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ASGE Standards of Practice Committee, Pawa S, Marya NB, Thiruvengadam NR, Ngamruengphong S, Baron TH, Bun Teoh AY, Bent CK, Abidi W, Alipour O, Amateau SK, Desai M, Chalhoub JM, Coelho-Prabhu N, Cosgrove N, Elhanafi SE, Forbes N, Fujii-Lau LL, Kohli DR, Machicado JD, Navaneethan U, Ruan W, Sheth SG, Thosani NC, Qumseya BJ, (ASGE Standards of Practice Committee Chair). American Society for Gastrointestinal Endoscopy guideline on the role of therapeutic EUS in the management of biliary tract disorders: summary and recommendations. Gastrointest Endosc 2024; 100:967-979. [PMID: 39078360 DOI: 10.1016/j.gie.2024.03.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/11/2024] [Accepted: 03/18/2024] [Indexed: 07/31/2024]
Abstract
This clinical practice guideline from the American Society for Gastrointestinal Endoscopy provides an evidence-based approach for the role of therapeutic EUS in the management of biliary tract disorders. This guideline was developed using the Grading of Recommendations Assessment, Development and Evaluation framework and addresses the following: 1: The role of EUS-guided biliary drainage (EUS-BD) versus percutaneous transhepatic biliary drainage (PTBD) in resolving biliary obstruction in patients after failed ERCP. 2: The role of EUS-guided hepaticogastrostomy versus EUS-guided choledochoduodenostomy in resolving distal malignant biliary obstruction after failed ERCP. 3: The role of EUS-directed transgastric ERCP (EDGE) versus laparoscopic-assisted ERCP and enteroscopy-assisted ERCP (E-ERCP) in resolving biliary obstruction in patients with Roux-en-Y gastric bypass (RYGB) anatomy. 4: The role of EUS-BD versus E-ERCP and PTBD in resolving biliary obstruction in patients with surgically altered anatomy other than RYGB. 5: The role of EUS-guided gallbladder drainage (EUS-GBD) versus percutaneous gallbladder drainage and endoscopic transpapillary transcystic gallbladder drainage in resolving acute cholecystitis in patients who are not candidates for cholecystectomy.
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Affiliation(s)
| | - Swati Pawa
- Department of Gastroenterology, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - Neil B Marya
- Division of Gastroenterology and Hepatology, University of Massachusetts Medical Center, Worcester, Massachusetts, USA
| | - Nikhil R Thiruvengadam
- Division of Gastroenterology and Hepatology, Loma Linda University, Loma Linda, California, USA
| | - Saowanee Ngamruengphong
- Division of Gastroenterology and Hepatology, The Johns Hopkins University, Baltimore, Maryland, USA
| | - Todd H Baron
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Anthony Yuen Bun Teoh
- Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
| | - Christopher K Bent
- Department of Radiology, Loma Linda University, Loma Linda, California, USA
| | - Wasif Abidi
- Division of Gastroenterology, Baylor College of Medicine, Houston, Texas, USA
| | - Omeed Alipour
- Division of Gastroenterology, University of Washington Medical Center, Seattle, Washington, USA
| | - Stuart K Amateau
- Division of Gastroenterology Hepatology and Nutrition, University of Minnesota Medical Center, Minneapolis, Minnesota, USA
| | - Madhav Desai
- Division of Gastroenterology Hepatology and Nutrition, University of Minnesota Medical Center, Minneapolis, Minnesota, USA
| | - Jean M Chalhoub
- Division of Gastroenterology and Hepatology, Staten Island University Hospital, Northwell Health, Staten Island, New York, USA
| | | | - Natalie Cosgrove
- Center for Interventional Endoscopy, AdventHealth, Orlando, Florida, USA
| | - Sherif E Elhanafi
- Division of Gastroenterology, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Nauzer Forbes
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Divyanshoo R Kohli
- Pancreas and Liver Clinic, Providence Sacred Medical Center, Elon Floyd School of Medicine, Washington State University, Spokane, Washington, USA
| | - Jorge D Machicado
- Division of Gastroenterology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Udayakumar Navaneethan
- Center for IBD and Interventional IBD, Orlando Health Digestive Health Institute, Orlando, Florida, USA
| | - Wenly Ruan
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Sunil G Sheth
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Nirav C Thosani
- Center for Interventional Gastroenterology at UTHealth, McGovern Medical School, Houston, Texas, USA
| | - Bashar J Qumseya
- Department of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, Florida, USA
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Marya NB, Pawa S, Thiruvengadam NR, Ngamruengphong S, Baron TH, Bun Teoh AY, Bent CK, Abidi W, Alipour O, Amateau SK, Desai M, Chalhoub JM, Coelho-Prabhu N, Cosgrove N, Elhanafi SE, Forbes N, Fujii-Lau LL, Kohli DR, Machicado JD, Navaneethan U, Ruan W, Sheth SG, Thosani NC, Qumseya BJ. American Society for Gastrointestinal Endoscopy guideline on the role of therapeutic EUS in the management of biliary tract disorders: methodology and review of evidence. Gastrointest Endosc 2024; 100:e79-e135. [PMID: 39412469 DOI: 10.1016/j.gie.2024.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/11/2024] [Accepted: 03/18/2024] [Indexed: 12/08/2024]
