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Sugimoto M, Takagi T, Suzuki R, Asama H, Shimizu H, Sato K, Ohira R, Nakamura J, Takasumi M, Kato T, Yanagita T, Otsuka M, Hikichi T, Ohira H. Selection methods for endoscopic ultrasound‑guided biliary drainage cases that are appropriate for beginners. Exp Ther Med 2025; 29:53. [PMID: 39885912 PMCID: PMC11775763 DOI: 10.3892/etm.2025.12803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2024] [Accepted: 12/18/2024] [Indexed: 02/01/2025] Open
Abstract
Endoscopic ultrasound-guided biliary drainage (EUS-BD) is performed as a second drainage method when endoscopic retrograde cholangiopancreatography-guided biliary drainage fails. There are several severe adverse events in EUS-BD, and avoiding technical failure is desirable. Although EUS-BD is a skilled endoscopic treatment, the appropriate conditions for EUS-BD beginners are not well known. The present study aimed to clarify the appropriate cases for EUS-BD beginners. The present retrospective cohort study included patients with malignant biliary obstruction who underwent EUS-BD, which was performed by beginners between March 2005 and June 2024. Factors associated with successful EUS-BD performed by beginners were evaluated by multivariate logistic regression analysis. The performance of each factor was evaluated via a receiver operating characteristic (ROC) curve. According to multivariate analysis, the diameter of the punctured bile duct was associated with successful EUS-BD performed by beginners (odds ratio, 1.34; 95% CI, 1.03-1.75; P=0.031). The area under the ROC curve for the diameter of the punctured bile duct was 0.79, and the cutoff value was 6.7 mm (71% sensitivity and 81.8% specificity). The diameter of the punctured bile duct might be associated with successful EUS-BD procedures performed by beginners. When a beginner performs EUS-BD, a diameter of the targeted bile duct >6.7 mm might be desirable for successful procedures.
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Affiliation(s)
- Mitsuru Sugimoto
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Fukushima 960-1295, Japan
| | - Tadayuki Takagi
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Fukushima 960-1295, Japan
| | - Rei Suzuki
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Fukushima 960-1295, Japan
| | - Hiroyuki Asama
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Fukushima 960-1295, Japan
| | - Hiroshi Shimizu
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Fukushima 960-1295, Japan
| | - Kentaro Sato
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Fukushima 960-1295, Japan
| | - Rei Ohira
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Fukushima 960-1295, Japan
| | - Jun Nakamura
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Fukushima 960-1295, Japan
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Fukushima 960-1295, Japan
| | - Mika Takasumi
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Fukushima 960-1295, Japan
| | - Tsunetaka Kato
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Fukushima 960-1295, Japan
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Fukushima 960-1295, Japan
| | - Takumi Yanagita
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Fukushima 960-1295, Japan
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Fukushima 960-1295, Japan
| | - Mitsuru Otsuka
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Fukushima 960-1295, Japan
| | - Takuto Hikichi
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Fukushima 960-1295, Japan
| | - Hiromasa Ohira
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Fukushima 960-1295, Japan
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Kaneko T, Kida M, Kurosu T, Kitahara G, Koyama S, Nomura N, Tahara K, Kusano C. Outcomes of bile duct cannulation using a novel contrast-enhanced catheter: A single-center, retrospective cohort study. World J Gastrointest Endosc 2025; 17:97840. [PMID: 39850917 PMCID: PMC11752468 DOI: 10.4253/wjge.v17.i1.97840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 12/19/2024] [Accepted: 01/02/2025] [Indexed: 01/16/2025] Open
Abstract
BACKGROUND Endoscopic retrograde cholangiopancreatography is a challenging procedure involving bile duct cannulation. Despite the development of several cannulation devices, none have effectively facilitated the procedure. AIM To evaluate the efficacy of a recently developed catheter for bile duct cannulation. METHODS We retrospectively examined 342 patients who underwent initial cholangiopancreatography. We compared the success rate of bile duct cannulation and the incidence of complications between the groups using existing and novel catheters. RESULTS The overall success rates of bile duct cannulation were 98.3% and 99.1% in the existing and novel catheter groups, respectively (P = 0.47). The bile duct cannulation rate using the standard technique was 73.0% and 82.1% in the existing and novel catheter groups, respectively (P = 0.042). Furthermore, when catheterization was performed by expert physicians, the bile duct cannulation rate was significantly higher in the novel catheter group (81.3%) than in the existing catheter group (65.2%) (P = 0.017). The incidence of difficult cannulation was also significantly lower in the novel catheter group (17.4%) than in the existing catheter group (33.0%) (P = 0.019). CONCLUSION The novel catheter improved the bile duct cannulation rate using the standard technique and reduced the frequency of difficult cannulation cases, valuable tool in endoscopic retrograde cholangiopancreatography procedures performed by experts.
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Affiliation(s)
- Toru Kaneko
- Department of Gastroenterology, Kitasato University Medical Center, Kitamoto 364-8501, Saitama, Japan
| | - Mitsuhiro Kida
- Department of Gastroenterology, Kitasato University Medical Center, Kitamoto 364-8501, Saitama, Japan
| | - Takahiro Kurosu
- Department of Gastroenterology, Kitasato University Medical Center, Kitamoto 364-8501, Saitama, Japan
| | - Gen Kitahara
- Department of Gastroenterology, Kitasato University Medical Center, Kitamoto 364-8501, Saitama, Japan
| | - Shiori Koyama
- Department of Gastroenterology, Kitasato University Medical Center, Kitamoto 364-8501, Saitama, Japan
| | - Nao Nomura
- Department of Gastroenterology, Kitasato University Medical Center, Kitamoto 364-8501, Saitama, Japan
| | - Kumiko Tahara
- Department of Gastroenterology, Kitasato University Medical Center, Kitamoto 364-8501, Saitama, Japan
| | - Chika Kusano
- Department of Gastroenterology, Kitasato University Hospital, Sagamihara 252-0375, Kanagawa, Japan
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Zhang W, Chen J, Zhang W, Xu M. Advances in Endoscopic Ultrasound in Pancreatic Cancer Screening, Diagnosis, and Palliative Care. Biomedicines 2024; 13:76. [PMID: 39857661 PMCID: PMC11762820 DOI: 10.3390/biomedicines13010076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2024] [Revised: 12/27/2024] [Accepted: 12/30/2024] [Indexed: 01/27/2025] Open
Abstract
Pancreatic cancer is a highly aggressive malignancy with a profoundly poor prognosis. Clinically, the condition most frequently manifests with symptoms including painless jaundice, abdominal discomfort, and back pain. Early diagnosis and the implementation of effective therapeutic strategies are critical for improving patient survival outcomes. However, merely 10-20% of patients are diagnosed at an early stage, with the majority presenting at advanced stages, often with metastasis. Consequently, early detection and intervention are crucial for enhancing prognosis. The widespread adoption of endoscopic ultrasonography (EUS) technology in recent years has significantly enhanced the diagnostic accuracy for pancreatic space-occupying lesions. EUS is increasingly recognized for its pivotal role in alleviating malignant biliary obstruction (MBO), gastric outlet obstruction (GOO), and refractory pain in advanced pancreatic cancer. This article aims to provide an overall review of the current applications of EUS in the diagnosis and treatment of pancreatic cancer, exploring its advantages and limitations in early screening, diagnosis, and palliative care. Furthermore, this review explores potential future directions in the field, aiming to provide valuable insights to inform and enhance the clinical management of pancreatic cancer.
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Affiliation(s)
- Wenyu Zhang
- Department of Gastroenterology, Affiliated Hospital of Jiangsu University, Zhenjiang 212001, China
| | - Jingzheng Chen
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang 212001, China
| | - Wei Zhang
- Department of Gastroenterology, Affiliated Hospital of Jiangsu University, Zhenjiang 212001, China
- Department of Gastroenterology, Digestive Disease Institute of Jiangsu University, Affiliated Hospital of Jiangsu University, Zhenjiang 212001, China
| | - Min Xu
- Department of Gastroenterology, Affiliated Hospital of Jiangsu University, Zhenjiang 212001, China
- Department of Gastroenterology, Digestive Disease Institute of Jiangsu University, Affiliated Hospital of Jiangsu University, Zhenjiang 212001, China
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Marzioni M, Crinò SF, Lisotti A, Fuccio L, Vanella G, Amato A, Bertani H, Binda C, Coluccio C, Forti E, Fugazza A, Ligresti D, Maida M, Marchegiani G, Mauro A, Mirante VG, Ricci C, Rizzo GEM, Scimeca D, Spadaccini M, Arvanitakis M, Anderloni A, Fabbri C, Tarantino I, Arcidiacono PG. Biliary drainage in patients with malignant distal biliary obstruction: results of an Italian consensus conference. Surg Endosc 2024; 38:6207-6226. [PMID: 39317905 PMCID: PMC11525304 DOI: 10.1007/s00464-024-11245-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 08/30/2024] [Indexed: 09/26/2024]
Abstract
BACKGROUND Malignant Distal Biliary Obstruction (MBDO) is a common event occurring along the natural history of both pancreatic cancer and cholangiocarcinoma. Epidemiological and biological features make MBDO one of the key elements of the clinical management of patients suffering for of pancreatic cancer or cholangiocarcinoma. The development of dedicated biliary lumen-apposing metal stents (LAMS) is changing the clinical work up of patients with MBDO. i-EUS is an Italian network of clinicians and scientists with a special interest in biliopancreatic endoscopy, EUS in particular. METHODS The scientific methodology was chosen in line with international guidance and in a fashion similar to those applied by broader scientific associations. PICO questions were elaborated and subsequently voted by a broad panel of experts within a simplified Delphi process. RESULTS AND CONCLUSIONS The manuscripts describes the results of a consensus conference organized by i-EUS with the aim of providing an evidence based-guidance for the appropriate use of the techniques in patients with MBDO.
