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1
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Kaneko T, Kida M, Kitahara G, Uehara K, Koyama S, Tachikawa S, Watanabe M, Kusano C. Introduction of endoscopic ultrasound-guided hepaticoenterostomy - experience from a general hospital in Japan. Endosc Int Open 2022; 10:E1364-E1370. [PMID: 36262513 PMCID: PMC9576336 DOI: 10.1055/a-1923-0074] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 08/11/2022] [Indexed: 11/06/2022] Open
Abstract
Abstract
Background and study aims Endoscopic ultrasound-guided biliary drainage (EUS-BD) is a widely used alternative to endoscopic retrograde cholangiopancreatography (ERCP) when ERCP is unsuccessful or there are contraindications such as duodenal stenosis or postsurgical intestinal reconstruction. Therefore, we retrospectively investigated the therapeutic outcomes of EUS-BD in a medium-sized hospital.
Patients and methods We included 31 consecutive patients who underwent EUS-BD at the Kitasato University Medical Center between April 2018 and October 2021. Patient characteristics, technical and clinical success rates, stent patency, adverse events (AEs), and procedure time were analyzed.
Results Of the 31 patients included in this study, one underwent endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) and 30 underwent endoscopic ultrasound-guided hepaticoenterostomy (EUS-HES). The technical success rates were 100 % for EUS-CDS and 96.8 % for EUS-HES because EUS-HES was unsuccessful in one patient who then underwent EUS-CDS as an alternative treatment. The clinical success rates were 100 % for EUS-CDS and 96.7% for EUS-HES. The median follow-up period was 84 days (range: 14–483 days). Zero and 5 (16.6 %) patients who underwent EUS-CDS and EUS, respectively had stent dysfunction. The median stent patency (stent dysfunction and death) for EUS-HES was 124 days. AEs were observed in only two patients (6.7 %) who underwent EUS-HES.
Conclusions EUS-BD is now more widely used than before, and advances in the devices used have enabled the procedure to be performed more safely. Our results suggest that this introduction in medium-sized hospitals can be conducted safely.
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Affiliation(s)
- Toru Kaneko
- Department of Gastroenterology of Kitasato University Medical Center, Saitama, Japan,Department of Gastroenterology of Kitasato University Hospital, Kanagawa, Japan
| | - Mitshiro Kida
- Department of Gastroenterology of Kitasato University Medical Center, Saitama, Japan,Department of Gastroenterology of Kitasato University Hospital, Kanagawa, Japan
| | - Gen Kitahara
- Department of Gastroenterology of Kitasato University Medical Center, Saitama, Japan,Department of Gastroenterology of Kitasato University Hospital, Kanagawa, Japan
| | - Kazuho Uehara
- Department of Gastroenterology of Kitasato University Medical Center, Saitama, Japan,Department of Gastroenterology of Kitasato University Hospital, Kanagawa, Japan
| | - Shiori Koyama
- Department of Gastroenterology of Kitasato University Medical Center, Saitama, Japan,Department of Gastroenterology of Kitasato University Hospital, Kanagawa, Japan
| | - Satsuki Tachikawa
- Department of Gastroenterology of Kitasato University Medical Center, Saitama, Japan
| | - Masaaki Watanabe
- Department of Gastroenterology of Kitasato University Medical Center, Saitama, Japan
| | - Chika Kusano
- Department of Gastroenterology of Kitasato University Hospital, Kanagawa, Japan
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2
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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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3
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Mishra A, Tyberg A. Endoscopic ultrasound guided biliary drainage: a comprehensive review. Transl Gastroenterol Hepatol 2019; 4:10. [PMID: 30976713 DOI: 10.21037/tgh.2019.01.03] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 01/11/2019] [Indexed: 12/13/2022] Open
Abstract
Endoscopic ultrasound-guided biliary drainage (EUS-BD) has become widely accepted over the past several years for complicated biliary drainage. When conventional endoscopic retrograde cholangiopancreatography (ERCP) is not successful or feasible due to a variety of constraints, an ultrasound-guided technique through intrahepatic and extrahepatic approaches allows adequate management of hepatobiliary obstruction. Other management alternatives include percutaneous transhepatic biliary drainages (PTBD) and complicated surgical approaches, both of which can be associated with increased morbidity and mortality. There are various technical approaches to allow successful biliary drainage which will be reviewed in this article.