Affiliation(s)
- Neil B Marya
- Division of Gastroenterology and Hepatology, University of Massachusetts Medical Center, Worcester, Massachusetts, USA
| | - Swati Pawa
- Department of Gastroenterology, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - Nikhil R Thiruvengadam
- Division of Gastroenterology and Hepatology, Loma Linda University, Loma Linda, California, USA
| | - Saowanee Ngamruengphong
- Division of Gastroenterology and Hepatology, The Johns Hopkins University, Baltimore, Maryland, USA
| | - Todd H Baron
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Anthony Yuen Bun Teoh
- Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
| | - Christopher K Bent
- Department of Radiology, Loma Linda University, Loma Linda, California, USA
| | - Wasif Abidi
- Division of Gastroenterology, Baylor College of Medicine, Houston, Texas, USA
| | - Omeed Alipour
- Division of Gastroenterology, University of Washington Medical Center, Seattle, Washington, USA
| | - Stuart K Amateau
- Division of Gastroenterology Hepatology and Nutrition, University of Minnesota Medical Center, Minneapolis, Minnesota, USA
| | - Madhav Desai
- Division of Gastroenterology Hepatology and Nutrition, University of Minnesota Medical Center, Minneapolis, Minnesota, USA
| | - Jean M Chalhoub
- Division of Gastroenterology and Hepatology, Staten Island University Hospital, Northwell Health, Staten Island, New York, USA
| | | | - Natalie Cosgrove
- Center for Interventional Endoscopy, AdventHealth, Orlando, Florida, USA
| | - Sherif E Elhanafi
- Division of Gastroenterology, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Nauzer Forbes
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Divyanshoo R Kohli
- Pancreas and Liver Clinic, Providence Sacred Medical Center, Elon Floyd School of Medicine, Washington State University, Spokane, Washington, USA
| | - Jorge D Machicado
- Division of Gastroenterology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Udayakumar Navaneethan
- Center for IBD and Interventional IBD, Orlando Health Digestive Health Institute, Orlando, Florida, USA
| | - Wenly Ruan
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Sunil G Sheth
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Nirav C Thosani
- Center for Interventional Gastroenterology at UTHealth, McGovern Medical School, Houston, Texas, USA
| | - Bashar J Qumseya
- Department of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, Florida, USA
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Rizqiansyah CY, Awatara PID, Amar N, Lesmana CRA, Mustika S. Efficacy and safety of endoscopic ultrasonography (EUS) hepaticogastrostomy (HGS) versus choledochoduodenostomy (CDS) in ERCP-failed malignant biliary obstruction: A systematic review and META-analysis. JGH Open 2024; 8:e70037. [PMID: 39439478 PMCID: PMC11494398 DOI: 10.1002/jgh3.70037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 09/19/2024] [Accepted: 09/23/2024] [Indexed: 10/25/2024]
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is the gold standard in managing malignant biliary obstruction. The success of ERCP has limitations, whereas surgical biliary bypass and percutaneous transhepatic approaches, as alternative modalities, come with significant costs, longer durations, and higher levels of mortality and morbidity. Endoscopic ultrasonography (EUS)-guided biliary drainage with two approaches, hepaticogastrostomy (EUS-HGS) and choledochoduodenostomy (EUS-CDS), is a favored and evolving alternative modality. This study aims to compare the efficacy and safety of EUS-HGS and EUS-CDS. We conducted a systematic review and meta-analysis by searching PubMed, ScienceDirect, Cochrane Library, and Scholar databases up to August 2023, based on the 2020 PRISMA guidelines. We identified randomized and nonrandomized studies comparing the efficacy and safety of EUS-HGS and EUS-CDS. Outcome measures included technical and clinical success, side effects, and mean procedure time. Nine nonrandomized studies and two randomized controlled trials involving 537 patients (225 EUS-HGS, 312 EUS-CDS) were analyzed. No difference was found in technical success (OR, 0.83; 95% CI, 0.41-1.68; I 2 = 0%) and clinical success between the two procedures (OR, 0.96; 95% CI, 0.51-1.81; I 2 = 9.94%). Side effects were significantly higher in EUS-HGS (OR, 2.01, 95% CI, 1.14-3.59; I 2 = 0%). No significant difference in mean procedure time was observed between the two procedures (0.13; 95% CI, -0.15-0.41; I 2 = 34.89%). There are differences in efficacy and safety between EUS-HGS and EUS-CDS. EUS-CDS has a faster procedure time, lower risk of side effects, and ease of puncture during the procedure.
