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Shen Y, Lv Y, Zheng X, Zhan W, Hou S, Zhou L, Cao J, Zhang B, Wang L, Zhu H, Zhang L. Comparison between Endoscopic Ultrasound-Guided Antegrade and Transluminal Stent Implantation in Distal Malignant Biliary Obstruction after Failed ERCP. Gastroenterol Res Pract 2024; 2024:1458297. [PMID: 38774521 PMCID: PMC11108689 DOI: 10.1155/2024/1458297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 03/29/2024] [Accepted: 04/05/2024] [Indexed: 05/24/2024] Open
Abstract
Background Distal malignant biliary obstruction (DMBO) can result in obstructive jaundice. Endoscopic ultrasound- (EUS-) guided biliary drainage (EUS-BD) has been an alternative for DMBO after failed ERCP. Aim To compare the efficacy and safety between antegrade and transluminal approaches in patients with unresectable DMBO when ERCP failed. Methods Patients with DMBO leading to obstructive jaundice after failed ERCP were enrolled in this study. We retrospectively evaluated the safety and efficacy between EUS-guided transluminal stenting (TLS group) and antegrade stenting (AGS group). Results 82 patients were enrolled, of which 45 patients were in TLS group and 37 in AGS group. There were no statistical differences in the malignancy type, baseline common bile duct diameter, total bilirubin level, reason for EUS-BD, and history of biliary drainage between TLS and AGS groups. The technical success rate was statistically higher in TLS group than in AGS group (97.8 vs. 81.1%, P = 0.031). There were no statistical differences in clinical success rate, procedure-related adverse events, stent migration rate, stent dysfunction rate, reintervention rate, and overall patient survival time between TLS and AGS groups. The median time to stent dysfunction or patient death in TLS and AGS groups was 53 and 81 days, respectively (P = 0.017). Conclusions Although AGS had a lower technical success rate than TLS, it was superior to TLS in stent patency in patients with DMBO.
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Affiliation(s)
- Yonghua Shen
- Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Ying Lv
- Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Xiaojiao Zheng
- Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Wei Zhan
- Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Senlin Hou
- Biliopancreatic Endoscopic Surgery Department, Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Lin Zhou
- Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Jun Cao
- Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Bin Zhang
- Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Lei Wang
- Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Hao Zhu
- Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Lichao Zhang
- Biliopancreatic Endoscopic Surgery Department, Second Hospital of Hebei Medical University, Shijiazhuang, China
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Moond V, Loganathan P, Koyani B, Khan SR, Kassab LL, Chandan S, Mohan BP, Broder A, Adler DG. Efficacy and safety of EUS-guided hepatogastrostomy: A systematic review and meta-analysis. Endosc Ultrasound 2024; 13:171-182. [PMID: 39318645 PMCID: PMC11419430 DOI: 10.1097/eus.0000000000000055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 12/13/2023] [Indexed: 09/26/2024] Open
Abstract
EUS-guided hepaticogastrostomy (EUS-HGS) is one of the preferred methods in biliary drainage where ERCP fails or is contraindicated. The clinical outcomes of EUS-HGS are not well studied because of variability in procedure technique. We conducted a search of multiple electronic databases and conference proceedings from inception through January 2023. The clinical outcomes studied were pooled technical success, clinical success, and adverse events. Standard meta-analysis methods were used using the random-effects model, and heterogeneity was studied by I 2 statistics. We analyzed 44 studies, which included 19 prospective and 25 retrospective studies. The pooled technical success rate of EUS-HGS was 94.4% (confidence interval [CI], 92.4%-95.9%; I 2 = 0%), and the pooled clinical success rate was 88.6% (CI, 83.7%-92.2%; I 2 = 0%). The pooled adverse outcomes with EUS-HGS were 23.8% (CI, 19.6%-28.5%; I 2 = 0%). The mild adverse event rate associated with HGS was 5.8% (4.2%-8.1%; I 2 = 0%), moderate adverse event rate was 12.1% (9.1%-15.8%; I 2 = 16%), and severe adverse event rate was 4.2% (3.0%-5.7%; I 2 = 61%), whereas fatal adverse event rate was 3.2% (1.9%-5.4%; I 2 = 62%). On subgroup analysis, the pooled rate of adverse events of EUS-guided hepaticogastrostomy with antegrade stenting was 13.3% (95% CI, 8.2%-21.0%). The pooled technical success with EUS-guided hepaticogastrostomy with antegrade stenting was 89.7% (95% CI, 82.6%-94.2%), and clinical success was 92.5% (95% CI, 77.9%-97.7%). On the basis of our analysis of EUS-HGS, the overall technical success was 94.4%, and the clinical success rate was 88.6%, and the overall adverse events were reported to be 23.8%. These data can also help improve the clinical benefits of EUS-HGS in the selected patients in whom it is performed.
