Journal Detail Information

1

Cite

Share

The role and utility of cholangioscopy for diagnosing indeterminate biliary strictures.

Gastrointestinal Intervention.2017;6(1):2-8. doi:10.18528/gii.160035

Biliary strictures are considered indeterminate when evaluation with imaging and standard tissue sampling during endoscopic retrograde cholangiopancreatography (ERCP) are non-diagnostic. Standard tissue sampling techniques include cytologic brushings, with or without fluorescence in situ hybridization (FISH), and endoscopic intraductal biopsies. These strictures are often clinically suspicious for malignancy. The management of these patients can vary substantially and relies on an accurate diagnosis of the lesion. Unfortunately, despite numerous modalities, the sensitivity of existing tissue sampling techniques remains low and can lead to delays in diagnosis and the need for additional procedures. Cholangioscopy has emerged as a means to visually inspect and obtain image-guided biopsies of the lesion in question, with improved sensitivity as well as a high specificity and accuracy for diagnosing the etiology of indeterminate biliary strictures. The types of cholangioscopy systems and a summary of the pertinent literature are discussed in this review.
Bile Duct Diseases ; Biopsy ; Cholangiocarcinoma ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis, Sclerosing ; Constriction, Pathologic* ; Diagnosis ; Fluorescence ; Humans ; Image-Guided Biopsy ; In Situ Hybridization ; Sensitivity and Specificity

2

Cite

Share

Greetings from the Guest Editor.

Jeffrey H LEE

Gastrointestinal Intervention.2017;6(1):1-1. doi:10.18528/gii.17000

No abstract available.

3

Cite

Share

Percutaneous transgastric stenting of proximal jejunal obstruction secondary to direct invasion of a pancreatic carcinoma.

Timothy Joseph S ORILLAZA ; Jinoo KIM ; Je Hwan WON

Gastrointestinal Intervention.2016;5(1):80-83. doi:10.18528/gii150033

Pancreatic cancer has been identified as one of the most common malignant causes of upper gastrointestinal obstruction. Most common sites of obstruction include the pyloric region and second and third portions of the duodenum. If surgical gastrojejunostomy is not a viable option, metallic stent placement may be performed either by transoral or transgastric approach. Transgastric technique is considered to be more invasive and is often employed only in failed attempts to insert a stent using transoral technique. This report presents a 70-year-old patient with pancreatic cancer involving the proximal jejunum. Although this is a rarely described location for stenting, the patient was successfully treated using transgastric technique.
Aged ; Duodenum ; Fluoroscopy ; Gastric Bypass ; Humans ; Jejunum ; Pancreatic Neoplasms ; Stents*

4

Cite

Share

Predictors of esophageal self-expandable metal stent migration: An academic center study.

Sunguk JANG ; Mansour PARSI ; James COLLINS ; John VARGO

Gastrointestinal Intervention.2016;5(1):72-79. doi:10.18528/gii150018

BACKGROUND: Although safe and effective, a wide array of complications of esophageal stent placement continues to pose a significant challenge to clinicians in providing optimal care for their patients. METHODS: To identify factors associated with migration of self-expandable metal stent (SEMS) used in treating malignant and benign disease of esophagus, a retrospective study analyzing 105 cases (85 patients) of esophageal SEMS placement between January 2013 and June 2015 was conducted. All cases were performed in a single tertiary referral center. The key outcomes of interest were SEMS migration rates based on indication, stent type, design, and endoscopic findings prior to SEMS placement. Technical success rate, other major adverse outcomes and subgroup analysis of interest were also performed. RESULTS: Overall esophageal SEMS migration rate was 26.7%. Significantly higher rates of stent migration were associated with fully covered stent use (38.1% vs 9.5%, P = 0.001) and stent use in benign conditions (43.9% vs 15.6%, P = 0.002). Our multivariable analysis also showed statistically significant increased risk of migration for SEMS placement in distal esophagus (P = 0.006). CONCLUSIONS: This study validated some of previously reported predictors of stent migration. In addition, stent use in benign esophageal disease was found to be a significant risk factor of SEMS migration. Large, prospective studies are necessary to further clarify modifiable risk factors to reduce the rate of SEMS migration.
Constriction, Pathologic ; Deglutition Disorders ; Esophageal Diseases ; Esophagus ; Humans ; Prospective Studies ; Retrospective Studies ; Risk Factors ; Stents* ; Tertiary Care Centers

5

Cite

Share

Lidocaine spray on an endoscope immediately before insertion improves patient tolerance to endoscopy: A single center, clinical observational study.