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Affiliation(s)
- Chrisandi Y Rizqiansyah
- Internal Medicine DepartmentFaculty of Medicine Universitas Brawijaya, Saiful Anwar General HospitalMalangIndonesia
| | | | - Nasim Amar
- Faculty of Medicine Universitas BrawijayaMalangIndonesia
| | - Cosmas R A Lesmana
- Hepatobiliary Division, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of MedicineUniversitas IndonesiaJakartaIndonesia
| | - Syifa Mustika
- Internal Medicine DepartmentFaculty of Medicine Universitas Brawijaya, Saiful Anwar General HospitalMalangIndonesia
- Gastroenterohepatology Division, Internal Medicine DepartmentFaculty of Medicine Universitas Brawijaya, Saiful Anwar General HospitalMalangIndonesia
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Sugimoto M, Takagi T, Suzuki R, Waragai Y, Konno N, Asama H, Sato Y, Irie H, Nakamura J, Takasumi M, Hashimoto M, Kato T, Yanagita T, Hikichi T, Ohira H. Factors Associated With Difficult Endoscopic Ultrasonography-guided Biliary Drainage. J Clin Gastroenterol 2024; 58:494-501. [PMID: 37390043 DOI: 10.1097/mcg.0000000000001876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 05/22/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND AND AIMS When endoscopic retrograde cholangiopancreatography-guided biliary drainage is challenging, endoscopic ultrasound-guided biliary drainage (EUS-BD) can be used as an alternate treatment; however, this method requires operator expertise. Therefore, this study aimed to clarify the factors that are associated with a difficult EUS-BD. PATIENTS AND METHODS Patients who successfully underwent EUS-BD were enrolled in this study. The patients were divided into the easy group and difficult group depending on whether the procedural time was more than 60 minutes, which was the cutoff value elicited from past reports. Patient characteristics and procedural factors were compared between the two groups. The factors associated with difficult procedures were also investigated. RESULTS The patient characteristics were not significantly different between the easy group (n=22) and the difficult group (n=19). The diameter of the punctured bile duct was significantly different between the two groups. In the multivariate analysis, the diameter of the punctured bile duct was the only factor associated with a difficult EUS-BD (odds ratio 0.65, 95% confidence interval 0.46-0.91, P value=0.012). The cutoff value for the diameter of the punctured bile duct in predicting a difficult EUS-BD was 7.0 mm (area under the curve: 0.83, sensitivity 84.2%, specificity 86.4%). CONCLUSIONS A nondilated bile duct might be a predictive factor for a difficult EUS-BD. For beginners of EUS-BD, the cutoff value for the punctured bile duct diameter found in this study, 7.0 mm, might become a barometer for puncture point selection.
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Affiliation(s)
- Mitsuru Sugimoto
- Department of Gastroenterology, School of Medicine, Fukushima Medical University
| | - Tadayuki Takagi
- Department of Gastroenterology, School of Medicine, Fukushima Medical University
| | - Rei Suzuki
- Department of Gastroenterology, School of Medicine, Fukushima Medical University
| | - Yuichi Waragai
- Department of Gastroenterology, Soma General Hospital, Niinuma, Soma, Japan
| | - Naoki Konno
- Department of Gastroenterology, School of Medicine, Fukushima Medical University
| | - Hiroyuki Asama
- Department of Gastroenterology, School of Medicine, Fukushima Medical University
| | - Yuki Sato
- Department of Gastroenterology, School of Medicine, Fukushima Medical University
| | - Hiroki Irie
- Department of Gastroenterology, School of Medicine, Fukushima Medical University
| | - Jun Nakamura
- Department of Gastroenterology, School of Medicine, Fukushima Medical University
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima
| | - Mika Takasumi
- Department of Gastroenterology, School of Medicine, Fukushima Medical University
| | - Minami Hashimoto
- Department of Gastroenterology, School of Medicine, Fukushima Medical University
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima
| | - Tsunetaka Kato
- Department of Gastroenterology, School of Medicine, Fukushima Medical University
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima
| | - Takumi Yanagita
- Department of Gastroenterology, School of Medicine, Fukushima Medical University
| | - Takuto Hikichi
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima
| | - Hiromasa Ohira
- Department of Gastroenterology, School of Medicine, Fukushima Medical University
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Yamazaki H, Yamashita Y, Shimokawa T, Minaga K, Ogura T, Kitano M. Endoscopic ultrasound-guided hepaticogastrostomy versus choledochoduodenostomy for malignant biliary obstruction: A meta-analysis. DEN OPEN 2024; 4:e274. [PMID: 37455944 PMCID: PMC10345703 DOI: 10.1002/deo2.274] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/23/2023] [Accepted: 07/02/2023] [Indexed: 07/18/2023]
Abstract
Objectives Endoscopic ultrasound (EUS)-guided biliary drainage encompasses techniques such as EUS-guided hepaticogastrostomy (EUS-HGS) and EUS-guided choledochoduodenostomy (EUS-CDS). This meta-analysis compared the efficacy of EUS-CDS with that of EUS-HGS for the treatment of biliary obstruction. Methods A systematic meta-analysis of all relevant articles listed was performed by searching the Cochrane Library, PubMed, and Google Scholar databases. We used random effects or fixed effects models to compare success rates, adverse events, procedure times, and time to recurrent biliary obstruction after EUS-CDS and EUS-HGS. Results This meta-analysis included 18 eligible studies. There was no significant difference between EUS-CDS and EUS-HGS with respect to technical success rate (odds ratio [OR] 1.04; 95% confidence interval [CI] 0.62-1.73) and clinical success rate (OR 0.66; 95% CI 0.43-1.04), or with respect to total procedure-related adverse events (OR 1.39; 95% CI 1.00-1.93). Subgroup analysis of adverse events revealed that the rate of recurrent biliary obstruction (RBO) was significantly higher for EUS-HGS (OR 2.95; 95% CI 1.54-5.64). There was no significant difference between the two methods with respect to time to recurrent biliary obstruction (mean difference -11.93 days; 95% CI -47.77-23.91). However, the procedure time was longer for EUS-HGS (mean difference, 3.21 min; 95% CI 1.24-5.19). Conclusion EUS-CDS and EUS-HGS are comparable in terms of technical success, clinical success, and rate of adverse events; however, EUS-CDS is superior with respect to procedure time and preventing RBO.
