New Self-expandable Spiral Metallic Stent: Preliminary Clinical. Evaluation in Malignant Biliary Obstruction
|
|
- Owen Daniel
- 6 years ago
- Views:
Transcription
1 New Self-expandable Spiral Metallic Stent: Preliminary Clinical Evaluation in Malignant Biliary Obstruction PPRPOSE: To describe a new self-expandable spiral-shaped metallic stent and to evaluate its clinical efficacy in malignant biliary obstructions. PATIENTS AND METHODS: The Stent was made of a 0.01-ineh (0.25mm) stainless steel wire bent in a ziggag pattern and it was formed into a spiral configuration by differing the length of legs on each bend. One revolution was composed of 10 bends, and the stent longitudinally connected by hanging each bending point of abutting bends, without use of suture or silver solder. Twenty-six stent placed to relieve malignant biliary obstruction in 18 patients. Follow-up of 5-11 months (mean, 7 months) was obtained. RESULTS: All stents were placed in the desired location, and no procedural complications were encountered. Within 1 week after placement, all stents regained 90% or more of their original diameters. Five patients died (range,5-36 weeks), and 13 patients as still alive (range,20-45 weeks). Two patients
2 experienced recurrent jaundice and underwent further treatment. The stent wag easily inserted, expanded well, was flexible, could be repositioned, and did not shorten. CONCLUSION: Favorable clinical results were obtained with this spiral stent in malignant biliary obstruction, and further clinical testing is warranted Since 1985, when Carrasco et al (1) used intraluminal metallic stents in the biliary system in an animal model, various types of metallic stents have been designed and used for vascular and nonvascular strictures. Over the past few fears, man artieles have reported good results with use of metallie stents, especially in biliary obstruction (2-21). Several problems, however, have still been reported concerning commercially available metallic stents. The Wallstent device (Bchneider, Buelach, Switzerland) shortens considerably after expansion. The Gianturco-Rosch Z stent (Cook, Bloomington, Ind) has wide interspaees, which theoretically increase the prevalence of blockage in malignant obstruction due to tumor ingrowth, and has weak radial force at the connected portion (22). To overcome these problems, we designed a new type of self-expandable spiralshaped metallic stent and report clinical results in patients with malignant biliary obstruction. PATIENTS AND METHODS Stent A new spiral stent was made of a 0.01-ineh (0.25-mm) stainless steel wire bent in a zigzag pattern with alternating leg lengths; the longer leg was 8 mm in length, and the shorter leg was 7.2 mm. One revolution consisted of 10 bends, farming a spiral cylindric configuration (Fig 1). Each bending point twas a 5" torsion angle that alternated direction to prevent distortion at each connecting point caused by hanging the abutting caudal bend. The stent was longitudinally connected by hanging he cephalic bending points of distal egment on the corresponding caudal bending points of proximal segment. That is, the cephalic bending point of the 11th bend was hung on the caudal bending point of the thirst bend, and the 12th bend on the second bend, in that order (Fig 2). The stent was 10 mm in fully expanded
3 diameter, and the length wart variable. The stent was construected with only one wire, without use of silver solder or suture for connection. To prevent twisting and overlapping of the stent, both ends of wire were used as struts, which traversed each segment obliquely, and were firmed to the bend of the opposite segment. The stents were made by hand and were not commercially manufactuned. These are, however, now available commercially (Sooho Meditech, Seoul, Korea). The research protocol was approved by the Hospital Institutional Review Committee, and all patients signed an experimental subject consent farm. Patients Between September 1993 and July 1994,26 self-expandable spiral metallic stents were placed in 18 consecutive patients with unreseetable malignant biliary obstruction. Patients ranged in age from 34 to 73 years(mean,58 years) and included 10 men and eight women (Table).
4 The causes of obstruction were hi-lar cholangiocarcinoma in eight patients, common bile duct (CBD) carcinoma in five, gallbladder carcinoma in one, pancreatic carcinoma in three, and metastasis from rectal carcinoma in one. The diagnoses were pathologically proved with surgery in seven patients, percutaneous needle aspiration in four, bile cytology in three, and biopsy through a percutaneous transhepatic biliary drainage (PTBD) tube in four. The site of obstruction was the hilar portion in eight patients and the CBD in 10. One patient with recurrentjaundice, which developed 13 mouths after placement of a Giantureo stent, was included in this study (patient 1 in Table). In this case, ingrowing tumor was pathologically proved to be papillary carciroma of the CBD with biopsy through a PTBD tube. Figure 4. Method of retrieving the deployed stent. (a) A puree-string suture is placed through the caudal bend of the tail stent and runs through the positioner. (b) The positioner is advanced, and the bends of the tail stent are gathered. (c) The sheath is advanced overthe stent.
5 Technique All patients had undergone PTBD under fluoroscopic guidance, and the stents were placed 3-5 days after the initial drainage procedure. Before stent insertion, cholangiograms were obtained through an external drainage tube to evaluate the level and length of biliary obstruction. The stents were inserted through the right intrahepatic duct in nine patients, the left intrahepatic duct in one, and the bilateral transhepatic route in eight (Fig 3).