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Affiliation(s)
- Vishali Moond
- Department of Internal Medicine, Saint Peter's University Hospital/Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | | | - Bhargav Koyani
- Department of Internal Medicine, Ascension Saint Francis Hospital, Evanston, IL, USA
| | | | - Lena L. Kassab
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Saurabh Chandan
- Department of Gastroenterology & Hepatology, CHI Creighton University Medical Center, Omaha, NE, USA
| | - Babu P. Mohan
- Gastroenterology & Hepatology, University of Utah Health School of Medicine, Salt Lake City, UT, USA
| | - Arkady Broder
- Department of Gastroenterology, Saint Peter's University Hospital/Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Douglas G. Adler
- Center for Advanced Therapeutic Endoscopy, Centura Health, Porter Adventist Hospital, Denver, CO, USA
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Giri S, Mohan BP, Jearth V, Kale A, Angadi S, Afzalpurkar S, Harindranath S, Sundaram S. Adverse events with EUS-guided biliary drainage: a systematic review and meta-analysis. Gastrointest Endosc 2023; 98:515-523.e18. [PMID: 37392952 DOI: 10.1016/j.gie.2023.06.055] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/01/2023] [Accepted: 06/20/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND AND AIMS Multiple meta-analyses have evaluated the technical and clinical success of EUS-guided biliary drainage (BD), but meta-analyses concerning adverse events (AEs) are limited. The present meta-analysis analyzed AEs associated with various types of EUS-BD. METHODS A literature search of MEDLINE, Embase, and Scopus was conducted from 2005 to September 2022 for studies analyzing the outcome of EUS-BD. The primary outcomes were incidence of overall AEs, major AEs, procedure-related mortality, and reintervention. The event rates were pooled using a random-effects model. RESULTS One hundred fifty-five studies (7887 patients) were included in the final analysis. The pooled clinical success rates and incidence of AEs with EUS-BD were 95% (95% confidence interval [CI], 94.1-95.9) and 13.7% (95% CI, 12.3-15.0), respectively. Among early AEs, bile leak was the most common followed by cholangitis with pooled incidences of 2.2% (95% CI, 1.8-2.7) and 1.0% (95% CI, .8-1.3), respectively. The pooled incidences of major AEs and procedure-related mortality with EUS-BD were .6% (95% CI, .3-.9) and .1% (95% CI, .0-.4), respectively. The pooled incidences of delayed migration and stent occlusion were 1.7% (95% CI, 1.1-2.3) and 11.0% (95% CI, 9.3-12.8), respectively. The pooled event rate for reintervention (for stent migration or occlusion) after EUS-BD was 16.2% (95% CI, 14.0-18.3; I2 = 77.5%). CONCLUSIONS Despite a high clinical success rate, EUS-BD may be associated with AEs in one-seventh of the cases. However, major AEs and mortality incidence remain less than 1%, which is reassuring.
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Affiliation(s)
- Suprabhat Giri
- Department of Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Babu P Mohan
- Department of Gastroenterology, University of Utah, Salt Lake City, Utah, USA
| | - Vaneet Jearth
- Department of Gastroenterology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Aditya Kale
- Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Sumaswi Angadi
- Department of Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Shivaraj Afzalpurkar
- Department of Gastroenterology, Nanjappa Multispecialty Hospital, Davanagere, India
| | - Sidharth Harindranath
- Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Sridhar Sundaram
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
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Cho JH, Park SW, Kim EJ, Park CH, Park DH, Lee KJ, Lee SS. Long-term outcomes and predictors of adverse events of EUS-guided hepatico-gastrostomy for malignant biliary obstruction: Multicenter, retrospective study. Surg Endosc 2022; 36:8950-8958. [PMID: 35680668 DOI: 10.1007/s00464-022-09346-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 05/20/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND AIMS Endoscopic ultrasound (EUS)-guided hepaticogastrostomy (HGS) may be a feasible and useful alternative in patients with malignant biliary obstruction (MBO) after failed endoscopic retrograde cholangiopancreatography (ERCP). To date, the risk factors for adverse events (AEs) and long-term outcomes of EUS-HGS have not been fully explored according to stent type. Therefore, we evaluated potential risk factors for AEs and long-term outcomes of EUS-HGS. METHODS In total, 120 patients who underwent EUS-HGS were retrospectively reviewed. A multivariate analysis through Cox proportional hazard and logistic regression model was used to identify the risk factors for stent dysfunction and AEs, respectively. Stent patency and patient survival were evaluated using Kaplan-Meier plots with a log-rank test for each stent. RESULTS The technical and clinical success rates were 96.2% (102/106) and 83.0% (88/106). The median duration of stent patency was longer in self-expandable metal stents (SEMS) compared to plastic stents (PS) (158 vs. 108 days). Kaplan-Meier analysis indicated that the type of stent was not associated with stent patency (Hazard ratios [HR] 0.997, 95% confidence interval [CI] [0.525-1.896]) or overall survival. In addition, multivariate analysis indicated that hilar MBO significantly associated with stent dysfunction (HR, 2.340; 95% CI, 1.028-5.326, p = 0.043) and late AEs. CONCLUSIONS Given the lower incidence of AEs and better long-term outcomes of EUS-HGS, it can be considered a safe alternative to ERCP or percutaneous approaches regardless of which stent is used. Furthermore, hilar MBO was established as a potential risk factor for stent dysfunction and late AEs.
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Affiliation(s)
- Jae Hee Cho
- Division of Gastroenterology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Se Woo Park
- Division of Gastroenterology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, 7, Keunjaebong-gil, Hwaseong-si, Gyeonggi-do, 18450, South Korea.
| | - Eui Joo Kim
- Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
| | - Chan Hyuk Park
- Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, South Korea
| | - Da Hae Park
- Division of Gastroenterology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, 7, Keunjaebong-gil, Hwaseong-si, Gyeonggi-do, 18450, South Korea
| | - Kyong Joo Lee
- Division of Gastroenterology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, 7, Keunjaebong-gil, Hwaseong-si, Gyeonggi-do, 18450, South Korea
| | - Sang Soo Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil Songpa-gu, Seoul, 05505, South Korea.
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Endoscopic Ultrasound-Guided Hepaticogastrostomy with Antegrade Stenting Without Dilation Device Application for Malignant Distal Biliary Obstruction in Pancreatic Cancer. Dig Dis Sci 2022; 68:2090-2098. [PMID: 36350476 DOI: 10.1007/s10620-022-07749-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 10/26/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Endoscopic ultrasound-guided hepaticogastrostomy with antegrade stenting (EUS-HGAS) is a promising therapeutic option for malignant distal biliary obstruction (MDBO) in the event of transpapillary approach failure. Eliminating the fistula dilation step may further decrease the incidence of adverse events (AE) and simplify the procedure. AIMS This study focused on MDBO associated with pancreatic cancer and aimed to examine the utility of EUS-HGAS without the use of any dilation devices. METHODS This retrospective study investigated consecutive patients in whom the transpapillary approach had failed or was difficult, and who underwent EUS-HGAS without dilation device usage, using a tapered small-diameter catheter, ultrathin delivery system, and tapered dedicated plastic stent. The outcomes of this study included the technical success, clinical success, AE incidence, and recurrent biliary obstruction (RBO) associated with the procedure. RESULTS During the study period, EUS-HGAS without dilation device usage was attempted for 57 patients with MDBO due to pancreatic cancer. The technical and clinical success rates were 91.2% (52/57) each. The median procedural time was 25 min. The rates of early and late AE besides RBO were 3.5% (2/57) and 1.9% (1/52), respectively. The incidence rate of RBO was 30.8% (16/52), and the median time to RBO was 245 days. The rate of successful endoscopic reintervention for RBO via the fistula was 100% (16/16). CONCLUSIONS EUS-HGAS without the use of dilation devices showed good technical feasibility with a low AE rate. It may be a useful option for MDBO associated with pancreatic cancer when the transpapillary approach is difficult.