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Affiliation(s)
- Marco Marzioni
- Clinic of Gastroenterology and Hepatology, Università Politecnica delle Marche - Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy.
| | - Stefano Francesco Crinò
- Diagnostic and Interventional Endoscopy of Pancreas, The Pancreas Institute, G.B. Rossi University Hospital, 37134, Verona, Italy
| | - Andrea Lisotti
- Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola, Italy
| | - Lorenzo Fuccio
- Department of Medical and Surgical Sciences, University of Bologna - Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, Bologna, Italy
| | - Giuseppe Vanella
- Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Institute, Milan, Italy
| | - Arnaldo Amato
- Department of Digestive Endoscopy and Gastroenterology ASST, Lecco, Italy
| | - Helga Bertani
- Gastroenterologia ed Endoscopia Digestiva Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - Cecilia Binda
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena, Italy
| | - Chiara Coluccio
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena, Italy
| | - Edoardo Forti
- Digestive and Interventional Endoscopy Unit, ASST Niguarda Hospital, Milan, Italy
| | - Alessandro Fugazza
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital - IRCCS, Rozzano, 20089, Milan, Italy
| | - Dario Ligresti
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS - ISMETT, Palermo, Italy
| | - Marcello Maida
- Gastroenterology Unit, Umberto I Hospital - Department of Medicine and Surgery, University of Enna 'Kore', Enna, Italy
| | - Giovanni Marchegiani
- Department of Surgical Oncological and Gastroenterological Sciences, Padua University Hospital, Padua, Italy
| | - Aurelio Mauro
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Foundation Policlinico San Matteo, Viale Camillo Golgi 19, 27100, Pavia, Italy
| | - Vincenzo Giorgio Mirante
- Gastroenterologia ed Endoscopia Digestiva, Dipartimento Oncologico e Tecnologie Avanzate, AUSL IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Claudio Ricci
- Department of Medical and Surgical Sciences, University of Bologna - Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | | | - Daniela Scimeca
- Gastroenterology and Endoscopy Unit, ARNAS Civico - Di Cristina - Benfratelli Hospital, 90127, Palermo, Italy
| | - Marco Spadaccini
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital - IRCCS, Rozzano, 20089, Milan, Italy
| | - Marianna Arvanitakis
- Clinic of Gastroenterology and Hepatology, Università Politecnica delle Marche - Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy
- Diagnostic and Interventional Endoscopy of Pancreas, The Pancreas Institute, G.B. Rossi University Hospital, 37134, Verona, Italy
- Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola, Italy
- Department of Medical and Surgical Sciences, University of Bologna - Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, Bologna, Italy
- Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Institute, Milan, Italy
- Department of Digestive Endoscopy and Gastroenterology ASST, Lecco, Italy
- Gastroenterologia ed Endoscopia Digestiva Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena, Italy
- Digestive and Interventional Endoscopy Unit, ASST Niguarda Hospital, Milan, Italy
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital - IRCCS, Rozzano, 20089, Milan, Italy
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS - ISMETT, Palermo, Italy
- Gastroenterology Unit, Umberto I Hospital - Department of Medicine and Surgery, University of Enna 'Kore', Enna, Italy
- Department of Surgical Oncological and Gastroenterological Sciences, Padua University Hospital, Padua, Italy
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Foundation Policlinico San Matteo, Viale Camillo Golgi 19, 27100, Pavia, Italy
- Gastroenterologia ed Endoscopia Digestiva, Dipartimento Oncologico e Tecnologie Avanzate, AUSL IRCCS Reggio Emilia, Reggio Emilia, Italy
- Department of Medical and Surgical Sciences, University of Bologna - Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
- Gastroenterology and Endoscopy Unit, ARNAS Civico - Di Cristina - Benfratelli Hospital, 90127, Palermo, Italy
| | - Andrea Anderloni
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Foundation Policlinico San Matteo, Viale Camillo Golgi 19, 27100, Pavia, Italy
| | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena, Italy
| | - Ilaria Tarantino
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS - ISMETT, Palermo, Italy
| | - Paolo Giorgio Arcidiacono
- Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Institute, Milan, Italy
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Pessoa RRDP, Bestetti AM, Oliveira VLD, Araujo WCD, Guaraldi S, Rodrigues Silva RR, Oliveira FAA, Ribeiro MSI, Carneiro FOAA, D'Assunção MA, Medrado BFOA, Retes FA, Paulo GAD, Schneider NC, Rossini LGB, Vallinoto L, Ardengh JC, Coelho Neto DE, Ide E, Silva MCB, Franco MC, Matuguma SE, Moura DTHD, Arantes VN, Nahoum R, Brunaldi VO, Santos MELD, Chaves DM, Micelli-Neto O, Salomao BC, Maluf-Filho F, Luz GDO. III BRAZILIAN CONSENSUS STATEMENT ON ENDOSCOPIC ULTRASOUND. ARQUIVOS DE GASTROENTEROLOGIA 2024; 61:e24062. [PMID: 39442127 DOI: 10.1590/s0004-2803.24612024-062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2024] [Accepted: 08/20/2024] [Indexed: 10/25/2024]
Abstract
BACKGROUND •Since its inception in the 1980s, endoscopic ultrasound has increased relevance and usefulness in clinical practice. BACKGROUND •Endoscopic ultrasound has evolved from solely diagnostic imaging to a valuable method for tissue sampling and therapeutic procedures, such as drainage of pancreatic fluid collections and creating gastrointestinal anastomoses under EUS guidance. BACKGROUND •Given the rapid advancements in EUS and new devices, an update to the last Consensus must include recent developments. BACKGROUND •Experts evaluated and discussed the best evidence on EUS-guided procedures and devices for tissue sampling, pancreatic and liver disease management, and biliary drainage. BACKGROUND In the past decades, endoscopic ultrasound has developed from a diagnostic tool to a platform for many therapeutic interventions. Various technological advancements have emerged since the last Brazilian Consensus, demanding a review and update of the recommendations based on the best scientific evidence. METHODS A group of 32 renowned echoendoscopists selected eight relevant topics to be discussed to generate clinical questions. After that, a literature review was conducted to answer these questions based on the most updated evidence. RESULTS Thirty-three statements were formulated and voted on by the experts to reach a consensus. The Oxford System was used to grade the level of evidence. CONCLUSION There is mo-derate evidence to support that the needle shape, gauge, or aspiration technique does not influence the yield of endoscopic ultrasound (EUS)-guided tissue sampling of pancreatic solid lesions. There is moderate evidence to support using EUS-TTNB of the cyst wall to differentiate between mucinous and non-mucinous cystic neoplasms. There is little evidence to support the EUS-guided treatment of gastric varices. There is a high level of evidence to support that EUS-guided biliary drainage and ERCP present similar outcomes in patients with distal malignant biliary obstruction. There is a high level of evidence for using EUS to diagnose neoplastic pancreatic cysts and detect necrosis before indicating drainage. There is moderate evidence to support EUS-GE over duodenal stent for malignant gastric outlet obstruction in patients with a life expectancy higher than 2 months. There is a high level of evidence to support the use of RFA in treating both functioning and non-functioning types of NET.