6 The technique of stent placement was the same as that far the GianturcoRosch Z stent, and it has been previously described in detail (7-10). For stent delivery, we used an 8.5-F Gianturco-Rosch biliary Z stent introducer set (Cook). The introducer sheath was placed across the desired deployment site in the bile duct, and the compressed stent was pushed by the positioned. When the stent was in the proper
7 position, the positioned was fixed and the sheath was withdrawn to expose the stent and allow it to expand. If the stent is malpositioned, it can, be relocated or retrieved easily. The method of relocation or retrieval is similar to that uses with the stent described by Irie et at (23). To be able to relocate the malpositioned stent, before the stent is inserted into the introducing sheath, a parse-string suture is run through the caudal bend of the stent tail and the positioner. If relocation is necessary after stent deployment, the positioned is advanced to the caudal end of the stent, the holding suture is pulled to compress the caudal bend of the stent, and the stent is retracted by advancing the sheath over it. The stent can now be retrieved by pulling the holding future or relocated by moving the sheath to a new position. After replacement, one limb of the retention loop is withdrawn out of the positioner (Fig 4). Antibiotics were administered intravenously to all patients prior to procedure, and intravenous analgesics (Demerol [meperidine hydroehloride]: Sanofi Winthrop Pharmaceuticals, New York, NY) were given to two patients who experienced pain during tine procedure. Balloon dilation of stenotic segments was not performed prior to stent insertion, and we chose a stent that twas at leasts 2 cm longer than the obstructed segment. The length of stent uses ranged from 7 to 13 cm (mean,8.3 cm). After stent placement, a 5-F external drainage catheter remained within the stent to monitor continued stent patency. Follow-up cholangiograms were obtained through the external drainage catheter on the 3rd and 7th day after placement. Plain abdominal radiography was used to evaluate the position and the degree of expansion of the stents. We analyzed the time course of stent expansion on follow-up image and monitored serum bilirubin leve to evaluate the effects on jaundice. RESULTS Initial stent placement was successful in all patients without need for repositioning or retrieval. No major complications were encountered during or after stent insertion. One patient with gallbladder carcinoma, who had undergone placement of two stents by means of bilateral transhepatic approaches,
8 also underwent intraluminal iridium-192 radiation therapy. Of 18 patients, five have died (range,5-36 weeks) and the remaining 13 patients are still alive (range, Weeks).Two Patients developed recurrent jaundiee and underwent PTBD. The time lag between stent insertion and recurrent jaundice was 35 weeks and 19 weeks (Table). The cause of reocclusion was tumor ingrowth in the former and tumor overgrowth in the latter. One patient (patient 1 in Table) who developed reocelusion due to tumor ingrowth had a papillary carcinoma of the CBD, which tends to grow intraluminally rather than to extend longitudinaliy. Initial serum bilirubin levels ranged from 11.5 to 44.3 ntg/dl ( mol/L)(mean, 23.4mg/dL(400mol/L); normal, <1.4 mg/dl [23.9mol/L]). After stent insertion values returned to the normal range in all patients. All of the inserted stents regaine, 90% or more of their original diameter within a week after placement and showed no shortening after ex- pansion. Three stents placed across the papilla of vater showed no problems such as erosion or ulceration of duodenal mucosa, which was confirmed with endoscopy during the follow-up period (Fig 5). The stent plaeed in a curved area maintained its flexibility without de crease in luminal diameter.
9 DISCUSSI0N Recently, various metallic stents have been introduced and used in the biliary system, they are variations of three major stent tapes. These are the Giantureo Z stent, the Wallstent, and the Streeker stent (Meditech/Boston Scientific, Watertown, Mass). While all three types of metallic stents are constructed of a
10 thin, wire-type material, they differ in wire composition, shape, and delivery method. For these reasons, they have diffarent characteristics.the Wallstent is made of stainless steel wires woven into a tubular mesh, The stent is compressed by a rolling membrane, which is removed during insertion. It erin be introduced through a 7-F sheath, the smallest diameter among available stents, and has narrow interspaces, lessening the occlusion rate due to tumor ingrowth. However, shortening after expansion (32%-40% shortening of initial length) and less radiopacity make adequate placement diffcult (5,6,15). It has been reported that duodenal ulceration and CBD perferation are caused by sharp wires on both ends of the stent (6). The Strecker stent is a balloonexpandable device made of tantalum wire. It hart superior flexibility and radiopaeity. On the other hand, because it has less self-expansibility, it is less desirable to usa the strecker stent in cases with rigid obstruction such as metastatic Iymphadenopathy. A 10-F introducing sheath is required due to the size of the deflated balloon, and shortening is shown after placement (19% shortening of initial fength) (7). The Gianturco Z stent is self-expandable and is constructed of fine Stainless steel wire with a zigzag configuration. It has good expansibility and shows no shortening after expansion. In the original design, individual bodied are connected by additional straight struts with soldering. Therefore, it has some limitations in curved lesions. In the modified design, six bands are tied with a nylon Buture that Passes through eyelets at the end of each bend to farm a cylinder.twelve eyelets located at the connected portion limit increases in number of bends, resulting in wide interspace, and limit decreased in the diameter of the introducer. It has lower expandable force in areas of connections be tween individual stent bodies. Also, it is difficult to push the stent with multiple bodied through the introducer due to overlapping at connected portion, especially in patient wish an angled tract. The inability to relocate the stent in cases of stent malposition and high costs are problems in all tapes of stents. Irie et at (23) designed a relocatable Gianturco-type expandable stent to replace malpositioned stent after placement but could not overcome the basic problems of the Z stent. We believe that an optimal stent should meet the following requirements: (a) be compressible and require only a small introducer, (b) have enough expansibility to expand the stricture segment and have
