Endoscopic ultrasound-guided antegrade stenting in an occluded biliary self-expandable metal stent

Endoscopic ultrasound-guided biliary drainage (EUS-BD) is an attractive option for patients who cannot undergo conventional endoscopic retrograde cholangiopancreatography (ERCP) and do not want surgery or percutaneous drainage procedures. We present the use of EUS-antegrade (EUS-AG) insertion of a self-expandable metal stent (SEMS) in a patient with a common hepatic duct cholangiocarcinoma, as well as a huge gastric lipoma, after recurrent biliary obstruction of a prior SEMS inserted via ERCP in the same session as a duodenal stent insertion for gastric outlet obstruction

Bowel preparation quality between hospitalized patients and outpatient colonoscopies

Background/Aims: Optimal bowel preparation is essential for a complete high-quality colonoscopy. We sought to determine whether an inpatient, as opposed to an ambulatory setting, would affect the quality of bowel preparation. Patients and Methods: A retrospective chart review was conducted in a tertiary care university hospital. We collected demographic data from consecutive patients who underwent a colonoscopy for any reason between August 2007 and April 2012. Results: A total of 2999 patients were included in the study with a mean age of 50.36 (95%CI; 49.79–50.94). Males comprised 58.12%. Ambulatory patients had a higher rate of good bowel preparations (67.23% vs. 56.64%, P value < 0.01), a lower rate of poor bowel preparations (18.22% vs. 27.14%, P value < 0.01), and a higher rate of colonoscopy completion (86.79% vs. 77.59%, P value < 0.01). There was no difference between the rates of polyps detected (18.90% vs. 20.83%, P value = 0.22). The univariabe modeling factors associated with a sub-optimal bowel preparation were age OR 1.02 (95% CI, 1.01 to 1.02), chronic kidney disease OR 2.34 (95% CI, 1.12 to 4.88), diabetes mellitus OR 2.00 (95% CI, 1.50 to 2.68), hypertension OR 1.48 (95% CI, 1.11 to 1.97), anemia OR 1.81 (95% CI, 1.33 to 2.47), and weight loss OR 1.41 (95% CI, 1.01 to 1.96). Better bowel preparation was associated with colonoscopies performed in the outpatient setting OR 0.63 (95% CI, 0.54 to 0.73). Conclusion: Bowel preparation quality is affected by the setting in which it is performed. This result suggests that, when appropriate, colonoscopies should be performed on an outpatient basis. Further studies are required to replicate this finding

Predictors of failure of endoscopic retrograde cholangiography in clearing bile duct stone on the initial procedure

Background/Aims: The aim of this study is to predict cases where the clearance of the biliary system from stones at the initial endoscopic retrograde cholangiopancreatography (ERCP) might be of value for better risk-stratifying patients. We attempted to identify factors that are associated with a higher failure rate of clearing the biliary system on the index ERCP. Patients and Methods: This is a retrospective study from January 2008 to January 2015. All patients with bile duct stones confirmed on ERCP were included in this study. Patients who had prior attempts of bile duct stone extraction were excluded. Results: A total of 554 ERCPs were performed to extract biliary duct stones from 426 patients. The mean age was 46.3 years and 41.7% were males. The group where the index ERCP did not clear the biliary system tended to be older (50.4 vs. 45.2 years, P = 0.03). On multivariate analysis, the presence of fever (OR 4.64; 95% CI, 1.66–12.79), a larger number of filling defects (OR 1.34; 95% CI, 1.13–1.93), presence of a stricture distal to a stone (OR 4.63; 95% CI, 1.36–15.78), the use of an extraction basket (OR 3.23; 95% CI, 1.56–6.74), and/or mechanical lithotripsy (OR 3.05; 95% CI, 1.10–8.49) were all associated with a lower odds of clearing the biliary system. The use of an extraction balloon was associated with the success of clearing the biliary system (99.7% vs. 77.4%, P < 0.01) and a lower odds of failing (OR 0.01; 95% CI, 0.00–0.08) on multivariate analysis. Conclusion: A few of the characteristics that are found on cholangiography at the index ERCP could be used to identify patients that might require more than one ERCP to clear the biliary system from stones