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Affiliation(s)
- Avantika Mishra
- Department of Gastroenterology, Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
| | - Amy Tyberg
- Department of Gastroenterology, Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
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4
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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: 8] [Impact Index Per Article: 1.3] [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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5
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Inoue T, Ito K, Yoneda M. Antegrade radiofrequency ablation and stenting for biliary stricture through endoscopic ultrasound-guided hepaticogastrostomy. Dig Endosc 2018; 30:793-794. [PMID: 29974982 DOI: 10.1111/den.13231] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Tadahisa Inoue
- Department of Gastroenterology, Aichi Medical University, Nagakute, Japan
| | - Kiyoaki Ito
- Department of Gastroenterology, Aichi Medical University, Nagakute, Japan
| | - Masashi Yoneda
- Department of Gastroenterology, Aichi Medical University, Nagakute, Japan
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6
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Siddiqui UD, Levy MJ. EUS-Guided Transluminal Interventions. Gastroenterology 2018; 154:1911-1924. [PMID: 29458153 DOI: 10.1053/j.gastro.2017.12.046] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 11/24/2017] [Accepted: 12/08/2017] [Indexed: 12/13/2022]
Abstract
The role of endoscopic ultrasound (EUS) has transitioned from a diagnostic to a therapeutic one over the past 40 years. With the advent of curvilinear array echoendoscopes in the 1990s with an accessory channel, multiple tools and devices have been developed and used for a variety of transluminal interventions. EUS provides a viable option and is becoming the procedure of choice for many interventions, including bile and pancreatic duct drainage, guiding angiotherapy, pancreatic fluid collection management, gallbladder drainage, and creating a gastrojejunostomy. Although reports demonstrate the technical success of these interventions, there is tremendous study heterogeneity and a relative lack of controlled randomized trials, which may limit our understanding of their role and utility. Furthermore, adverse events are relatively common and occasionally severe. Despite the limitations, available data strongly indicate the efficacy of EUS interventions when performed by well-trained endosonographers in carefully selected patients and managed in a multidisciplinary setting.
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Affiliation(s)
- Uzma D Siddiqui
- Center for Endoscopic Research and Therapeutics (CERT), The University of Chicago Medicine, Chicago, Illinois.
| | - Michael J Levy
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
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7
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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: 60] [Impact Index Per Article: 8.6] [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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8
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Yamamoto K, Itoi T, Tsuchiya T, Tanaka R, Tonozuka R, Honjo M, Mukai S, Fujita M, Asai Y, Matsunami Y, Kurosawa T, Sofuni A, Nagakawa Y. EUS-guided antegrade metal stenting with hepaticoenterostomy using a dedicated plastic stent with a review of the literature (with video). Endosc Ultrasound 2018; 7:404-412. [PMID: 30531024 PMCID: PMC6289013 DOI: 10.4103/eus.eus_51_18] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background and Objectives: Recently, a novel EUS-guided biliary drainage (EUS-BD) technique consisting of EUS-guided antegrade stenting and EUS-guided hepaticoenterostomy (EUS-AS+HES) using two conventional metal stents (MS) has been reported to decrease adverse events and maintain longer stent patency for malignant biliary obstruction (MBO). However, only a few limited reports have evaluated this technique. Finally, dedicated plastic stents (PSs) have been developed to perform EUS-HES safely. The aim of the present study was to evaluate the outcome in EUS-AS+HES for MBO using the dedicated HES PSs. Methods: The results of a total of 23 patients who underwent EUS-AS+HES (18 simultaneous cases and 5 sequential cases) for MBO from October 2014 to July 2017 were retrospectively reviewed. Results: Technical and clinical success rates were 100% (23/23). Adverse events were seen in 8.7% (2/23); 2 cases of mild biliary peritonitis, which were successfully managed conservatively. Overall survival was 96 days and the median duration of stent patency, including stent dysfunction, patient death, and last follow-up, was 66.0 days (53 days in simultaneous cases and 78 days in sequential cases). Stent dysfunction was seen in 13.0% (3/23) of patients in 267, 263, and 135 days after the procedure. Conclusions: The novel EUS-BD technique, EUS-AS using MS plus HES employing a dedicated PS, was shown to be a feasible procedure for MBO and should yield longer duration of stent patency. Furthermore, sequential antegrade stenting in cases of occluded HES seems to be one other option instead of HES stent exchange. Further large-scale comparison studies with EUS-HES or EUS-AS are required to confirm its clinical efficacy.
