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Search Results: 1 - 10 of 2738 matches for " Biliary plastic stents "
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- , 2017, DOI: 10.3969/j.issn.1007-1989.2017.02.003
Abstract: 摘要: 目的??探讨胰管塑料支架和/或鼻胆管引流在胆总管结石患者内镜逆行胰胆管造影术(ERCP)选择性胆管插管困难(DSBC)时的应用。方法?回顾性分析57例ERCP术中DSBC的胆总管结石患者的临床资料,将患者分为胰管塑料支架组、鼻胆管引流组、胰管塑料支架+鼻胆管引流组,观察其手术成功率、术后并发胰腺炎、高淀粉酶血症或其他并发症的发生率,对比分析3组间的差异。结果?接受ERCP的57例患者中,胰管塑料支架组13例患者,手术成功2例(15.4%),高淀粉酶血症1例(7.7%),术后胰腺炎2例(15.4%),发热1例(7.7%),出血1例(7.7%);鼻胆管引流组20例患者,手术成功20例(100.0%),无高淀粉酶血症及术后胰腺炎,无出血及发热等并发症的发生;胰管塑料支架+鼻胆管引流组24例患者1次ERCP手术成功19例(79.2%),2次ERCP成功5例(20.8%),4例出现高淀粉酶血症(16.7%),2例出现出血(8.3%),无发热及术后胰腺炎。3组间比较术后胰腺炎的发生和手术成功率差异有统计学意义。结论?ERCP术中DSBC的患者可通过放置胰管支架和/或鼻胆管引流术提高手术的成功率,减少胰腺炎的发生。
Abstract: Objective?To explore the application of plastic pancreatic stents and/or nasal biliary drainage for choledocholithiasis patients having DSBC during Endoscopic Retrograde Cholangiopancreatography (ERCP).?Methods?Retrospective analysis on clinical data of 57 ERCP cases aiming at choledocholithiasis patients having DSBC from January 2010 to December 2015 has been carried out. According to the guide wire cannulation in an operation, patients are divided into three groups, i.e. plastic pancreatic stents group, nasal biliary drainage group, and plastic pancreatic stents + nasal biliary drainage group, so as to observe the success rate of operation and the occurrence rate of postoperative complications, such as pancreatitis or hyperamylasemia, as well as to compare the differences between the three groups.?Results?Out of the 57 patients receiving ERCP, 13 patients are in the plastic pancreatic stents group, with two successful operations (15.4%), one case of hyperamylasemia (7.7%), two cases of postoperative pancreatitis (15.4%), one case of fever (7.7%) and one case of hemorrhage (7.7%); 20 patients are in the nasal biliary drainage group, with 20 successful operations (100.0%), no occurrence of hyperamylasemia or postoperative pancreatitis or other complications including hemorrhage and fever; 24 patients are in the plastic pancreatic stents + nasal biliary drainage group, with 19 ERCP operations succeeded at the first attempt (79.2%) and 5 ERCP operations succeeded at the second try (20.8%), as well as 4 cases of hyperamylasemia (16.7%), 2 cases of hemorrhage (8.3%) , no occurrence of fever cases and postoperative pancreatitis. In comparison between the three groups, the occurrence of postoperative pancreatitis and successful rate of operation show a significant difference.?Conclusion?By adopting plastic pancreatic stents and/or nasal biliary drainage for patients having a difficult selective biliary cannulation during ERCP, the success rate of operation can be improved, and the occurrence of pancreatitis can also be reduced.