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Affiliation(s)
- Hirofumi Yamazaki
- Second Department of Internal MedicineWakayama Medical UniversityWakayamaJapan
| | - Yasunobu Yamashita
- Second Department of Internal MedicineWakayama Medical UniversityWakayamaJapan
| | - Toshio Shimokawa
- Clinical Study Support CenterWakayama Medical University HospitalWakayamaJapan
| | - Kosuke Minaga
- Department of Gastroenterology and HepatologyKindai University Faculty of MedicineOsakaJapan
| | - Takeshi Ogura
- Second Department of Internal MedicineOsaka Medical and Pharmaceutical UniversityOsakaJapan
| | - Masayuki Kitano
- Second Department of Internal MedicineWakayama Medical UniversityWakayamaJapan
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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. [DOI: https:/doi.org/10.1016/j.gie.2023.06.055] [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: 04/13/2025]
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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: 33] [Impact Index Per Article: 16.5] [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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Canakis A, Baron TH. Therapeutic Endoscopic Ultrasound: Current Indications and Future Perspectives. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2023; 30:4-18. [PMID: 37818395 PMCID: PMC10561320 DOI: 10.1159/000529089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/26/2022] [Indexed: 10/12/2023]
Abstract
The transcendence of endoscopic ultrasound (EUS) from diagnostic to therapeutic tool has revolutionized management options in the field of gastroenterology. Through EUS-guided methods, pancreaticobiliary obstruction can now be utilized as an alternative to surgical and percutaneous approaches. This modality also allows for gallbladder drainage in patients who are not ideal operative candidates. By utilizing its unique imaging capabilities, EUS also allows for drainage access points in cases of gastric outlet obstruction as well as windows to ablate pancreatic cystic lesions. As technical progress continues to evolve, interventional gastroenterology continues to push the envelope of minimally invasive therapeutic procedures in a multidisciplinary setting. In this comprehensive review, we set out to describe current indications and innovations through EUS.
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Affiliation(s)
- Andrew Canakis
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Todd H. Baron
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Eisenberg I, Gaidhane M, Kahaleh M, Tyberg A. Drainage Approach for Malignant Biliary Obstruction: A Changing Paradigm. J Clin Gastroenterol 2023; 57:546-552. [PMID: 37079870 DOI: 10.1097/mcg.0000000000001854] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is the standard of care in the management of unresectable malignant biliary obstruction. However, endoscopic ultrasound (EUS)-guided biliary drainage has become widely accepted over the past several years for complicated biliary drainage in cases when ERCP is unsuccessful or not feasible. Recent emerging evidence suggests EUS-guided hepaticogastrostomy and EUS-guided choledochoduodenostomy are noninferior, and possibly even superior to conventional ERCP for primary palliation of malignant biliary obstruction. This article reviews the procedural techniques and considerations of the different techniques as well as comparative literature on safety and efficacy between techniques.
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Affiliation(s)
- Ian Eisenberg
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD
| | - Monica Gaidhane
- Department of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Michel Kahaleh
- Department of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Amy Tyberg
- Department of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
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Canakis A, Kahaleh M. Endoscopic palliation of malignant biliary obstruction. World J Gastrointest Endosc 2022; 14:581-596. [PMID: 36303806 PMCID: PMC9593514 DOI: 10.4253/wjge.v14.i10.581] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 08/20/2022] [Accepted: 10/05/2022] [Indexed: 02/05/2023] Open
Abstract
Malignant biliary obstruction often presents with challenges requiring the endoscopist to assess the location of the lesion, the staging of the disease, the eventual resectability and patient preferences in term of biliary decompression. This review will focus on the different modalities available in order to offer the most appropriate palliation, such as conventional endoscopic retrograde cholangiopancreatography, endoscopic ultrasound guided biliary drainage as well as ablative therapies including photodynamic therapy or radiofrequency ablation.
