A267 EUS-GUIDED HEPATOGASTROSTOMY POST PERCUTANEOUS BILIARY DRAINAGE IN COLLABORATION WITH INTERVENTIONAL RADIOLOGY
Notice bibliographique
Résumé
Endoscopic ultrasound guided hepatogastrostomy (EUS-HGS) is a popular approach to EUS-biliary drainage especially in the setting of concomitant gastric outlet obstruction. The main disadvantage of EUS-HGS is that it requires a dilated biliary system A case report (with video) describing the first conversion of a percutaneous transhepatic biliary drain (PTBD) into an HGS in a non-dilated biliary system using EUS and interventional radiology (IR) techniques. A 43-year old male underwent a staged R0 hepatic resection for colon cancer metastases, during which the common bile duct was fully transected. Bilateral PTBD were placed. Definitive stable drainage was required to allow adjuvant chemotherapy. The surgical option was a Roux-en-Y hepatico-jejunostomy. HGS was chosen as less invasive option allowing faster recovery and earlier initiation of chemo Under EUS guidance, a non-dilated segment II bile duct was punctured with a 19-gauge needle; however, given the small ductal caliber wire passage was not possible. Via the PTBD, 2 occlusive balloons were inserted into the target duct, with one central and one peripheral to the target puncture site. Saline was infused between the balloons, dilating the isolated bile duct segment. This eased the duct puncture and passage of an 0.035-inch guidewire. The wire; however, traveled peripherally in the bile ducts but was successfully grasped with a loop-snare (via PTBD access) and pulled out the PTBD track. With control of both ends of the wire, the hepatogastrostomy tract was easily dilated to 6 mm with a balloon inserted by PTBD. During tract dilation, A 10 mmx80 mm partially covered self-expandable metal stent was simultaneously loaded through the endoscope and advanced through the HGS tract immediately following deflation of the balloon thereby minimizing the time between dilation and stent insertion, to reduce bile leak. The stent was then successfully deployed with excellent spontaneous drainage of contrast. The patient was discharged 4 days later following check cholangiogram, normalization of bilirubin and removal of the PTBD. He was pain free with no evidence of bile leak We report the first successful conversion of PTBD to HGS using EUS and IR techniques in a non-dilated biliary system. Collaboration between endoscopists and IR can enhance the safety and feasability None
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».