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- 저자 : Yasuki Hori (검색결과 2 건)
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( Michihiro Yoshida ),( Itaru Naitoh ),( Kazuki Hayashi ),( Naruomi Jinno ),( Yasuki Hori ),( Makoto Natsume ),( Akihisa Kato ),( Kenta Kachi ),( Go Asano ),( Naoki Atsuta ),( Hidenori Sahashi ),( Hir 대한소화기학회 2021 Gut and Liver Vol.15 No.3
Background/Aims: Although endoscopic transpapillary gallbladder drainage (ETGBD) has been reported as an alternative procedure for acute cholecystitis, it requires advanced endoscopic techniques. In terms of the certainty of achieving drainage, it remains a challenging procedure. The aim of the current study was to elucidate the practical efficacy of cholangioscopic assistance and to develop a new classification that could be used to evaluate the technical difficulty of ETGBD and provide a theoretical strategy to apply cholangioscopy appropriately for difficult ETGBD. Methods: A total of 101 patients undergoing ETGBD were retrospectively studied. The characteristics and technical outcomes of ETGBD with conventional ETGBD (C-ETGBD) and Spy- Glass DS-assisted ETGBD (SG-ETGBD) were evaluated. The characteristics and technique-dependent factors of unsuccessful C-ETGBD/SG-ETGBD were evaluated using the classification based on the steps of the procedure. The predictive factors of successful C-ETGBD/SG-ETGBD were examined. Results: C-ETGBD was successful in 73 patients (72.3%). SG-ETGBD was successful in 11 of 13 patients (84.6%) who had C-ETGBD failure. Optional SG-ETGBD significantly increased the final success rate (94.1%) compared to C-ETGBD alone (p=0.003). ETGBD procedures could be classified into four steps. SG-assistance worked as an excellent troubleshooter in step 1 (failure to identify the cystic duct orifice) and step 2 (failure of guidewire advancement across the downturned angle of cystic duct takeoff). Magnetic resonance cholangiopancreatography could provide predictive information based on the classification. Conclusions: Optional SG-ETGBD achieved a significantly higher success rate than C-ETGBD alone. Step classification is helpful for determining the technical difficulty of ETGBD and developing a theoretical strategy to apply cholangioscopy in a coordinated manner. (Gut Liver 2021;15:476-485)
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Michihiro Yoshida,Tadahisa Inoue,Itaru Naitoh,Kazuki Hayashi,Yasuki Hori,Makoto Natsume,Naoki Atsuta,Hiromi Kataoka 대한소화기내시경학회 2022 Clinical Endoscopy Vol.55 No.1
We reviewed 7 patients with unsuccessful endoscopic hemostasis using covered self-expandable metal stent (CSEMS) placementfor post-endoscopic sphincterotomy (ES) bleeding. ES with a medium incision was performed in 6 and with a large incision in 1patient. All but 1 of them (86%) showed delayed bleeding, warranting second endoscopic therapies followed by CSEMS placement1–5 days after the initial ES. Subsequent CSEMS placement did not achieve complete hemostasis in any of the patients. Lateral-sideincision lines (3 or 9 o’clock) had more frequent bleeding points (71%) than oral-side incision lines (11–12 o’clock; 29%). Additionalendoscopic hemostatic procedures with hemostatic forceps, hypertonic saline epinephrine, or hemoclip achieved excellenthemostasis, resulting in complete hemostasis in all patients. These experiences provide an alert: CSEMS placement is not an ultimatetreatment for post-ES bleeding, despite its effectiveness. The lateral-side of the incision line, as well as the oral-most side, should becarefully examined for bleeding points, even after the CSEMS placement.
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