Fully covered self-expanding metal stents in the management of difficult common bile duct stones Prótesis metálicas autoexpandibles totalmente recubiertas en el tratamiento de coledocolitiasis difíciles
Jesús García-Cano,Amanda Karolina Reyes-Guevara,Teresa Martínez-Pérez,Laura Valiente-González
Revista Espa?ola de Enfermedades Digestivas , 2013,
Abstract: Background and objectives: plastic biliary stents are often used after an ERCP session without complete common bile duct stones (CBDS) extraction. Sometimes, the volume of biliary drainage with these stents may be insufficient. We present our experience with the use of fully covered self-expanding metal stents (FCSEMS) in the setting of incomplete CBDS extraction. Patients and methods: after an ERCP session with difficult CBDS not completely removed, biliary FCSEMS (Wallflex) were inserted in some patients when it was deemed that biliary sphincterotomy and a single plastic stent would not provide an adequate drainage. Results: a retrospective study was performed. Biliary FCSEMS were inserted in 29 patients, mean age 81 years. CBDS could not be extracted through a biliary sphincterotomy due to its large size (n = 18) or because of the presence of inflammatory distal strictures (n = 11). The greatest biliary drainage with shortest ERCP time was considered mandatory due to clinical instability of patients and/or poor tolerance to conscious sedation administered by the endoscopist. Successful biliary drainage was obtained in all cases. FCSEMS were removed after a median of 199.5 days in 16 patients with a complete CBDS extraction in 15 (93.7%). FCSEMS were not removed in the remaining 13 patients due to their clinical condition, and a wait-and-see strategy was undertaken. Conclusions: in selected cases, utilization of removable FCSEMS can be a good option for a quick and adequate biliary drainage in the setting of difficult CBDS. Because of the higher cost of these stents its use needs to be individualized. Introducción y objetivos: las prótesis biliares plásticas suelen emplearse tras una sesión de CPRE sin extracción completa de coledocolitiasis. En ocasiones, el calibre de drenaje con estas prótesis puede ser insuficiente. Presentamos nuestra experiencia en la utilización de prótesis metálicas autoexpandibles totalmente recubiertas (PMATR) en coledocolitiasis no extraídas. Pacientes y métodos: se insertó una PMATR (Wallflex biliar) en algunos pacientes con coledocolitiasis difíciles no extraídas tras una sesión de CPRE cuando se consideró que la esfinterotomía biliar y una prótesis plástica no aportaban un calibre de drenaje adecuado. Resultados: estudio retrospectivo en el que se utilizó una PMATR en 29 pacientes, edad media 81 a os. Las coledocolitiasis no pudieron extraerse por la esfinterotomía biliar debido a su gran tama o (n = 18) o por la presencia de estenosis distal inflamatoria (n = 11). Se consideró que era preciso el mayor drenaje biliar con
Desempe?o del stent plástico para la paliación en la obstrucción biliar maligna proximal versus distal
Casta?o,Rodrigo; Ricardo,Andrés; Velásquez,Lina; Ruiz,Mario H; Ruiz,Luis M;
Revista Colombiana de Gastroenterologia , 2011,
Abstract: aim: to compare the efficacy of plastic stents in the treatment of distal and proximal stricture of biliary tract neoplasm?s. methods: from january 2002 to february 2009, 70 patients (37 males, 33 females) with non surgically resectable malignant biliary obstruction who received plastic stent implantation were reviewed retrospectively. the stents were inserted by endoscopy. the endoscopist implants one or more stents if he considers this necessary. the end points of the study were stent occlusion and patient death. results: the mean time of stent patency was 81 ± 75 days in the group of proximal stricture (group 1) and 130 ± 68 days in the group of distal stricture (group 2), (p 0.40, with ci 95% 0.47-1.37). the mean survival time was 126 days in group 1 and 159 days in group 2. there was not a significant difference between the two groups. conclusion: plastic stent implantation is a feasible, palliative method for unresectable malignant biliary obstruction. the overall survival and obstruction with the use of plastic stent in patients with distal stenoses compared with proximal obstruction was not significantly different in our study.
The first transendoscopic plastic to self-expandable metal stent replacement in Serbia and Montenegro using a diagnostic duodenoscope
Bulaji? M.,Milojkovi? B.,Jakovljevi? M.,Milo?evi? P.
Acta Chirurgica Iugoslavica , 2008, DOI: 10.2298/aci0801115b
Abstract: Studies have shown that SEMS remain patient longer with fewer associated complications compared with conventional plastic strents. Zilver stent , a nitinol zig-zag mash SEMS has a special advantage, having a thin introducer diameter of 7 Fr with a fully deployed span of 10mm. For a 48- year-old woman presented with obstructive jaundice and a diagnosis of unresectable pancreatic carcinoma with consequent stenosis of common bile duct (CBD), infiltration of local blood vessels and life expectancy longer than six months, it was decided that an endoscopic palliative drainage procedure should be performed. The technique of transendoscopic plastic to metal stent exchange is described, using a diagnostic duodenoscope. The patient lived 7 months after implementation of Zilver stent and died anicteric due to progression of a primary disease. The transendoscopic plastic to metal stent exchange is feasible palliative method which requires a basic endoscopic equipment and experienced staff and therefore is applicable in developing countries as well.