Byung Hyo CHA ; Ban Seok LEE ; Jin Hyuck HWANG ; Sang Hyub LEE ; Min Jung PARK ; Seung Joo KANG

Gastrointestinal Intervention.2016;5(1):67-71. doi:10.18528/gii150029

BACKGROUND: Topical pharyngeal anesthesia reduces discomfort during upper gastrointestinal endoscopy (UGIE) but may not increase tolerance to the procedure. This case-control study was performed to assess whether lidocaine spray on the endoscope in addition to pharyngeal anesthesia improves patient tolerance to endoscopy we performed. METHODS: Patients who underwent UGIE were assigned to either the case group where the endoscope was treated with 2 sprays of 10% lidocaine before insertion or the control group given only conventional pharyngeal anesthesia. And we compared the frequency of belching and retching during endoscopy. RESULTS: Among 497 eligible patients, 262 were assigned to the case group and 235 to the control group. There were significant differences between the two groups in belching (odds ratio [OR] = 0.15, 95% confidence interval [CI] = 0.09-0.24, P < 0.01) and retching (OR = 0.22, 95% CI = 0.15-0.34, P = 0.01) during endoscopy using multivariate analysis. Younger patients (OR = 0.96, 95% CI = 0.94-0.98, P < 0.01) and female patients (OR = 2.16, 95% CI = 1.40-3.33, P = 0.01) had belching more frequently than older patients and male patients, respectively. Retching was more frequent in sedated patients (OR = 0.39, 95% CI = 0.25-0.61, P = 0.01) and those with gastro-esophageal reflux disease (OR = 1.48, 95% CI = 1.00-2.21, P = 0.06). CONCLUSIONS: Use of lidocaine spray on the endoscope improves patient tolerance during UGIE compared to only conventional pharyngeal anesthesia.
Anesthesia ; Case-Control Studies ; Endoscopes* ; Endoscopy* ; Endoscopy, Gastrointestinal ; Eructation ; Female ; Gagging ; Gastroesophageal Reflux ; Humans ; Lidocaine* ; Male ; Multivariate Analysis ; Observational Study*

6

Cite

Share

Articulated percutaneous plastic biliary stents: How to do it.

Jorge E LOPERA

Gastrointestinal Intervention.2016;5(1):60-66. doi:10.18528/gii150010

The use of articulated plastic biliary stents is not well known. This technique allows drainage of two or more biliary segments using a single percutaneous access in hilar lesions. In patients that need dilatation of benign biliary stenoses, articulated plastic biliary stent allows placing two or more plastic in the area of stenosis achieving a large internal temporal dilatation while using smaller external biliary drains.
Biliary Tract ; Constriction, Pathologic ; Dilatation ; Drainage ; Humans ; Liver Transplantation ; Plastics* ; Stents*

7

Cite

Share

Multiple metallic stents placement for malignant hilar biliary obstruction: Perspective of a radiologist.

Yozo SATO ; Yoshitaka INABA ; Kazuo HARA ; Hidekazu YAMAURA ; Mina KATO ; Shinichi MURATA ; Yui ONODA

Gastrointestinal Intervention.2016;5(1):52-59. doi:10.18528/gii150027

In the palliative setting, the necessity of biliary drainage of both liver lobes for malignant hilar biliary obstruction remains controversial. However, bilateral biliary drainage is a reasonable option to prevent cholangitis of the undrained lobe and to preserve liver function during the course of chemotherapy. Bilateral biliary drainage can be accomplished by the percutaneous or endoscopic placement of multiple self-expandable metallic stents (SEMS). Although SEMS placement via bilateral (multiple) percutaneous routes is technically simple, multiple percutaneous transhepatic biliary drainage (PTBD) may lead to additional morbidity. SEMS placement via a single percutaneous route is a useful method; however, negotiation of a guidewire into the contralateral bile duct is occasionally impossible if the hilar angle between the right hepatic duct and left hepatic duct is acute. Percutaneous dual SEMS placement is generally performed using the stent-in-stent technique (T configuration or Y configuration) or the side-by-side technique. In addition, the crisscross technique has been reported as being a useful method for trisegmental drainage. The side-to-end technique is also useful for multiple SEMS placement. In the future, the combination of percutaneous intervention and endoscopic ultrasonography-guided procedures may be effective in the management of malignant hilar biliary obstruction.
Bile Ducts ; Biliary Tract Neoplasms ; Cholangitis ; Drainage ; Drug Therapy ; Hepatic Duct, Common ; Liver ; Methods ; Negotiating ; Stents*

8

Cite

Share

Interventional radiologic approach to hilar malignant biliary obstruction.

