Prevention and Management of Post-Endoscopic Retrograde Cholangiopancreatography Complications

Michel Kahaleh,Martin Freeman 대한소화기내시경학회 2012 Clinical Endoscopy Vol.45 No.3

Endoscopic retrograde cholangiopancreatography (ERCP) is associated with a spectrum of complications such as pancreatitis, hemorrhage, perforation, and cardiopulmonary events. These complications can range from mild to severe resulting in extended hospitalization, requiring surgical intervention, and leading to permanent disability or even death. Complications of ERCP have been better understood in the past decade, with adoption of standardized consensus-based definitions of complications and introduction of new recommendations to minimize risks of ERCP. Adequate selection of patients undergoing ERCP, skilled operators using novel techniques and prompt identification and treatment are key to successful prevention and management.

Endoscopic Necrosectomy for Walled-Off Pancreatic Necrosis

Michel Kahaleh 대한소화기내시경학회 2012 Clinical Endoscopy Vol.45 No.3

Approximately 20% of patients with acute pancreatitis develop pancreatic necrosis with significant mortality. Surgical debridement is the traditional management of necrotizing pancreatitis, but it is associated with significant morbidity and mortality. Endoscopic necrosectomy using repeats session of debridement and stent insertion has been more frequently used within the last decade and half. This technique continues to evolve as we attempt to optimize the post-procedural outcomes.

The Learning Curve for Peroral Endoscopic Myotomy in Latin America: A Slide to the Right?

Michel Kahaleh,Amy Tyberg,Supriya Suresh,Arnon Lambroza,Fernando Rodriguez Casas,Mario Rey,Jose Nieto,Guadalupe Ma Martínez,Felipe Zamarripa,Vitor Arantes,Maria G Porfilio,Monica Gaidhane,Pietro Fami 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.5

Background/Aims: Peroral endoscopic myotomy (POEM) has been increasingly used for achalasia in Latin America, where Chagasdisease is prevalent, and this makes POEM more challenging. The aim of this study was to determine the learning curve for POEMin Latin America. Methods: Patients undergoing POEM in Latin America with a single operator were included from a prospective registry over 4 years. Non-linear regression and cumulative sum control chart (CUSUM) analyses were conducted for the learning curve. Results: A total of 125 patients were included (52% male; mean age, 59 years), of which 80 had type II achalasia (64%), and 38 hadChagas disease (30%). The average pre-procedure and post-procedure Eckardt scores were 6.79 and 1.87, respectively. Technicalsuccess was achieved in 93.5% of patients, and clinical success was achieved in 88.8%. Adverse events occurred in 27 patients (22%)and included bleeding (4 patients), pneumothorax (4 patients), mucosal perforation (13 patients), mediastinitis (2 patients), andleakage (4 patients). The CUSUM chart showed a median procedure time of 97 min (range, 45-196 min), which was achieved at the 61st procedure. Procedure duration progressively decreased, with the last 10 procedures under 50 min approaching a plateau (p-value <0.01). Conclusions: Mastering POEM in Latin America requires approximately 61 procedures for both POEM efficiency and to accomplishthe procedure within 97 minutes.

Spyglass Direct Visualization System

Michel Kahaleh 대한소화기내시경학회 2012 Clinical Endoscopy Vol.45 No.3

Although endoscopic retrograde cholangiopancreatography is considered the gold standard to manage biliary disorders, it has its own limitations. The single-operator cholangioscopy (SOC) system (Spyglass) may offer an interesting compromise for most advanced biliary endoscopists, in terms of size (10 Fr diameter) and complexity of use. SOC is a great step toward intraductal visualization and therapy but the best is yet to come.

Review : Photodynamic Therapy for Cholangiocarcinoma

( Jayant P. Talreja ),( Michel Kahaleh ) The Editorial Office of Gut and Liver 2010 Gut and Liver Vol.4 No.s1

Cholangiocarcinoma is the primary malignancy arising from the biliary epithelium, and it presents as jaundice, cholestasis, and cholangitis. Over 50 percent of patients present with advanced-stage disease, and the prognosis is poor with the survival measured in months even after biliary decompression. Palliative management has become the standard of care for unresectable disease, and this involves an endoscopic approach. Photodynamic therapy (PDT) involves the administration of a photosensitizer followed by local irradiation with laser therapy. The use of PDT for palliation of bile-duct tumors has produced promising results. Several studies conducted in Europe and the United States have shown that PDT produces a marked improvement in the symptoms of cholestasis, survival, and quality of life. This chapter summarizes the principle of PDT, the technique employed, and the published experience regarding PDT for cholangiocarcinoma. (Gut Liver 2010;4(Suppl. 1):S62-66)

