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:
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.
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
Research background

Since it was initially described in 2001, endoscopic ultrasound-guided biliary drainage (EUS-BD) has been developed as an alternative therapeutic technique for biliary obstruction. Although many EUS-BD techniques are available, the optimal algorithm of EUS-BD techniques has not yet been well established.

Research motivation

To date, limited data are available on troubleshooting when the initial EUS-BD plan is challenging. When it was difficult to accomplish the initial EUS-BD procedure, we attempted to convert the puncture target or drainage method in the same endoscopic session.

Research objectives

This study aimed to evaluate the usefulness of converting the treatment methods during a single endoscopic session for difficult cases in initially planned EUS-BD.

Research methods

Patients with biliary obstruction undergoing EUS-BD between May 2008 and April 2016 in a single tertiary-care center were retrospectively reviewed based on our prospectively accumulated database.

Research results

During the study period, 208 patients underwent EUS-BD. In 18.8% of the patients, the treatment methods were converted from the initial plan. The technical and clinical success rates of the conversion cases were 97.4% and 89.5%, respectively. The rate of AEs was 10.3% and all were graded as mild. Puncture target and drainage technique were altered in 25 and 14 cases, respectively. The final technical success rate of all the 208 cases was 97.1%, and that of the initially planned EUS-BD was 78.8%.

Research conclusions

When initially planned EUS-BD is technically challenging, alteration of treatment methods during the single endoscopic session contributed to improvements in the technical success of EUS-BD, without incurring serious AEs.

Research perspectives

Future, multicenter, and prospective studies with larger cohorts are necessary to confirm the suitability and utility of converting the treatment methods in the same endoscopic session from the initially planned EUS-BD technique.