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Miyano A, Ogura T, Ueno S, Nishioka N, Higuchi K. Antegrade metal stent deployment under endoscopic ultrasound guidance using a novel uncovered metal stent with a fine-gauge stent delivery system. Endoscopy 2022; 54:E417-E418. [PMID: 34496438 DOI: 10.1055/a-1562-1040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Akira Miyano
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Takeshi Ogura
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Saori Ueno
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Nobu Nishioka
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Kazuhide Higuchi
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
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Zhang Y, Wang X, Sun K, Chen J, Zhang Y, Shi L, Fan Z, Liu L, Chen B, Ding Y. Application of endoscopic ultrasound-guided hepaticogastrostomy combined with antegrade stenting in patients with malignant biliary obstruction after failed ERCP. Surg Endosc 2022; 36:5930-5937. [PMID: 35178592 DOI: 10.1007/s00464-022-09117-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 02/07/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND This study was aimed at comparing the safety and effectiveness of endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) and EUS-HGS combined with antegrade stenting (EUS-HGAS) in patients with malignant biliary obstruction (MBO) after failed endoscopic retrograde cholangiopancreatography (ERCP). METHODS Patients diagnosed with MBO and receiving EUS-HGS or EUS-HGAS from September 2015 to October 2020 were enrolled in this study. Clinical success, complications, reintervention rate, post-operative hospital stay, time to stent dysfunction, and patient death were compared. RESULTS A total of 45 patients (21 in the EUS-HGAS group and 24 in the EUS-HGS group) were enrolled in this study. In the EUS-HGAS group, 21 patients all achieved clinical success (100%); in the EUS-HGS group, 24 patients also achieved technical success (100%) (P > 0.05). The differences between pre- and post-operative TB and ALT and AST levels were greater in the single-step EUS-HGAS group (P < 0.05). The incidence of complications was 2 of 21 (9.5%) in the EUS-HGAS group and 5 of 24 (20.8%) in the EUS-HGS group (P > 0.05). The reintervention rate was 0 in the EUS-HGAS group and 1 (4.2%) in the EUS-HGS group (P > 0.05). Time to stent dysfunction or patient death was longer in the EUS-HGAS group (P < 0.05). The post-operative hospital stay was longer and the total cost was higher in the EUS-HGAS group. CONCLUSION EUS-HGAS was superior to EUS-HGS in terms of biliary drainage effectiveness and time to stent dysfunction or patient death in patients with MBO after failed ERCP. Furthermore, two-step EUS-HGAS may be safer in some patients.
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Affiliation(s)
- Yin Zhang
- Department of Gastroenterology, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, No.185 Juqianjie Road, Changzhou, 213003, Jiangsu, China
| | - Xiaohong Wang
- Department of Gastroenterology, The Second Affiliated Hospital of Xuzhou Medical University, General Hospital of XuZhou Mining Group, Xuzhou, China
| | - Kewen Sun
- Department of Gastroenterology, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, No.185 Juqianjie Road, Changzhou, 213003, Jiangsu, China
| | - Jianping Chen
- Department of Gastroenterology, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, No.185 Juqianjie Road, Changzhou, 213003, Jiangsu, China
| | - Yue Zhang
- Department of Hepatopancreatobiliary Surgery, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Longqing Shi
- Department of Hepatopancreatobiliary Surgery, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Zhining Fan
- Digestive Endoscopy Department, Jiangsu Provincial People's Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Li Liu
- Digestive Endoscopy Department, Jiangsu Provincial People's Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Bingfang Chen
- Department of Gastroenterology, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, No.185 Juqianjie Road, Changzhou, 213003, Jiangsu, China
| | - Yanbo Ding
- Department of Gastroenterology, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, No.185 Juqianjie Road, Changzhou, 213003, Jiangsu, China.
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Which Are the Most Suitable Stents for Interventional Endoscopic Ultrasound? J Clin Med 2020; 9:jcm9113595. [PMID: 33171627 PMCID: PMC7695190 DOI: 10.3390/jcm9113595] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 10/28/2020] [Accepted: 11/05/2020] [Indexed: 02/06/2023] Open
Abstract
Endoscopic ultrasound (EUS)-guided interventions provide easy access to structures adjacent to the gastrointestinal tract, effectively targeting them for therapeutic purposes. They play an important role in the management of pancreatic fluid collections (PFC) and bile duct (BD) and pancreatic duct (PD) drainage in cases of failed endoscopic retrograde cholangiopancreatography (ERCP) or gallbladder (GB) drainage. Specially designed stents and delivery systems for EUS-guided transluminal interventions allow various new applications and improve the efficacy and safety of these procedures. In fact, EUS-guided drainage has emerged as the treatment of choice for the management of PFC, and recent innovations such as fully covered metal stents (including lumen-apposing metal stents) have improved outcomes in patients with walled-off necrosis. Similarly, EUS-guided BD and PD drainage with specially designed stents can be beneficial for patients with failed ERCP due to an inaccessible papilla, gastric outlet obstruction, or surgically altered anatomy. EUS-guided GB drainage is also performed using dedicated stents in patients with acute cholecystitis who are not fit for surgery. Although the field of dedicated stents for interventional EUS is rapidly advancing with increasing innovations, the debate on the most appropriate stent for EUS-guided drainage has resurfaced. Furthermore, some important questions remain unaddressed, such as which stent improves clinical outcomes and safety in EUS-guided drainage. Herein, the current status and problems of the available stents are reviewed, including the applicable indications, long-term clinical outcomes, comparison between each stent, and their future prospects.