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Affiliation(s)
- Kenjiro Yamamoto
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Takayoshi Tsuchiya
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Reina Tanaka
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Ryosuke Tonozuka
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Mitsuyoshi Honjo
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Shuntaro Mukai
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Mitsuru Fujita
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Yasutsugu Asai
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Yukitoshi Matsunami
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Takashi Kurosawa
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Atsushi Sofuni
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Yuichi Nagakawa
- Third Department of Surgery, Tokyo Medical University, Tokyo, Japan
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Affiliation(s)
- Mihai Rimbaş
- Digestive Endoscopy Unit, Catholic University, Rome, Italy.,Department of Gastroenterology, Colentina Clinical Hospital, Carol Davila University of Medicine, Bucharest, Romania.,Department of Internal Medicine, Colentina Clinical Hospital, Carol Davila University of Medicine, Bucharest, Romania
| | - Alberto Larghi
- Digestive Endoscopy Unit, Catholic University, Rome, Italy
| | - Rastislav Kunda
- Department of Surgical Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
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10
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Godat S, Bories E, Caillol F, Pesenti C, Ratone JP, de Cassan C, Giovannini M. Efficacy and safety in case of technical success of endoscopic ultrasound-guided transhepatic antegrade biliary drainage: A report of a monocentric study. Endosc Ultrasound 2017. [PMID: 28621295 PMCID: PMC5488521 DOI: 10.4103/2303-9027.208174] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background and Objectives: Endoscopic ultrasound (EUS)-guided biliary drainage techniques are alternative procedures in cases of obstructive jaundice with altered anatomy or failed ERCP. Complications related to EUS-guided antegrade drainage (EUS-AD) are still present in up to 10% of cases, and combination of procedures is sometimes suggested to avoid adverse events. The purpose of our study is to evaluate the efficacy and safety of EUS-AD with transhepatic access in case of technical success. Methods: We retrospectively reviewed patients who underwent EUS-AD in a single, tertiary care center. Results: Twenty patients were included (mean age 68), malignant stenosis in 95%. The reasons for EUS-AD were failed ERCP in 13/20, duodenal stenosis in 4/20, and altered anatomy after surgery in 3/20. A cystostome 6 Fr was always used to create the hepaticogastric tract, without puncture site closure. Self-expandable metallic stent (SEMS) was transpapillary in 95%. Drainage was completed in intraoperative stage by a EUS-hepaticogastrostomy (EUS-HGS) in 1/20 and by percutaneous drainage of the right liver (percutaneous transhepatic biliary drainage) in one out of 20. Overall clinical success was 17/20 (85%). One out of 20 presented a persistent obstructive cholangitis treated by another SEMS through ERCP. Two out of 20 patients died of infectious complications with incomplete drainage, in case of advanced neoplastic disease. One of these two patients was treated by EUS-AD and EUS-HGS at the same time. None of the 20 patients developed bilioma or bile leakage. Conclusion: EUS-AD by transhepatic way is clinically effective and safe. Closure of the gastric puncture site is not mandatory and complementary methods for biliary decompression should be combined in case of incomplete drainage and not to prevent potential adverse events.
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Affiliation(s)
- Sébastien Godat
- Division of Gastroenterology, Paoli-Calmettes Institute, Marseille, France
| | - Erwan Bories
- Division of Gastroenterology, Paoli-Calmettes Institute, Marseille, France
| | - Fabrice Caillol
- Division of Gastroenterology, Paoli-Calmettes Institute, Marseille, France
| | - Christian Pesenti
- Division of Gastroenterology, Paoli-Calmettes Institute, Marseille, France
| | | | - Chiara de Cassan
- Division of Gastroenterology, Paoli-Calmettes Institute, Marseille, France
| | - Marc Giovannini
- Division of Gastroenterology, Paoli-Calmettes Institute, Marseille, France
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11
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Khashab MA, Van der Merwe S, Kunda R, El Zein MH, Teoh AY, Marson FP, Fabbri C, Tarantino I, Varadarajulu S, Modayil RJ, Stavropoulos SN, Peñas I, Ngamruengphong S, Kumbhari V, Romagnuolo J, Shah R, Kalloo AN, Perez-Miranda M, Artifon EL. Prospective international multicenter study on endoscopic ultrasound-guided biliary drainage for patients with malignant distal biliary obstruction after failed endoscopic retrograde cholangiopancreatography. Endosc Int Open 2016; 4:E487-96. [PMID: 27092334 PMCID: PMC4831932 DOI: 10.1055/s-0042-102648] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 01/22/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND AIMS Endoscopic ultrasound-guided biliary drainage (EUS-BD) has emerged as an alternative to traditional radiologic and surgical drainage procedures after failed endoscopic retrograde cholangiopancreatography (ERCP). However, prospective multicenter data are lacking. The aims of this study were to prospectively assess the short- and long-term efficacy and safety of EUS-BD in patients with malignant distal biliary obstruction. PATIENTS AND METHODS Consecutive patients at 12 tertiary centers (5 US, 5 European, 1 Asian, 1 South American) with malignant distal biliary obstruction and failed ERCP underwent EUS-BD. Technical success was defined as successful stent placement in the desired position. Clinical success was defined as a reduction in bilirubin by 50 % at 2 weeks or to below 3 mg/dL at 4 weeks. Adverse events were prospectively tracked and graded according to the American Society for Gastrointestinal Endoscopy (ASGE) lexicon's severity grading system. Overall survival and duration of stent patency were calculated using Kaplan-Meier analysis. RESULTS A total of 96 patients (mean age 66 years, female 45 %, pancreatic cancer 55 %) underwent EUS-BD. Stent placement (technical success) was achieved in 92 (95.8 %) patients (metallic stent 84, plastic stent 8). Mean procedure time was 40 minutes. Clinical success was achieved in 86 (89.5 %) patients. A total of 10 (10.5 %) adverse events occurred: pneumoperitoneum (n = 2), sheared wire (n = 1), bleeding (n = 1), bile leak (n = 3), cholangitis (n = 2), and unintentional perforation (n = 1); 4 graded as mild, 4 moderate, 1 severe, and 1 fatal (due to perforation). A total of 38 (44 %) patients died of disease progression during the study period. The median patient survival was 167 days (95 %CI 112 - 221) days. The 6-month stent patency rate was 95 % (95 %CI 94.94 - 95.06 %) and the 1-year stent patency was 86 % (95 %CI 85.74 - 86.26 %). CONCLUSION This study on EUS-BD demonstrates excellent efficacy and safety of EUS-BD when performed by experts. STUDY REGISTRATION NCT01889953.