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Affiliation(s)
| | - Alexandre Moraes Bestetti
- Universidade de São Paulo, Hospital das Clínicas, Unidade de Endoscopia Gastrointestinal, São Paulo, SP, Brasil
| | - Victor Lira de Oliveira
- Universidade de São Paulo, Hospital das Clínicas, Unidade de Endoscopia Gastrointestinal, São Paulo, SP, Brasil
| | | | | | - Rodrigo Roda Rodrigues Silva
- Hospital das Clínicas da Faculdade de Medicina da Universidade Federal de Minas Gerais, Endoscopia, Belo Horizonte, MG, Brasil
| | | | | | - Fred Olavo Aragão Andrade Carneiro
- Hospital das Clínicas da Faculdade de Medicina da Universidade Federal do Ceará, Departamento de Gastroenterologia, Unidade de Endoscopia, São Paulo, SP, Brasil
| | | | | | - Felipe Alves Retes
- Hospital das Clínicas da Faculdade de Medicina da Universidade Federal de Minas Gerais, Endoscopia, Belo Horizonte, MG, Brasil
| | | | | | | | - Leonardo Vallinoto
- Universidade de São Paulo, Hospital das Clínicas, Unidade de Endoscopia Gastrointestinal, São Paulo, SP, Brasil
| | | | | | - Edson Ide
- Universidade de São Paulo, Hospital das Clínicas, Unidade de Endoscopia Gastrointestinal, São Paulo, SP, Brasil
| | | | | | - Sergio Eiji Matuguma
- Universidade de São Paulo, Hospital das Clínicas, Unidade de Endoscopia Gastrointestinal, São Paulo, SP, Brasil
| | | | - Vitor Nunes Arantes
- Hospital das Clínicas da Faculdade de Medicina da Universidade Federal de Minas Gerais, Endoscopia, Belo Horizonte, MG, Brasil
| | - Rafael Nahoum
- Universidade de São Paulo, Hospital das Clínicas, Unidade de Endoscopia Gastrointestinal, São Paulo, SP, Brasil
| | - Vitor Ottoboni Brunaldi
- Universidade de São Paulo, Hospital das Clínicas, Unidade de Endoscopia Gastrointestinal, São Paulo, SP, Brasil
| | | | - Dalton Marques Chaves
- Universidade de São Paulo, Hospital das Clínicas, Unidade de Endoscopia Gastrointestinal, São Paulo, SP, Brasil
| | | | | | - Fauze Maluf-Filho
- Universidade de São Paulo Instituto do Câncer do Estado de São Paulo, Gastroenterologia, São Paulo, SP, Brasil
| | - Gustavo de Oliveira Luz
- Universidade de São Paulo, Hospital das Clínicas, Unidade de Endoscopia Gastrointestinal, São Paulo, SP, Brasil
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Okuno N, Hara K, Haba S, Kuwahara T, Fukui T, Urata M, Yamamoto Y, Kondo T. The New Potential for Using Franseen Needles in Interventional EUS. Intern Med 2024; 63:2723-2727. [PMID: 38403760 PMCID: PMC11557192 DOI: 10.2169/internalmedicine.3207-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/04/2024] [Indexed: 02/27/2024] Open
Abstract
Objective Adverse events such as bile leakage and bleeding are among the issues that need to be resolved in EUS-guided choledochoduodenostomy (EUS-CDS). To overcome this problem, we developed a new EUS-CDS technique using a 19-G Franseen needle without tract dilation. This study aimed to evaluate the safety and efficacy of the new EUS-CDS technique. Methods This single-center retrospective study included 20 consecutive patients who underwent EUS-CDS for primary drainage using a 19-G Franseen needle between March 2020 and May 2023. The primary endpoint was the technical success rate of EUS-CDS without tract dilation. Results The technical success rate of EUS-CDS was 20/20 (100%). None of the patients required any additional tract dilation, such as by using a balloon or electric cautery. The median procedure time was 7.8 [range, 3.2-19.4] min. No early adverse events were observed. Conclusion The 19-G Franseen needle appeared to have a sufficient dilatory effect during puncturing. This EUS-CDS technique appears to be safe and effective and has the advantages of no adverse events and it is also a simplified procedure, which suggests its potential for widespread use in primary drainage.
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Affiliation(s)
- Nozomi Okuno
- Department of Gastroenterology, Aichi Cancer Center Hospital, Japan
| | - Kazuo Hara
- Department of Gastroenterology, Aichi Cancer Center Hospital, Japan
| | - Shin Haba
- Department of Gastroenterology, Aichi Cancer Center Hospital, Japan
| | | | - Toshitaka Fukui
- Department of Gastroenterology, Aichi Cancer Center Hospital, Japan
| | - Minako Urata
- Department of Gastroenterology, Aichi Cancer Center Hospital, Japan
| | | | - Takashi Kondo
- Department of Gastroenterology, Aichi Cancer Center Hospital, Japan
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Antonini F, Merlini I, Di Saverio S. Endoscopic ultrasound-guided biliary drainage after failed endoscopic retrograde cholangiopancreatography: The road is open for almighty biliopancreatic endoscopists! World J Gastrointest Surg 2024; 16:2765-2768. [PMID: 39351565 PMCID: PMC11438791 DOI: 10.4240/wjgs.v16.i9.2765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 05/17/2024] [Accepted: 06/14/2024] [Indexed: 09/18/2024] Open
Abstract
Commentary on the article written and published by Peng et al, investigating the role of endoscopic ultrasound (EUS)-guided biliary drainage for palliation of malignant biliary obstruction after failed endoscopic retrograde cholangiopancreatography (ERCP). For 40 years endoscopic biliary drainage was synonymous with ERCP, and EUS was used mainly for diagnostic purposes. The advent of therapeutic EUS has revolutionized the field, especially with the development of a novel device such as electrocautery-enhanced lumen-apposing metal stents. Complete biliopancreatic endoscopists with both skills in ERCP and in interventional EUS, would be ideally suited to ensure patients the best drainage technique according to each individual situation.
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Affiliation(s)
- Filippo Antonini
- Gastroenterology and Interventional Endoscopy UnitMazzoni Hospital AST Ascoli Piceno, Ascoli Piceno 63100, Italy
| | - Ilenia Merlini
- Department of Surgery, Madonna del Soccorso Hospital AST Ascoli Piceno, San Benedetto del Tronto 63074, Italy
| | - Salomone Di Saverio
- Department of Surgery, Madonna del Soccorso Hospital AST Ascoli Piceno, San Benedetto del Tronto 63074, Italy
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Nabi Z, Samanta J, Dhar J, Aggarwal M, Basha J, Gahra A, Golchha A, Crinò SF, Facciorusso A, Lakhtakia S, Reddy DN. Comparative Effectiveness of ERCP and EUS-Guided Techniques for "Primary Biliary Drainage" in Malignant Distal Biliary Obstruction: A Systematic Review and Meta-Analysis. J Clin Gastroenterol 2024:00004836-990000000-00351. [PMID: 39312532 DOI: 10.1097/mcg.0000000000002075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 08/14/2024] [Indexed: 09/25/2024]
Abstract
BACKGROUND AND OBJECTIVES Endoscopic ultrasound-guided biliary drainage (EUS-BD) is a viable alternative in cases with failed ERCP transpapillary drainage (ERCP-TPD). This systematic review and meta-analysis aimed to compare the efficacy and safety of EUS-BD and ERCP-TPD for primary biliary drainage in patients with distal malignant biliary obstruction (DMBO). METHODS We searched Embase, PubMed, and Medline databases for studies comparing EUS-BD and ERCP-TPD in DMBO, from inception until September 2023. The primary endpoint was clinical success and secondary endpoints included technical success, procedure duration, and adverse events. RESULTS Eight studies (815 patients, 56.1% male) were included in this analysis. Indications for biliary drainage were pancreatic carcinoma (75.1%), followed by cholangiocarcinoma (10.1%). Clinical success was comparable between EUS-BD and ERCP-TPD groups (OR 1.34; 95% CI, 0.75-2.40; P=0.32). Technical success was similar between the 2 groups (OR 2.09; 95% CI, 0.83-5.25; P=0.12). There was a trend toward fewer adverse events in the EUS-BD group (OR 0.65; 95% CI, 0.40-1.07; P=0.09), with significantly lower odds of post-procedure pancreatitis (OR 0.17; 95% CI, 0.06-0.50; P=0.001). CONCLUSION EUS-BD is comparable to ERCP for primary biliary drainage in DMBO patients with shorter procedural time and a significantly reduced risk of post-procedure pancreatitis.
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Affiliation(s)
- Zaheer Nabi
- Interventional Endoscopy, Asian Institute of Gastroenterology, Hyderabad
| | | | - Jahnvi Dhar
- Department of Gastroenterology, PGIMER, Chandigarh
| | - Mona Aggarwal
- Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Jahangeer Basha
- Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Amrit Gahra
- Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Aman Golchha
- Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Stefano Francesco Crinò
- Diagnostic and Interventional Endoscopy of the Pancreas, The Pancreas Institute, University Hospital of Verona, Verona
| | - Antonio Facciorusso
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Sundeep Lakhtakia
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - D Nageshwar Reddy
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
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9
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Ogura T, Ishiwatari H, Hijioka S, Takeshita K, Sato J, Takenaka M, Fukunaga T, Omoto S, Fujimori N, Ohno A, Hatamaru K, Tamura T, Imai H, Yamada M, Hakoda A, Nishikawa H, Kitano M. Multicenter study comparing EUS-guided hepaticogastrostomy and ERCP for malignant biliary obstruction in patients with accessible papillae. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2024; 31:680-687. [PMID: 39022838 DOI: 10.1002/jhbp.12055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
BACKGROUND One advantage of endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is that it is difficult for reflux cholangitis, caused by duodenal pressure increasing due to duodenal obstruction, to occur. In addition, since stent deployment is performed away from the malignant stricture site, longer stent patency than with endoscopic retrograde cholangiopancreatography (ERCP) may be obtained. However, no study has previously compared EUS-HGS and ERCP for patients without duodenal obstruction or surgically altered anatomy. The aim of the present study was to compare clinical outcomes between EUS-HGS and ERCP in normal anatomy patients without duodenal obstruction. METHOD In the ERCP group, patients who initially underwent biliary drainage were included. In the EUS-HGS group, patients who underwent EUS-HGS due to failed biliary cannulation were included. Patients with an inaccessible papilla, such as with surgically altered anatomy or duodenal obstruction, were excluded. RESULTS A total of 314 patients who underwent ERCP and EUS-HGS were enrolled in this study. Of the 314 patients, 289 underwent biliary stenting under ERCP guidance, and 25 patients underwent biliary stenting under EUS-HGS. After propensity score-matching analysis, the adverse event rate tended to be lower in the EUS-HGS group than in the ERCP group. Although overall survival was not significantly different between the EUS-HGS and ERCP groups (p = .228), stent patency was significantly longer in the EUS-HGS group (median 366.0 days) than in the ERCP group (median 76.5 days). CONCLUSIONS EUS-HGS had a lower adverse event rate, shorter procedure time, and longer stent patency than ERCP in cases of normal anatomy without duodenal obstruction.
