• 1. Demling L, Classen M. Duodenojejunoskopie. Dtsch Med Wochenschr 1970; 95: 14271428.

  • 2. Joyce AM, Kochman M. Update on biliary endoscopy. Curr Opin Gastroentrol 2005; 21: 354358.

  • 3. Ferreira L, Baron T. Acute biliary conditions. Best Pract Res Clin Gastroenterol 2013; 27: 745756.

  • 4. Issa H, Al-Haddad A, Al-Salem AH. Diagnostic and therapeutic ERCP in the pediatric age group. Pediatr Surg Int 2007; 23: 111116.

  • 5. Rabenstein T, Schneider HT, Nicklas M, et al. Impact of skill and experience of the endoscopist on the outcome of endoscopic sphincterotomy techniques. Gastrointest Endosc 1999; 50: 628636.

    • Search Google Scholar
    • Export Citation
  • 6. Cohen S, Bacon BR, Berlin JA, et al. National Institutes of Health state-of-the-science conference statement: ERCP for diagnosis and therapy, January 14–16, 2002. Gastrointest Endosc 2002; 56: 803809.

    • Search Google Scholar
    • Export Citation
  • 7. Enestvedt BK, Tofani C, Lee DY, et al. Endoscopic retrograde cholangiopancreatography in the pediatric population is safe and efficacious. J Pediatr Gastroenterol Nutr 2013; 57: 649654.

    • Search Google Scholar
    • Export Citation
  • 8. Waldthaler A, Schutte K, Weigt J, et al. Long-term outcome of self expandable metal stents for biliary obstruction in chronic pancreatitis. JOP 2013; 14: 5762.

    • Search Google Scholar
    • Export Citation
  • 9. Craig PI. Role of endoscopic stenting for biliary strictures in chronic pancreatitis. Digest Endosc 2012; 21: 3842.

  • 10. Spohn K, Muller-Kluge M. Operations in malignant obstructive jaundice. Int Surg 1973; 58: 721722.

  • 11. Vellacott KD, Powell PH. Exploration of the common bile duct: a comparative study. Br J Surg 1979; 66: 389391.

  • 12. Kim JH, Gwon DI, Ko GY, et al. Temporary placement of retrievable fully covered metallic stents versus percutaneous balloon dilation in the treatment of benign biliary strictures. J Vasc Interv Radiol 2011; 22: 893899.

    • Search Google Scholar
    • Export Citation
  • 13. Judah JR, Draganov PV. Endoscopic therapy of benign biliary strictures. World J Gastroenterol 2007; 13: 35313539.

  • 14. Mehler S, Mayhew P, Drobatz K, et al. Variables associated with outcome in dogs undergoing extrahepatic biliary surgery: 60 cases (1988–2002). Vet Surg 2004; 33: 644649.

    • Search Google Scholar
    • Export Citation
  • 15. Ansellem P, Selm H, MacPhail C, et al. Long-term survival and risk factors associated with biliary surgery in dogs: 34 cases (1994–2004). J Am Vet Med Assoc 2006; 229: 14511457.

    • Search Google Scholar
    • Export Citation
  • 16. Mayhew P, Richardson R, Mehler S, et al. Choledochal tube stenting for decompression of the extrahepatic portion of the biliary tract in dogs: 13 cases (2002–2005). J Am Vet Med Assoc 2006; 228: 12091214.

    • Search Google Scholar
    • Export Citation
  • 17. Mayhew P, Weisse C. Treatment of pancreatitis-associated extrahepatic biliary tract obstruction by choledochal stenting in 7 cats. J Small Anim Pract 2008; 49: 133138.

    • Search Google Scholar
    • Export Citation
  • 18. Bacon N, White R. Extrahepatic biliary tract surgery in the cat: a case series and review. J Small Anim Pract 2003; 44: 231235.

  • 19. Buote N, Mitchell S, Penninck D, et al. Cholecystoenterostomy for treatment of extrahepatic biliary tract obstruction in cats: 22 cases (1994–2003). J Am Vet Med Assoc 2006; 228: 13761382.

    • Search Google Scholar
    • Export Citation
  • 20. Hakaim A, Broughan T, Vogt D, et al. Long-term results of the surgical management of chronic pancreatitis. Am Surg 1994; 60: 306308.

