Interventionelle endoskopische ultraschall-cholangiografie: Langzeitergebnisse einer neuen alternative zur perkutanen cholangiografie

Translated title of the contribution: Interventional endoscopic ultrasound-guided cholangiography: Long-term experience of an emerging alternative to percutaneous transhepatic cholangiography

Jennifer Maranki, A. J. Hernandez, B. Arslan, A. A. Jaffan, J. F. Angle, V. M. Shami, M. Kahaleh, H. J. Schulz

Research output: Contribution to journalArticle

Abstract

Background and study aims: Endoscopic retro-grade cholangiography (ERC) with stenting is the procedure of choice for biliary decompression in patients with obstructive jaundice. In cases where biliary access cannot be achieved, interventional endoscopic ultrasound-guided cholangiography (IEUC) has become an alternative to percutaneous transhepatic cholangiography (PTC). Patients and methods: We report on 5years of experience in patients who underwent IEUC after -failed endoscopic retrograde cholangiopancreatography (ERCP). Endoscopic ultrasound-guided access to the targeted biliary duct was attempted with one of two approaches: transgastric-transhepatic (intrahepatic) or transenteric- transcholedochal (extrahepatic). A stent was then advanced over the wire and into the biliary tree. Results: A total of 49patients underwent IEUC: 35had biliary obstruction due to malignancy and 14had a benign etiology. The overall success rate of IEUC was 84% (41/49), with an overall complication rate of 16%. Of the 35patients who underwent the intrahepatic approach, 23 had a stent placed across the major papilla, one had a stent placed intra-ductally in the common bile duct, and three patients underwent placement of a gastrohepatic stent. Resolution of obstruction was achieved in 29patients, with a success rate of 83%. In all, 14patients underwent an extrahepatic approach. In 8/14 (57%), stent placement across the major papilla was achieved. A transenteric stent was placed in four patients. Biliary decompression was achieved in 12/14cases (86%). Based on intention-to-treat analysis, the intrahepatic approach achieved success in 29 of 40cases (73%), and the extrahepatic approach was successful in seven of nine cases (78%). There were no procedure-related deaths. Conclusion: IEUC offers a feasible alternative to PTC in patients with obstructive jaundice in whom ERC has failed.

Original languageGerman
Pages (from-to)174-180
Number of pages7
JournalEndoskopie Heute
Volume22
Issue number3
DOIs
StatePublished - Dec 1 2009

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Interventional Ultrasonography
Cholangiography
Stents
Obstructive Jaundice
Decompression
Intention to Treat Analysis
Endoscopic Retrograde Cholangiopancreatography
Common Bile Duct
Biliary Tract

All Science Journal Classification (ASJC) codes

  • Surgery
  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

Cite this

Maranki, Jennifer ; Hernandez, A. J. ; Arslan, B. ; Jaffan, A. A. ; Angle, J. F. ; Shami, V. M. ; Kahaleh, M. ; Schulz, H. J. / Interventionelle endoskopische ultraschall-cholangiografie : Langzeitergebnisse einer neuen alternative zur perkutanen cholangiografie. In: Endoskopie Heute. 2009 ; Vol. 22, No. 3. pp. 174-180.
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title = "Interventionelle endoskopische ultraschall-cholangiografie: Langzeitergebnisse einer neuen alternative zur perkutanen cholangiografie",
abstract = "Background and study aims: Endoscopic retro-grade cholangiography (ERC) with stenting is the procedure of choice for biliary decompression in patients with obstructive jaundice. In cases where biliary access cannot be achieved, interventional endoscopic ultrasound-guided cholangiography (IEUC) has become an alternative to percutaneous transhepatic cholangiography (PTC). Patients and methods: We report on 5years of experience in patients who underwent IEUC after -failed endoscopic retrograde cholangiopancreatography (ERCP). Endoscopic ultrasound-guided access to the targeted biliary duct was attempted with one of two approaches: transgastric-transhepatic (intrahepatic) or transenteric- transcholedochal (extrahepatic). A stent was then advanced over the wire and into the biliary tree. Results: A total of 49patients underwent IEUC: 35had biliary obstruction due to malignancy and 14had a benign etiology. The overall success rate of IEUC was 84{\%} (41/49), with an overall complication rate of 16{\%}. Of the 35patients who underwent the intrahepatic approach, 23 had a stent placed across the major papilla, one had a stent placed intra-ductally in the common bile duct, and three patients underwent placement of a gastrohepatic stent. Resolution of obstruction was achieved in 29patients, with a success rate of 83{\%}. In all, 14patients underwent an extrahepatic approach. In 8/14 (57{\%}), stent placement across the major papilla was achieved. A transenteric stent was placed in four patients. Biliary decompression was achieved in 12/14cases (86{\%}). Based on intention-to-treat analysis, the intrahepatic approach achieved success in 29 of 40cases (73{\%}), and the extrahepatic approach was successful in seven of nine cases (78{\%}). There were no procedure-related deaths. Conclusion: IEUC offers a feasible alternative to PTC in patients with obstructive jaundice in whom ERC has failed.",
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Interventionelle endoskopische ultraschall-cholangiografie : Langzeitergebnisse einer neuen alternative zur perkutanen cholangiografie. / Maranki, Jennifer; Hernandez, A. J.; Arslan, B.; Jaffan, A. A.; Angle, J. F.; Shami, V. M.; Kahaleh, M.; Schulz, H. J.