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Affiliation(s)
- Takeshi Ogura
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | | | - Susumu Hijioka
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Chuo-ku, Japan
| | - Kotaro Takeshita
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Chuo-ku, Japan
| | - Junya Sato
- Division of Endoscopy, Shizuoka Cancer Center, Nagaizumi-cho, Japan
| | - Mamoru Takenaka
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka-sayama, Japan
| | - Tomohiro Fukunaga
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka-sayama, Japan
| | - Shunsuke Omoto
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka-sayama, Japan
| | - Nao Fujimori
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akihisa Ohno
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Keiichi Hatamaru
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takaaki Tamura
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Hajime Imai
- Department of Gastroenterology, Okanami General Hospital, Iga, Japan
| | - Masanori Yamada
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Akitoshi Hakoda
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Hiroki Nishikawa
- Division of Endoscopy, Shizuoka Cancer Center, Nagaizumi-cho, Japan
| | - Masayuki Kitano
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
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10
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Gopakumar H, Singh RR, Revanur V, Kandula R, Puli SR. Endoscopic Ultrasound-Guided vs Endoscopic Retrograde Cholangiopancreatography-Guided Biliary Drainage as Primary Approach to Malignant Distal Biliary Obstruction: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Am J Gastroenterol 2024; 119:1607-1615. [PMID: 38421018 DOI: 10.14309/ajg.0000000000002736] [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: 09/19/2023] [Accepted: 02/14/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Endoscopic ultrasound-guided biliary drainage (EUS-BD) is an alternative to endoscopic retrograde cholangiopancreatography (ERCP)-guided transpapillary drainage in malignant distal biliary obstruction (MDBO). This meta-analysis of randomized controlled trials (RCTs) aims to compare the outcomes of these 2 approaches. METHODS Electronic databases from January 2005 through December 2023 were searched for RCTs comparing outcomes of EUS-BD and ERCP for treating MDBO. Pooled proportions, risk ratio (RR), and odds ratio were calculated using random-effects models. RESULTS Five RCTs comprising 519 patients were included in the final analysis. The pooled RR for overall technical success with EUS-BD compared with ERCP was 1.05 (95% confidence interval [CI] = 0.96-1.16, P = 0.246, I2 = 61%) and for clinical success was 0.99 (95% CI = 0.95-1.04, P = 0.850, I2 = 0%). The pooled rate of procedure-related pancreatitis was 7.20% (95% CI = 3.60-13.80, I2 = 34%) in the ERCP group compared with zero in the EUS-BD group. The pooled RR for stent dysfunction with EUS-BD compared with ERCP was 0.48 (95% CI = 0.28-0.83, P = 0.008, I2 = 7%). The weighted mean procedure time was 13.43 (SD = 10.12) minutes for EUS-BD compared with 21.06 (SD = 6.64) minutes for ERCP. The mean stent patency was 194.11 (SD = 52.12) days in the EUS-BD group and 187 (SD = 60.70) days in the ERCP group. DISCUSSION EUS-BD is an efficient and safe alternative to ERCP in MDBO. An almost nonexistent risk of procedure-related pancreatitis, lower procedure time, and ease of use make this an attractive primary approach to biliary decompression in centers with expertise.
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Affiliation(s)
- Harishankar Gopakumar
- Department of Gastroenterology and Hepatology, University of Illinois College of Medicine at Peoria, Peoria, Illinois, USA
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11
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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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12
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Binda C, Trebbi M, Coluccio C, Giuffrida P, Perini B, Gibiino G, Fabbri S, Liverani E, Fabbri C. Endoscopic management of malignant biliary obstructions. Ann Gastroenterol 2024; 37:291-302. [PMID: 38779637 PMCID: PMC11107404 DOI: 10.20524/aog.2024.0883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 03/21/2024] [Indexed: 05/25/2024] Open
Abstract
Malignant biliary obstruction (MBO), both distal and hilar, represents an ensemble of different clinical conditions frequently encountered in everyday practice. Given the frequent unresectability of the disease at presentation and the increasing indications for neoadjuvant chemotherapy, endoscopic biliary drainage is generally required during the course of the disease. With the widespread use of interventional endoscopic ultrasound (EUS) and the introduction of dedicated devices, EUS-guided biliary drainage has rapidly gained acceptance, together with transpapillary endoscopic biliary drainage and the percutaneous approach. This comprehensive review describes the current role of endoscopy for distal and hilar MBO supported by evidence, with a focus on the current hot topics in this field.
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Affiliation(s)
- Cecilia Binda
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena (Cecilia Binda, Margherita Trebbi, Chiara Coluccio, Paolo Giuffrida, Barbara Perini, Giulia Gibiino, Stefano Fabbri, Elisa Liverani, Carlo Fabbri)
| | - Margherita Trebbi
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena (Cecilia Binda, Margherita Trebbi, Chiara Coluccio, Paolo Giuffrida, Barbara Perini, Giulia Gibiino, Stefano Fabbri, Elisa Liverani, Carlo Fabbri)
| | - Chiara Coluccio
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena (Cecilia Binda, Margherita Trebbi, Chiara Coluccio, Paolo Giuffrida, Barbara Perini, Giulia Gibiino, Stefano Fabbri, Elisa Liverani, Carlo Fabbri)
| | - Paolo Giuffrida
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena (Cecilia Binda, Margherita Trebbi, Chiara Coluccio, Paolo Giuffrida, Barbara Perini, Giulia Gibiino, Stefano Fabbri, Elisa Liverani, Carlo Fabbri)
| | - Barbara Perini
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena (Cecilia Binda, Margherita Trebbi, Chiara Coluccio, Paolo Giuffrida, Barbara Perini, Giulia Gibiino, Stefano Fabbri, Elisa Liverani, Carlo Fabbri)
- Gastroenterology Unit, Azienda Ospedale-Università di Padova (AOUP), Padua (Barbara Perini), Italy
| | - Giulia Gibiino
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena (Cecilia Binda, Margherita Trebbi, Chiara Coluccio, Paolo Giuffrida, Barbara Perini, Giulia Gibiino, Stefano Fabbri, Elisa Liverani, Carlo Fabbri)
| | - Stefano Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena (Cecilia Binda, Margherita Trebbi, Chiara Coluccio, Paolo Giuffrida, Barbara Perini, Giulia Gibiino, Stefano Fabbri, Elisa Liverani, Carlo Fabbri)
| | - Elisa Liverani
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena (Cecilia Binda, Margherita Trebbi, Chiara Coluccio, Paolo Giuffrida, Barbara Perini, Giulia Gibiino, Stefano Fabbri, Elisa Liverani, Carlo Fabbri)
| | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena (Cecilia Binda, Margherita Trebbi, Chiara Coluccio, Paolo Giuffrida, Barbara Perini, Giulia Gibiino, Stefano Fabbri, Elisa Liverani, Carlo Fabbri)
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13
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Itonaga M, Ashida R, Emori T, Hatamaru K, Yamashita Y, Kawaji Y, Tamura T, Tuda I, Tamura T, Koutani H, Yamazaki H, Shimokawa T, Kitano M. Safety of skipping the tract dilation step for EUS-guided biliary drainage in patients with unresectable malignant biliary obstruction (with video). Surg Endosc 2024; 38:2288-2296. [PMID: 38488871 DOI: 10.1007/s00464-024-10731-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 01/28/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Thin delivery system stents can be inserted directly without the need for a tract dilation step and are expected to reduce bile leakage during endoscopic ultrasound-guided biliary drainage (EUS-BD). The present study retrospectively compared the safety and efficacy of EUS-BD using a thin metal stent (< 7.5 Fr) with those of EUS-BD using a conventional stent (≥ 7.5 Fr). METHODS The present study enrolled 112 patients who underwent EUS-BD using metal stents for unresectable malignant biliary obstruction between April 2016 and July 2022. The primary endpoint was the rate of adverse events (AEs). The secondary endpoints were clinical success rate, procedure time, procedure success rate in the absence of the tract dilation step, recurrent biliary obstruction rate, time to biliary obstruction, and overall survival. Risk factors associated with early AEs were also evaluated. RESULTS The rate of early AEs was significantly lower (12% vs. 35%, P = 0.013) and the procedure success without the tract dilation step was significantly higher (82% vs. 33%, P < 0.001) in the thin than in the conventional delivery system stent group. None of the other secondary endpoints differed significantly between the two groups. Multivariate analysis showed that employing the tract dilation step during EUS-BD was a significant independent risk factor for early AEs (skipping vs. employing; HR, 9.66; 95% CI, 1.13-83.0, P = 0.028). CONCLUSION Employing the tract dilation step during EUS-BD was a significant risk factor for early AEs. Metal stents with a delivery diameter < 7.5 Fr can be inserted directly without the tract dilation step, resulting in lower early AE rates.
