Endoscopic Retrograde Stenting Research Articles

Results of surgical treatment of extrahepatic bile duct injuries

Aim. To evaluate the short-and long-term outcomes after surgical repair of iatrogenic lesions of extrahepatic bile ducts depending on the timing of diagnosis in conditions of specialized clinic.
 Materials and methods. Our study involved a retrospective analysis of 159 patients who were treated for iatrogenic lesions of extrahepatic bile ducts during 1987-2017. These patients were divided into two groups depending on the timing of surgical treatments: early biliary reconstruction ( 5 days after bile duct transection) and late biliary reconstruction ( 5 days post-transection). These groups were compared on the basis of postoperative morbidity and long-term outcomes.
 Results. Following laparoscopic cholecystectomy, 2 patients received endoscopic retrograde stents due to bile leakage from the cystic ducts, and 14 patients underwent hepaticocholedochostomy using Ker drainage. The incidence of bile leakage was observed in 14. 3 % of cases during the early post-operative period, strictures appeared in 28.6 % of cases. Hepaticojejunostomy was performed in 91 cases: in 62 with stents and in 29 without stents. Bile leakage was observed in 17.6 % of cases, and strictures in 19.8 % of cases. Our statistical analyses revealed no significant differences between the two groups (i.e., early and late timing of surgical treatment) in the rates of bile leakage and strictures. The extent of surgeons experience in bile surgery significantly correlated with positive outcomes.
 Conclusions. Endoscopic retrograde stent proved to be an effective and fast solution in cases of bile leakage from cystic ducts following laparoscopic cholecystectomy. Although it is preferable to perform reconstructive surgeries within the first five days after bile duct injury, our results indicated that in the presence of external bile fistula without peritonitis and severe cholangitis, reconstructive surgery can be performed in specialized surgical departments later than 5 days with satisfactory results.

Retrograde stenting of the bile ducts for benign hepatopancreatoduodenal diseases

Aim.To evaluate the immediate results of endoscopic retrograde stenting of bile ducts in benign hepatopancreatoduodenal diseases and to justify enlargement of indications for surgery.Material and methods.There were 341 patients with various benign hepatopancreatoduodenal diseases for the period 2007–2017. Plastic stents were installed in 326 (95.6%) patients, metal self-expanding stents – in 15 (4.4%) patients.Results.There was a tendency to increase of the number of stenting procedures in patients with benign hepatopancreatoduodenal diseases that was primarily due to expansion of indications for this intervention. Therapeutic and prophylactic purposes of biliary stenting were determined. The main objectives of therapeutic stenting were bile drainage restoration in obstructive jaundice, reduction of extra- and intrahepatic biliary pressure, as well as drainage of cavities in liver communicating with biliary system. The main prophylactic goal was to prevent violation of bile outflow after endoscopic manipulations on the major duodenal papilla at high risk of migration of stones from gallbladder and reflux cholangitis. Severe complications of endoscopic transpapillary procedures were not observed.Conclusion.The indications for endoscopic transpapillary stenting of the bile ducts in case of benign hepatopancreatoduodenal diseases were systematized and reasonably expanded. Immediate results of biliary stenting confirm high efficacy of the method.

Endoscopic Biliary Stenting for Malignant Obstructive Jaundice

Aim. To identify opportunities for endoscopic retrograde biliary stenting for malignant obstructive jaundice and to compare long-term results of stenting using plastic and self-expanding metal stents. Material and Methods. We analyzed the results of endoscopic methods of di-agnostics and treatment of inoperable patients with malignant obstructive jaundice, as well as incidence of early and late complications of biliary stenting as the final treatment. Total number of patients were 160 people which were divided into 2 groups by 80 patients. In the 1st group plastic biliary stents with the diameter of 3–3.5 mm (10–11.5 Fr) were used for bile ducts drainage. In the 2nd group covered self-expanding metal stents with the diameter of 10 mm (28–30 Fr) were applied. All patients underwent a comprehensive diagnostic program including traditional ultrasound (US), computer tomography (CT), EUS (EUS) and endoscopic retrograde cholangiopancreaticography (ERCP). Results. Early postoperative complications were observed in 7 (8.7%) and 5 (6.7%) patients in the 1st and 2nd group respectively. Remote complications such as recurrent obstructive jaundice and/or cholangitis in various time periods after discharge occurred 2 times more often in the 1st group (28 out of 80 patients) than in the 2nd group (12 out of 80 patients) that required repeated hospitalizations and re-stenting. Malignant duodenal stenosis arose in 20 (12.5%) patients. Average time was 8.2 months. Conclusion. Endoscopic retrograde stenting can be used as an effective final method of bile ducts decompression in patients with inoperable pancreatobiliary tumors complicated by obstructive jaundice. The term of plastic biliary and self-expanding metal stents function was 119.9 ± 131.4 days (4 months) and 257.5 ± 91.3 days (8.6 months) respectively. Improvement of equipment and tools, use of antegrade techniques combined with EUS-guided interventions, pyloroduodenal self-expanding stents allow to bypass pre-existing limitation with duodenal neoplastic stenosis.