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Kunda R. Recent development of endoscopic ultrasound-guided biliary drainage. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2020. [DOI: 10.18528/ijgii200047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Rastislav Kunda
- Department of Surgery, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Gastroenterology-Hepatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Advanced Interventional Endoscopy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
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Sugawara S, Sone M, Morita S, Hijioka S, Sakamoto Y, Kusumoto M, Arai Y. Radiologic Assessment for Endoscopic US-guided Biliary Drainage. Radiographics 2020; 40:667-683. [PMID: 32216704 DOI: 10.1148/rg.2020190158] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Endoscopic US-guided biliary drainage (BD) is performed for various types of biliary obstruction and is mainly indicated for unsuccessful conventional transpapillary endoscopic retrograde cholangiodrainage. In endoscopic US BD, an extra-anatomic drainage route between the gastrointestinal (GI) tract and the biliary system is created with a covered metallic stent or plastic stent. Procedural types of endoscopic US BD include hepaticogastrostomy, hepaticojejunostomy (after gastrectomy), choledochoduodenostomy, hepaticoduodenostomy, and endoscopic US-guided gallbladder drainage. The technical and clinical success rates of endoscopic US BD are reported to be 94%-97% and 88%-100%, respectively. CT is crucial both in preprocedural assessment and postprocedural monitoring. CT is used to determine the indications for endoscopic US BD, which include the type of biliary obstruction, collateral vessels in the puncture route, ascites, the volume of the liver segment, the distribution of an intrahepatic tumor, and GI tract patency. After endoscopic US BD, common subclinical findings are a small amount of intraperitoneal gas, localized edematous change in the GI tract, a notch in the placed stent, and localized biliary dilatation caused by stent placement. Stent malfunction after endoscopic US BD is caused by impaction of debris and/or food, stent migration into the GI tract, or tumor overgrowth and/or hyperplasia. Complications that can occur include internal stent migration, intraperitoneal biloma, arterial bleeding or pseudoaneurysm, perforation of the GI tract, and portobiliary fistula. The incidence of clinical endoscopic US BD-related complications is 11%-23%. ©RSNA, 2020.
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Affiliation(s)
- Shunsuke Sugawara
- Department of Diagnostic Radiology (S.S., M.S., M.K., Y.A.) and Department of Hepatobiliary and Pancreatic Oncology (S.H., Y.S.), National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan; and Department of Gastroenterology and Hepatology, Uonuma Institute of Community Medicine, Niigata University Hospital, Minamiuonuma, Niigata, Japan (S.M.)
| | - Miyuki Sone
- Department of Diagnostic Radiology (S.S., M.S., M.K., Y.A.) and Department of Hepatobiliary and Pancreatic Oncology (S.H., Y.S.), National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan; and Department of Gastroenterology and Hepatology, Uonuma Institute of Community Medicine, Niigata University Hospital, Minamiuonuma, Niigata, Japan (S.M.)
| | - Shinichi Morita
- Department of Diagnostic Radiology (S.S., M.S., M.K., Y.A.) and Department of Hepatobiliary and Pancreatic Oncology (S.H., Y.S.), National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan; and Department of Gastroenterology and Hepatology, Uonuma Institute of Community Medicine, Niigata University Hospital, Minamiuonuma, Niigata, Japan (S.M.)
| | - Susumu Hijioka
- Department of Diagnostic Radiology (S.S., M.S., M.K., Y.A.) and Department of Hepatobiliary and Pancreatic Oncology (S.H., Y.S.), National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan; and Department of Gastroenterology and Hepatology, Uonuma Institute of Community Medicine, Niigata University Hospital, Minamiuonuma, Niigata, Japan (S.M.)
| | - Yasunari Sakamoto
- Department of Diagnostic Radiology (S.S., M.S., M.K., Y.A.) and Department of Hepatobiliary and Pancreatic Oncology (S.H., Y.S.), National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan; and Department of Gastroenterology and Hepatology, Uonuma Institute of Community Medicine, Niigata University Hospital, Minamiuonuma, Niigata, Japan (S.M.)
| | - Masahiko Kusumoto
- Department of Diagnostic Radiology (S.S., M.S., M.K., Y.A.) and Department of Hepatobiliary and Pancreatic Oncology (S.H., Y.S.), National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan; and Department of Gastroenterology and Hepatology, Uonuma Institute of Community Medicine, Niigata University Hospital, Minamiuonuma, Niigata, Japan (S.M.)
| | - Yasuaki Arai
- Department of Diagnostic Radiology (S.S., M.S., M.K., Y.A.) and Department of Hepatobiliary and Pancreatic Oncology (S.H., Y.S.), National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan; and Department of Gastroenterology and Hepatology, Uonuma Institute of Community Medicine, Niigata University Hospital, Minamiuonuma, Niigata, Japan (S.M.)
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11
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Mazzawi T, Chaiyapo A, Kongkam P, Ridtitid W, Rerknimitr R. EUS-guided transhepatic antegrade stenting of dilated intrahepatic duct due to a pancreatic head malignancy (with videos). Arab J Gastroenterol 2020; 21:65-66. [PMID: 32241697 DOI: 10.1016/j.ajg.2019.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 12/01/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Tarek Mazzawi
- Section of Gastroenterology, Department of Medicine, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway; Gastrointestinal Endoscopy Excellence Center and Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; Pancreas Research Unit, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Auamduan Chaiyapo
- Gastrointestinal Endoscopy Excellence Center and Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; Pancreas Research Unit, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Department of Surgery, Prapokklao Hospital, Chanthaburi, Thailand
| | - Pradermchai Kongkam
- Gastrointestinal Endoscopy Excellence Center and Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; Pancreas Research Unit, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
| | - Wiriyaporn Ridtitid
- Gastrointestinal Endoscopy Excellence Center and Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; Pancreas Research Unit, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Rungsun Rerknimitr
- Gastrointestinal Endoscopy Excellence Center and Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; Pancreas Research Unit, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
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12
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Castellani D, Germani U, Bassotti G, Manta R. EUS Standard Devices. ENDOTHERAPY IN BILIOPANCREATIC DISEASES: ERCP MEETS EUS 2020:47-63. [DOI: 10.1007/978-3-030-42569-2_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2025]
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13
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Jovani M, Ichkhanian Y, Vosoughi K, Khashab MA. EUS-guided biliary drainage for postsurgical anatomy. Endosc Ultrasound 2019; 8:S57-S66. [PMID: 31897381 PMCID: PMC6896432 DOI: 10.4103/eus.eus_53_19] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 07/15/2019] [Indexed: 12/19/2022] Open
Abstract
ERCP is the mainstay of therapy for pancreatobiliary diseases in patients with native upper gastrointestinal (UGI) anatomy. However, when UGI anatomy is surgically altered, standard ERCP becomes technically challenging or not possible. In such instances, EUS-guided biliary drainage (EUS-BD) has been increasingly employed by advanced endoscopists as a safe and effective method of access to the biliary tree. In this study, we review the technical aspects and outcomes of EUS-BD in patients with surgical UGI anatomy.