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Affiliation(s)
- Masahiro Itonaga
- Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-0012, Japan
| | - Reiko Ashida
- Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-0012, Japan
| | - Tomoya Emori
- Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-0012, Japan
| | - Keiichi Hatamaru
- Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-0012, Japan
| | - Yasunobu Yamashita
- Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-0012, Japan
| | - Yuki Kawaji
- Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-0012, Japan
| | - Takashi Tamura
- Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-0012, Japan
| | - Ikuhisa Tuda
- Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-0012, Japan
| | - Takaaki Tamura
- Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-0012, Japan
| | - Hiromu Koutani
- Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-0012, Japan
| | - Hirofumi Yamazaki
- Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-0012, Japan
| | - Toshio Shimokawa
- Clinical Study Support Center, Wakayama Medical University, Wakayama, Japan
| | - Masayuki Kitano
- Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-0012, Japan.
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14
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Mikalsen IM, Breder S, Medhus AW, Folseraas T, Aabakken L, Ånonsen KV. ERCP for the initial management of malignant biliary obstruction - real world data on 596 procedures. Scand J Gastroenterol 2024; 59:369-377. [PMID: 37994406 DOI: 10.1080/00365521.2023.2282375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 11/07/2023] [Accepted: 11/07/2023] [Indexed: 11/24/2023]
Abstract
AIMS To evaluate outcomes of ERCP as first-line management in patients with malignant biliary obstruction (MBO) of all causes and stages, reflecting a real-life setting. METHODS Retrospective observational study of patients with ERCP as the first-line management of MBO at Oslo University Hospital between 2015 and 2021. Primary outcome measure was a ≥ 50% decrease from the pre-procedural bilirubin within 30 days after ERCP. Secondary outcome measures were technical success of ERCP, complications and overall mortality. RESULTS A total of 596 patients were included, median age 70 years. ASA score was ≥ III in 67% of patients. The most common cancers causing MBO were pancreatic cancer (52%), metastatic lesions (20%) and cholangiocarcinoma (16%). The primary outcome measure was achieved in 62% of patients. With endoscopic access, overall technical success was 80% with 85% for the distal extrahepatic group, 71% for the perihilar, 40% for the intrahepatic and 53% for multiple level MBOs. Reinterventions were performed in 27% of the patients. Complications occurred in 15% of the patients, including post-ERCP pancreatitis in 9%. Most complications were of minor/moderate severity (81%). Overall mortality was 33% within the first 90 days. Patients deceased by the end of the study period (83%) had median survival of 146 days (range 1-2,582 days). CONCLUSIONS ERCP has a high rate of clinical effect and technical success in the management of both distal extrahepatic and perihilar MBO. Our data indicate that ERCP is a valid option in the first-line management of MBO.
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Affiliation(s)
- I M Mikalsen
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
| | - S Breder
- Section of Gastroenterology, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Norway
| | - A W Medhus
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Norway
| | - T Folseraas
- Section of Gastroenterology, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Norway
| | - L Aabakken
- Section of Gastroenterology, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Norway
| | - K V Ånonsen
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
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15
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Mukai S, Itoi T. Preoperative endoscopic ultrasound-guided biliary drainage for primary drainage in obstructive jaundice. Expert Rev Gastroenterol Hepatol 2023; 17:1197-1204. [PMID: 38124621 DOI: 10.1080/17474124.2023.2293813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION Endoscopic transpapillary approach by endoscopic retrograde cholangiopancreatography (ERCP) is the established technique for preoperative biliary drainage (PBD). Recently, endoscopic ultrasound-guided biliary drainage (EUS-BD) has been reported to be a useful alternative technique after ERCP fail. However, the optimal strategy remain controversial. AREA COVERED This review summarizes the literature on EUS-BD techniques for PBD with a literature search using PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials database between 2000 and 2023 using keywords for 'preoperative biliary drainage' and all types of EUS-BD techniques. EXPERT OPINION As there is no consensus on the optimal EUS-BD technique for PBD, selection of the EUS-BD approach depends on the patient's condition, the biliary obstruction site, the anastomosis after surgical intervention, and the preference of the endoscopist. However, we consider that EUS-HGS using a dedicated plastic stent may have some advantages in the adverse impact of surgical procedure because the location where the fistula is created by EUS-HGS is away from the site of the surgical procedure. Although there remain many issues that require further investigation, EUS-BD can be a feasible and safe alternative method of PBD for malignant biliary obstruction after ERCP fail.
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Affiliation(s)
- Shuntaro Mukai
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
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16
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Rizzo GEM, Carrozza L, Rancatore G, Binda C, Fabbri C, Anderloni A, Tarantino I. The Role of Endoscopy in the Palliation of Pancreatico-Biliary Cancers: Biliary Drainage, Management of Gastrointestinal Obstruction, and Role in Relief of Oncologic Pain. Cancers (Basel) 2023; 15:5367. [PMID: 38001627 PMCID: PMC10670525 DOI: 10.3390/cancers15225367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/20/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
Therapeutic endoscopy permits many and various treatments for cancer palliation in patients with bilio-pancreatic cancers, enabling different options, supporting patients during their route to oncologic treatments, and trying to improve their quality of life. Therefore, both endoscopic and endoscopic ultrasound (EUS)-guided techniques are performed in this scenario. We performed a literature review focusing on the role of endoscopy in the palliation of those advanced pancreatic and biliary cancers developing malignant biliary obstruction (MBO), gastric outlet obstruction (GOO), and pain unresponsive to medical therapies. Therefore, we explored and focused on the clinical outcomes of endoscopic procedures in this scenario. In fact, the endoscopic treatment is based on achieving biliary drainage in the case of MBO through endoscopic retrograde cholangiopancreatography (ERCP) or EUS-guided biliary drainage (EUS-BD), while GOO is endoscopically treated through the deployment of an enteral stent or the creation of EUS-guided gastro-entero-anastomosis (EUS-GEA). Furthermore, untreatable chronic abdominal pain is a major issue in patients unresponsive to high doses of painkillers, so EUS-guided celiac plexus neurolysis (CPN) or celiac ganglia neurolysis (CGN) helps to reduce dosage and have better pain control. Therefore, therapeutic endoscopy in the palliative setting is an effective and safe approach for managing most of the clinical manifestations of advanced biliopancreatic tumors.
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Affiliation(s)
- Giacomo Emanuele Maria Rizzo
- Endoscopy Unit, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT Palermo, 90127 Palermo, Italy; (G.E.M.R.); (L.C.); (G.R.)
- Ph.D. Program, Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, 90133 Palermo, Italy
| | - Lucio Carrozza
- Endoscopy Unit, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT Palermo, 90127 Palermo, Italy; (G.E.M.R.); (L.C.); (G.R.)
| | - Gabriele Rancatore
- Endoscopy Unit, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT Palermo, 90127 Palermo, Italy; (G.E.M.R.); (L.C.); (G.R.)
| | - Cecilia Binda
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, 48100 Forlì-Cesena, Italy; (C.B.); (C.F.)
| | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, 48100 Forlì-Cesena, Italy; (C.B.); (C.F.)
| | - Andrea Anderloni
- Gastroenterology and Digestive Endoscopy Unit, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi 19, 27100 Pavia, Italy;
| | - Ilaria Tarantino
- Endoscopy Unit, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT Palermo, 90127 Palermo, Italy; (G.E.M.R.); (L.C.); (G.R.)