In: Endoskopie Heute, Vol. 22, No. 3, 01.12.2009, p. 174-180.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Interventionelle endoskopische ultraschall-cholangiografie

T2 - Langzeitergebnisse einer neuen alternative zur perkutanen cholangiografie

AU - Maranki, Jennifer

AU - Hernandez, A. J.

AU - Arslan, B.

AU - Jaffan, A. A.

AU - Angle, J. F.

AU - Shami, V. M.

AU - Kahaleh, M.

AU - Schulz, H. J.

PY - 2009/12/1

Y1 - 2009/12/1

N2 - Background and study aims: Endoscopic retro-grade cholangiography (ERC) with stenting is the procedure of choice for biliary decompression in patients with obstructive jaundice. In cases where biliary access cannot be achieved, interventional endoscopic ultrasound-guided cholangiography (IEUC) has become an alternative to percutaneous transhepatic cholangiography (PTC). Patients and methods: We report on 5years of experience in patients who underwent IEUC after -failed endoscopic retrograde cholangiopancreatography (ERCP). Endoscopic ultrasound-guided access to the targeted biliary duct was attempted with one of two approaches: transgastric-transhepatic (intrahepatic) or transenteric- transcholedochal (extrahepatic). A stent was then advanced over the wire and into the biliary tree. Results: A total of 49patients underwent IEUC: 35had biliary obstruction due to malignancy and 14had a benign etiology. The overall success rate of IEUC was 84% (41/49), with an overall complication rate of 16%. Of the 35patients who underwent the intrahepatic approach, 23 had a stent placed across the major papilla, one had a stent placed intra-ductally in the common bile duct, and three patients underwent placement of a gastrohepatic stent. Resolution of obstruction was achieved in 29patients, with a success rate of 83%. In all, 14patients underwent an extrahepatic approach. In 8/14 (57%), stent placement across the major papilla was achieved. A transenteric stent was placed in four patients. Biliary decompression was achieved in 12/14cases (86%). Based on intention-to-treat analysis, the intrahepatic approach achieved success in 29 of 40cases (73%), and the extrahepatic approach was successful in seven of nine cases (78%). There were no procedure-related deaths. Conclusion: IEUC offers a feasible alternative to PTC in patients with obstructive jaundice in whom ERC has failed.

AB - Background and study aims: Endoscopic retro-grade cholangiography (ERC) with stenting is the procedure of choice for biliary decompression in patients with obstructive jaundice. In cases where biliary access cannot be achieved, interventional endoscopic ultrasound-guided cholangiography (IEUC) has become an alternative to percutaneous transhepatic cholangiography (PTC). Patients and methods: We report on 5years of experience in patients who underwent IEUC after -failed endoscopic retrograde cholangiopancreatography (ERCP). Endoscopic ultrasound-guided access to the targeted biliary duct was attempted with one of two approaches: transgastric-transhepatic (intrahepatic) or transenteric- transcholedochal (extrahepatic). A stent was then advanced over the wire and into the biliary tree. Results: A total of 49patients underwent IEUC: 35had biliary obstruction due to malignancy and 14had a benign etiology. The overall success rate of IEUC was 84% (41/49), with an overall complication rate of 16%. Of the 35patients who underwent the intrahepatic approach, 23 had a stent placed across the major papilla, one had a stent placed intra-ductally in the common bile duct, and three patients underwent placement of a gastrohepatic stent. Resolution of obstruction was achieved in 29patients, with a success rate of 83%. In all, 14patients underwent an extrahepatic approach. In 8/14 (57%), stent placement across the major papilla was achieved. A transenteric stent was placed in four patients. Biliary decompression was achieved in 12/14cases (86%). Based on intention-to-treat analysis, the intrahepatic approach achieved success in 29 of 40cases (73%), and the extrahepatic approach was successful in seven of nine cases (78%). There were no procedure-related deaths. Conclusion: IEUC offers a feasible alternative to PTC in patients with obstructive jaundice in whom ERC has failed.

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