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Affiliation(s)
- Manol Jovani
- Clinical and Translational Epidemiology Unit, Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA.,Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA
| | - Yervant Ichkhanian
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Kia Vosoughi
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
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14
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Ogura T, Nishioka N, Higuchi K. Antegrade stent deployment using a novel, covered metal stent through EUS-guided hepaticogastrostomy (with video). Endosc Ultrasound 2019; 8:279-280. [PMID: 30880728 PMCID: PMC6714484 DOI: 10.4103/eus.eus_5_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Takeshi Ogura
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Nobu Nishioka
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Kazuhide Higuchi
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
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15
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EUS-Guided Antegrade Biliary Stenting Using a Novel Fully Covered Metal Stent (with Video). J Gastrointest Surg 2019; 23:192-198. [PMID: 30128830 DOI: 10.1007/s11605-018-3914-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 08/01/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Recently, endoscopic ultrasound (EUS)-guided hepaticogastrostomy (HGS) combined with antegrade stenting (AS) has been reported to be associated with longer stent patency and reduced procedure-related adverse events. In EUS-AS, an uncovered metal stent is usually selected to prevent stent misplacement or dislocation. However, because patient survival has improved with advances in chemotherapy, longer stent patency may be required. AIM The technical feasibility and safety of EUS-guided transhepatic biliary drainage combined with EUS-AS using a novel covered metal stent were evaluated. METHODS Patients with malignant biliary obstruction leading to obstructive jaundice, in whom standard ERCP had failed or was contraindicated, were enrolled in this study between July 2015 and October 2017. As the control group, patients undergoing EUS-AS using an uncovered metal stent were enrolled between October 2014 and June 2015. RESULTS A total of 39 patients were enrolled in this study. Among them, EUS-AS using a covered metal stent was performed in 17 patients and using an uncovered metal stent in the remaining 22 patients. Median stent patency including stent dysfunction and patient death was longer in the covered metal stent group (153 days) compared with that of the uncovered metal stent group (108 days) although there were no significant differences (P = 0.06). In only cases with stent dysfunction was median stent patency of the covered metal stent group significantly longer than that of the uncovered metal stent group (not available vs 150 days, P = 0.02). CONCLUSIONS In conclusion, EUS-guided transluminal biliary drainage combined with EUS-AS using a covered metal stent may be feasible and safe, although the indications for this procedure should be carefully considered.
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16
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Ogura T, Nishioka N, Higuchi K. EUS-Guided Hepaticojejunostomy Using Novel Plastic Stent Combined with Antegrade Metal Stent Placement. J Gastrointest Surg 2018; 22:1309-1311. [PMID: 29700682 DOI: 10.1007/s11605-018-3719-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 02/11/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Endoscopic ultrasound-guided hepaticojejunostomy (EUS-HJS) combined with antegrade stenting (AS) can proceed if patients are complicated with duodenal obstruction or surgical anatomy such as Roux-en-Y esophagojejunostomy. A novel plastic stent (Gadelius Medical Co. Ltd., Tokyo, Japan) that is designed to prevent stent migration into the abdominal cavity was made available in Japan. Here, we describe technical tips for EUS-HJS combined with EUS-AS using this plastic stent. TECHNICAL PRESENTATION After the intrahepatic bile duct is punctured, the guidewire is inserted into the intestine across the bile duct obstruction site. Next, the fistula is dilated using a balloon catheter. And then, metal stent placement is antegradely performed. Finally, stent placement using this novel plastic stent is performed from the intrahepatic bile duct to the intestine. CONCLUSION Compared with EUS-HJS using a metal stent, EUS-HJS using this novel plastic stent has several advantages such as cost benefit, easy re-intervention, and preventing vomiting due to reflux bile juice. Therefore, EUS-HJS combined with AS using this novel plastic stent may be preferable compared with using a metal stent.
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Affiliation(s)
- Takeshi Ogura
- 2nd Department of Internal Medicine, Osaka Medical College, 2-7 Daigakuchou, Takatsukishi, Osaka, 569-8686, Japan.
