; Constriction, Pathologic ; Diagnosis ; Drainage ; Duodenal Obstruction ; Duodenum ; Endoscopy, Gastrointestinal ; Head and Neck Neoplasms ; Humans ; Palliative Care* ; Pancreas ; Retrospective Studies ; Self Expandable Metallic Stents ; Seoul ; Stents*

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Percutaneous radiologic gastrostomy in patients with failed percutaneous endoscopic gastrostomy.

Tang Fei LEE ; Young Jong CHO ; Ji Hoon SHIN ; Heung Kyu KO ; Jihong PARK ; Soo Hwan KIM ; Jin Hyoung KIM ; Ho Young SONG

Gastrointestinal Intervention.2017;6(3):166-170. doi:10.18528/gii160031

BACKGROUND: To determine the technical feasibility and success rate of percutaneous radiologic gastrostomy (PRG) after failure of percutaneous endoscopic gastrostomy (PEG). METHODS: Consecutive patients referred for PRG after failure of PEG between May 2011 and June 2016 were included in this study. The reasons for the failure of PEG, as well as the technical success and complications of PRG were noted. RESULTS: Fifteen patients (14 men, 1 woman; age, 27-93 years) were included. The most common reasons for PEG failure were esophageal stricture due to malignancies (n = 8), unfavorable abdominal wall conditions (n = 3), unstable patient condition during endoscopy (n = 2), and other miscellaneous conditions (n = 2). PRG placement was technically successful in all 15 cases. In one case, early slip-out of the gastrostomy tube occurred, which required removal and repositioning. No mortality was noted. CONCLUSION: PRG is technically feasible in patients with failed PEG insertion, and has advantages over PEG and a high overall success rate.
Abdominal Wall ; Endoscopy ; Esophageal Stenosis ; Female ; Gastrostomy* ; Humans ; Male ; Mortality

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Recent development of innovative resection methods for gastric neoplasms using hybrid natural orifice transluminal endoscopic surgery approach.

Sun Gyo LIM

Gastrointestinal Intervention.2017;6(3):162-165. doi:10.18528/gii170017

There have been an evolutionary development with respect to the resection modality for the treatment of the gastric neoplasms such as gastric subepithelial tumors (SETs) or early gastric cancers (EGCs). Hybrid natural orifice transluminal endoscopic surgery (hybrid NOTES) played a central role in the process of development. In the earlier period, the non-exposure type hybrid NOTES such as laparoscopy and endoscopy cooperative surgery (LECS), endoscope-assisted wedge resection (EAWR), and laparoscopy-assisted endoscopic full-thickness resection (LAEFTR) has been introduced by several investigators. However, a concern about a spillage of gastric content including the tumor cells has been continuously raised among the clinicians. Accordingly, the non-exposure type hybrid NOTES such as combination of laparoscopic and endoscopic approaches to neoplasia with a non-exposure technique (CLEAN-NET), non-exposed endoscopic wall-inversion surgery (NEWS), and hybrid neo-endoscopic full-thickness resection (hybrid neo-EFTR) have been developed to the clinicians. Although most of studies about hybrid NOTES for the treatment of the gastric neoplasms have a small number of patients and require further validations, those are enough to receive our attention. Here, we describe and summarize the development process of the innovative resection methods for gastric neoplasms using hybrid NOTES approach.
Endoscopy ; Humans ; Laparoscopy ; Methods* ; Natural Orifice Endoscopic Surgery* ; Research Personnel ; Stomach Neoplasms*

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Management of gastrointestinal tract perforations.

Yunho JUNG

Gastrointestinal Intervention.2017;6(3):157-161. doi:10.18528/gii170016

Digestive endoscopy has evolved from primary diagnosis to extensive therapeutic approaches for the management of gastrointestinal diseases. Increased health awareness has encouraged more people to undergo endoscopic examinations. For these reasons, the absolute number of iatrogenic perforations is likely to increase. Because of the very low incidence of perforations, clinicians are not always prepared or experienced in cases of unexpectedly encountered perforations during diagnostic or therapeutic endoscopic procedures. In this study, the proper approach to handling perforations is discussed including selection of endoscopic devices, endoscopic closure procedures, and management of patients after a perforation occurs in the gastrointestinal tract.
Diagnosis ; Endoscopy ; Gastrointestinal Diseases ; Gastrointestinal Tract* ; Humans ; Incidence

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Pancreaticoduodenal artery pseudoaneurysm-induced hemobilia caused by a plastic biliary stent.

Hong Joo KIM

Gastrointestinal Intervention.2017;6(2):148-150. doi:10.18528/gii.170007

SUMMARY OF EVENT: Melena with abdominal pain were developed in a patient who had undergone endoscopic retrograde cholangiopancreatography (ERCP) with common bile duct stones removal and endoscopic retrograde biliary drainage (ERBD) using a plastic biliary stent. He subsequently underwent laparoscopic cholecystectomy. For the diagnosis and treatment of hemobilia caused by a plastic biliary stent, selective angiography for gastroduodenal artery with subsequent embolization for small pseudoaneurysm of pancreaticoduodenal artery was done successfully. TEACHING POINT: A plastic biliary stent induced pseudoaneurysm can be a cause of hemobilia after ERCP with ERBD procedure. Selective angiography with embolization for bleeding pseudoaneurysm can be an effective treatment for this situation.
Abdominal Pain ; Aneurysm, False ; Angiography ; Arteries* ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy, Laparoscopic ; Common Bile Duct ; Diagnosis ; Drainage ; Hemobilia* ; Hemorrhage ; Humans ; Melena ; Plastics* ; Stents*

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Biodegradable stent insertion for ischaemic colorectal strictures: Tiger country.

Pavan Singh NAJRAN ; Damian MULLAN ; Hans Ulrich LAASCH

Gastrointestinal Intervention.2017;6(2):145-147. doi:10.18528/gii.160011

We describe our initial experience with the use of biodegradable (BD) stents in benign ischemic colorectal strictures with two cases. The first case is of a 40-year-old male with a history of retroperitoneal sarcoma who developed a benign stricture in the descending colon postsurgical and radiotherapy treatment. Balloon dilation was required in order to pass the delivery system. The patient experienced significant pain postdeployment and post procedure computed tomography scan demonstrated a small perforation requiring an emergency laparotomy. The second case is a 61-year-old male with a history of retroperitoneal sarcoma who also developed an ischemic stricture in the descending colon after surgical excision. Using a combined fluoroscopic and endoscopic approach 3 separate BD stents were inserted over a 17-month period improving clinical symptoms of intermittent obstruction. These symptoms reoccurred after stent disintegration and the patient was definitively managed surgically with colostomy formation. The use of BD stents, although appealing, does not provide an adequate long term result. Additionally, more flexible, smaller calibre systems are required for deployment in tortuous environments.
Adult ; Colon, Descending ; Colostomy ; Constriction, Pathologic* ; Emergencies ; Humans ; Laparotomy ; Male ; Middle Aged ; Radiotherapy ; Sarcoma ; Stents* ; Tigers*

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