11 uniform expansibility throughout it entire length, (e) be easily delivered. (d) be radiopaque and well seen during delivery and positioning, (e) have narrow interspaces to prevent tumor ingrowth, (f) keep its length and not shorten after expansion, (g) be flexible and adjusts to a curved tract, and (h) be legs expensive. To solve some of the problems associated with the Giantureo Z stent. Maeda et at (24) firsts developed a spiral-shapes Z stent, and Nakamura et al (25) reported results of transjugular intrahepatic portosystemic shunt placement in an experimental model with use of a spiral stent. Their stent has uniform expansile farce throughout its effective length, good compressibility, and good stability. In their spiral stent, however, because one revolution consists of six bends, it has wide interspaces between leg wires, which is not considered suitable for use in malignant obstruction. On the contrary, as our stent was connected by a "hanging method" without using eyelets and suture, and was eomposed of 10 bends in one revolution, we could narrow the interspace as well as achieve uniformity in expansile force throughout the ontire length of the stent. Cragg et at (26) designed other type of spinal stent, which differed from that of Maeda et al in wire component (nitinol) and suture configuration (interrupted fashion). However, it is doubtful that their preclinical results in vascular system can be applied to the human biliafy system. We found that our new stent fulfilled all the aforementioned requirements in our experience. Firat it bas adequate compressibility. The 10-mm-diameter stent could be easily delivered through a 8.5-F sheath. Second, it has enough expansibility to relieve malignant obstruction an has better radiopacity than the Wallstent. Third, we could narrow the interspace by eliminating the eyelets and increasing the number of leg bendy. Fourth, it shown no shortening in length after expansion. Fifth, our stent kept its cylindrieal lumen in curved portions of the bile duct without decreasing its luminal diameter, because each segment was connected in a hanging fashion and was not fried. Finally, our spinal stent can be retrieved and relocated immediately after placement. Recently, Rossi et at (27) reported their multieenter clinical study concerning patency of
12 various tapes of metallic stents in 240 patients with malignant biliary obstruction. In their study, the 25- week patency rates were 78% for the nitinol Strecker stents,67% for the Wallstents,30% for the Z stents, and 20% for the tantalun Strecker stents. The 50-week patency rates were 68%,51%,0%, and 15% or less, respectively. Average patency was 8.3,5.9,2.3, and 4.0 months, respectively. In our clinical trials, the patency rate of this new stent was not worse than that of the other metallic stents. In conclusion, we obtained favorable clinical results with this new spiral stent in patients wish malignant biliary obstruetions. We believe that our stent may be premising for clinical Use. Aclmowledgments: We thank Mi Jae Lee and Young Soo Lee far assistance in our stent placement procedure, Sung Boon An, Jae Yong Lee, and Buk Jae Lee at Sooho Medi-tech far manufacturing the stent. References 1. Carrasco CH, Wallace S, Charnsangavej C, et al. Expandable biliary endoprosthesis: an experimental study. AJR 1985; 145: McLean GK Burke DR. Role of endoprostheses in the management of malignant biliary obstruction. Ra- diology 1989; 10: Mueller PR, Damson SL. Metallic biliary endoprostheses and biliary stricture dilation. Syllabus: a diag- nostic categorical course in interventional radiology. Oak Brook, III: Radiological Society of North America,1991; Lammer J, Klein GE, Kleinert R, Hausegger K, Einspieler R. Obstructive jaundice: use of expandable metal endoprosthesis for biliary drainage. Radiology 1990; 177:
13 5. Adam A, Chetty N, Roddie M, Yeung B, Benjamin IS. Self-expandable stainless steel endoprostheses for treatment of malignant bile duct obstruction. AJR 1991; 156: Lameris JS, Stoker J, Nijs HGT et al. Malignant biliary obstruction: percutaneous use of selfexpandable stents. Radiology 1991; 179: hammer J, Fluectiger F, Hausegger KA, Klein GE, Aschauer M. Biliary expandable metal stents. Bemin Intervent Radiol 1991; 8: Damson SL, Lee MJ, Mueller PR. Metal endoprostheses in malignant biliary obstruction. Semin Interment Radiol 1991; 8: frying JD, Adam A, Dick R, Dondelinger RF, Lunderquist A, Roche A. Gianturco expandable metallic bitiary stents: results of a European clinical trial. Radiology 1989;172: Coons HG. Self-expanding stainless ateel biliary agents. Radiology 1989; 170: Iwamiya T, Sawada S, Fuijwara Y, et al. Clinical experience of expandable metallic stent placement for malignant biliary obstruction. Nippon Acta Radiol 1991; 51: LaBerge JM, Doherty M, Gordon RL, Ring EJ. Hilar malignancy: treatment with an expandable metallic transhepatic biliary stent. Radiology 1990; 177: Cordon RL, Ring EJ, LaBerge JM, Dohfrty MM. Malignant biliary obstruction: treatment with expandable metallic stents-follow-up of 50 consecutive patients. Radiology 1992; 182: Yoshioka T, Sakaguchi B, Yoshimura H, et al. Expandable metallic biliary endoprostheses: preliminary clinical evaluation. Radiology 1990; 177: Gillams A, Dick R, Dooley JB, Wallstent H, Bl-Din A. Belf.expandable stainless steel braided
14 endoprostheais for biliary strictured. Radiology 1990; 174: Morita S. Biliary endoprosthesis of malignant biliary obstruction using expandable metallic stent: preliminary clinical evaluation. Nippon Acta Radiol 1992: 52: Saito H. A clinical study of biliary endoprosthesis using expandable metallic stent: evaluation of early results. Nippon Acta Radiol 1992; 52: Salomonowitz EK Adam A, Antonucci F, Stuckmann G, Zollikofer CL. Malignant biliary obstruction: treatment with self-expandable stainless steel enddoprosthesis. Cardiovasc Intervent Radiol 1992; 15: Jaschke W, Klose KJ, Strecker EP. A new balloon-expandable tantalum stent (Strecker-stent) for the biliary system: preliminary experience. Cardiovasc Interment Radiol 1992; 15: Maccioni F, Rossi M, SaIvatori FM, Ricci P, Bezzi M, Rossi p. Metallie stents in benign biliary strictures: three-year follow-up. Cardiovasc Interment Radios 1992:15: Coon H. Metallic stents for the treatment of biliary obstruction: a report of 100 cases. Cardiovasc Intervent Radiol 1992; 15: Lee MJ, Dawson SL, Mueller PR, et al. Pereutaneous management of hilar biliary malignancies with metallic endoprostheaea: results, technical problems, and causes of failure. RadioGraphies 1993: 13: Irie T, Furui S, Yamauchi T, Makita K Sawada S, Takenaka E.Relocattable Giantureo expandable metallic stents. Radiology 1991; 178: Maeda M, Timmermans HA, Uchida BT, Kelier FS, Rosch J. In vitro comparison of the spiral
15 Z stent and the Gianturco Z stent.jvir 1992; 3: Nakamura K Takashima S, Kichikawa K Uchida BT, Holler FS, Rosch J. Postal decompression after transjugular intrahepatic potatosystemic shunt creation with use of a spiral stent.jvir 1993; 4: Cragg AH, De Jong SC, Barnhart WH, Landas SK, Smith TP. Nitinol inttavascular stent: results of preclinical evaluation. Radiology 1993; 189: Rossi R, Bezzi M, Rossi M, et at. Metallic stents in malignant biliary obstruction: resu1ts of a multicenter European study of 240 patients. JVIR 1994; 5:
16
Intraluminal Brachytherapy after Metallic Stent Placement in Primary Bile Duct Carcinoma 1
Intraluminal Brachytherapy after Metallic Stent Placement in Primary Bile Duct Carcinoma 1 Kyu-Hong Park, M.D., Soon Gu Cho, M.D., Sung-Gwon Kang, M.D. 1,2, Don Haeng Lee, M.D. 3, Woo Cheol Kim, M.D. 4,
More informationEarly Infectious Complications of Percutaneous Metallic Stent Insertion for Malignant Biliary Obstruction
Vascular and Interventional Radiology Original Research Sol et al. Stent Insertion in Biliary Obstruction Vascular and Interventional Radiology Original Research Yu Li Sol 1 Chang Won Kim 1 Ung Bae Jeon
More informationIn Vitro Evaluation of Endovascular Stents to Assess Suitability for Endovascular Graft Fixation*
Eur J Vasc Endovasc Surg 9, 403-407 (1995) In Vitro Evaluation of Endovascular Stents to Assess Suitability for Endovascular Graft Fixation* S. M. Andrews ~, A. W. Anson 2, R. M. Greenhalgh ~ and D. M.