TREATMENT OF PATIENTS WITH EXTERNAL PANCREATIC FISTULAS AFTER PERCUTANEOUS DRAINAGE INTERVENTIONS OF PANCREATIC PSEUDOCYSTS

Introduction. External pancreatic fistulas are developed up to 45 % during the postoperative period after the percutaneous drainage of pancreatic pseudocysts. According to some authors this fact is the main contraindication for using of transcutaneous method in treatment of these patients. The objective is to optimize the tactics of treatment for minimizing the possible development of external pancreatic fistulas Materials and methods. Puncture-draining operations were performed in 164 patients with chronic pancreatic pseudocysts. Puncture operations with ultrasound control were primarily performed in 54 patients (32.9 %), they were effective for 29 patients (53.7 %). Traditional surgical interventions were performed in 7 patients (12.9 %) from this group. Percutaneous drainage of pseudocyst was secondary used in 18 patients (33.4 %). Percutaneous drainage of pseudocysts was primarily used in other group consisting of 110 (67.1 %) patients. During the postoperative period, external pancreatic fistula formed in 36 (32.7 %) patients from this group. The fistulas were eliminated by supplementing the transcutaneous interventions with endoscopic methods. Results. Endoscopic papillosphincterotomy was performed in 36 patients. Pancreatic fistulas were closed after the operation in 12 patients (33.3 %). Endoscopic formation cystogastro-, cystoduodenoanastomosis on «lost drainage» were performed in 9 patients (25 %). Temporary decompression transpapillary stenting of the MPD was performed in 15 patients (41.7 %), endoscopic retrograde stenting was performed in 5 of them. Antegrade stenting of the MPD was transcutaneously performed in 10 patients. There were no lethal outcomes. Fistulas regressed in all patients. Recurrence of cyst formation, pancreatic hypertension were not be to dynamic examinations. Algorithm of treatment was formed and based on the results of a retrospective analysis to treatment of pancreatic cysts in general surgical clinic of «Pavlov First Saint Petersburg State Medical University». Conclusions. Coherent combining of minimally invasive technologies in the treatment of patients with chronic pancreatic pseudocysts leads to good results: absolute cystic regression and elimination of pancreatic fistulas as appropriate.

The Management of Ureteric Obstruction Secondary to Malignant Pelvic Disease

AIM: Management of upper-tract obstruction secondary to a malignant pelvic process is a difficult problem and is best dealt with by a multi-disciplinary team. In the present audit, we address the question: is staged antegrade stenting better than retrograde ureteric stenting? MATERIALS AND METHODS: We reviewed our present management of upper-tract obstruction secondary to malignant pelvic disease in 65 patients treated over a period of 2 years. Fifty-eight patients had urological cancer and seven patients had non-urological cancers; 70% of all cases had renal impairment. Twenty-four of 65 patients had an attempt at endoscopic retrograde ureteric stenting as a primary method of decompression while percutaneous nephrostomy followed by antegrade ureteric stenting was performed in 41/65 patients. RESULTS: Endoscopic retrograde stenting had a success rate of 21% whereas two-stage antegrade stenting was successful in 98% of patients. The antegrade approach had minimal morbidity. CONCLUSION: Obstruction of the pelvic ureter secondary to any pelvic malignancy is best managed by two-stage antegrade ureteric stenting. This approach has a high success rate with minimal morbidity, and should be preferred to an endoscopic approach. This highlights the important role of an interventional uroradiologist in the management of these patients. Chitale, S. V. et al. (2002). Clinical Radiology57, 1118–1121.