  • 21. Toumi Z, Alijarabah M, Ammori BJ. Role of laparoscopic approach to biliary bypass for benign and malignant biliary diseases: a systematic review. Surg Endosc 2011; 25: 21052116.

    • Search Google Scholar
    • Export Citation
  • 22. Costamagna G, Boskoski I. To drain or not to drain? That is the question. Dig Dis Sci 2013; 58: 14541456.

  • 23. Murphy S, Rodriguez J, McAnulty J. Minimally invasive cholecystostomy in the dog: evaluation of placement techniques and use in extrahepatic biliary obstruction. Vet Surg 2007; 36: 675683.

    • Search Google Scholar
    • Export Citation
  • 24. Herman BA, Brawer RS, Murtaugh RJ, et al. Therapeutic percutaneous ultrasound-guided cholecystocentesis in dogs with extrahepatic biliary obstruction and pancreatitis. J Am Vet Med Assoc 2005; 227: 17821753.

    • Search Google Scholar
    • Export Citation
  • 25. Clements WD, Parks R, Erwin P, et al. Role of the gut in the pathophysiology of extrahepatic biliary obstruction. Gut 1996; 39: 5870593.

    • Search Google Scholar
    • Export Citation
  • 26. Clements WD, McCaigue M, Halliday I, et al. Biliary decompression promotes Kupffer cell recovery in obstructive jaundice. Gut 1996; 38: 925931.

    • Search Google Scholar
    • Export Citation
  • 27. Falkenstein DB, Abrams RM, Kessler RE, et al. Endoscopic retrograde cholangiopancreaotography in the dog: a model of training and research. Gastrointest Endosc 1974; 21: 2526.

    • Search Google Scholar
    • Export Citation
  • 28. Spillmann T, Happonen I, Kahkonen T, et al. Endoscopic retrograde choangio-pancreatography in healthy Beagles. Vet Radiol Ultrasound 2005; 46: 97104.

    • Search Google Scholar
    • Export Citation
  • 29. Spillmann T, Schnell-Kretschmer H, Dick M, et al. Endoscopic retrograde cholangio-pancreatography in dogs with chronic gastrointestinal problems. Vet Radiol Ultrasound 2005; 46: 293299.

    • Search Google Scholar
    • Export Citation
  • 30. Casal ML, Scheidt JL, Rhodes JL, et al. Mutation identification in a canine model of X-linked ectodermal dysplasia. Mamm Genome 2005; 16: 524531.

    • Search Google Scholar
    • Export Citation
  • 31. Bellenger CR. Surgery for bile duct reupture and obstruction in the dog. Aust Vet J 1973; 49: 298306.

  • 32. Hunt C, Gofton N. Primary repair of a transected bile duct. J Am Anim Hosp Assoc 1984; 20: 5764.

  • 33. Beale BS, Goring RL, Schaer M, et al. Surgical treatment of perforating duodenal ulcer in a dog by use of modified choledochoduodenostomy and gastrojejunostomy. J Am Vet Med Assoc 1991; 198: 281285.

    • Search Google Scholar
    • Export Citation
  • 34. Martin R, MacCoy DM, Harvey HJ. Surgical management of extrahepatic biliary tract disease: a report of eleven cases. J Am Anim Hosp Assoc 1986; 22: 301307.

    • Search Google Scholar
    • Export Citation
  • 35. Jowell P, Baillie J, Branch M, et al. Quantitative assessment of procedural competence. A prospective study of training in endoscopic retrograde cholangiopancreatography. Ann Intern Med 1996; 125: 983989.

    • Search Google Scholar
    • Export Citation
  • 36. Otto AK, Neal MD, Slivka AN, et al. An appraisal of endoscopic retrograde cholangiopancreatography (ERCP) for pancreatoicobiliary disease in children: our institutional experience in 231 cases. Surg Endosc 2011; 25: 25362540.

    • Search Google Scholar
    • Export Citation
  • 37. Andriulli A, Loperfido S, Napolitano G, et al. Incidence rates of post-ERCP complications: a systemic survey of prospective studies. Am J Gastroentol 2007; 102: 17811788.

