Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 7, 2020; 26(9): 947-959
Published online Mar 7, 2020. doi: 10.3748/wjg.v26.i9.947
Clinical utility of treatment method conversion during single-session endoscopic ultrasound-guided biliary drainage
Kosuke Minaga, Mamoru Takenaka, Kentaro Yamao, Ken Kamata, Shunsuke Omoto, Atsushi Nakai, Tomohiro Yamazaki, Ayana Okamoto, Rei Ishikawa, Tomoe Yoshikawa, Yasutaka Chiba, Tomohiro Watanabe, Masatoshi Kudo
Kosuke Minaga, Mamoru Takenaka, Kentaro Yamao, Ken Kamata, Shunsuke Omoto, Atsushi Nakai, Tomohiro Yamazaki, Ayana Okamoto, Rei Ishikawa, Tomoe Yoshikawa, Tomohiro Watanabe, Masatoshi Kudo, Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama 589-8511, Japan
Yasutaka Chiba, Clinical Research Center, Kindai University Hospital, Osaka-Sayama 589-8511, Japan
Author contributions: All authors helped to perform the research; Minaga K, Takenaka M and Kudo M drafting conception and design; Minaga K manuscript writing; Takenaka M, Yamao K, Kamata K, Minaga K and Omoto S performing endoscopic interventions; Nakai A, Yamazaki T, Okamoto A, Ishikawa R and Yoshikawa T analysis and interpretation of data; Chiba T performing statistical analyses; Watanabe T critical manuscript revision.
Institutional review board statement: Ethical permission for this study was granted by the review board of Kindai University Faculty of Medicine (approval number: 28-173).
Informed consent statement: Patients were not required to give informed consent to this study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent. And informed consent was waived by the institutional review board of the Kindai University Faculty of Medicine because of retrospective study design.
Conflict-of-interest statement: All authors declare no conflicts of interest related to this article. We disclose that this work was presented in part at Digestive Disease Week (DDW 2017), May 6-9, 2017, Chicago, United States (Gastrointestinal Endoscopy 2017; 85: 5 Supplement, AB493).
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Kosuke Minaga, MD, PhD, Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama 589-8511, Japan. kousukeminaga@med.kindai.ac.jp
Received: December 6, 2019
Peer-review started: December 6, 2019
First decision: January 12, 2020
Revised: February 13, 2020
Accepted: February 21, 2020
Article in press: February 21, 2020
Published online: March 7, 2020
Abstract
BACKGROUND

Although several techniques for endoscopic ultrasound-guided biliary drainage (EUS-BD) are available at present, an optimal treatment algorithm of EUS-BD has not yet been established.

AIM

To evaluate the clinical utility of treatment method conversion during single endoscopic sessions for difficult cases in initially planned EUS-BD.

METHODS

This was a single-center retrospective analysis using a prospectively accumulated database. Patients with biliary obstruction undergoing EUS-BD between May 2008 and April 2016 were included. The primary outcome was to evaluate the improvement in EUS-BD success rates by converting the treatment methods during a single endoscopic session. Secondary outcomes were clarification of the factors leading to the conversion from the initial EUS-BD and the assessment of efficacy and safety of the conversion as judged by technical success, clinical success, and adverse events (AEs).

RESULTS

A total of 208 patients underwent EUS-BD during the study period. For 18.8% (39/208) of the patients, the treatment methods were converted to another EUS-BD technique from the initial plan. Biliary obstruction was caused by pancreatobiliary malignancies, other malignant lesions, biliary stones, and other benign lesions in 22, 11, 4, and 2 patients, respectively. The reasons for the difficulty with the initial EUS-BD were classified into the following 3 procedures: Target puncture (n = 13), guidewire manipulation (n = 18), and puncture tract dilation (n = 8). Technical success was achieved in 97.4% (38/39) of the cases and clinical success was achieved in 89.5% of patients (34/38). AEs occurred in 10.3% of patients, including bile leakage (n = 2), bleeding (n = 1), and cholecystitis (n = 1). The puncture target and drainage technique were altered in subsequent EUS-BD procedures in 25 and 14 patients, respectively. The final technical success rate with 95%CI for all 208 cases was 97.1% (95%CI: 93.8%-98.9%), while that of the initially planned EUS-BD was 78.8% (95%CI: 72.6%-84.2%).

CONCLUSION

Among multi-step procedures in EUS-BD, guidewire manipulation appeared to be the most technically challenging. When initially planned EUS-BD is technically difficult, treatment method conversion in a single endoscopic session may result in successful EUS-BD without leading to severe AEs.

Keywords: Endoscopic ultrasound, Endoscopic ultrasound-guided biliary drainage, Interventional endoscopic ultrasound, Biliary drainage, Biliary obstruction

Core tip: Treatment methods were converted from an initially planned endoscopic ultrasound-guided biliary drainage (EUS-BD) technique in a single endoscopic session in cases with difficulties. In 18.8% cases, treatment methods were converted to another EUS-BD technique. The technical and clinical success rates were 97.4% and 89.5%, respectively. Mild adverse events occurred in 10.5%. Final technical success rate of all 208 cases was 97.1%-much higher than that of the initially planned EUS-BD. When the initially planned EUS-BD was technically difficult, treatment method conversion during the single endoscopic session was likely to contribute to improvements in the technical success of EUS-BD, without leading to serious AEs.