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DOI: 10.1055/a-2554-2784
Transpapillary biliary drainage using a forward-viewing endoscope for patients with distal malignant biliary obstruction and type I duodenal stenosis
Abstract
Background and study aims
Distal malignant biliary obstruction and duodenal stenosis may be complicated in patients with pancreaticobiliary cancer. It is often difficult to insert a side-viewing duodenoscope and perform transpapillary biliary drainage in patients with duodenal stenosis on the oral side of the major papilla; hence, in this study, we attempted transpapillary biliary drainage using a forward-viewing endoscope and reported its efficacy and safety.
Patients and methods
This retrospective single-center cohort study included 12 patients (17 sessions) who underwent transpapillary biliary drainage using a forward-viewing endoscope between April 2020 and October 2024. The tip of the forward-viewing endoscope was inverted around the inferior duodenal angulus and the major papilla was viewed from the anal side. We evaluated patient characteristics, outcomes, and adverse events (AEs) during these procedures.
Results
Biliary cannulation and drainage were successful in all cases, with a median cannulation and procedure time of 7 minutes (range 0.5–34) and 33 minutes (range 10–101), respectively. Median biliary cannulation time required was 3.5 minutes (range 0.5–15) for 10 sessions in patients with a history of endoscopic sphincterotomy and 9 minutes (range 4–34) for seven sessions in patients with native papilla (P = 0.01). The types of biliary drainage were plastic stent in nine sessions, endoscopic nasobiliary drainage in two sessions, and self-expandable metal stent in six sessions. Hyperamylasemia as AEs occurred in three sessions.
Conclusions
Transpapillary biliary drainage using a forward-viewing endoscope is a useful option for patients with type I duodenal stenosis.
Publication History
Received: 25 November 2024
Accepted after revision: 09 March 2025
Accepted Manuscript online:
10 March 2025
Article published online:
04 April 2025
© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
Yuichi Hirata, Kazuhiro Iida, Kei Takahashi, Mariko Hatada, Kana Miyara, Yuichiro Aoyama, Ryosuke Mizukami, Takahiro Oribe, Mizuka Yonezawa, Daisuke Orita, Ryutaro Yoshida, Michitaka Kouhashi, Takuya Mimura, Akihiko Nishizawa, Yoshihide Ueda, Kenzo Yamashiro, Yoshihiro Okabe. Transpapillary biliary drainage using a forward-viewing endoscope for patients with distal malignant biliary obstruction and type I duodenal stenosis. Endosc Int Open 2025; 13: a25542784.
DOI: 10.1055/a-2554-2784
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References
- 1 Hirschowitz BI, Curtiss LE, Peters CW. et al. Domonstration of new gastroscope, the fiberscope. Gastroenterology 1958; 35: 50
- 2 McCune WS, Shorb PE, Moscovitz H. Endoscopic cannulation of the ampulla of Vater: a preliminary report. Ann Surg 1968; 167: 752-756
- 3 Takagi K, Ikeda S, Nakagawa Y. et al. Retrograde pancreatography and cholangiography by fiber duodenoscope. Gastroenterology 1970; 59: 445-452
- 4 Mutignani M, Tringali A, Shah SG. et al. Combined endoscopic stent insertion in malignant biliary and duodenal obstruction. Endoscopy 2007; 39: 440-447
- 5 Hirata Y, Oribe T, Sugihara K. et al. Transpapillary biliary drainage using a forward-viewing endoscope for distal malignant biliary obstruction after placement of a duodenal stent for type I duodenal stenosis. Endoscopy 2024; 56: E253-E255
- 6 Isayama H, Hamada T, Yasuda I. et al. TOKYO criteria 2014 for transpapillary biliary stenting. Digest Endosc 2015; 27: 259-264
- 7 Kiriyama S, Kozaka K, Takada T. et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with video). J Hepatobiliary Pancreat Sci 2018; 25: 17-30
- 8 Gonzalez Valverde FM, Fernandez Lopez AJ. Management of duodenal perforations after endoscopic retrograde cholangiopancreatography. Revista Espanola de Enfermedades Digestivas 2019; 111: 331-333
- 9 Anastassiades CP, Salah W, Pauli EM. et al. Cap-assisted ERCP with a forward-viewing gastroscope as a rescue endoscopic intervention in patients with Billroth II anatomy. Surg Endosc 2013; 27: 2237
- 10 Itoi T, Ishii K, Sofuni A. et al. Ultrathin endoscope-assisted ERCP for inaccessible peridiverticular papilla by a single-baloon enteroscope in a patient with Roux-en-Y anastomosis. Dig Endosc 2010; 22: 334-336
- 11 Mori A, Ohashi N, Maruyama T. et al. Transnasal endoscopic retrograde cholangiopancreatography using an ultrathin endoscope: A prospective comparison with a routine oral procedure. World J Gastroenterol 2008; 14: 1514-1520
- 12 Mori A, Asano T, Maruyama T. et al. Transnasal ERCP/ENBD using as ultrathin esophagogastroduodenoscope. J Gastroenterol 2006; 41: 1237-1238
- 13 Mori A, Ohashi N, Maruyama T. et al. Endoscopic retrograde cholangiopancreatography through gastric stoma using ultrathin endoscope: a novel approach. Endoscopy 2007; 39: E323
- 14 Mori A, Tatebe H, Ohashi N. et al. Balloon-assisted insertion of a cholangioscope into the common bile duct: a novel technique. Endoscopy 2008; 40: E106-E107
- 15 Larghi A, Waxman I. Endoscopic direct cholangioscopy by using an ultra-slim upper endoscope: a feasibility study. Gastrointest Endosc 2006; 63: 853-857
- 16 Garcia-Cano J. Use of an ultrathin gastroscope to locate a papilla hidden within a duodenal diverticulum. Endoscopy 2010; 42: E96-E97
- 17 Qian Y, Huang J, Zhang Y. et al. Using a gastroscope to accomplish ERCP: a forward-viewing endoscope for cannulation of the intradiverticular papilla. Endoscopy 2014; 46: E139
- 18 Kim J, Lee JS, Kim EJ. et al. The usefulness of cap-assisted endoscopic retrograde cholangiopancreatography for cannulation complicated by a periampullary diverticulum. Korean J Gastroenterol 2018; 71: 168-172