| | - Nobu Nishioka
- 2nd Department of Internal Medicine, Osaka Medical College, 2-7 Daigakuchou, Takatsukishi, Osaka, 569-8686, Japan
| | - Kazuhide Higuchi
- 2nd Department of Internal Medicine, Osaka Medical College, 2-7 Daigakuchou, Takatsukishi, Osaka, 569-8686, Japan
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17
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Itonaga M, Hatamaru K, Kitano M. EUS-guided hepaticogastrostomy. Dig Endosc 2018; 30:548. [PMID: 29676030 DOI: 10.1111/den.13177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 04/11/2018] [Accepted: 04/13/2018] [Indexed: 02/08/2023]
Affiliation(s)
- Masahiro Itonaga
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Keiichi Hatamaru
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Masayuki Kitano
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
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18
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Ogura T, Kitano M, Takenaka M, Okuda A, Minaga K, Yamao K, Yamashita Y, Hatamaru K, Noguchi C, Gotoh Y, Kuroda T, Yokota T, Nishikiori H, Sagami R, Higuchi K, Chiba Y. Multicenter prospective evaluation study of endoscopic ultrasound-guided hepaticogastrostomy combined with antegrade stenting (with video). Dig Endosc 2018; 30:252-259. [PMID: 29055054 DOI: 10.1111/den.12976] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 10/16/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIM Endoscopic ultrasonography-guided hepaticogastrostomy (EUS-HGS) is often indicated for advanced stage patients. Therefore it is important to prevent adverse events associated with EUS-HGS procedures and obtain long stent patency. EUS-guided antegrade stenting (AS) has been developed as an advanced technique. Thus, to prevent adverse events and achieve long stent patency, EUS-AS combined with EUS-HGS (EUS-HGAS) has been reported. The aim of the present study was to evaluate the technical feasibility and efficacy of EUS-HGAS in a multicenter, prospective study. METHODS This prospective study was carried out at each hospital of the Therapeutic Endoscopic Ultrasound Group. Primary endpoint of this multicenter prospective study was stent patency of EUS-HGAS. RESULTS A total of 49 patients were enrolled. Technical success rate of EUS-HGS was 95.9% (47/49). EUS-AS failed in five patients because the guidewire could not be advanced into the intestine across the bile duct obstruction site. Therefore, EUS-HGAS was successfully carried out in 40 patients (technical success rate: 85.7%). Median overall survival was 114 days. Median stent patency including stent dysfunction and patient death was 114 days. In contrast, mean stent patency was 320 days. Adverse events were seen in 10.2% (5/49) of cases. Hyperamylasemia was seen in four patients, and bleeding was seen in one patient. CONCLUSIONS The present study is the first to evaluate EUS-HGAS. EUS-HGAS has clinical benefit for obtaining long stent patency and avoiding adverse events, although the possibility of acute pancreatitis as a result of obstruction of the orifice of the pancreatic duct must be considered.
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Affiliation(s)
- Takeshi Ogura
- Therapeutic Endoscopic Ultrasound Group: TEUS, Takatuki, Japan.,2nd Department of Internal Medicine, Osaka Medical College, Takatuki, Japan
| | - Masayuki Kitano
- Therapeutic Endoscopic Ultrasound Group: TEUS, Takatuki, Japan.,Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Mamoru Takenaka
- Therapeutic Endoscopic Ultrasound Group: TEUS, Takatuki, Japan.,Department of Gastroenterology and Hepatology, Osaka-Sayama, Japan
| | - Atsushi Okuda
- Therapeutic Endoscopic Ultrasound Group: TEUS, Takatuki, Japan.,2nd Department of Internal Medicine, Osaka Medical College, Takatuki, Japan
| | - Kosuke Minaga
- Therapeutic Endoscopic Ultrasound Group: TEUS, Takatuki, Japan.,Department of Gastroenterology and Hepatology, Osaka-Sayama, Japan
| | - Kentaro Yamao
- Therapeutic Endoscopic Ultrasound Group: TEUS, Takatuki, Japan.,Department of Gastroenterology and Hepatology, Osaka-Sayama, Japan
| | - Yukitaka Yamashita
- Therapeutic Endoscopic Ultrasound Group: TEUS, Takatuki, Japan.,Department of Gastroenterology and Hepatology, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan
| | - Keiichi Hatamaru
- Therapeutic Endoscopic Ultrasound Group: TEUS, Takatuki, Japan.,Department of Gastroenterology and Hepatology, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan
| | - Chishio Noguchi
- Therapeutic Endoscopic Ultrasound Group: TEUS, Takatuki, Japan.,Department of Gastroenterology, Shinbeppu Hospital, Beppu, Japan
| | - Yasuhiko Gotoh
- Therapeutic Endoscopic Ultrasound Group: TEUS, Takatuki, Japan.,Department of Gastroenterology, Shinbeppu Hospital, Beppu, Japan
| | - Taira Kuroda
- Therapeutic Endoscopic Ultrasound Group: TEUS, Takatuki, Japan.,Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Matsuyama, Japan
| | - Tomoyuki Yokota
- Therapeutic Endoscopic Ultrasound Group: TEUS, Takatuki, Japan.,Center for Liver-Biliary-Pancreatic Disease, Matsuyama Red Cross Hospital, Matsuyama, Japan
| | - Hidefumi Nishikiori
- Therapeutic Endoscopic Ultrasound Group: TEUS, Takatuki, Japan.,Department of Gastroenterology, Oita Sanai Medical Center, Oita, Japan
| | - Ryota Sagami
- Therapeutic Endoscopic Ultrasound Group: TEUS, Takatuki, Japan.,Department of Gastroenterology, Oita Sanai Medical Center, Oita, Japan
| | - Kazuhide Higuchi
- Therapeutic Endoscopic Ultrasound Group: TEUS, Takatuki, Japan.,2nd Department of Internal Medicine, Osaka Medical College, Takatuki, Japan
| | - Yasutaka Chiba
- Therapeutic Endoscopic Ultrasound Group: TEUS, Takatuki, Japan.,Clinical Research Center, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
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19
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Yamauchi H, Kida M, Miyazawa S, Okuwaki K, Iwai T, Imaizumi H, Koizumi W. Endoscopic ultrasound-guided antegrade metal stent placement using the stent-in-stent technique in a patient with malignant hilar biliary obstruction. Endosc Ultrasound 2018; 7:204-206. [PMID: 28836515 PMCID: PMC6032706 DOI: 10.4103/eus.eus_19_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Hiroshi Yamauchi
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara City, Kanagawa, Japan
| | - Mitsuhiro Kida
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara City, Kanagawa, Japan
| | - Shiro Miyazawa
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara City, Kanagawa, Japan
| | - Kosuke Okuwaki
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara City, Kanagawa, Japan
| | - Tomohisa Iwai
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara City, Kanagawa, Japan
| | - Hiroshi Imaizumi
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara City, Kanagawa, Japan
| | - Wasaburo Koizumi
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara City, Kanagawa, Japan
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20
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Minaga K, Kitano M. Recent advances in endoscopic ultrasound-guided biliary drainage. Dig Endosc 2018; 30:38-47. [PMID: 28656640 DOI: 10.1111/den.12910] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 06/22/2017] [Indexed: 12/12/2022]
Abstract
Endoscopic ultrasound-guided biliary drainage (EUS-BD) is increasingly used as an alternative in patients with biliary obstruction who fail standard endoscopic retrograde cholangiopancreatography (ERCP). The two major endoscopic approach routes for EUS-BD are the transgastric intrahepatic and the transduodenal extrahepatic approaches. Biliary drainage can be achieved by three different methods, transluminal biliary stenting, transpapillary rendezvous technique, and antegrade biliary stenting. Choice of approach route and drainage method depends on individual anatomy, underlying disease, and location of the biliary stricture. Recent meta-analyses have revealed that cumulative technical success and adverse event rates were 90-94% and 16-23%, respectively. Development of new dedicated devices for EUS-BD would help refine the technical aspects and minimize the possibility of complications, making it a more promising procedure.