Estenoses biliares benignas: repara??o e resultados com o uso de silastic transhepático transanastomótico
Sampaio, José Artur;Kruse, Cristine Kist;Passarin, Thiago Luciano;Waechter, Fábio Luiz;Nectoux, Mauro;Fontes, Paulo Roberto Ott;Pereira-Lima, Luiz;
ABCD. Arquivos Brasileiros de Cirurgia Digestiva (S?o Paulo) , 2010, DOI: 10.1590/S0102-67202010000400011
Abstract: background: the medical advances is not always related to homogeneous good results for all the patients. this is the case of laparoscopic cholecystectomy, whose advantages are largely recognized in the medical literature. however, this operation most dreaded complication, iatrogenic major bile duct injury, is rising in the last years, despite the learning curve, and stabilized in a level higher than that experienced in open cholecystectomy. among the features which can bring to this event a good outcome is the use of transhepatic transanastomotic tubes in association with the corrective hepaticojejunostomy. aim: to report a 20 years experience on biliary reconstruction of bile duct injuries with the use of transhepatic transanastomotic tubes. methods: data were analysed from 338 patients who underwent operation for major bile duct injuries between january 1988 and december 2009. results: all the 338 patients were submitted to roux-en-y hepaticojejunostomy (hepp-couinaud approach) or distinct cholangiojejunostomies, all with the use of transhepatic transanastomotic silastic tubes. a successful long-term result was achieved in 240 (92,9%) of 338 patients, including those who required subsequent procedures. conclusion: benign bile duct strictures near the hepatic duct confluence remains a surgical challenge. the use of silastic transhepatic transanastomotic tubes in high biliary tract reconstruction is an option which can provides a successful repair of bile duct injuries with low complication rates.
Nintinol Self-Expandable Metallic Stenting in Management of Malignant Obstructive Jaundice: A Case Series
Hossein Ghanaati,Kavous Firouznia,Seyed Mehran Vaziri Bozorg,Ahmad Reza Ghasemi Esfe
Hepatitis Monthly , 2010,
Abstract: Background and Aims: Palliation therapy is the only available therapeutic method for most patients with tumor-induced obstructive jaundice. Metallic stents are now performed percutaneously as an alternative route to the endoscopic approach. It is widely accepted because of its safety, good patency rate, and minimal invasiveness. This study was designed to evaluate the long-term results of metallic self-expandable stent insertion in patients with malignant stenosis of the biliary tree.Methods: It is a longitudinal study of patients with percutaneously biliary stenting from September 2005 to March 2009. The patients had unresectable malignant biliary obstruction with unsuccessful endoscopic stenting and access. Percutaneous transhepatic cholangiogram performed after adequate local anesthesia, under sonographic or fluoroscopic guidance. Stenting or balloon dilation was performed through the hydrophilic guide wire. Among 50 patients, 45 stents were placed in biliary tree stenosis sites. Patients' follow-up was during the first, second, third, and then the sixth month after insertion of biliary stents. Stent patency was considered successful in our patients, when there were no lab results or sonographic appearance of biliary tree obstruction.Results: 10(20%) patients' stent placement treatment failed because of unsuccessful technical procedure. The stenosis of biliary tract was complete and passage of guide wire was not possible through the tumor growth. 6 (15 %) patients with successful stent placements died within one month (mean, 22 days). Total serum bilirubin resolved to below 1.5 mg/dl within 30 days for 36 (90%) patients with successful stent placements. Early complications not leading to death occurred in 28% of cases. The mean survival time for all patients who underwent stent placement was 140 days (16-420days). The mean patency rate for all stents was 147 days.Conclusions: Percutaneous biliary stenting is a safe procedure with few technical complications and a high success rate of palliation for patients with malignant biliary jaundice. Early complications are mostly managed conservatively and death is mainly due to systemic effects of the malignant disease.
Tratamento endoscópico das les?es biliares
Artifon, Everson L. A.;Couto Júnior, Décio Sampaio;Sakai, Paulo;
Revista do Colégio Brasileiro de Cirurgi?es , 2010, DOI: 10.1590/S0100-69912010000200012
Abstract: standard surgical techniques offer a good chance of cure forthe majority of patients affected by extrahepatic benign biliarystricture. nevertheless, operative repair has a long-termrecurrence rate of stricture in 10% to 30% of patients. advancesin endoscopic procedures have provided alternative options ofrelieving biliary obstructions, but prolonged length of treatmentand rehospitalization have to be considered if endoscopy isperformed. malignant stenoses are an important factor determining cholangitis, jaundice and pain and it's each systemic consequences. the endoscopic approach intends to create a deviation of bile juice to duodenum by means of metal or plastic stents aiming a safe palliation. the purpose of this review is to show to the readers effectiveness of endoscopic treatments of benign and malignat stenosis of the bile duct and pancreatic.