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17
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De Angelis CG, Dall’Amico E, Staiano MT, Gesualdo M, Bruno M, Gaia S, Sacco M, Fimiano F, Mauriello A, Dibitetto S, Canalis C, Stasio RC, Caneglias A, Mediati F, Rocca R. The Endoscopic Retrograde Cholangiopancreatography and Endoscopic Ultrasound Connection: Unity Is Strength, or the Endoscopic Ultrasonography Retrograde Cholangiopancreatography Concept. Diagnostics (Basel) 2023; 13:3265. [PMID: 37892086 PMCID: PMC10606726 DOI: 10.3390/diagnostics13203265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 10/05/2023] [Accepted: 10/08/2023] [Indexed: 10/29/2023] Open
Abstract
Endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) are both crucial for the endoscopic management of biliopancreatic diseases: the combination of their diagnostic and therapeutic potential is useful in many clinical scenarios, such as indeterminate biliary stenosis, biliary stones, chronic pancreatitis and biliary and pancreatic malignancies. This natural and evident convergence between EUS and ERCP, which by 2006 we were calling the "Endoscopic ultrasonography retrograde colangiopancreatography (EURCP) concept", has become a hot topic in the last years, together with the implementation of the therapeutic possibilities of EUS (from EUS-guided necrosectomy to gastro-entero anastomoses) and with the return of ERCP to its original diagnostic purpose thanks to ancillary techniques (extraductal ultrasound (EDUS), intraductal ultrasound (IDUS), cholangiopancreatoscopy with biopsies and probe-based confocal laser endomicroscopy (pCLE)). In this literary review, we retraced the recent history of EUS and ERCP, reported examples of the clinical applicability of the EURCP concept and explored the option of performing the two procedures in only one endoscopic session, with its positive implications for the patient, the endoscopist and the health care system. In the last few years, we also evaluated the possibility of combining EUS and ERCP into a single endoscopic instrument in a single step, but certain obstacles surrounding this approach remain.
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Affiliation(s)
- Claudio Giovanni De Angelis
- Gastroenterology and Digestive Endoscopy Unit, AOU Città della Salute e della Scienza, University of Turin, 10126 Turin, Italy; (M.G.)
| | - Eleonora Dall’Amico
- Gastroenterology and Digestive Endoscopy Unit, AOU Città della Salute e della Scienza, University of Turin, 10126 Turin, Italy; (M.G.)
| | - Maria Teresa Staiano
- Gastroenterology and Digestive Endoscopy Unit, AOU Città della Salute e della Scienza, University of Turin, 10126 Turin, Italy; (M.G.)
| | - Marcantonio Gesualdo
- Gastroenterology and Digestive Endoscopy Unit, AOU Città della Salute e della Scienza, University of Turin, 10126 Turin, Italy; (M.G.)
| | - Mauro Bruno
- Gastroenterology and Digestive Endoscopy Unit, AOU Città della Salute e della Scienza, University of Turin, 10126 Turin, Italy; (M.G.)
| | - Silvia Gaia
- Gastroenterology and Digestive Endoscopy Unit, AOU Città della Salute e della Scienza, University of Turin, 10126 Turin, Italy; (M.G.)
| | - Marco Sacco
- Gastroenterology and Digestive Endoscopy Unit, AOU Città della Salute e della Scienza, University of Turin, 10126 Turin, Italy; (M.G.)
| | - Federica Fimiano
- Gastroenterology and Digestive Endoscopy Unit, AOU Città della Salute e della Scienza, University of Turin, 10126 Turin, Italy; (M.G.)
| | - Anna Mauriello
- Gastroenterology and Digestive Endoscopy Unit, AOU Città della Salute e della Scienza, University of Turin, 10126 Turin, Italy; (M.G.)
| | - Simone Dibitetto
- Gastroenterology and Digestive Endoscopy Unit, AOU Città della Salute e della Scienza, University of Turin, 10126 Turin, Italy; (M.G.)
| | - Chiara Canalis
- Gastroenterology and Digestive Endoscopy Unit, AOU Città della Salute e della Scienza, University of Turin, 10126 Turin, Italy; (M.G.)
| | - Rosa Claudia Stasio
- Gastroenterology and Digestive Endoscopy Unit, AOU Città della Salute e della Scienza, University of Turin, 10126 Turin, Italy; (M.G.)
| | - Alessandro Caneglias
- Gastroenterology and Digestive Endoscopy Unit, AOU Città della Salute e della Scienza, University of Turin, 10126 Turin, Italy; (M.G.)
| | - Federica Mediati
- Gastroenterology and Digestive Endoscopy Unit, AOU Città della Salute e della Scienza, University of Turin, 10126 Turin, Italy; (M.G.)
| | - Rodolfo Rocca
- Gastroenterology Department, Mauriziano Hospital, 10128 Turin, Italy
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18
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Akshintala VS, Singh VK. Postendoscopic Retrograde Cholangiopancreatography Pancreatitis Pathophysiology and Prevention. Gastrointest Endosc Clin N Am 2023; 33:771-787. [PMID: 37709410 DOI: 10.1016/j.giec.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is an essential procedure for the management of pancreato-biliary disorders. Pancreatitis remains the most frequent complication of the ERCP procedure, and it is, therefore, necessary to recognize the pathophysiology and risk factors contributing to the development of pancreatitis and understand the methods to prevent this complication.
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Affiliation(s)
- Venkata S Akshintala
- Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
| | - Vikesh K Singh
- Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
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19
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Tyberg A, Sarkar A, Shahid HM, Shah-Khan SM, Gaidhane M, Simon A, Eisenberg IA, Lajin M, Karagyozov P, Liao K, Patel R, Zhao E, Martínez MG, Artifon EL, Lino AD, Vanella G, Arcidiacono PG, Kahaleh M. EUS-Guided Biliary Drainage Versus ERCP in Malignant Biliary Obstruction Before Hepatobiliary Surgery: An International Multicenter Comparative Study. J Clin Gastroenterol 2023; 57:962-966. [PMID: 36730114 DOI: 10.1097/mcg.0000000000001795] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 10/07/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Endoscopic ultrasound-guided biliary drainage (EUS-BD) is the procedure of choice for patients who cannot undergo endoscopic retrograde cholangiopancreatography (ERCP). The outcomes of patients undergoing surgery after EUS-BD for malignancy are unknown. METHODS We conducted an international, multicenter retrospective comparative study of patients who underwent hepatobiliary surgery after having undergone EUS-BD or ERCP from 6 tertiary care centers. Patient demographics, procedural data, and follow-up care were collected in a registry. RESULTS One hundred forty-five patients were included: EUS-BD n=58 (mean age 66, 45% male), ERCP n=87 (mean age 68, 53% male). The majority of patients had pancreatic cancer, cholangiocarcinoma, or gallbladder malignancy. In the EUS-BD group, 29 patients had hepaticogastrostomy, 24 had choledochoduodenostomy, and 5 had rendezvous technique done. The most common surgery was Whipple in both groups (n=41 EUS-BD, n=56 ERCP) followed by partial hepatectomy (n=7 EUS-BD, n=14 ERCP) and cholecystectomy (n=2 EUS-BD, n=2 ERCP). Endoscopy clinical success was comparable in both groups (98% EUS-BD, 94% ERCP). Adverse event rates were similar in both groups: EUS-BD (n=10, 17%) and ERCP (n=23, 26%). Surgery technical success and clinical success were significantly higher in the EUS-BD group compared with the ERCP group (97% vs. 83%, 97% vs. 75%). Total Hospital stay from surgery to discharge was significantly higher in the ERCP group (19 d vs. 10 d, P =0.0082). DISCUSSION Undergoing EUS-BD versus ERCP before hepatobiliary surgery is associated with fewer repeat endoscopic interventions, shorter duration between endoscopy and surgical intervention, higher rates of surgical clinical success, and shorter length of hospital stay after surgery.
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Affiliation(s)
- Amy Tyberg
- Gastroenterology, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Avik Sarkar
- Gastroenterology, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Haroon M Shahid
- Gastroenterology, Robert Wood Johnson Medical School, New Brunswick, NJ
| | | | - Monica Gaidhane
- Gastroenterology, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Alexa Simon
- Gastroenterology, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Ian A Eisenberg
- Gastroenterology, Robert Wood Johnson Medical School, New Brunswick, NJ
| | | | | | - Kelvin Liao
- Gastroenterology, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Roohi Patel
- Gastroenterology, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Eric Zhao
- Gastroenterology, Robert Wood Johnson Medical School, New Brunswick, NJ
| | | | | | - André D Lino
- Universidade de Sao Paulo Faculdade de Medicina, Sao Paulo, Brazil
| | | | | | - Michel Kahaleh
- Gastroenterology, Robert Wood Johnson Medical School, New Brunswick, NJ
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20
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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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21
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Fugazza A, Andreozzi M, De Marco A, Da Rio L, Colombo M, Spadaccini M, Carrara S, Giacchetto M, Sharma M, Craviotto V, Busacca A, Ferrari C, Repici A. Endoscopy Ultrasound-Guided Biliary Drainage Using Lumen Apposing Metal Stent in Malignant Biliary Obstruction. Diagnostics (Basel) 2023; 13:2788. [PMID: 37685326 PMCID: PMC10487072 DOI: 10.3390/diagnostics13172788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/16/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
This narrative review provides an overview of the application of endoscopic ultrasound-guided biliary drainage (EUS-BD), including EUS-guided gallbladder drainage (EUS-GBD), for the treatment of malignant biliary obstruction. EUS-BD has demonstrated excellent technical and clinical success rates, with lower rates of adverse events when compared with percutaneous trans-hepatic biliary drainage (PTBD). EUS-BD is currently the preferred alternative technique for biliary drainage (BD) in patients with distal malignant biliary obstruction (DMBO) after failed endoscopic retrograde cholangiopancreatography (ERCP). Particularly, this review will focus on EUS-BD performed with the use of lumen apposing metal stent (LAMS). The introduction of these innovative devices, followed by the advent of electrocautery-enhanced LAMS (EC-LAMS), gave the procedure a great technical implementation and a widespread application.