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Affiliation(s)
- Kosuke Minaga
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Masayuki Kitano
- Second Department of Internal Medicine, Wakayama Medical University School of Medicine, Wakayama, Japan
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21
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Iwashita T, Yasuda I, Mukai T, Iwata K, Doi S, Uemura S, Mabuchi M, Okuno M, Shimizu M. Endoscopic ultrasound-guided antegrade biliary stenting for unresectable malignant biliary obstruction in patients with surgically altered anatomy: Single-center prospective pilot study. Dig Endosc 2017; 29:362-368. [PMID: 28066983 DOI: 10.1111/den.12800] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 01/06/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIM Endoscopic retrograde cholangiography (ERCP) with biliary stenting for the treatment of unresectable malignant biliary obstruction (MBO) is challenging among patients with surgically altered anatomy. Endoscopic ultrasound-guided antegrade biliary stenting (EUS-ABS) was introduced as an alternative biliary drainage method, although it has not yet been well studied. In this single-center prospective pilot study, we aimed to evaluate the feasibility and safety of EUS-ABS for MBO in patients with surgically altered anatomy. METHODS EUS-ABS for MBO was attempted in patients with surgically altered anatomy. In EUS-ABS, the bile duct in the left lobe was accessed from the intestine under EUS guidance, and a guidewire was placed. Thereafter, an uncovered metallic stent was deployed at the MBO through the fistula. All devices were then removed. Technical, clinical, and adverse event rates, as well as patient characteristics and procedure details, were evaluated. RESULTS Twenty patients (10 women; median age, 69 years) were enrolled in the present study. Technical and clinical success rates of EUS-ABS were both 95% (19/20). In one patient, unsuccessful EUS-ABS as a result of failed visualization of the left lobe of the liver with EUS was salvaged with percutaneous biliary drainage. Rate of adverse events was 20% (4/20), including mild pancreatitis in three patients and mild fever in one patient, which were successfully managed conservatively. CONCLUSIONS EUS-ABS for MBO in patients with surgically altered anatomy was a feasible and safe procedure. Further large scale comparison studies are needed to confirm its efficacy (Clinical Trial Registration Number: UMIN000008589).
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Affiliation(s)
- Takuji Iwashita
- First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan
| | - Ichiro Yasuda
- Department of Gastroenterology, Teikyo University Mizonokuchi Hospital, Kanagawa, Japan
| | - Tsuyoshi Mukai
- First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan
| | - Keisuke Iwata
- First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan
| | - Shinpei Doi
- Department of Gastroenterology, Teikyo University Mizonokuchi Hospital, Kanagawa, Japan
| | - Shinya Uemura
- First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan
| | - Masatoshi Mabuchi
- Department of Gastroenterology, Teikyo University Mizonokuchi Hospital, Kanagawa, Japan
| | - Mitsuru Okuno
- First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan
| | - Masahito Shimizu
- First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan
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22
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Mandai K, Uno K, Okada Y, Suzuki A, Yasuda K. Endoscopic ultrasound-guided hepaticogastrostomy using a 6-F cystotome and 12-cm covered metal stent. Endosc Int Open 2016; 4:E287-91. [PMID: 27004245 PMCID: PMC4798835 DOI: 10.1055/s-0041-111502] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 12/15/2015] [Indexed: 11/23/2022] Open
Abstract
An iincreasing number of reports describe endoscopic ultrasound-guided hepaticogastrostomy for malignant biliary obstruction in patients with endoscopic retrograde cholangiopancreatography failure. However, this procedure has not yet been standardized; as a result, the rate of adverse events, including bile leakage and stent migration, is relatively high. Here, we report our experience with four cases of endoscopic ultrasound-guided hepaticogastrostomy performed according to our institutional procedure.
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Affiliation(s)
- Koichiro Mandai
- Department of Gastroenterology, Kyoto Second Red Cross Hospital, 355-5 Haruobi-cho, Kamigyo-ku, Kyoto 602-8026, Japan
| | - Koji Uno
- Department of Gastroenterology, Kyoto Second Red Cross Hospital, 355-5 Haruobi-cho, Kamigyo-ku, Kyoto 602-8026, Japan
| | - Yusuke Okada
- Department of Gastroenterology, Kyoto Second Red Cross Hospital, 355-5 Haruobi-cho, Kamigyo-ku, Kyoto 602-8026, Japan
| | - Azumi Suzuki
- Department of Gastroenterology, Kyoto Second Red Cross Hospital, 355-5 Haruobi-cho, Kamigyo-ku, Kyoto 602-8026, Japan
| | - Kenjiro Yasuda
- Department of Gastroenterology, Kyoto Second Red Cross Hospital, 355-5 Haruobi-cho, Kamigyo-ku, Kyoto 602-8026, Japan
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23
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De Lisi S, Giovannini M. Endoscopic ultrasonography: Transition towards the future of gastro-intestinal diseases. World J Gastroenterol 2016; 22:1779-1786. [PMID: 26855537 PMCID: PMC4724609 DOI: 10.3748/wjg.v22.i5.1779] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 10/09/2015] [Accepted: 12/08/2015] [Indexed: 02/06/2023] Open
Abstract
Endoscopic ultrasonography (EUS) is a technique with an established role in the diagnosis and staging of gastro-intestinal tumors. In recent years, the spread of new devices dedicated to tissue sampling has improved the diagnostic accuracy of EUS fine-needle aspiration. The development of EUS-guided drainage of the bilio-pancreatic region and abdominal fluid collections has allowed EUS to evolve into an interventional tool that can replace more invasive procedures. Emerging techniques applying EUS in pancreatic cancer treatment and in celiac neurolysis have been described. Recently, confocal laser endomicroscopy has been applied to EUS as a promising technique for the in vivo histological diagnosis of gastro-intestinal, bilio-pancreatic and lymph node lesions. In this state-of-the-art review, we report the most recent data from the literature regarding EUS devices, interventional EUS, EUS-guided confocal laser endomicroscopy and EUS pancreatic cancer treatment, and we also provide an overview of their principles, clinical applications and limitations.