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Affiliation(s)
- Andrew Canakis
- Department of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD 21201, United States
| | - Michel Kahaleh
- Department of Gastroenterology and Hepatology, Robert Wood Johnson Medical Center, New Brunswick, NJ 08901, United States
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Li J, Tang J, Liu F, Fang J. Comparison of Choledochoduodenostomy and Hepaticogastrostomy for EUS-Guided Biliary Drainage: A Meta-Analysis. Front Surg 2022; 9:811005. [PMID: 35356500 PMCID: PMC8959983 DOI: 10.3389/fsurg.2022.811005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/07/2022] [Indexed: 12/29/2022] Open
Abstract
Background Although endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) or hepaticogastrostomy (EUS-HGS) has emerged as an option for patients of failed endoscopic retrograde cholangiopancreatography (ERCP), there has no agreement on which approach is preferred. Therefore, a meta-analysis was performed to examine the two methods. Methods We performed a comprehensive search in databases of PubMed, Embase, and Cochrane library to find relevant studies reporting the efficacy and safety of the two EUS-guided biliary drainage methods. Results In total, 12 studies with 623 patients (EUS-CDS: 303 and EUS-HGS: 320) were included. The cumulative technical success and clinical success for EUS-CDS and EUS-HGS was 95.0% (288/303), 93.1% (268/288), and 96.6% (309/320), 91.3% (282/309), respectively. Compared with EUS-HGS, the pooled odds ratio (OR) was 0.74 (95% CI 0.33–1.65; p = 0.46) for EUS-CDS technical success and 0.94 (95% CI 0.56–1.59; p = 0.83) for clinical success. The pooled difference in means of procedure time of EUS-CDS and EUS-HGS was −2.68 (95% CI −5.12 to −0.24; p = 0.03). The cumulative early adverse events for EUS-CDS and EUS-HGS was 12.2% (37/303) and 17.5% (56/320), respectively. Compared with EUS-HGS, the pooled OR of early adverse events for EUS-CDS was 0.58 (95% CI: 0.36–0.93; p = 0.02). Conclusion This meta-analysis further suggests EUS-CDS and EUS-HGS have equal high technical and clinical success, but EUS-CDS with a slightly short procedure time and with less early adverse events compared to EUS-HGS.
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Affiliation(s)
- Jiasu Li
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jian Tang
- Digestive Endoscopy Center, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Feng Liu
- Digestive Endoscopy Center, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
- *Correspondence: Feng Liu
| | - Jun Fang
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China
- Jun Fang
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12
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Choledochoduodenostomy Versus Hepaticogastrostomy in Endoscopic Ultrasound-guided Drainage for Malignant Biliary Obstruction: A Meta-analysis and Systematic Review. Surg Laparosc Endosc Percutan Tech 2021; 32:124-132. [PMID: 34469370 PMCID: PMC8812416 DOI: 10.1097/sle.0000000000000992] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/12/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVES This study aimed to estimate the safety and efficacy of endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) and endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) for malignant biliary obstruction. METHODS We conducted a literature search using PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov. Studies that compared EUS-CDS and EUS-HGS were included in this study. RESULTS Thirteen studies were eligible for inclusion. The technical [odds ratio (OR): 0.95; 95% confidence interval (CI): 0.51-1.74) and clinical (OR: 1.13; 95%CI: 0.66-1.94) success rates of EUS-CDS were comparable to those of EUS-HGS. However, EUS-CDS had less reintervention (OR: 0.31; 95%CI: 0.16-0.63) and stent obstruction (OR: 0.48; 95%CI: 0.21-0.94) than EUS-HGS. Both groups had similar adverse events (OR: 1.00; 95%CI: 0.70-1.43) and overall survival (hazard ratio: 1.07; 95%CI: 0.58-1.97). CONCLUSIONS EUS-CDS and EUS-HGS have comparable technical and clinical success rates, adverse events, and overall survival. However, EUS-CDS has less reintervention and stent obstruction.
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13
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Canakis A, Baron TH. Relief of biliary obstruction: choosing between endoscopic ultrasound and endoscopic retrograde cholangiopancreatography. BMJ Open Gastroenterol 2021; 7:bmjgast-2020-000428. [PMID: 32727716 PMCID: PMC7394303 DOI: 10.1136/bmjgast-2020-000428] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/26/2020] [Accepted: 06/28/2020] [Indexed: 12/11/2022] Open
Abstract
Endoscopic ultrasound (EUS) was originally devised as a novel diagnostic technique to enable endoscopists to stage malignancies and acquire tissue. However, it rapidly advanced toward therapeutic applications and has provided gastroenterologists with the ability to effectively treat and manage advanced diseases in a minimally invasive manner. EUS-guided biliary drainage (EUS-BD) has gained considerable attention as an approach to provide relief in malignant and benign biliary obstruction for patients when endoscopic retrograde cholangiopancreatography (ERCP) fails or is not feasible. Such instances occur in those with surgically altered anatomy, gastroduodenal obstruction, periampullary diverticulum or prior transampullary duodenal stenting. While ERCP remains the gold standard, a multitude of studies are showing that EUS-BD can be used as an alternative modality even in patients who could successfully undergo ERCP. This review will shed light on recent EUS-guided advancements and techniques in malignant and benign biliary obstruction.
