Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society
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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.
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The aim of the present study was to assess the safety and efficacy of CO(2) during double-balloon enteroscopy (DBE) in an experimental animal model study. In this study, insufflation with room air and with CO(2) was compared. ⋯ The use of CO(2) for insufflation during DBE was safe and no complications associated with CO(2) were observed. In addition, the use of CO(2) offers benefits over the use of room air for insufflation during DBE.
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To determine the immediate and long-term results of endoscopic drainage and necrosectomy for symptomatic pancreatic fluid collections. ⋯ Endoscopic drainage of symptomatic pancreatic fluid collections is safe and effective, with excellent immediate and long-term results. Endoscopic necrosectomy has a risk of serious complications. The underlying pancreatic duct abnormalities must be addressed to prevent recurrence of fluid collections.
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Randomized Controlled Trial Comparative Study
Sedation with dexmedetomidine hydrochloride during endoscopic submucosal dissection of gastric cancer.
Although the treatment of early gastric cancer with endoscopic submucosal dissection (ESD) has been widely carried out, a standardized method of sedation for ESD has not been established. The purpose of the present study was to evaluate the efficacy and safety of sedation with dexmedetomidine (DEX). ⋯ Sedation with DEX is effective and safe for patients with gastric tumors who are undergoing ESD.
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Celiac plexus neurolysis (CPN) is an established treatment for upper abdominal cancer pain. Recently, endoscopic ultrasound-guided CPN (EUS-CPN) was introduced and has enabled the performance of CPN under real-time imaging guidance, thereby making this technique much safer and easier. However, this procedure is not always efficacious, and a limited number of patients benefit from it. It should not be recommended for patients suspected of having unfavorable outcomes. We determined the predictive factors for response to EUS-CPN in order to enable rational selection of the therapeutic strategy. ⋯ EUS-CPN seems to be less effective in patients with direct invasion of the celiac plexus. Ethanol should be injected on both sides of the celiac axis to obtain greater pain relief.