More informationBiliary Metal Stents MAKING A DIFFERENCE TO HEALTH
Biliary Metal Stents In a fast paced and maturing market, Diagmed Healthcare s Hanarostent has managed to continue to innovate and add unique and clinically superior features to its already premium range.
More informationCovered biliary stents with proximal bare stent extension for the palliation of malignant biliary disease: can we reduce tumour overgrowth rate?
Original Article Covered biliary stents with proximal bare stent extension for the palliation of malignant biliary disease: can we reduce tumour overgrowth rate? Miltiadis Krokidis 1, Adam Hatzidakis 2
More informationСтенты «Ella-cs» Уважаемые коллеги! Высылаем очередной выпуск «Issue of ELLA Abstracts»
Уважаемые коллеги! Высылаем очередной выпуск «Issue of ELLA Abstracts» A. Esophageal Stenting and related topics 1 AMJG 2009; 104:1329 1330 Letters to Editor Early Tracheal Stenosis Post Esophageal Stent
More informationExpandable stents in digestive pathology present use in an emergency hospital
ORIGINAL ARTICLES Article received on November30, 2015 and accepted for publishing on December15, 2015. Expandable stents in digestive pathology present use in an emergency hospital Mădălina Ilie 1, Vasile
More informationMaximize Control. Minimize Migration.
Maximize Control. Minimize Migration. New SHORT WIRE Delivery System SHORT W IRE BILIARY ENDOPROSTHESIS Improved treatment of biliary strictures The self-expanding, fully covered metal stent is intended
More informationACUTE CHOLANGITIS AS a result of an occluded
Digestive Endoscopy 2017; 29 (Suppl. 2): 88 93 doi: 10.1111/den.12836 Current status of biliary drainage strategy for acute cholangitis Endoscopic treatment for acute cholangitis with common bile duct
More informationGastric / EUS Metal Stents
Gastric / EUS Metal Stents In a fast paced and maturing market, Diagmed Healthcare s Hanarostent has managed to continue to innovate and add unique and clinically superior features to its already premium
More informationColonic Metal Stents MAKING A DIFFERENCE TO HEALTH
Colonic Metal Stents In a fast paced and maturing market, Diagmed Healthcare s Hanarostent has managed to continue to innovate and add unique and clinically superior features to its already premium range.
More informationJennifer Hsieh 1, Amar Thosani 1, Matthew Grunwald 2, Satish Nagula 1, Juan Carlos Bucobo 1, Jonathan M. Buscaglia 1. Introduction
How We Do It Serial insertion of bilateral uncovered metal stents for malignant hilar obstruction using an 8 Fr biliary system: a case series of 17 consecutive patients Jennifer Hsieh 1, Amar Thosani 1,
More informationEvaluation of the Biodurability of Polyurethane-Covered Stent Using a Flow Phantom
Evaluation of the Biodurability of Polyurethane-Covered Stent Using a Flow Phantom Dong Hyun Kim, MD 1 Sung-Gwon Kang, MD 1 Jung Ryul Choi, MD 1 Ju Nam Byun, MD 1 Young Chul Kim, MD 1 Young Moo Ahn, PhD
More informationVascular complications in percutaneous biliary interventions: A series of 111 procedures
Vascular complications in percutaneous biliary interventions: A series of 111 procedures Poster No.: C-0744 Congress: ECR 2013 Type: Educational Exhibit Authors: A. BHARADWAZ; AARHUS, Re/DK Keywords: Obstruction
More informationDouble-Stent System with Long Duodenal Extension for Palliative Treatment of Malignant Extrahepatic Biliary Obstructions: A Prospective Study
Original Article Intervention https://doi.org/10.3348/kjr.2018.19.2.230 pissn 1229-6929 eissn 2005-8330 Korean J Radiol 2018;19(2):230-236 Double-Stent System with Long Duodenal Extension for Palliative
More informationAfferent Loop Syndrome: Treatment by Means of the Placement of Dual Stents
Vascular and Interventional Radiology Original Research Han et al. Use of Dual Stents for Treatment of Afferent Loop Syndrome Vascular and Interventional Radiology Original Research Kichang Han 1 Ho-Young
More informationPrimary patency of percutaneously inserted self-expanding metallic stents in patients with malignant biliary obstructionhpb_
DOI:10.1111/j.1477-2574.2009.00069.x HPB ORIGINAL ARTICLE Primary patency of percutaneously inserted self-expanding metallic stents in patients with malignant biliary obstructionhpb_069 358..363 Ursula
More informationEndoscopic Management of Biliary Strictures. Sammy Ho, MD Director of Pancreaticobiliary Services and Endoscopic Ultrasound Montefiore Medical Center
Endoscopic Management of Biliary Strictures Sammy Ho, MD Director of Pancreaticobiliary Services and Endoscopic Ultrasound Montefiore Medical Center Malignant Biliary Strictures Etiologies: Pancreatic
More informationThe first stents designed for use in the biliary tree and
Imaging and Advanced Technology Michael B. Wallace, Section Editor Expandable Gastrointestinal Stents TODD H. BARON Department of Medicine, Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester,
More informationApproach to the Biliary Stricture
Approach to the Biliary Stricture ACG Eastern Postgraduate Course Washington DC June 8, 2014 Steven A. Edmundowicz MD FASGE Chief of Endoscopy Division of Gastroenterology Professor of Medicine Disclosures
More informationWallFlex Stents Technique Spotlights
WallFlex Stents Technique Spotlights OPEN TO THE POSSIBILITIES SEAN E. McGarr, do Kennebec Gastrointestinal Associates Maine General Medical Center, Augusta, ME 04330, United States Director of Gastrointestinal
More informationAllium Trans-hepatic Biliary Stent (BIS)
Allium Trans-hepatic Biliary (BIS) Instructions for Use Manufactured by Allium Ltd. DEVICE NAME Allium Trans-hepatic Biliary (BIS) DEVICE DESCRIPTION The Trans-hepatic BIS is a flexible, self-expanding
More informationEndoscopic Management of the Iatrogenic CBD Injury
The Liver Week 2014, Jeju, Korea Endoscopic Management of the Iatrogenic CBD Injury Jong Ho Moon, MD, PhD Department of Internal Medicine Soon Chun Hyang University School of Medicine Bucheon/Seoul, KOREA
More informationTo evaluate 792 patients with malignant biliary obstruction after inner-stents drainage procedure