    • Search Google Scholar
    • Export Citation
  • 38. Ruppin H, Amon R, Ettl W, Classen M, Demling L. Acute pancreatitis after endoscopic/radiological pancreatography (ERP). Endoscopy 1974; 6: 9498.

    • Search Google Scholar
    • Export Citation
  • 39. Spillmann T, Happonen I, Sankari S, et al. Evaluation of serum values of pancreatic enzymes after endoscopic retrograde pancreatography in dogs. Am J Vet Res 65. 2004; 65: 616619.

    • Search Google Scholar
    • Export Citation
  • 40. Buscaglia JM, Simons BW, Prosser BJ et al. Severity of post-ERCP pancreatitis directly proportional to the invasiveness of endoscopic intervention: a pilot study in a canine model. Endoscopy 2008; 40: 506512.

    • Search Google Scholar
    • Export Citation
  • 41. Karsten TM, Davids PH, van Gulik TM, et al. Effects of biliary endoprostheses on the extrahepatic bile ducts in relation to subsequent operation of the biliary tract. J Am Coll Surg 1994; 178: 343352.

    • Search Google Scholar
    • Export Citation
  • 42. Dumonceau JM, Tringali A, Blero D, et al. Biliary stenting: indications, choice of stents and results: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. Endoscopy 2012; 44: 277298.

    • Search Google Scholar
    • Export Citation
  • 43. Cheon YK, Oh HC, Cho YD, et al. New 10 F soft and pliable polyurethane stents decrease the migration rate compared with conventional 10F polyethylene stents in hilar biliary obstruction: results of a pilot study. Gastrointest Endosc 2012; 75: 790797.

    • Search Google Scholar
    • Export Citation
  • 44. Kwon C, Ko KH, Hahm KB, et al. Functional self-expandable metal stents in biliary obstruction. Clin Endosc 2013; 46: 515521.

  • 45. Deviere J, Cremer M, Baize M, et al. Management of common bile duct structure caused by chronic pancreatitis with metal mesh self-expandable stents. Gut 1994; 35: 122126.

    • Search Google Scholar
    • Export Citation
  • 46. Van Berkel AM, Cahen DL., Van Westerloo DJ, et al. Self-expanding metal stents in benign biliary strictures due to chronic pancreatitis. Endoscopy 2004; 36: 381384.

    • Search Google Scholar
    • Export Citation
  • 47. Kim JH, Gwon D, Ko G, et al. Temporary placement of retrievable fully covered metallic stents versus percutaneous balloon dilation in the treatment of benign biliary strictures. J Vasc Interv Radiol 2011; 22: 893899.

    • Search Google Scholar
    • Export Citation
  • 48. Paumgartner G, Beuers U. Mechanisms of action and therapeutic efficacy of ursodeoxycholic acid in cholestatic liver disease. Clin Liver Dis 2004; 8: 6781.

    • Search Google Scholar
    • Export Citation
  • 49. Ward A, Brogden RN, Heel RC, et al. Ursodeoxycholic acid: a review of its pharmacological properties and therapeutic efficacy. Drugs 1984; 27: 95131.

    • Search Google Scholar
    • Export Citation

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Initial experience with endoscopic retrograde cholangiography and endoscopic retrograde biliary stenting for treatment of extrahepatic bile duct obstruction in dogs

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  • 1 Department of Diagnostic Imaging and Interventional Radiology, Animal Medical Center, 510 E 62nd St, New York, NY 10065.
  • | 2 Department of Diagnostic Imaging and Interventional Radiology, Animal Medical Center, 510 E 62nd St, New York, NY 10065.
  • | 3 Gastroenterology and Nutrition Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065.
  • | 4 Gastroenterology and Nutrition Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065.
  • | 5 Veterinary Specialty and Emergency Center, 301 Veterans Hwy, Levittown, PA 19056.
  • | 6 Division of Gastroenterology, Department of Medicine and the Wilmott Center for Endoscopic Innovation, Research and Training, University of Pennsylvania, Philadelphia, PA 19104.

Abstract

Objective—To describe techniques for endoscopic retrograde cholangiography (ERC) and endoscopic retrograde biliary stenting of the common bile duct (CBD) for minimally invasive treatment of extrahepatic bile duct obstruction (EHBDO) in dogs.