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Affiliation(s)
- Alessandro Fugazza
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital–IRCSS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (A.F.); (M.A.); (A.D.M.); (L.D.R.); (M.C.); (M.S.); (S.C.); (M.G.); (V.C.); (A.B.)
| | - Marta Andreozzi
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital–IRCSS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (A.F.); (M.A.); (A.D.M.); (L.D.R.); (M.C.); (M.S.); (S.C.); (M.G.); (V.C.); (A.B.)
| | - Alessandro De Marco
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital–IRCSS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (A.F.); (M.A.); (A.D.M.); (L.D.R.); (M.C.); (M.S.); (S.C.); (M.G.); (V.C.); (A.B.)
| | - Leonardo Da Rio
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital–IRCSS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (A.F.); (M.A.); (A.D.M.); (L.D.R.); (M.C.); (M.S.); (S.C.); (M.G.); (V.C.); (A.B.)
| | - Matteo Colombo
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital–IRCSS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (A.F.); (M.A.); (A.D.M.); (L.D.R.); (M.C.); (M.S.); (S.C.); (M.G.); (V.C.); (A.B.)
| | - Marco Spadaccini
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital–IRCSS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (A.F.); (M.A.); (A.D.M.); (L.D.R.); (M.C.); (M.S.); (S.C.); (M.G.); (V.C.); (A.B.)
| | - Silvia Carrara
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital–IRCSS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (A.F.); (M.A.); (A.D.M.); (L.D.R.); (M.C.); (M.S.); (S.C.); (M.G.); (V.C.); (A.B.)
| | - Marco Giacchetto
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital–IRCSS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (A.F.); (M.A.); (A.D.M.); (L.D.R.); (M.C.); (M.S.); (S.C.); (M.G.); (V.C.); (A.B.)
| | - Mrigya Sharma
- G.M.E.R.S Medical College & Hospital, Gotri, Vadodara 390021, India
| | - Vincenzo Craviotto
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital–IRCSS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (A.F.); (M.A.); (A.D.M.); (L.D.R.); (M.C.); (M.S.); (S.C.); (M.G.); (V.C.); (A.B.)
| | - Anita Busacca
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital–IRCSS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (A.F.); (M.A.); (A.D.M.); (L.D.R.); (M.C.); (M.S.); (S.C.); (M.G.); (V.C.); (A.B.)
| | - Chiara Ferrari
- Division of Anaesthesiology, Humanitas Research Hospital–IRCCS, Via Manzoni 56, Rozzano, 20089 Milan, Italy;
| | - Alessandro Repici
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital–IRCSS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (A.F.); (M.A.); (A.D.M.); (L.D.R.); (M.C.); (M.S.); (S.C.); (M.G.); (V.C.); (A.B.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
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22
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Voiosu TA, Rimbaș M, Larghi A. The Role of Lumen Apposing Metal Stents in the Palliation of Distal Malignant Biliary Distal Obstruction. Cancers (Basel) 2023; 15:2730. [PMID: 37345067 PMCID: PMC10216748 DOI: 10.3390/cancers15102730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 05/03/2023] [Accepted: 05/08/2023] [Indexed: 06/23/2023] Open
Abstract
Malignant biliary obstruction (DMBO) has been traditionally managed by endoscopic retrograde cholangiopancreatography (ERCP). In the case of ERC failure, percutaneous transhepatic biliary drainage (PT-BD) has been widely utilized as a salvage procedure. However, over the last decade, endoscopic ultrasound-guided biliary drainage (EUS-BD) has gained increasing popularity, especially after the advent of electrocautery-enhanced lumen apposing metal stent devices (EC-LAMSs) which enable a one-step procedure, granting prevention of biliary leakage and minimizing occurrence of adverse events (AEs). In parallel, increasing evidence suggests a possible role of EUS-BD in the management of DMBO as a primary palliative drainage modality. In the current paper, we aim to review all the available evidence on the role of EUS-BD performed with EC-LAMSs and discuss salient technical aspects of this type of procedure.
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Affiliation(s)
- Theodor Alexandru Voiosu
- Carol Davila Faculty of Medicine, 021155 Bucharest, Romania; (T.A.V.); (M.R.)
- Gastroenterology Department, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Mihai Rimbaș
- Carol Davila Faculty of Medicine, 021155 Bucharest, Romania; (T.A.V.); (M.R.)
- Gastroenterology Department, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Alberto Larghi
- Digestive Endoscopy Unit, Scientific Institute for Research, Hospitalization, and Health Care, Fondazione Policlinico Universitario A. Gemelli, Catholic University, 00168 Rome, Italy
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23
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DA-Silva RRR, Mafra LGDEA, Brunaldi VO, Almeida LFDE, Artifon ELDEA. Endoscopic ultrasound-guided biliary drainage: a literature review. Rev Col Bras Cir 2023; 50:e20233414. [PMID: 36995833 PMCID: PMC10595038 DOI: 10.1590/0100-6991e-20233414-en] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 01/09/2023] [Indexed: 03/29/2023] Open
Abstract
Neoplasms of the biliopancreatic confluence may present with obstruction of the bile tract, leading to jaundice, pruritus and cholangitis. In these cases drainage of the bile tract is imperative. Endoscopic retrograde cholangiopancreatography (ERCP) with placement of a choledochal prosthesis is an effective treatment in about 90% of cases, even in experienced hands. In cases of ERCP failure, therapeutic options traditionally include surgical bypass by hepaticojejunostomy (HJ) or percutaneous transparietohepatic drainage (DPTH). In recent years, endoscopic ultrasound-guided biliary drainage techniques have gained space because they are less invasive, effective and have an acceptable incidence of complications. Endoscopic echo-guided drainage of the bile duct can be performed through the stomach (hepatogastrostomy), duodenum (choledochoduodenostomy) or by the anterograde drainage technique. Some services consider ultrasound-guided drainage of the bile duct the procedure of choice in the event of ERCP failure. The objective of this review is to present the main types of endoscopic ultrasound-guided biliary drainage and compare them with other techniques.
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Affiliation(s)
- Rodrigo Roda Rodrigues DA-Silva
- - Hospital Mater Dei Santo Agostinho, Serviço de Endoscopia Digestiva - Belo Horizonte - MG - Brasil
- - Hospital das Clínicas da UFMG, Instituto Alfa de Gastroenterologia do Hospital das Clínicas da UFMG - Belo Horizonte - MG - Brasil
| | | | - Vitor Ottoboni Brunaldi
- - Hospital das Clínicas de Ribeirão Preto, Departamento de Cirurgia e Anatomia, Centro de Endoscopia - Ribeirão Preto - SP - Brasil
- -Hospital das Clínicas da Faculdade de Medicina da USP, Departamento de Gastroenterologia, Unidade de Endoscopia Gastrointestinal - São Paulo - SP - Brasil
| | - Letícia França DE Almeida
- - Hospital Mater Dei Santo Agostinho, Serviço de Endoscopia Digestiva - Belo Horizonte - MG - Brasil
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24
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Experience-Related Factors in the Success of Beginner Endoscopic Ultrasound-Guided Biliary Drainage: A Multicenter Study. J Clin Med 2023; 12:jcm12062393. [PMID: 36983393 PMCID: PMC10051516 DOI: 10.3390/jcm12062393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/16/2023] [Accepted: 03/17/2023] [Indexed: 03/22/2023] Open
Abstract
Endoscopic ultrasound-guided biliary drainage (EUS-BD) has become comparable to endoscopic retrograde cholangiopancreatography and is now considered a first-line intervention for certain biliary obstructions. Although analysis of experience-related factors may help achieve better outcomes and contribute to its wider adoption, no concrete evidence exists regarding the required operator or institutional experience levels. This study aimed to analyze experience-related factors at beginner multicenters. Patients who underwent EUS-BD using self-expandable metal stents and/or dedicated plastic stents during the study period (up to the first 25 cases since introducing the technique) were retrospectively enrolled from seven beginner institutions and operators. Overall, 90 successful (technical success without early adverse events) and 22 failed (technical failure and/or early adverse events) cases were compared. EUS-BD-related procedures conducted at the time of applicable EUS-BD by each institution/operator were evaluated. The number of institution-conducted EUS-BD procedures (≥7) and operator-conducted EUS screenings (≥436), EUS-guided fine-needle aspirations (FNA) (≥93), and EUS-guided drainages (≥13) significantly influenced improved EUS-BD outcomes (p = 0.022, odds ratio [OR], 3.0; p = 0.022, OR, 3.0; p = 0.022, OR, 3.0; and p = 0.028, OR, 2.9, respectively). Our threshold values, which significantly divided successful and failed cases, were assessed using receiver operating characteristic curve analysis and may provide useful approximate indications for successful EUS-BD.