Comparing palliative treatment options for cholangiocarcinoma: photodynamic therapy vs. radiofrequency ablation

Tayyaba Mohammad,Michel Kahaleh 대한소화기내시경학회 2022 Clinical Endoscopy Vol.55 No.3

Referral to an endoscopist is often done once curative resection is no longer an option for cholangiocarcinoma management. In suchcases, palliation has become the main objective of the treatment. Photodynamic therapy and radiofrequency ablation can be performedto achieve palliation, with both procedures associated with improved stent patency and survival. Despite the greatly increased cost andassociation with photosensitivity, photodynamic therapy allows transmission to the entire biliary tree. In contrast, radiofrequency ablationis cheaper and faster to apply, but requires intraductal contact. This paper reviews both modalities and compares their efficacy andsafety for bile duct cancer palliation.

Safety and Complications of Interventional Endoscopic Ultrasound

Monica Saumoy,Michel Kahaleh 대한소화기내시경학회 2018 Clinical Endoscopy Vol.51 No.3

Endoscopic ultrasound (EUS) has become an essential tool for the diagnostic and therapeutic intervention of gastrointestinal diseases. Beyond the drainage of fluid collections, it enables decompression of inaccessible bile and pancreatic ducts, the gallbladder, and thecreation of anastomosis within the gastrointestinal tract using fully lumen-apposing stents. This review explored the safety and efficacyof these novel procedures and discussed the training pathway that is necessary to perform them efficiently and safely.

Management of Benign and Malignant Pancreatic Duct Strictures

Enad Dawod,Michel Kahaleh 대한소화기내시경학회 2018 Clinical Endoscopy Vol.51 No.2

The diagnosis and management of pancreatic strictures, whether malignant or benign, remain challenging. The last 2 decades haveseen dramatic progress in terms of both advanced imaging and endoscopic therapy. While plastic stents remain the cornerstone of thetreatment of benign strictures, the advent of fully covered metal stents has initiated a new wave of interest in calibrating the pancreaticduct with fewer sessions. In malignant disease, palliation remains the priority and further data are necessary before offering systematicpancreatic stenting.

A Review of Probe-Based Confocal Laser Endomicroscopy for Pancreaticobiliary Disease

Kunal Karia,Michel Kahaleh 대한소화기내시경학회 2016 Clinical Endoscopy Vol.49 No.5

Confocal laser endomicroscopy (CLE) is a novel in vivo imaging technique that can provide real-time optical biopsies in the evaluation of pancreaticobiliary strictures and pancreatic cystic lesions (PCLs), both of which are plagued by low sensitivities of routine evaluation techniques. Compared to pathology alone, CLE is associated with a higher sensitivity and accuracy for the evaluation of indeterminate pancreaticobiliary strictures. CLE has the ability to determine the malignant potential of PCLs. As such, CLE can increase the diagnostic yield of endoscopic retrograde cholangiopancreatography and endoscopic ultrasound, reducing the need for repeat procedures. It has been shown to be safe, with an adverse event rate of ≤1%. Published literature regarding its cost-effectiveness is needed.

Endoscopic Ultrasound-Guided Treatment beyond Drainage:Hemostasis, Anastomosis, and Others

Jessica L. Widmer,Michel Kahaleh 대한소화기내시경학회 2014 Clinical Endoscopy Vol.47 No.5

Since the introduction of endoscopic ultrasound (EUS) in the 1990s, it has evolved from a primarily diagnostic modality into an instrument that can be used in various therapeutic interventions. EUS-guided fine-needle injection was initially described for celiac plexus neurolysis. By using the fundamentals of this method, drainage techniques emerged for the biliary and pancreatic ducts, fluid collections, and abscesses. More recently, EUS has been used for ablative techniques and injection therapies for patients with for gastrointestinal malignancies. As the search for minimally invasive techniques continued, EUS-guided hemostasis methods have also been described. The technical advances in EUS-guided therapies may appear to be limitless; however, in many instances, these procedures have been described only in small case series. More data are required to determine the efficacy and safety of these techniques, and new accessories will be needed to facilitate their implementation into practice.