Design—Experimental study and clinical report.

Animals—7 healthy research dogs and 2 canine patients.

Procedures—ERC and endoscopic retrograde biliary stenting were performed in healthy purpose-bred research dogs and client-owned dogs with a diagnosis of EHBDO that underwent an attempted biliary stent procedure. Research dogs were euthanized after completion of the procedure and underwent necropsy. With dogs under general anesthesia, the pylorus was cannulated with a side-view duodenoscope, and the duodenum was entered. The major duodenal papilla (MDP) and minor duodenal papilla were then identified, and the MDP was cannulated. Endoscopic retrograde cholangiography and endoscopic retrograde biliary stenting were attempted with the aid of endoscopy and fluoroscopy in all dogs. Procedure time, outcome for duodenal and MDP cannulation, and success of stent placement were recorded.

Results—Endoscopic retrograde cholangiography was successfully performed in 5 of 7 research dogs and in 1 of 2 patients. Biliary stenting was achieved in 4 of 7 research dogs and 1 of 2 patients, with a polyurethane (n = 4) or self-expanding metallic stent (1). One patient had a mass such that visualization of the MDP was impossible and no attempt at biliary cannulation could be made. After placement, stent patency was documented by means of contrast cholangiography and visualization of biliary drainage into the duodenum intra-operatively. No major complications occurred during or after the procedure in any patient. Follow-up information 685 days after stent placement in 1 patient provided evidence of biliary patency on serial repeated ultrasonography and no evidence of complications.

Conclusions and Clinical Relevance—ERC and endoscopic retrograde biliary stenting were successfully performed in a small group of healthy dogs and 1 patient with EHBDO, but were technically challenging procedures. Further investigation of this minimally invasive technique for the treatment of EHBDO in dogs is necessary before this may be considered a viable alternative to current treatment methods.

Abstract

Objective—To describe techniques for endoscopic retrograde cholangiography (ERC) and endoscopic retrograde biliary stenting of the common bile duct (CBD) for minimally invasive treatment of extrahepatic bile duct obstruction (EHBDO) in dogs.

Design—Experimental study and clinical report.

Animals—7 healthy research dogs and 2 canine patients.

Procedures—ERC and endoscopic retrograde biliary stenting were performed in healthy purpose-bred research dogs and client-owned dogs with a diagnosis of EHBDO that underwent an attempted biliary stent procedure. Research dogs were euthanized after completion of the procedure and underwent necropsy. With dogs under general anesthesia, the pylorus was cannulated with a side-view duodenoscope, and the duodenum was entered. The major duodenal papilla (MDP) and minor duodenal papilla were then identified, and the MDP was cannulated. Endoscopic retrograde cholangiography and endoscopic retrograde biliary stenting were attempted with the aid of endoscopy and fluoroscopy in all dogs. Procedure time, outcome for duodenal and MDP cannulation, and success of stent placement were recorded.

Results—Endoscopic retrograde cholangiography was successfully performed in 5 of 7 research dogs and in 1 of 2 patients. Biliary stenting was achieved in 4 of 7 research dogs and 1 of 2 patients, with a polyurethane (n = 4) or self-expanding metallic stent (1). One patient had a mass such that visualization of the MDP was impossible and no attempt at biliary cannulation could be made. After placement, stent patency was documented by means of contrast cholangiography and visualization of biliary drainage into the duodenum intra-operatively. No major complications occurred during or after the procedure in any patient. Follow-up information 685 days after stent placement in 1 patient provided evidence of biliary patency on serial repeated ultrasonography and no evidence of complications.

Conclusions and Clinical Relevance—ERC and endoscopic retrograde biliary stenting were successfully performed in a small group of healthy dogs and 1 patient with EHBDO, but were technically challenging procedures. Further investigation of this minimally invasive technique for the treatment of EHBDO in dogs is necessary before this may be considered a viable alternative to current treatment methods.

Contributor Notes

Portions of this manuscript were presented in abstract form at the American College of Veterinary Internal Medicine Forum, San Antonio, Tex, June 2008; and the American College of Veterinary Surgeons Symposium, San Antonio Tex, October 2013.

Address correspondence to Dr. Berent (Allyson.Berent@amcny.org).