Medline ® Abstracts for References 6-8
EUS-guided drainage of bilomas: a new alternative?
Shami VM, Talreja JP, Mahajan A, Phillips MS, Yeaton P, Kahaleh M
Gastrointest Endosc. 2008;67(1):136.
BACKGROUND: Bilomas have traditionally been treated by either percutaneous drainage or surgery. However, percutaneous drainage is associated with discomfort and infection, whereas surgery, which is usually reserved for refractory cases, has high morbidity and mortality rates. Recently, endoscopic drainage of bilomas adjacent to the GI lumen has been reported in isolated reports.
OBJECTIVE: We analyzed our 4 years' experience with this innovative technique.
DESIGN: Patients with symptomatic bilomas were offered EUS-guided drainage and were followed up prospectively for clinical and radiologic responses.
SETTING: Tertiary care center with long-standing experience in EUS-guided drainage.
PATIENTS: A total of 5 patients underwent EUS-guided transenteric drainage of symptomatic bilomas.
INTERVENTION: The technique included transenteric EUS-guided puncture, placement of a guidewire into the biloma, and creation of an enteral-biloma fistula with placement of a plastic endoprosthesis after balloon dilation. In 4 cases, the stents were removed at a mean of 6.8 +/- 4.3 weeks. In one patient with malignancy, the stent was left in place for palliation.
MAIN OUTCOME MEASUREMENTS: Efficacy and safety of EUS-guided drainage of bilomas.
RESULTS: EUS-guided transenteric biloma drainage was successfully performed in 5 patients without any significant morbidity. Biloma resolution was confirmed in all 5 patients, and none of the 4 patients relapsed after stent removal (mean follow-up of 12.8 +/- 6.1 months).
CONCLUSIONS: EUS-guided drainage of bilomas is technically feasible, appears safe, and provides an attractive alternative to percutaneous or surgical drainage.
Charlottesville, Virginia, USA.
Endoscopic ultrasound-guided drainage of a biloma: a novel approach.
Ponnudurai R, George A, Sachithanandan S, Abdullah A, Ganesaligam K, Sanker L, Merican I, Seewald S, Soehendra N
Hepatology Unit, Selayang Hospital, Selangor, Malaysia. firstname.lastname@example.org
Drainage of gallbladder fossa fluid collections with endoprosthesis placement under endoscopic ultrasound guidance: a preliminary report of two cases.
Kahaleh M, Wang P, Shami VM, Tokar J, Yeaton P
Collections of fluid in the gallbladder fossa can be detected by ultrasound in as many as 29% of patients following cholecystectomy. Traditionally, persistent collections are treated by percutaneous drainage and bile duct decompression. We present two cases of persistent gallbladder fossa fluid collections which were refractory to bile duct decompression but which were successfully drained by endoscopic ultrasound-guided endoprosthesis placement. Under endoscopic ultrasound (EUS) control, a 19-gauge needle was inserted through the duodenal wall into the gallbladder fossa fluid collection. A guide wire was coiled within the collection, and an endoprosthesis was placed over the wire. Endoprosthesis insertion was successful in both cases, resulting in rapid symptomatic and radiographic improvement. EUS-guided drainage offers a minimally invasive alternative to percutaneous treatment of persistent gallbladder fossa fluid collections following cholecystectomy.
Digestive Health Center of Excellence, University of Virginia Health System, Charlottesville, Virginia 22908-0708, USA. email@example.com