Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society
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Review Meta Analysis
Otaru consensus on biliary stenting for unresectable distal malignant biliary obstruction.
Endoscopic biliary drainage with biliary stent placement is the treatment of choice for palliation in patients with malignant biliary obstruction caused by unresectable neoplasms. Various biliary stent designs have become available, but lack of a clear consensus persists on the use of covered versus uncovered metal stents in malignant distal bile duct obstructions, and plastic versus metal stents. In 2012, the European Society of Gastrointestinal Endoscopy indicated guidelines for biliary stenting. ⋯ Two of four statements (related to the usefulness of self-expandable metallic stents, and reintervention after stenting) were agreed upon by almost all participants. Nevertheless, our opinions were divided on the other two statements (necessity of sphincterotomy for stenting, and covered metal stent versus uncovered metal stent). We herein report the results of the meeting, and present proposed new statements via discussion.
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Multicenter Study
Clinical advantages of a metal stent with an S-shaped anti-reflux valve in malignant biliary obstruction.
Transpapillary stent insertion is the standard treatment for palliating malignant biliary obstruction. However, luminal occlusion often occurs due to sludge formation, tumor ingrowth, or tumor overgrowth. Currently, influx of duodenal contents by duodenobiliary reflux is considered a mechanism of stent obstruction. The aim of the present study was to evaluate the efficacy and safety of a metal stent with an anti-reflux valve in distal malignant biliary obstruction. ⋯ The new metal stent with an S-shaped anti-reflux valve demonstrated a relatively long duration of stent patency. This was attributable to reductions in duodenobiliary reflux by the anti-reflux valve. Also, the stent with an S-shaped anti-reflux valve is technically feasible and very safe. However, further prospective, randomized comparison studies of stents with anti-reflux valves and conventional stents are needed to evaluate the duration of stent patency.
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Review
Recommended sedation and intraprocedural monitoring for gastric endoscopic submucosal dissection.
Endoscopic submucosal dissection is associated with a longer treatment time and a higher risk of patient discomfort than conventional procedures. Adequate, safe sedation is therefore essential. ⋯ A combination of benzodiazepines and analgesics are generally used for sedation, but new sedatives such as propofol and dexmedetomidine hydrochloride are expected to be useful agents. Endoscopists should become more familiar with sedatives, analgesics, and emergency procedures in the future.
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Letter Randomized Controlled Trial
Is topical pharyngeal anesthesia necessary in esophagogastroduodenoscopy in all unsedated patients?
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Case Reports
One-step, simultaneous triple endoscopic nasobiliary drainage for hilar biliary stricture.
The management of advanced hilar malignant and benign biliary strictures remains difficult regardless of the advances in endoscopic biliary stenting. Endoscopic nasobiliary drainage (ENBD) is suitable for the management, but the number of ENBD tubes is limited by the diameter of the accessory channel of the duodenoscope. In the present study,we demonstrated the feasibility and safety of one-step simultaneous triple ENBD insertion to manage hilar biliary strictures. ⋯ Three patients with hilar biliary stricture who suffered from acute cholangitis due to stent occlusion were successfully managed by one-step, simultaneous triple ENBD insertion. There were no procedure-related complications. One-step simultaneous triple ENBD is the most suitable drainage method for patients with advanced hilar biliary obstruction, especially in the setting of acute cholangitis due to occlusion of the previously placed stent.