Dong Il GWON

Gastrointestinal Intervention.2016;5(1):47-51. doi:10.18528/gii150004

Biliary obstruction due to advanced hepatic hilar malignancy is difficult to treat, both surgically and non-surgically, using endoscopic or percutaneous drainage. Since only about 10% to 20% of patients are eligible for resection of hepatic hilar malignancies, most patients receive palliative rather than curative treatment. Percutaneous palliation of advanced hepatic hilar malignancies can be accomplished in a variety of ways. Percutaneous bilateral metallic stent placement may be a reasonable option in patients with hilar malignancies to preserve the functional volume of the liver during the course of chemotherapy and to prevent procedure-related cholangitis of a contaminated undrained lobe. Percutaneous bilateral stent-in-stent placement using wide-mesh or open-cell design stents is a feasible and effective method of achieving bilateral drainage. Moreover, unilateral covered or uncovered metallic stent placement in the lobe with patent portal vein is safe and effective method for palliative treatment in patients with contralateral portal vein occlusion caused by hilar malignancies, obviating the need for bilateral stent placement in these patients.
Bile Ducts, Intrahepatic ; Cholangitis ; Drainage ; Drug Therapy ; Humans ; Liver ; Methods ; Palliative Care ; Portal Vein ; Stents

9

Cite

Share

Evaluation of malignant intraductal papillary mucinous neoplasms of the pancreas on computed tomography and magnetic resonance imaging.

Nieun SEO ; Jae Ho BYUN

Gastrointestinal Intervention.2016;5(1):40-46. doi:10.18528/gii150020

Preoperative cross-sectional imaging, such as computed tomography and magnetic resonance imaging, plays a key role in differentiating between benign and malignant intraductal papillary mucinous neoplasms. This article reviews the imaging features associated with malignant intraductal papillary mucinous neoplasm, as well as the recent studies validating the 2012 international consensus guidelines. This review also compared the diagnostic performance of computed tomography and magnetic resonance imaging in differentiating malignant from benign intraductal papillary mucinous neoplasms.
Consensus ; Magnetic Resonance Imaging* ; Mucins* ; Pancreas*

10

Cite

Share

Systematic review of 12 years of thermal ablative therapies of non-resectable colorectal cancer liver metastases.

Sameh SAIF ; Ania Z. KIELAR ; Matthew MCINNES

Gastrointestinal Intervention.2016;5(1):27-39. doi:10.18528/gii150007

To compare the effectiveness and complications of various thermal ablative therapies through reviewing the available literature. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement was used to report this systematic review. Our PICO (patient group-intervention-comparator-outcomes) question: In patients with unresectable colorectal cancer liver metastasis (CRCLM), what are the comparative effectiveness and complication rates of the various thermal ablative therapies? All study designs published between 2000 and 2012 considered. Search results were screened in duplicate to determine eligible studies. A customized "risk of bias" assessment tool was utilized. Asymmetry of the funnel plot and heterogeneity were quantified. Representative forest plots of the 1, 3, and 5 years survival rates, major complication rates and local recurrence rates were performed. Data not amenable to pooling is presented in a qualitative and tabular manner. Thirty radiofrequency ablation (RFA), 11 cryoablation (CA), and 5 microwave ablation (MWA) studies were finally included in the qualitative synthesis. The number of patients included from all the studies was 3,107 patients; 2,021 in the RFA group, 988 in the CA, and 98 in the MWA. The forest plots confirm the significant heterogeneity of the included studies. Visual assessment of forest plots, as well as qualitative analysis of included papers suggested that between-studies heterogeneity was too great and thus, pooling through meta-analysis was not appropriate. RFA is the most commonly used ablative modality to treat unresectable CRCLM. Significant heterogeneity of the included studies was encountered precluding a meaningful meta-analysis. Future comparisons of local ablative therapies outcome necessitate prospective, randomized controlled studies.
Ablation Techniques ; Catheter Ablation ; Colorectal Neoplasms* ; Cryosurgery ; Forests ; Humans ; Liver* ; Microwaves ; Neoplasm Metastasis* ; Population Characteristics ; Prospective Studies ; Recurrence ; Survival Rate

DISPLAY OPTIONS

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share