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24
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Ogura T, Yamamoto K, Sano T, Onda S, Imoto A, Masuda D, Takagi W, Fukunishi S, Higuchi K. Stent length is impact factor associated with stent patency in endoscopic ultrasound-guided hepaticogastrostomy. J Gastroenterol Hepatol 2015; 30:1748-52. [PMID: 26083496 DOI: 10.1111/jgh.13021] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 05/21/2015] [Accepted: 05/24/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND STUDY AIM Despite high technical and functional success rates with endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS), rates of adverse events have also been high. No reports have focused on EUS-HGS alone with a large sample size about predictors of stent patency. The present study examined predictors of stent patency in patients who underwent EUS-HGS. PATIENTS AND METHODS The consecutive 51 patients who underwent EUS-HGS using one metallic stent were retrospectively enrolled in this study. Baseline characteristics, stent length from the hepatic portion and in the luminal portion, kinds of stent dysfunction, and stent patency were reviewed. RESULTS Median duration of stent patency was significantly shorter with stent length in the luminal portion <3 cm (52 days) than with ≥3 cm (195 days; P < 0.01). On the other hand, median duration of stent patency did not differ significantly between ≥4 cm (194 days) and <4 cm (127 days; P = 0.1726). Length of stent in the luminal portion ≥3 cm (Hazard ration [HR], 9.242; 95% confidence interval [CI], 3.255-26.244, P < 0.05) and performance of chemotherapy (HR, 3.022; 95% CI, 1.448-6.304, P < 0.05) were also associated with long stent patency on the Cox proportional hazards model. CONCLUSION In conclusion, to obtain long-term stent patency, our data suggest that a stent length ≥3 cm in the luminal portion may be suitable for EUS-HGS.
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Affiliation(s)
- Takeshi Ogura
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | | | - Tatsushi Sano
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Saori Onda
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Akira Imoto
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Daisuke Masuda
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Wataru Takagi
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Shinya Fukunishi
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Kazuhide Higuchi
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
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Srinivasan I, Tang SJ, Vilmann AS, Menachery J, Vilmann P. Hepatic applications of endoscopic ultrasound: Current status and future directions. World J Gastroenterol 2015; 21:12544-12557. [PMID: 26640331 PMCID: PMC4658609 DOI: 10.3748/wjg.v21.i44.12544] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 09/28/2015] [Accepted: 10/13/2015] [Indexed: 02/06/2023] Open
Abstract
The diagnosis and staging of various gastrointestinal malignancies have been made possible with the use of endoscopic ultrasound, which is a relatively safe procedure. The field of endoscopic ultrasound is fast expanding due to advancements in therapeutic endoscopic ultrasound. Though various studies have established its role in gastrointestinal malignancies and pancreatic conditions, its potential in the field of hepatic lesions still remains vastly untapped. In this paper the authors attempt to review important and landmark trials, case series and case studies involving hepatic applications of endoscopic ultrasound, thus not only providing an overview of utilization of endoscopic ultrasound in various liver conditions but also speculating its future role.
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Kawakubo K, Kawakami H, Kuwatani M, Haba S, Kawahata S, Abe Y, Kubota Y, Kubo K, Isayama H, Sakamoto N. Recent advances in endoscopic ultrasonography-guided biliary interventions. World J Gastroenterol 2015; 21:9494-9502. [PMID: 26327757 PMCID: PMC4548110 DOI: 10.3748/wjg.v21.i32.9494] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 05/15/2015] [Accepted: 07/15/2015] [Indexed: 02/06/2023] Open
Abstract
Interventional endoscopic ultrasonography (EUS) based on EUS-guided fine-needle aspiration has rapidly spread as a minimally invasive procedure. Especially in patients with failed endoscopic retrograde cholangiopancreatography, EUS-guided biliary intervention is reported to be useful as salvage therapy. EUS-guided biliary interventions are carried out using three techniques: EUS-guided bilioenteric anastomosis, EUS-guided rendezvous procedure, and EUS-guided antegrade treatment. Although interventional EUS is not yet a standardized procedure, there have been recent advances in this field that address various biliary diseases. Here, we summarize the indications, techniques, clinical results of previous studies, and future perspectives.
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Ogura T, Higuchi K. Does endoscopic ultrasound-guided biliary drainage really have clinical impact? World J Gastroenterol 2015; 21:1049-1052. [PMID: 25632176 PMCID: PMC4306147 DOI: 10.3748/wjg.v21.i4.1049] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 11/29/2014] [Accepted: 12/22/2014] [Indexed: 02/06/2023] Open
Abstract
The well established, gold standard method for treatment of obstructive jaundice involves biliary drainage under endoscopic retrograde cholangiopancreatography (ERCP) performed by pancreatobiliary endoscopists. Recently, interventions using endoscopic ultrasound (EUS) have been developed not only for obtaining cytological and histological diagnosis, but also for biliary drainage as alternative method. EUS-guided biliary drainage (EUS-BD) was first reported by Giovannini et al. EUS-BD broadly includes EUS-guided rendezvous technique, EUS-guided choledochoduodenostomy, and EUS-guided hepaticogastrostomy. More recently, EUS-guided antegrade stenting and EUS-guided gallbladder drainage have also been reported. many case reports, series, and retrospective studies on EUS-BD have been reported. However, because prospective studies and comparisons between the different biliary drainage methods have not been reported, the technical success, functional success, adverse events, and stent patency with long-term follow up of EUS-BD are still unclear. Therefore, prospective, randomized controlled studies addressing these issues are needed. Despite this, EUS-BD undoubtedly is clinically useful as an alternative biliary drainage method. EUS-BD has the potential to be a first-line biliary drainage method instead of ERCP if results of clinical trials are favorable and the technique is simplified.
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