To evaluate 792 patients with malignant biliary obstruction after inner-stents drainage procedure Zhu wei, Zhang xiquan, Pan xiaolin, Dong ge, Guo feng. The Cardio-Interventional Center, The 148th PLA
More informationThe Efficacy of Metallic Stent Placement in the Treatment of Colorectal Obstruction
The Efficacy of Metallic Stent Placement in the Treatment of Colorectal Obstruction Sung-Gwon Kang, MD 1 Gyu Sik Jung, MD 2 Soon Gu Cho, MD 3 Jae Gyu Kim, MD 4 Joo Hyung Oh, MD 5 Ho Young Song, MD 6 Eun
More informationEGIS BILIARY STENT. 1. Features & Benefits 2. Ordering information 3. References
EGIS BILIARY STENT 1. Features & Benefits 2. Ordering information 3. References 1. Features & Benefits (1) Features Superior flexibility & conformability 4 Types Single bare, Single cover, Double bare,
More informationMAKING CONNECTIONS. Los Angeles Medical Center
MAKING CONNECTIONS Los Angeles Medical Center Resident: Chris Molloy, MD Fellow: Christian Coroian, MD, MBA Attending: Tina Hardley, MD Program/Dept(s): Los Angeles Medical Center CHIEF COMPLAINT & HPI
More informationPartially Covered Metal Stents May Not Prolong Stent Patency Compared to Uncovered Stents in Unresectable Malignant Distal Biliary Obstruction
Gut and Liver, Vol. 11, No. 3, May 217, pp. 44-446 ORiginal Article Partially Covered Metal Stents May Not Prolong Stent Patency Compared to Uncovered Stents in Unresectable Malignant Distal Biliary Obstruction
More informationAcute dissections of the descending thoracic aorta (Debakey
Endovascular Treatment of Acute Descending Thoracic Aortic Dissections Nimesh D. Desai, MD, PhD, and Joseph E. Bavaria, MD Acute dissections of the descending thoracic aorta (Debakey type III or Stanford
More informationRecanalisation of urethral strictures with new-generation temporary covered biocompatible metal endoprostheses
Acta Chirurgica Iugoslavica (ACI) Vol: LIV, (3) 2007, pages 123-127 SCIENTIFIC PAPER UDC: 616.65-007.271-089.819.5 Recanalisation of urethral strictures with new-generation temporary covered biocompatible
More informationOwen Dickinson. Consultant in Endoscopy & Interventional Radiology. Upper GI Stenting. Rotherham Foundation Trust
Owen Dickinson Consultant in Endoscopy & Interventional Radiology Upper GI Stenting Rotherham Foundation Trust Owen Dickinson Consultant in Endoscopy & Interventional Radiology Rotherham Foundation Trust
More informationWallFlex Biliary RX Fully Covered Stent System Prescriptive Information
Caution/Rx Only: Federal Law (USA) restricts this device to sale by or on the order of a physician. Warning Contents supplied STERILE using an ethylene oxide (EO) process. Do not use if sterile barrier
More informationA Guide for Patients Living with a Biliary Metal Stent
A Guide for Patients Living with a Biliary Metal Stent What is a biliary metal stent? A biliary metal stent (also known as a bile duct stent ) is a flexible metallic tube specially designed to hold your
More informationWallFlex Biliary Metal Stents
WallFlex Biliary Metal Stents Please Note: These steps are intended to be for general guidance only. For complete instructions for use, indications, contraindications and warnings, please refer to the
More informationEndoscopic stenting in bile duct cancer increases liver volume
Endoscopic stenting in bile duct cancer increases liver volume Chang Hun Lee 1,3, Seung Young Seo 1,3, Seong Hun Kim 1,3, In Hee Kim 1,3, Sang Wook Kim 1,3, Soo Teik Lee 1,3, Dae Ghon Kim 1,3, Jae Do Yang
More informationClinical Performance of GORE VIABIL Biliary Endoprosthesis in the Treatment of Malignant Strictures
Clinical Performance of GORE VIABIL Biliary Endoprosthesis in the Treatment of Malignant Strictures Scientific Literature Summary (n = 663 patients) * GORE VIABIL Biliary Endoprosthesis Advancing Biliary
More informationAdvanced Bronchoscopy
Advanced Bronchoscopy Radial Jaw 4 Pulmonary Forceps Ultraflex Tracheobronchial Stent System CRE Pulmonary Balloon Alair Bronchial Thermoplasty Catheter CRE Pulmonary Balloon Radial Jaw 4 Pulmonary Forceps
More informationexpandable stents by chronic pancreatitis with metal mesh self Management of common bile duct stricture caused
122 Medicosurgical Department of Gastroenterology, H6pital Erasme, Universite Libre de Bruxelles, Brussels, Belgium J Deviere M Cremer M Baize J Love B Sugai A Vandermeeren Correspondence to: Dr J Deviere,
More informationEGIS ESOPHAGEAL STENT. 1. Features & Benefits 2. Ordering information 3. References & Clinical case
EGIS ESOPHAGEAL STENT 1. & Benefits 2. Ordering information 3. References & Clinical case 1. & Benefits (1) Benefits Superior flexibility & conformability Improving compliance in curved organ(tortuous
More informationNorth Medical Endoscopic Biliary Stent (BilS)
North Medical Endoscopic Biliary Stent (BilS) Instructions for Use Manufactured by North Medical DEVICE NAME North Medical Endoscopic Biliary Stent (BilS) DEVICE DESCRIPTION North Medical's BilS stent
More informationMalperfusion Syndromes Type B Aortic Dissection with Malperfusion
Malperfusion Syndromes Type B Aortic Dissection with Malperfusion Jade S. Hiramoto, MD, MAS April 27, 2012 Associated with early mortality Occurs when there is end organ ischemia secondary to aortic branch
More informationTools of the Gastroenterologist: Introduction to GI Endoscopy
Tools of the Gastroenterologist: Introduction to GI Endoscopy Objectives Endoscopy Upper endoscopy Colonoscopy Endoscopic retrograde cholangiopancreatography (ERCP) Endoscopic ultrasound (EUS) Endoscopic
More informationTrimming of a Broken Migrated Biliary Metal Stent with the Nd:YAG Laser
16 Trimming of a Broken Migrated Biliary Metal Stent with the Nd:YAG Laser I. Zuber-Jerger F. Kullmann Department of Internal Medicine I, University of Regensburg, Regensburg, Germany Key Words Broken
More informationIII. United States Patent (19) Sheiban 5,226,889. Jul. 13, and at least a pair of inflatable balloons carried on the
United States Patent (19) Sheiban (54) DOUBLE BALLOON CATHETER FOR STENT IMPLANTATION 76 Inventor: Imad Sheiban, Via Sommavalle No. 9, Verona, 37128, Italy (21) Appl. No.: 734,968 (22 Filed: Jul. 24, 1991
More informationNewly Designed Sheaths for Gastroduodenal Intervention: An Experimental Study in a Phantom and Dogs