Placement of percutaneous transhepatic biliary stent using a silicone drain with channels
Hiroshi Yoshida, Yasuhiro Mamada, Nobuhiko Taniai, Sho Mineta, Yoshiaki Mizuguchi, Yoichi Kawano, Junpei Sasaki, Yoshiharu Nakamura, Takayuki Aimoto, Takashi Tajiri
World Journal of Gastroenterology , 2009,
Abstract: This report describes a method for percutaneous transhepatic biliary stenting with a BLAKE Silicone Drain, and discusses the usefulness of placement of the drain connected to a J-VAC Suction Reservoir for the treatment of stenotic hepaticojejunostomy. Percutaneous transhepatic biliary drainage was performed under ultrasonographic guidance in a patient with stenotic hepaticojejunostomy after hepatectomy for hepatic hilum malignancy. The technique used was as follows. After dilatation of the drainage root, an 11-Fr tube with several side holes was passed through the stenosis of the hepaticojejunostomy. A 10-Fr BLAKE Silicone Drain is flexible, which precludes one-step insertion. One week after insertion of the 11-Fr tube, a 0.035-inch guidewire was inserted into the tube. After removal of the 11-Fr tube, the guidewire was put into the channel of a 10-Fr BLAKE Silicone Drain. The drain was inserted into the jejunal limb through the intrahepatic bile duct and was connected to a J-VAC Suction Reservoir. Low-pressure continued suction was applied. Patients can be discharged after insertion of the 10-Fr BLAKE Silicone Drain connected to the J-VAC Suction Reservoir. Placement of a percutaneous transhepatic biliary stent using a 10-Fr BLAKE Silicone Drain connected to a J-VAC Suction Reservoir is useful for the treatment of stenotic hepaticojejunostomy.
Endoscopic management of occluded biliary uncovered metal stents: A multicenter experience
Panagiotis Katsinelos, Athanasios Beltsis, Grigoris Chatzimavroudis, Dimitris Paikos, George Paroutoglou, Dimitris Kapetanos, Sotiris Terzoudis, Georgia Lazaraki, Ioannis Pilpilidis, Kostas Fasoulas, Stefanos Atmatzidis, Christos Zavos, Jannis Kountouras
World Journal of Gastroenterology , 2011,
Abstract: AIM: To compare diverse endoscopic interventions in the management of occluded uncovered self-expanding metal stents (SEMSs) that had been placed for palliative treatment of unresectable malignant biliary obstruction.METHODS: A retrospective review was undertaken in 4 tertiary endoscopic centers to determine optimal management of different types of occluded SEMSs. The technical success of performed treatment in occluded SEMSs, the patency of the stent, the need for re-intervention and the financial costs of each treatment were analyzed.RESULTS: Fifty four patients were included in the analysis; 21 received Hanaro, 19 Wallstent and 14 Flexus. For the relief of obstruction, a plastic stent was inserted in 24 patients, a second SEMS in 25 and mechanical cleaning was performed in 5 patients. The overall median second patency rates between second SEMSs and plastic stents did not differ (133 d for SEMSs vs 106 d for plastic stents; P = 0.856). Similarly, no difference was found between the overall survival of SEMS and plastic stent groups, and no procedure-related complications occurred. Incremental cost analysis showed that successive plastic stenting was a cost-saving strategy at least in Greece.CONCLUSION: Insertion of uncovered SEMSs or plastic stents is a safe and effective treatment for occluded uncovered SEMSs; insertion of plastic stents appears to be the most cost-effective strategy.
Endoscopic Palliation for Pancreatic Cancer
Mihir Bakhru,Bezawit Tekola,Michel Kahaleh
Cancers , 2011, DOI: 10.3390/cancers3021947
Abstract: Pancreatic cancer is devastating due to its poor prognosis. Patients require a multidisciplinary approach to guide available options, mostly palliative because of advanced disease at presentation. Palliation including relief of biliary obstruction, gastric outlet obstruction, and cancer-related pain has become the focus in patients whose cancer is determined to be unresectable. Endoscopic stenting for biliary obstruction is an option for drainage to avoid the complications including jaundice, pruritus, infection, liver dysfunction and eventually failure. Enteral stents can relieve gastric obstruction and allow patients to resume oral intake. Pain is difficult to treat in cancer patients and endoscopic procedures such as pancreatic stenting and celiac plexus neurolysis can provide relief. The objective of endoscopic palliation is to primarily address symptoms as well improve quality of life.
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