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Affiliation(s)
- Andrew Canakis
- Department of Medicine, Boston University Medical Center, Boston, Massachusetts, USA
| | - Todd H Baron
- Division of Gastroenterology and Hepatology, Director of Advanced Therapeutic Endoscopy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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14
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Khoo S, Do NDT, Kongkam P. Efficacy and safety of EUS biliary drainage in malignant distal and hilar biliary obstruction: A comprehensive review of literature and algorithm. Endosc Ultrasound 2020; 9:369-379. [PMID: 33318375 PMCID: PMC7811708 DOI: 10.4103/eus.eus_59_20] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Malignant biliary obstruction (MBO) encompasses a variety of malignancies arising from the pancreaticobiliary system. This can be divided into malignant hilar biliary obstruction (MHBO) or malignant distal biliary obstruction (MDBO) biliary obstruction to which clinical outcomes and technical considerations of various biliary drainage methods may differ. EUS biliary drainage (EUS-BD) has been increasingly influential in the management of MBO together with other familiar biliary drainage methods such as ERCP and percutaneous transhepatic biliary drainage (PTBD). Conventionally, ERCP has always been the primary choice of endoscopic biliary drainage in both MHBO and MDBO and that PTBD or EUS-BD is used as a salvage method when ERCP fails for which current guidelines recommends PTBD, especially for MHBO. This review was able to show that with today's evidence, EUS-BD is equally efficacious and possesses a better safety profile in the management of MBO and should be on the forefront of endoscopic biliary drainage. Therefore, EUS-BD could be used either as a primary or preferred salvage biliary drainage method in these cases.
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Affiliation(s)
- Stanley Khoo
- Department of Medicine, Gastroenterology and Hepatology Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nhan Duc Tri Do
- Department of Endoscopy, Can Tho General Hospital, Can Tho; Department of General Surgery, Can Tho General Hospital, Can Tho, Vietnam
| | - Pradermchai Kongkam
- Department of Medicine, Division of Gastroenterology, Gastrointestinal Endoscopy Excellence Center, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok; Pancreas Research Unit, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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15
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Abstract
Endoscopic retrograde cholangiopancreatography is the preferred procedure for biliary drainage in benign and malignant obstructions. Endoscopic ultrasound-guided biliary drainage is an emerging technique for when endoscopic retrograde cholangiopancreatography fails. It is a highly versatile procedure with several options of access point, stent direction, and drainage route. Based on the current literature, the cumulative success rate is 88% to 93%, with an overall complication rate of 13% to 20%. Endoscopic ultrasound-guided biliary drainage seems to be an effective and valuable alternative technique after failed endoscopic retrograde cholangiopancreatography when performed by highly skilled endoscopists.
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Affiliation(s)
- Jeremy S Nussbaum
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1069, New York, NY 10029, USA
| | - Nikhil A Kumta
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1069, New York, NY 10029, USA.
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16
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Hindryckx P, Degroote H, Tate DJ, Deprez PH. Endoscopic ultrasound-guided drainage of the biliary system: Techniques, indications and future perspectives. World J Gastrointest Endosc 2019; 11:103-114. [PMID: 30788029 PMCID: PMC6379744 DOI: 10.4253/wjge.v11.i2.103] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 01/23/2019] [Accepted: 02/13/2019] [Indexed: 02/06/2023] Open
Abstract
Over the last decade, endoscopic ultrasound-guided biliary drainage (EUS-BD) has evolved into a widely accepted alternative to the percutaneous approach in cases of biliary obstruction with failed endoscopic retrograde cholangiopancreaticography (ERCP). The available evidence suggests that, in experienced hands, EUS-BD might even replace ERCP as the first-line procedure in specific situations such as malignant distal bile duct obstruction. The aim of this review is to summarize the available data on EUS-BD and propose an evidence-based algorithm clarifies the role of the different EUS-BD techniques in the management of benign and malignant biliary obstructive disease.
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Affiliation(s)
- Pieter Hindryckx
- Department of Gastroenterology, University Hospital of Ghent, Ghent 9000, Belgium
| | - Helena Degroote
- Department of Gastroenterology, University Hospital of Ghent, Ghent 9000, Belgium
| | - David J Tate
- Department of Gastroenterology, University Hospital of Ghent, Ghent 9000, Belgium
| | - Pierre H Deprez
- Hepato-Gastroenterology Department, Cliniques universitaires Saint-Luc, Brussels 1200, Belgium
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17
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Guo J, Giovannini M, Sahai AV, Saftoiu A, Dietrich CF, Santo E, Fusaroli P, Siddiqui AA, Bhutani MS, Bun Teoh AY, Irisawa A, Arturo Arias BL, Achanta CR, Jenssen C, Seo DW, Adler DG, Kalaitzakis E, Artifon E, Itokawa F, Poley JW, Mishra G, Ho KY, Wang HP, Okasha HH, Lachter J, Vila JJ, Iglesias-Garcia J, Yamao K, Yasuda K, Kubota K, Palazzo L, Sabbagh LC, Sharma M, Kida M, El-Nady M, Nguyen NQ, Vilmann P, Garg PK, Rai P, Mukai S, Carrara S, Parupudi S, Sridhar S, Lakhtakia S, Rana SS, Ogura T, Baron TH, Dhir V, Sun S. A multi-institution consensus on how to perform EUS-guided biliary drainage for malignant biliary obstruction. Endosc Ultrasound 2018; 7:356-365. [PMID: 30531022 PMCID: PMC6289007 DOI: 10.4103/eus.eus_53_18] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 10/25/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND AND OBJECTIVES EUS-guided biliary drainage (EUS-BD) was shown to be useful for malignant biliary obstruction (MBO). However, there is lack of consensus on how EUS-BD should be performed. METHODS This was a worldwide multi-institutional survey among members of the International Society of EUS conducted in February 2018. The survey consisted of 10 questions related to the practice of EUS-BD. RESULTS Forty-six endoscopists of them completed the survey. The majority of endoscopists felt that EUS-BD could replace percutaneous transhepatic biliary drainage after failure of ERCP. Among all EUS-BD methods, the rendezvous stenting technique should be the first choice. Self-expandable metal stents (SEMSs) were recommended by most endoscopists. For EUS-guided hepaticogastrostomy (HGS), superiority of partially-covered SEMS over fully-covered SEMS was not in agreement. 6-Fr cystotomes were recommended for fistula creation. During the HGS approach, longer SEMS (8 or 10 cm) was recommended. During the choledochoduodenostomy approach, 6-cm SEMS was recommended. During the intrahepatic (IH) approach, the IH segment 3 was recommended. CONCLUSION This is the first worldwide survey on the practice of EUS-BD for MBO. There were wide variations in practice, and randomized studies are urgently needed to establish the best approach for the management of this condition.