Newly Designed Sheaths for Gastroduodenal Intervention: An Experimental Study in a Phantom and Dogs Tae-Seok Seo, MD, PhD 1,2 Ho-Young Song, MD, PhD 1 Jong-Heon Lee, PhD 3 Gi-Young Ko, MD, PhD 1 Kyu-Bo
More informationSelf-Expanding Metal Stents for Palliative Treatment of Superior Vena Caval Syndrome
Cardiovasc Intervent Radiol (1996) 19:146 151 CardioVascular and Interventional Radiology Springer-Verlag New York Inc. 1996 Self-Expanding Metal Stents for Palliative Treatment of Superior Vena Caval
More informationCurved Planar Reformatted Images of MDCT for Differentiation of Biliary Stent Occlusion in Patients With Malignant Biliary Obstruction
Gastrointestinal Imaging Original Research Bang et al. MDCT of Biliary Stent Occlusion Gastrointestinal Imaging Original Research Byoung Wook Bang 1 Seok Jeong 1 Don Haeng Lee 2 Chul Hyun Kim 1 Soon Gu
More informationPercutaneous Transhepatic Release of an Impacted Lithotripter Basket and Its Fractured Traction Wire Using a Goose-Neck Snare: a Case Report
Case Report DOI: 10.3348/kjr.2011.12.2.247 pissn 1229-6929 eissn 2005-8330 Korean J Radiol 2011;12(2):247-251 Percutaneous Transhepatic Release of an Impacted Lithotripter Basket and Its Fractured Traction
More informationWallFlex Biliary RX Partially Covered Stent System Prescriptive Information
Caution/Rx Only: Federal Law (USA) restricts this device to sale by or on the order of a physician. Intended Use/Indications for Use The WallFlex Biliary RX is indicated for use in the palliative treatment
More informationMalignant Tracheobronchial Strictures: Palliation with Covered Retrievable Expandable Nitinol Stent
Malignant Tracheobronchial Strictures: Palliation with Covered Retrievable Expandable Nitinol Stent Ji Hoon Shin, MD, Sang-We Kim, MD, Tae Sun Shim, MD, Gyoo-Sik Jung, MD, Tae-Hyung Kim, MS, Gi-Young Ko,
More information7/11/2017. We re gonna help a lot of people today. Biliary/Pancreatic Endoscopy. AGS July 1-2, Kenneth M. Sigman, MD
Biliary/Pancreatic Endoscopy AGS July 1-2, 2017 Kenneth M. Sigman, MD We re gonna help a lot of people today 1 2 3 4 Cannulation It all starts with cannulation Double Wire Cannulation Difficult cannulations
More informationPRODUCTS FOR. Gastroenterology
PRODUCTS FOR Gastroenterology Contents Chait Percutaneous Cecostomy Set................................................. 2-3 Cope Gastrointestinal Suture Anchor Set..............................................
More informationPercutaneous Biliary Drainage Using Open Cell Stents for Malignant Biliary Hilar Obstruction
Original Article http://dx.doi.org/10.3348/kjr.2012.13.6.795 pissn 1229-6929 eissn 2005-8330 Korean J Radiol 2012;13(6):795-802 Percutaneous Biliary Drainage Using Open Cell Stents for Malignant Biliary
More informationInterventional Radiology Rounds:
1295 Interventional Radiology Rounds: University of California, San Francisco Percutaneous Biliary Drainage in the Management of Cholangiocarcinoma Robert K. Kerlan, Jr., Moderator1 Anton C. Pogany2 Henry
More informationCholangiocarcinoma (Bile Duct Cancer)
Cholangiocarcinoma (Bile Duct Cancer) The Bile Duct System (Biliary Tract) A network of bile ducts (tubes) connects the liver and the gallbladder to the small intestine. This network begins in the liver
More informationBiliary small intestinal submucosa covered Z-stents: preliminary results in an animal model
Biliary small intestinal submucosa covered Z-stents: preliminary results in an animal model Koichiro Yamakado 1,3, Dušan Pavčnik 1, Barry T Uchida 1, Hans Timmermans 1, Christopher L. Corless 2, Joong
More informationA tale of two LAMS: a report of benign tissue ingrowth resulting in recurrent gastric outlet obstruction
A tale of two LAMS: a report of benign tissue ingrowth resulting in recurrent gastric outlet obstruction Authors Parth J. Parekh, Mohammad H. Shakhatreh, Paul Yeaton Institution Department of Internal
More informationOriginal Article Intervention
Original Article Intervention http://dx.doi.org/10.3348/kjr.2013.14.5.789 pissn 1229-6929 eissn 2005-8330 Korean J Radiol 2013;14(5):789-796 Percutaneous Placement of Self-Expandable Metallic Stents in
More informationPercutaneous Biliary Forceps Biopsy for Suspect Malignant Biliary Obstruction
Chin J Radiol 2004; 29: 123-127 123 Percutaneous Biliary Forceps Biopsy for Suspect Malignant Biliary Obstruction ANDY SHAU-BIN CHOU 1,3 PAU-YANG CHANG 1 YUNG-HSIANG HSU 2 CHAU-CHIN LEE 1 SEA-KIAT LEE
More information6/17/2016. ERCP in June 26, Kenneth M. Sigman, M.D. Birmingham Gastroenterology Associates
ERCP in 2016 June 26, 2016 Kenneth M. Sigman, M.D. Birmingham Gastroenterology Associates 1 2 3 Diagnostic/Therapeutic ERCP Biliary Obstruction Benign stricture Malignant Stones Ductal injuries Cholangitis
More informationTherapeutic Bronchoscopy Etiology - Benign Stenosis Post - intubation Trauma Post - operative Inflammatory Idiopathic
Endobronchial Palliation of Airway Disease Douglas E. Wood, MD Professor and Chief Division of Cardiothoracic Surgery Vice-Chair, Department of Surgery Endowed Chair in Lung Cancer Research University
More informationTata Memorial Centre s opinion is summarized as follows: 1. Given the type 1 stricture (as mentioned in the structured summary), assessment
March 5 th 2016 Dear Ms. Malti Sinha, Thank you for reaching out to Tata Memorial Centre for an expert opinion in regard to assessing your treatment options. Navya Network is pleased to offer this online
More informationVersatility and Proven Safety
Versatility and Proven Safety Indicated for: Temporary or Permanent placement Standard or Over-The-Wire Delivery Jugular, Femoral, Antecubital, and Popliteal Access > Proven Safety Initial Clinical Trial
More informationPictorial review of Benign Biliary tract abnormality on MRCP/MRI Liver with Endoscopic (including splyglass) and Endoscopic Ultrasound correlation
Pictorial review of Benign Biliary tract abnormality on MRCP/MRI Liver with Endoscopic (including splyglass) and Endoscopic Ultrasound correlation Poster No.: C-2617 Congress: ECR 2015 Type: Educational
More informationAccess More Patients. Customize Each Seal.
