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Endoscopic Ultrasound-Guided Gastroenterostomy for Afferent Loop Syndrome
Hideyuki Shiomi,Arata Sakai,Ryota Nakano,Shogo Ota,Takashi Kobayashi,Atsuhiro Masuda,Hiroko Iijima 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.6
Afferent loop syndrome (ALS) is a mechanical obstruction of the afferent limbs after gastrectomy with gastrojejunostomyreconstruction. Patients with cancer recurrence require immediate and less invasive treatment because of their poor condition. Percutaneous transhepatic/transluminal drainage (PTD) and endoscopic enteral stenting offer reasonable palliative treatment formalignant ALS but are not fully satisfactory in terms of patient quality of life (QoL) and stent patency. Endoscopic ultrasound-guidedgastroenterostomy (EUS-GE) using a lumen-apposing metal stent may address these shortcomings. Clinical data from 11 reportsshowed that all patients who had undergone EUS-GE had positive technical and clinical outcomes. The adverse event rate was11.4%, including only mild or moderate abdominal pain, with no severe adverse events. Indirect comparative studies indicated thatpatients who had undergone EUS-GE had a significantly superior QoL, a higher clinical success rate, and a lower reintervention ratethan those who had undergone PTD or endoscopic enteral stenting. Although the evidence is limited, EUS-GE may be consideredas a first-line treatment for malignant ALS because it has better clinical outcomes than other less invasive treatments, such as PTD orendoscopic enteral stenting. Further prospective randomized control trials are necessary to establish EUS-GE as a standard treatmentfor ALS.
Ryota Nakano,Hideyuki Shiomi,Shogo Ota,Hiroko Iijima 소화기인터벤션의학회 2022 Gastrointestinal Intervention Vol.11 No.3
Cancer associated abdominal pain, as typified by pancreatic cancer, has conventionally been treated with narcotic drugs, but often the severe abdominal pain is difficult to control. Endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN) is commonly performed for abdominal pain that is difficult to control. EUS-CPN can be performed more safely and reliably than other conventional procedures on the celiac plexus, and good outcomes of pain relief have been reported. Although a variety of endoscopic techniques are available for EUS-CPN, the choice varies among institutions, and evidence on the efficacy and safety of each procedure is limited. In this review, we summarize the indications for treatment, specific endoscopic techniques, therapeutic efficacy for pain relief, and complications from previous reports on EUS-CPN.
Arata Sakai,Hideyuki Shiomi,Takao Iemoto,Ryota Nakano,Takuya Ikegawa,Takashi Kobayashi,Atsuhiro Masuda,Yuzo Kodama 대한소화기내시경학회 2020 Clinical Endoscopy Vol.53 No.4
In this study, we assessed a series of our cases in which endoscopic self-expandable metal stents (SEMSs) were used to treat malignantafferent loop obstruction (ALO) that arose after pancreaticoduodenectomy (PD). We retrospectively examined the records of 7 patientswho underwent endoscopic SEMS placement for malignant ALO following PD. Clinical success was achieved in all cases. The medianprocedure time was 30 min (range, 15–50 min). There were no cases of stent occlusion, and no procedure-related adverse events wereencountered. All patients died of their primary disease, and the median overall survival period was 155 days (range, 96–374 days). Are-intervention involving endoscopic ultrasound-guided hepaticogastrostomy combined with antegrade stenting was performed forobstructive jaundice and acute cholangitis in 1 case. In conclusion, endoscopic SEMS placement may be an effective and safe treatmentfor malignant ALO that arises after PD.
Ryota Nakano,Hideyuki Shiomi,Shogo Ota,Hiroko Iijima 소화기인터벤션의학회 2022 International journal of gastrointestinal interven Vol.11 No.3
Cancer associated abdominal pain, as typified by pancreatic cancer, has conventionally been treated with narcotic drugs, but often the severe abdominal pain is difficult to control. Endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN) is commonly performed for abdominal pain that is difficult to control. EUS-CPN can be performed more safely and reliably than other conventional procedures on the celiac plexus, and good outcomes of pain relief have been reported. Although a variety of endoscopic techniques are available for EUS-CPN, the choice varies among institutions, and evidence on the efficacy and safety of each procedure is limited. In this review, we summarize the indications for treatment, specific endoscopic techniques, therapeutic efficacy for pain relief, and complications from previous reports on EUS-CPN.