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Affiliation(s)
- Jintao Guo
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Marc Giovannini
- Pathology Unit (Flora Poizat), Institute Paoli-Calmettes, Marseille, France
| | - Anand V. Sahai
- Center Hospitalier de l’Université de Montréal, Montreal, Canada
| | - Adrian Saftoiu
- Department of Endoscopy, University of Medicine and Pharmacy, Craiova, Romania
| | | | - Erwin Santo
- Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Pietro Fusaroli
- Department of Medical and Surgical Sciences, Gastroenterology Unit, Hospital of Imola, University of Bologna, Bologna, Italy
| | - Ali A. Siddiqui
- Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Manoop S. Bhutani
- Department of Gastroenterology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anthony Yuen Bun Teoh
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Atsushi Irisawa
- Department of Gastroenterology, Dokkyo Medical University, Mibu, Japan
| | | | | | - Christian Jenssen
- Surgical Clinical Gastroenterolgy, Universidad de Caldas, Manizales, Colombia
| | - Dong-Wan Seo
- Gastroenterologist at Queen's NRI Hospital, Visakhapatnam, Andhra Pradesh, India
| | - Douglas G. Adler
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Evangelos Kalaitzakis
- Division of Endoscopy, Gastro Unit, Copenhagen University Hospital Herlev, Copenhagen, Denmark
| | - Everson Artifon
- Department of Surgery, University of Sao Paulo, Sao Paulo, Brazil
| | - Fumihide Itokawa
- Department of Gastroenterology and Hepatology, Tokyo Adventist Hospital, Tokyo, Japan
| | - Jan Werner Poley
- Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Girish Mishra
- Department of Gastroenterology, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Khek Yu Ho
- Department of Medicine, National University of Singapore, Singapore, Singapore
| | - Hsiu-Po Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, China
| | | | | | - Juan J. Vila
- Endoscopy Unit, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Julio Iglesias-Garcia
- Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Spain
| | | | - Kenjiro Yasuda
- Department of Gastroenterology, Kyoto Second Red Cross Hospital, Kyoto, Japan
| | - Kensuke Kubota
- Department of Endoscopy, Yokohama City University School of Medicine, Yokohama, Japan
| | | | | | - Malay Sharma
- Department of Gastroenterology, Jaswant Rai Specialty Hospital, Meerut, Uttar Pradesh, India
| | - Mitsuhiro Kida
- Department of Gastroenterology, Kitasato University East Hospital, Sagamihara, Japan
| | - Mohamed El-Nady
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nam Q. Nguyen
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, North Terrace, Adelaide, Australia
| | - Peter Vilmann
- Division of Endoscopy, Gastro Unit, Copenhagen University Hospital Herlev, Copenhagen, Denmark
| | - Pramod Kumar Garg
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Praveer Rai
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Shuntaro Mukai
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Silvia Carrara
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sreeram Parupudi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Subbaramiah Sridhar
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Milan, Italy
| | | | - Surinder S. Rana
- Section of Gastroenterology/Hepatology, Augusta University, Augusta, GA, USA
| | - Takeshi Ogura
- Asian Institute of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Todd H. Baron
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vinay Dhir
- 2 Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Siyu Sun
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
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Sandru V, Ilie M, Plotogea O, Ungureanu BS, Stoica A, Gheonea DI, Constantinescu G. Endoscopic ultrasound-guided choledochoduodenostomy using a lumen apposing metal stent for acute cholangitis. THE TURKISH JOURNAL OF GASTROENTEROLOGY : THE OFFICIAL JOURNAL OF TURKISH SOCIETY OF GASTROENTEROLOGY 2018; 29:511-514. [PMID: 30249569 PMCID: PMC6284640 DOI: 10.5152/tjg.2018.18095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 04/29/2018] [Indexed: 11/22/2022]
Abstract
We present the case of a 51-year-old woman with a history of uterine cancer who presented to the emergency room with a clinical picture of acute cholangitis. An abdominal ultrasound and a computed tomography scan were performed, revealing a gigantic lymphadenopathy mass compressing the common bile duct and the duodenum. After failure to perform an endoscopic retrograde cholangiopancreatography (ERCP) due to a modified anatomy, we performed an endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) and placed a Hot AXIOS 10Fr/10 mm stent with efficient biliary drainage. In addition, we inserted a duodenal uncoated 120/22 mm expandable metallic stent. EUS-CDS presents a valid alternative in patients with failed ERCP and should be considered as an important option for rapid biliary decompression in patients with acute cholangitis.