Access More. Customize Each Seal. The Least Invasive Path Towards Proven Patency ULTRA LOW PROFILE TO EASE ADVANCEMENT The flexible, ultra-low 12F ID Ovation ix delivery system enables you to navigate
More informationBifurcated system Proximal suprarenal stent Modular (aortic main body and two iliac legs) Full thickness woven polyester graft material Fully
Physician Training Bifurcated system Proximal suprarenal stent Modular (aortic main body and two iliac legs) Full thickness woven polyester graft material Fully supported by self-expanding z-stents H&L-B
More informationPlacement of self-expanding metal stents is a safe and effective palliative
Diagn Interv Radiol 2012; 18:360 364 Turkish Society of Radiology 2012 ABDOMINAL IMAGING ORIGINAL ARTICLE Placement of duodenal stents across the duodenal papilla may predispose to acute pancreatitis:
More informationcreating stability a bess group company Stents for Gastroenterology
a bess group company Stents for Gastroenterology a bess group company Page 2 CONTENTS aixstent self-expanding Nitinol stents aixstent OES Esophageal Stent... 6 aixstent OEL Esophageal Leakage Stent...
More informationPercutaneous biliary drainage: complications and efficiency at short and mean terms: about 50 cases
Percutaneous biliary drainage: complications and efficiency at short and mean terms: about 50 cases Poster No.: C-1497 Congress: ECR 2016 Type: Scientific Exhibit Authors: M. Matri, L. Ben Farhat, I. Marzouk
More informationProven Performance Through Innovative Design *
Proven Performance Through Innovative Design * Deliver Our Next Generation AV Covered Stent Results The COVERA Vascular Covered Stent builds upon proven technologies from the category leader in AV Access.
More informationPercutaneous treatment in malignant biliary obstruction: a prospective study
Percutaneous treatment in malignant biliary obstruction: a prospective study Poster No.: C-2620 Congress: ECR 2015 Type: Scientific Exhibit Authors: A. Rroji, E. Enesi, F. Bilaj, F. Tuka, S. Butorac; Tirana/AL
More informationINTRODUCTION. Key Words: Cholestasis, extrahepatic; Stents; Cholangiography; Endoscopic retrograde. ORiginal Article
Gut and Liver, Vol. 7, No. 6, November 2013, pp. 725-730 ORiginal Article A Novel, Fully Covered Laser-Cut Nitinol Stent with Antimigration Properties for Nonresectable Distal Malignant Biliary Obstruction:
More informationBalloon Sheaths for Gastrointestinal Guidance and Access: A Preliminary Phantom Study
Balloon Sheaths for Gastrointestinal Guidance and Access: A Preliminary Phantom Study Xu He, MD 1, 2 Ji Hoon Shin, MD 1 Hyo-Cheol Kim, MD 1 Cheol Woong Woo, BS 1 Sung Ha Woo, BS 1 Won-Chan Choi, BS 1 Jong-Gyu
More information(12) United States Patent
(12) United States Patent Jones et al. USOO6833003B2 (10) Patent No.: (45) Date of Patent: Dec. 21, 2004 (54) EXPANDABLE STENT AND DELIVERY SYSTEM (75) Inventors: Donald K. Jones, Lauderhill, FL (US);
More informationStent Collapse as a Delayed Complication of Placement of a Covered Gastroduodenal Stent
Gastroduodenal Stent Collapse Interventional Radiology Original Research Jin Hyoung Kim 1 Ho-Young Song 1 Ji Hoon Shin 1 Eugene Choi 1 Tae Won Kim 2 Sung Koo Lee 2 Byung Sik Kim 3 Kim JH, Song HY, Shin
More informationDual Catheter Placement Technique for Treatment of Biliary Anastomotic Strictures After Liver Transplantation
LIVER TRANSPLANTATION 17:159-166, 2011 ORIGINAL ARTICLE Dual Catheter Placement Technique for Treatment of Biliary Anastomotic Strictures After Liver Transplantation Dong Il Gwon, 1 Kyu-Bo Sung, 1 Gi-Young
More informationRadRx Your Prescription for Accurate Coding & Reimbursement Copyright All Rights Reserved.