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25
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Rai P, Udawat P, Chowdhary SD, Gunjan D, Samanta J, Bhatia V, Singla V, Mukewar S, Mehta N, Achanta CR, Dalal A, Sahu MK, Balekuduru A, Bale A, Basha J, Philip M, Rana S, Puri R, Lakhtakia S, Dhir V. Society of Gastrointestinal Endoscopy of India Consensus Guidelines on Endoscopic Ultrasound-Guided Biliary Drainage: Part I (Indications, Outcomes, Comparative Evaluations, Training). JOURNAL OF DIGESTIVE ENDOSCOPY 2023. [DOI: 10.1055/s-0043-1761591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
Abstract
AbstractEndoscopic management of bile duct obstruction is a key aspect in gastroenterology practice and has evolved since the first description of biliary cannulation by McCune et al in 1968. Over many decades, the techniques and accessories have been refined and currently, the first-line management for extrahepatic biliary obstruction is endoscopic retrograde cholangiopancreaticography (ERCP). However, even in expert hands the success rate of ERCP reaches up to 95%. In almost 4 to 16% cases, failure to cannulate the bile duct may necessitate other alternatives such as surgical bypass or more commonly percutaneous transhepatic biliary drainage (PTBD). While surgery is associated with high morbidity and mortality, PTBD has a very high reintervention and complication rate (∼80%) and poor quality of life. Almost parallelly, endoscopic ultrasound (EUS) has come a long way from a mere diagnostic tool to a substantial therapeutic option in various pancreatico-biliary diseases. Biliary drainage using EUS-guidance (EUS-BD) has gained momentum since the first report published by Giovannini et al in 2001. The concept of accessing the bile duct through a different route than the papilla, circumventing the shortcomings of PTBD and sometimes bypassing the actual obstruction have enthused a lot of interest in this novel strategy. The three key methods of EUS-BD entail transluminal, antegrade, and rendezvous approach. Over the past decade, with growing experience, EUS-BD has been found to be equivalent to ERCP or PTBD for malignant obstruction with better success rates.EUS-BD, albeit, is not devoid of adverse events and can carry fatal adverse events. However, neither the technique of EUS-BD, nor the accessories and stents for EUS-BD have been standardized.Additionally, different countries and regions have different availability of the accessories making generalizability a difficult task. Thus, technical aspects of this evolving therapy need to be outlined. For these reasons, the Society of Gastrointestinal Endoscopy India deemed it appropriate to develop technical consensus statements for performing safe and successful EUS-BD.
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Affiliation(s)
- Praveer Rai
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Priyanka Udawat
- Institute of Digestive and Liver Care, School of EUS, S. L. Raheja Hospital, Mumbai, Maharashtra, India
| | | | - Deepak Gunjan
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Jayanta Samanta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikram Bhatia
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Vikas Singla
- Department of Gastroenterology, Max Superspeciality Hospital, New Delhi, India
| | | | - Nilay Mehta
- Department of Gastroenterology, Zydus Hospital, Ahmedabad, Gujarat, India
| | - Chalapathi Rao Achanta
- Department of Gastroenterology, KIMS ICON Hospital, Vishakhapatnam, Andhra Pradesh, India
| | - Ankit Dalal
- Baldota Institute of Digestive Sciences, Global Hospital, Mumbai, Maharashtra, India
| | - Manoj Kumar Sahu
- Institute of GI Sciences, Apollo Hospitals, Bhubaneshwar, Orissa, India
| | - Avinash Balekuduru
- Department of Gastroenterology, MS Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Abhijit Bale
- Department of Medical Gastroenterology, Sapthagiri Institute of Medical Sciences, Bengaluru, Karnataka, India
| | - Jahangir Basha
- Asian Institute of Gastroenterology, AIG Hospitals, Hyderabad, Telangana, India
| | - Mathew Philip
- Department of Gastroenterology, Lisie Hospital, Kochi, Kerala, India
| | - Surinder Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajesh Puri
- Institute of Digestive and Hepatobiliary Sciences, Medanta Hospital, Gurugram, Haryana, India
| | - Sundeep Lakhtakia
- Asian Institute of Gastroenterology, AIG Hospitals, Hyderabad, Telangana, India
| | - Vinay Dhir
- Institute of Digestive and Liver Care, School of EUS, S. L. Raheja Hospital, Mumbai, Maharashtra, India
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Hu J, Wang G, Gao H, Sheng S, Sun S. The formation process and mechanism of gastrointestinal anastomosis after retrieval anchor-assisted endoscopic ultrasound-guided gastroenterostomy: a preclinical study. Surg Endosc 2023; 37:2043-2049. [PMID: 36289084 DOI: 10.1007/s00464-022-09565-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 08/14/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND AND AIMS Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is a promising method of treating gastric outlet obstruction. However, no study has investigated gastrointestinal anastomosis formation after EUS-GE. We aimed to evaluate the formation of gastrointestinal anastomosis after EUS-GE in a porcine model. METHODS Retrieval anchor-assisted EUS-GE was performed on 15 Bama mini pigs. Five pigs each were randomly euthanized 3, 7, and 14 days postoperatively to evaluate the formation of gastrointestinal anastomosis and measure the anastomotic distance. The expression of transforming growth factor-β1(TGF-β1) and Smad3 in the anastomosis site were examined by immunohistochemistry. RESULTS EUS-GE was successfully performed in all 15 pigs. The mean procedure time was 29.2 ± 6.0 (range 18-40) minutes. The anastomotic distance was 34.0 ± 3.6 cm in 14 pigs. The site of gastroenterostomy of one pig was at the ileum. For pigs euthanized 3 days postoperatively, the structure was mechanically maintained by a stent. For pigs euthanized 7 or 14 days postoperatively, the stomach and small intestine were anastomosed to form a stable structure. The level of TGF-β1 and Smad3 in the anastomosis site gradually increased from 3 to 14 days after EUS-GE. TGF-β1 and Smad3 expression had a significant difference between 3 days, 7 days, and 14 days after EUS-GE (P < 0.05). CONCLUSIONS For EUS-GE, the stomach and small intestine were initially linked together mechanically and spontaneously anastomosed to form a stable structure 7 days postoperatively. TGF-β1 and Smad3 play an important role in the formation of a stable structure of gastrointestinal anastomosis.
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Affiliation(s)
- Jinlong Hu
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Guoxin Wang
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Haixin Gao
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Shiyun Sheng
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Siyu Sun
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, 110004, China.
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Nakshabandi AA, Lee JH. Contemporary advances in the endoscopic management of cholangiocarcinoma: a review of accomplished milestones and prospective opportunities. Expert Rev Gastroenterol Hepatol 2023; 17:175-187. [PMID: 36683580 DOI: 10.1080/17474124.2023.2170875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Cholangiocarcinoma, a primary malignancy of epithelial cells of the bile ducts, has been shown to have increasing incidence rates globally. Many of the current advances aim to improve the accuracy of differentiation between benign biliary strictures and cholangiocarcinoma, which include endoscopic techniques, devices, image processing, and the use of genomic sequencing in acquired specimens. AREAS COVERED In this review, the authors explore the historical timeline of changes leading to modern management of cholangiocarcinoma, with special emphasis on endoscopic modalities and novel therapeutic interventions. The authors also expand on the strengths and shortcomings of endoscopic diagnostics and techniques in biliary drainage and finally discuss potential areas to focus for future research and development. EXPERT OPINION Despite the advances in diagnosis and management of cholangiocarcinoma, there remain multiple tasks that are still awaiting to be completed. Next-generation sequencing in the diagnosis of cholangiocarcinoma needs to be further tested, validated, and easily obtainable. Other innovative diagnostic modalities, such as the use of artificial intelligence in cholangioscopy, may provide an effective complementary modality to existing techniques. A consensus on biliary drainage needs to be defined and account for longevity and patient convenience.
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Affiliation(s)
- Ahmad Al Nakshabandi
- Department of Gastroenterology, Hepatology & Nutrition, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey H Lee
- Department of Gastroenterology, Hepatology & Nutrition, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Yuan L, Shi X, Shan H, Xiao D, Wang X, Wang F. Treatment of obstructive jaundice induced by non-hodgkin lymphoma with EUS-guided transgastric anterograde common bile duct stenting: Technical case report and literature review. Front Surg 2023; 9:1031718. [PMID: 36684212 PMCID: PMC9852524 DOI: 10.3389/fsurg.2022.1031718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/03/2022] [Indexed: 01/08/2023] