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An unusual stent migration after endoscopic ultrasound-guided choledochoduodenostomy
Aditya Kale,Sridhar Sundaram,Manish Dodmani 소화기인터벤션의학회 2022 Gastrointestinal Intervention Vol.11 No.1
Summary of event: Endoscopic ultrasound-guided choledochoduodenostomy (EUS-CD) with the placement of a fully covered self-expandable metal stent (SEMS) is an alternative method to percutaneous transhepatic biliary drainage in cases of failed endoscopic retrograde cholangiopancreatography (ERCP) for malignant distal biliary obstruction. We report the case of a 64-year-old female who underwent EUS-CD with placement of a fully covered SEMS for obstructive jaundice due to distal bile duct obstruction by a pancreatic head mass and failed ERCP. Five months after the procedure, she presented with spontaneous expulsion of the stent in vomitus. She did not have bile leak and jaundice due to the formation of an epithelialized fistulous tract between the bile duct and duodenum (choledocho-duodenal fistula). Teaching point: Delayed distal migration of a fully covered SEMS after EUS-CD can occur. The formation of an epithelialized choledochoduodenal fistula prevented the occurrence of bile leak, pneumoperitoneum and perforation. Re-stenting through the same tract is possible. Stents with antimigration flanges or lumen-apposing metal stents may prevent migration.
An unusual stent migration after endoscopic ultrasound-guided choledochoduodenostomy
Aditya Kale,Sridhar Sundaram,Manish Dodmani 소화기인터벤션의학회 2022 International journal of gastrointestinal interven Vol.11 No.1
Summary of event: Endoscopic ultrasound-guided choledochoduodenostomy (EUS-CD) with the placement of a fully covered self-expandable metal stent (SEMS) is an alternative method to percutaneous transhepatic biliary drainage in cases of failed endoscopic retrograde cholangiopancreatography (ERCP) for malignant distal biliary obstruction. We report the case of a 64-year-old female who underwent EUS-CD with placement of a fully covered SEMS for obstructive jaundice due to distal bile duct obstruction by a pancreatic head mass and failed ERCP. Five months after the procedure, she presented with spontaneous expulsion of the stent in vomitus. She did not have bile leak and jaundice due to the formation of an epithelialized fistulous tract between the bile duct and duodenum (choledocho-duodenal fistula). Teaching point: Delayed distal migration of a fully covered SEMS after EUS-CD can occur. The formation of an epithelialized choledochoduodenal fistula prevented the occurrence of bile leak, pneumoperitoneum and perforation. Re-stenting through the same tract is possible. Stents with antimigration flanges or lumen-apposing metal stents may prevent migration.
Outcomes of Dilation of Recalcitrant Pancreatic Strictures Using a Wire-Guided Cystotome
Sridhar Sundaram,Dhaval Choksi,Aditya Kale,Suprabhat Giri,Biswaranjan Patra,Shobna Bhatia,Akash Shukla 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.6
Background/Aims: Pancreatic strictures in chronic pancreatitis are treated using endoscopic retrograde cholangiopancreatography(ERCP) with plastic stent placement. The management of recalcitrant strictures remains a challenge, with the use of a Soehendrastent retriever or a needle knife described in case reports. Here, we discuss our experience with dilation of dominant pancreaticstrictures with a 6-Fr cystotome. Methods: A retrospective review of an endoscopy database was performed to search for patients with pancreatic strictures recalcitrant toconventional methods of dilation in which a cystotome was used. Technical success was defined as the successful dilation of the stricturewith plastic stent placement. Functional success was defined as substantial pain relief or resolution of pancreatic fistulae. Results: Ten patients (mean age, 30.8 years) underwent dilation of a dominant pancreatic stricture secondary to chronic pancreatitis,with a 6-Fr cystotome. Seven patients presented with pain. Three patients had pancreatic fistulae (two had pancreatic ascites and onehad a pancreaticopleural fistula). The median stricture length was 10 mm (range, 5–25 mm). The head of the pancreas was the mostcommon location of the stricture (60%). Technical and functional success was achieved in all patients. One patient had self-limitingbleeding, whereas another patient developed mild post-ERCP pancreatitis. Conclusions: The use of a 6-Fr cystotome (diathermy catheter) can be an alternative method for dilation of recalcitrant pancreaticstrictures after the failure of conventional modalities.