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Affiliation(s)
- Mouen A. Khashab
- Johns Hopkins Medical Institute, Baltimore, MD, USA,Corresponding author Mouen A. Khashab, MD Johns Hopkins Hospital – Gastroenterology1800 Orleans Street Suite 7125BBaltimoreMD 21287USA+1-443-683-8335
| | - Schalk Van der Merwe
- Department of Hepatology, Division of Liver, and Pancreatico-Biliary Disorders, University Hospital Gastuisberg, University of Leuven, Leuven Belgium
| | | | | | - Anthony Y. Teoh
- Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | | | - Carlo Fabbri
- Unit of Gastroenterology and Digestive Endoscopy, AUSL Bologna Bellaria-Maggiore Hospital, Bologna, Italy
| | - Ilaria Tarantino
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy
| | | | | | | | - Irene Peñas
- Hospital Universitario Rio Hortega, Valladolid, Spain
| | | | | | - Joseph Romagnuolo
- Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, SC, USA
| | - Raj Shah
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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12
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Hara K, Yamao K, Mizuno N, Hijioka S, Imaoka H, Tajika M, Tanaka T, Ishihara M, Okuno N, Hieda N, Yoshida T, Niwa Y. Endoscopic ultrasonography-guided biliary drainage: Who, when, which, and how? World J Gastroenterol 2016; 22:1297-1303. [PMID: 26811666 PMCID: PMC4716039 DOI: 10.3748/wjg.v22.i3.1297] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Revised: 09/28/2015] [Accepted: 11/13/2015] [Indexed: 02/06/2023] Open
Abstract
Both endoscopic ultrasonography (EUS)-guided choledochoduodenostomy (EUS-CDS) and EUS-guided hepaticogastrostomy (EUS-HGS) are relatively well established as alternatives to percutaneous transhepatic biliary drainage (PTBD). Both EUS-CDS and EUS-HGS have high technical and clinical success rates (more than 90%) in high-volume centers. Complications for both procedures remain high at 10%-30%. Procedures performed by endoscopists who have done fewer than 20 cases sometimes result in severe or fatal complications. When learning EUS-guided biliary drainage (EUS-BD), we recommend a mentor’s supervision during at least the first 20 cases. For inoperable malignant lower biliary obstruction, a skillful endoscopist should perform EUS-BD before EUS-guided rendezvous technique (EUS-RV) and PTBD. We should be select EUS-BD for patients having altered anatomy from malignant tumors before balloon-enteroscope-assisted endoscopic retrograde cholangiopancreatography, EUS-RV, and PTBD. If both EUS-CDS and EUS-HGS are available, we should select EUS-CDS, according to published data. EUS-BD will potentially become a first-line biliary drainage procedure in the near future.
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Khashab MA, Levy MJ, Itoi T, Artifon ELA. EUS-guided biliary drainage. Gastrointest Endosc 2015; 82:993-1001. [PMID: 26384159 DOI: 10.1016/j.gie.2015.06.043] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 06/20/2015] [Indexed: 02/06/2023]
Affiliation(s)
- Mouen A Khashab
- Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Michael J Levy
- Department of Medicine and Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical, University, Tokyo, Japan
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Endoscopic ultrasonography-guided biliary drainage: an alternative to percutaneous transhepatic puncture. GASTROINTESTINAL INTERVENTION 2015. [DOI: 10.1016/j.gii.2015.04.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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