Air cholangiogram is not inferior to dye cholangiogram for malignant hilar biliary obstruction: a randomized study of efficacy and safety.

BACKGROUND: Endoscopic biliary drainage is the palliative treatment of choice in patients with malignant hilar biliary obstruction. Contrast injection can lead to cholangitis, whereas air cholangiography may have a lesser incidence of cholangitis. OBJECTIVE: The objective of the present study is to prospectively compare the efficacy and safety of air vs. dye cholangiogram in malignant hilar biliary obstruction. METHODS: Patients with type II and III malignant hilar biliary stricture were included in a prospectively randomized manner at a tertiary care center. Unilateral self-expanding metal stent was placed in patients with a malignant hilar block using either air or dye as a contrast medium. Outcome measures were successful deployment, successful drainage, early complications, and procedure-related and 30-day mortality. RESULTS: Forty-nine patients were randomized to air cholangiogram (25 patients, group A) or dye cholangiogram (24 patients, group B). Most of the patients had type II stricture (19 in group A and 20 in group B). Successful stenting and drainage were achieved in 25 (100 %) and 24 (96 %) in group A and 23 (95.8 %) and 22 (91.6 %) (p = ns), respectively. Cholangitis developed in 1 (4 %) and 4 (16.6 %) in group A and B, respectively (p < 0.05). There was no procedure-related or 30-day mortality. CONCLUSION: Use of air cholangiography was as safe and as effective as dye cholangiography in patients with malignant hilar biliary obstruction, and it decreased the risk of post-ERCP cholangitis.

Endoscopic ultrasound-guided drainage of pelvic abscess without fluoroscopy guidance.

BACKGROUND AND AIMS: Few case series are reported on endoscopic ultrasound (EUS)-guided drainage of pelvic abscesses under fluoroscopy guidance. We hypothesized that EUS-guided drainage of pelvic abscesses without fluoroscopy is an effective alternative to surgery in patients whose abscesses are not amenable to percutaneous drainage techniques. The aim of this study is to evaluate the clinical efficacy of EUS-guided trans-rectal/transcolonic drainage of pelvic abscess without fluoroscopy. METHODS: Fourteen consecutive patients with pelvic abscesses not amenable to percutaneous drainage underwent EUS-guided drainage over a period of 22 months. Main outcome measures were the resolution of the pelvic abscess on repeat imaging and improved clinical symptoms. RESULTS: Fourteen consecutive patients were enrolled. EUS-guided aspiration was performed in three patients. In two patients, dilatation and aspiration was performed, while trans-rectal stent was placed in nine patients. All patients became afebrile within 72 h. Stent was removed in all patients, after confirming the resolution of the abscess on repeat computed tomography after 7 days. One patient in whom only aspiration was done had recurrence of fever and abscess on the seventh day and was treated by surgical drainage. A follow-up EUS done in 13 of the patients after 3 months revealed no recurrence, and all patients were asymptomatic at 6 months. The procedure was uneventful in all patients. CONCLUSION: Endoscopic ultrasound-guided drainage without fluoroscopy is a safe and effective modality of treatment for pelvic abscesses not amenable to radiologically guided drainage, thus reducing the need for surgical intervention.