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Affiliation(s)
- Vasile Sandru
- Department of Gastroenterology, Clinical Emergency Hospital, Bucharest, Romania
| | - Mădălina Ilie
- Department of Gastroenterology, Clinical Emergency Hospital, Bucharest, Romania
| | - Oana Plotogea
- Department of Gastroenterology, Clinical Emergency Hospital, Bucharest, Romania
| | - Bogdan Silviu Ungureanu
- Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy Craiova, Romania
| | - Adina Stoica
- Department of Gastroenterology, Clinical Emergency Hospital, Bucharest, Romania
| | - Dan Ionut Gheonea
- Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy Craiova, Romania
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EUS-guided Choledochoduodenostomy Versus Hepaticogastrostomy: A Systematic Review and Meta-analysis. J Clin Gastroenterol 2018; 52:123-130. [PMID: 29095426 DOI: 10.1097/mcg.0000000000000948] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Endoscopic ultrasound-guided biliary drainage (EUS-BD) has emerged as an alternative in cases of endoscopic retrograde cholangiopancreatography (ERCP) failure. Two types of EUS-BD methods for achieving biliary drainage when ERCP fails are choledochoduodenostomy (CDS) or hepaticogastrostomy (HGS). However, there is no consensus if one approach is better than the other. Therefore, we conducted a systematic review and meta-analysis to evaluate these 2 main EUS-BD methods. METHODS We searched MEDLINE, Embase, Scopus, Cochrane database, LILACS from inception through April 8, 2017, using the following search terms in various combinations: biliary drainage, biliary stent, transluminal biliary drainage, choledochoduodenostomy, hepaticogastrostomy, endoscopic ultrasound-guided biliary drainage. We selected studies comparing CDS and HGS in patients with malignant biliary obstruction with ERCP failure. Pooled odds ratio (OR) were calculated for technical success, clinical success, and adverse events and difference of means calculated for duration of procedure and survival after procedure. RESULTS A total of 10 studies with 434 patients were included in the meta-analysis: 208 underwent biliary drainage via HGS and the remaining 226 via CDS. The technical success for CDS and HGS was 94.1% and 93.7%, respectively, pooled OR=0.96 [95% confidence interval (CI)=0.39-2.33, I=0%]. Clinical success was 88.5% in CDS and 84.5% in HGS, pooled OR=0.76 (95% CI=0.42-1.35, I=17%). There was no difference for adverse events OR=0.97 (95% CI=0.60-1.56), I=37%. CDS was about 2 minutes faster with a pooled difference in means of was -2.69 (95% CI=-4.44 to -0.95). CONCLUSION EUS-CDS and EUS-HGS have equal efficacy and safety, and are both associated with a very high technical and clinical success. The choice of approach may be selected based on patient anatomy.
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Makmun D, Fauzi A, Abdullah M, Syam AF. The Role of EUS-BD in the Management of Malignant Biliary Obstruction: The Indonesian Perspective. DIAGNOSTIC AND THERAPEUTIC ENDOSCOPY 2017; 2017:4856276. [PMID: 29180841 PMCID: PMC5664256 DOI: 10.1155/2017/4856276] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 08/14/2017] [Accepted: 09/20/2017] [Indexed: 02/06/2023]
Abstract
AIMS To evaluate the success rate and related factors of endoscopic ultrasound guided-biliary drainage (EUS-BD). MATERIAL AND METHODS We conducted a retrospective study among 24 patients with malignant biliary obstruction who underwent EUS-BD after failed ERCP from January 2015 to December 2016 in a tertiary health center. The bilirubin levels before and after the procedure were used to define the clinical success rate, while the stent deployment was used to define the technical success rate. We placed either transluminal biliary stents or transpapillary biliary stents. RESULTS Among 24 patients, choledochoduodenostomy technique was conducted in 23 patients (95.8%) and hepaticogastrostomy technique in 1 patient (4.2%). Transluminal stent placement was conducted in 23 patients, while transpapillary stent placement was conducted in 1 patient. The clinical success rate was 78.2% (18) in choledochoduodenostomy route and 100% (1) in hepaticogastrostomy route. EUS-BD was 2.37 times and 2.11 times more likely to be successful in reducing the bilirubin level in patients with tumor of the head of pancreas and periampullary tumor, respectively, but not in cholangiocarcinoma. CONCLUSIONS EUS-BD is an effective and efficient procedure to achieve biliary drainage among patients with malignant biliary obstruction after ERCP failure.
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Affiliation(s)
- Dadang Makmun
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta Pusat, Jakarta 10430, Indonesia
| | - Achmad Fauzi
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta Pusat, Jakarta 10430, Indonesia
| | - Murdani Abdullah
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta Pusat, Jakarta 10430, Indonesia
| | - Ari Fahrial Syam
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta Pusat, Jakarta 10430, Indonesia
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