Suprabhat Giri,Amrit Gopan,Sridhar Sundaram,Aditya Kale 대한소화기학회 2022 대한소화기학회지 Vol.80 No.4
Background/Aims: Endoscopic stenting is an evolving treatment for symptomatic Crohn's strictures. Several case series and small studies have reported its efficacy. Future studies can be designed based on a systematic review of the evaluation of efficacy. Hence, this meta-analysis was conducted to assess the critical role of stents in the management of intestinal strictures associated with Crohn's disease (CD). Methods: A literature search of various databases from 2000 to February 2022 was conducted for studies evaluating the outcome of stents in patients with CD-related stricture. The outcomes assessed included technical and clinical success, adverse events, symptom recurrence, and the need for a surgical resection. Pooled event rates across studies were expressed with summative statistics. Results: Ten studies with 170 patients were included in the present analysis. The pooled event rates for technical success, clinical success, stent migration, and post-procedural pain were 98.2% (95% CI, 95.8-100), 71.3% (95% CI, 57.4-85.1), 32% (95% CI, 0.0-65.3) and 20.2% (95% CI, 4.1-36.2), respectively. The cumulative recurrence rate and need for surgery were 40.1% (95% CI, 20.3-59.9) and 8.6% (95% CI, 1.7-15.5), respectively. Subgroup analysis showed that partially-covered (PC) self-expanding metallic stent (SEMS) was significantly better than fully-covered SEMS with a lower stent migration rate and symptom recurrence rate. Conclusions: Overall efficacy of stents in the management of CD-related stricture remains moderate with a low complication rate. Among the stents, PC-SEMS may be associated with a more favorable outcome. Future studies will be needed to determine the long-term benefits of endoscopic stenting.
Sridhar Sundaram,Sidharth Harindranath,Praveen Kumar Rao,Nitin Ramani,Aditya Kale,Shraddha Patkar 소화기인터벤션의학회 2021 Gastrointestinal Intervention Vol.10 No.4
Combined biliary and duodenal stent placement has been reported previously in multiple series. Rarely, colonic obstruction may present simultaneously with duodenal and biliary obstruction in advanced pancreaticobiliary cancers. Biliary, duodenal and colonic obstruction managed simultaneously using endoscopic modalities have been reported in only one case report previously. Here we report outcomes of a case of carcinoma of the gall bladder with biliary, gastric outlet and colonic obstruction managed by endoscopic placement of biliary, gastroduodenal and colonic self-expanding metal stents.
Sridhar Sundaram,Sidharth Harindranath,Praveen Kumar Rao,Nitin Ramani,Aditya Kale,Shraddha Patkar 소화기인터벤션의학회 2021 International journal of gastrointestinal interven Vol.10 No.4
Combined biliary and duodenal stent placement has been reported previously in multiple series. Rarely, colonic obstruction may present simultaneously with duodenal and biliary obstruction in advanced pancreaticobiliary cancers. Biliary, duodenal and colonic obstruction managed simultaneously using endoscopic modalities have been reported in only one case report previously. Here we report outcomes of a case of carcinoma of the gall bladder with biliary, gastric outlet and colonic obstruction managed by endoscopic placement of biliary, gastroduodenal and colonic self-expanding metal stents.
( Suprabhat Giri ),( Dhiraj Agrawal ),( Shivaraj Afzalpurkar ),( Sunil Kasturi ),( Amrit Gopan ),( Sridhar Sundaram ),( Aditya Kale ) 대한장연구학회 2023 Intestinal Research Vol.21 No.3
Background/Aims: The data on the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection in patients with inflammatory bowel disease (IBD) are conflicting. The present systematic review was thus conducted to study the prevalence of HBV and HCV markers in patients with IBD. Methods: A comprehensive literature search of 3 databases was conducted from 2000 to April 2022 for studies evaluating the prevalence of HBV or HCV in patients with IBD. Pooled prevalence rates across studies were expressed with summative statistics. Results: A total of 34 studies were included in the final analysis. The pooled prevalence of hepatitis B surface antigen (HBsAg) and hepatitis B core antibodies were 3.3% and 14.2%, respectively. In HBsAg positive IBD patients, hepatitis B e antigen positivity and detectable HBV DNA were seen in 15.3% and 61.0% of patients, respectively. Only 35.6% of the IBD patients had effective HBV vaccination. The pooled prevalence of anti-HCV and detectable HCV RNA were 1.8% and 0.8%, respectively. The pooled prevalence of markers of HBV infection was higher in Asian studies, while the prevalence of markers of HCV infection was higher in European studies. The prevalence of viral hepatitis markers was similar between IBD patients and the general population and that between ulcerative colitis and Crohn’s disease. Conclusions: The prevalence of markers of viral hepatitis remains same as the general population with significant regional variations, although the quality of evidence remains low due to publication bias. Only a small proportion of IBD patients had an effective HBV vaccination, requiring improvement in screening and vaccination practices. (Intest Res 2023;21:392-405)