Interventional Radiology Coding Case Studies Prepared by Stacie L. Buck, RHIA, CCS-P, RCC, CIRCC, AAPC Fellow President & Senior Consultant INDICATION: Abdominal aortic aneurysm. INTERVENTIONAL RADIOLOGIST:
More informationPercutaneous Metallic Stents in Patients with Obstructive Jaundice due to Hepatocellular Carcinoma
Percutaneous Metallic Stents in Patients with Obstructive Jaundice due to Hepatocellular Carcinoma Hyun Pyo Hong, MD, Seung Kwon Kim, MD, and Tae-Seok Seo, MD PURPOSE: To evaluate the technical success
More informationImaging of liver and pancreas
Imaging of liver and pancreas.. Disease of the liver Focal liver disease Diffusion liver disease Focal liver disease Benign Cyst Abscess Hemangioma FNH Hepatic adenoma HCC Malignant Fibrolamellar carcinoma
More informationZenith Renu AAA Converter Graft. Device Description Planning and Sizing Deployment Sequence Patient Follow-Up
Zenith Renu AAA Converter Graft Device Description Planning and Sizing Deployment Sequence Patient Follow-Up Device description: Device indications The Zenith Renu AAA Converter Graft with Z-Trak Introduction
More informationP atients with malignant biliary obstruction generally have
729 BILIARY DISEASE A prospective randomised study of covered versus uncovered diamond stents for the management of distal malignant biliary obstruction H Isayama, Y Komatsu, T Tsujino, N Sasahira, K Hirano,
More information(12) Patent Application Publication (10) Pub. No.: US 2007/ A1
(19) United States (12) Patent Application Publication (10) Pub. No.: US 2007/0208302 A1 Webster et al. US 200702083 02A1 (43) Pub. Date: Sep. 6, 2007 (54) DEFLECTION CONTROL CATHETERS, SUPPORT CATHETERS
More informationMICRO-TECH Europe. MICRO-TECH Colon and rectum stents. Colon and rectum stents
MICRO-TECH Europe MICRO-TECH. MICRO-TECH Europe Colon and rectum stents OTW. Maximum hold for maximum patient comfort. Colon stents demand a particularly high positional stability. The OTW colon and rectum
More informationCook Medical. Zenith Flex AAA Endovascular Graft with Z-Trak Introduction System Physician Training
Cook Medical Zenith Flex AAA Endovascular Graft with Z-Trak Introduction System Physician Training Bifurcated system Proximal suprarenal stent Modular (aortic main body and two iliac legs) Full-thickness,
More informationTransjugular Intrahepatic
Transjugular Intrahepatic Portosystemic Shunt (TIPS): A Clinical and Procedural Review Mark R. Werley, M.D. and John Briguglio, M.D. Lancaster Radiology Associates, Ltd. INTRODUCTION This article reviews
More information58 Field of Search /191,192, wire stent which extends in a path defining a generally
USOO5882335A United States Patent (19) 11 Patent Number: Leone et al. (45) Date of Patent: Mar 16, 1999 54 RETRIEVABLE DRUG DELIVERY STENT 5,306,250 4/1994 March et al.... 604/104 5,306,286 4/1994 Stack
More informationInserting a percutaneous biliary drain and biliary stent (a tube to drain bile)
Patient information - Radiology Unit Tel 0118 322 7991 Inserting a percutaneous biliary drain and biliary stent (a tube to drain bile) Introduction This leaflet tells you about the procedures known as
More informationPercutaneous Metallic Stent Placement for Palliative Management of Malignant Biliary Hilar Obstruction
Original Article Intervention https://doi.org/10.3348/kjr.2018.19.4.597 pissn 1229-6929 eissn 2005-8330 Korean J Radiol 2018;19(4):597-605 Percutaneous Metallic Stent Placement for Palliative Management
More informationPaola Figueroa-Barojas, Mihir R. Bakhru, Nagy A. Habib, Kristi Ellen, Jennifer Millman, Armeen Jamal-Kabani, Monica Gaidhane, and Michel Kahaleh
Oncology Volume 2013, Article ID 910897, 5 pages http://dx.doi.org/10.1155/2013/910897 Clinical Study Safety and Efficacy of Radiofrequency Ablation in the Management of Unresectable Bile Duct and Pancreatic
More informationAncillary Components with Z-Trak Introduction System
Ancillary Components with Z-Trak Introduction System Zenith Flex AAA Endovascular Graft Ancillary Components Converter Converters can be used to convert a bifurcated graft into an aortouniiliac graft if
More informationPrimary Sclerosing Cholangitis and Cholestatic liver diseases. Ahsan M Bhatti MD, FACP Bhatti Gastroenterology Consultants
Primary Sclerosing Cholangitis and Cholestatic liver diseases Ahsan M Bhatti MD, FACP Bhatti Gastroenterology Consultants I have nothing to disclose Educational Objectives What is PSC? Understand the cholestatic
More informationPrinciples of ERCP: papilla cannulation, indications/contraindications and risks. Dr. med. Henrik Csaba Horváth PhD
Principles of ERCP: papilla cannulation, indications/contraindications and risks Dr. med. Henrik Csaba Horváth PhD Evolution of ERCP 1968. 1970s ECPG Endoscopic CholangioPancreatoGraphy Japan 1974 Biliary
More informationAERO DV Tracheobronchial Direct Visualization Stent System
AERO DV Tracheobronchial Direct Visualization Stent System Review Instructions For Use Before Using This System. Single Use Only Non-sterile MR Conditional CONTENTS Instructions for Use...............................
More informationNavigating the Biliary Tract with CT & MR: An Imaging Approach to Bile Duct Obstruction
Navigating the Biliary Tract with CT & MR: An Imaging Approach to Bile Duct Obstruction Ann S. Fulcher, MD Medical College of Virginia Virginia Commonwealth University Richmond, Virginia Objectives To
More informationRecanalization Techniques: Sharp Needle Recanalization. Recanalization Techniques: Sharp Needle Recanalization
Recanalization of Occluded Central Veins When Conventional Methods Failed: Abigail Falk, MD, FSIR American Access Care New York, NY Conventional Methods of Recanalization Directional 0.035 and 0.018 Guidewires
More informationRX Biliary System. Start
Start We re in! When you control the wire, efficiency comes along for the ride. The of Physician-Controlled Wireguided Cannulation Physician-controlled wireguided cannulation (WGC) facilitates deep biliary
More informationIVUS Guided Case Review Case Performed by Frank R. Arko III, MD Charlotte, NC
IVUS Guided Case Review Case Performed by Frank R. Arko III, MD Charlotte, NC The opinions and clinical experiences presented herein are for informational purposes only. Dr. Arko is a paid consultant for
More informationProspective, randomized controlled study of paclitaxel-coated versus plain balloon angioplasty for the treatment of failing dialysis access
Prospective, randomized controlled study of paclitaxel-coated versus plain balloon angioplasty for the treatment of failing dialysis access Disclosure Speaker name:... I have the following potential conflicts
More informationChronic Total Occlusion (CTO) Technologies
to receive our latest news and key activities. Chronic Total Occlusion (CTO) Technologies Re-open vital channels LinkedIn page Follow us on CORDIS EMEA OUTBACK LTD Re-Entry Catheter True Lumen Re-Entry
More informationDouble endoscopic bypass for gastric outlet obstruction and biliary obstruction
Double endoscopic bypass for gastric outlet obstruction and biliary obstruction Authors Olaya I. Brewer Gutierrez 1,JoseNieto 2, Shayan Irani 3, Theodore James 4,RenataPierattiBueno 1, Yen-I Chen 1, Majidah
More information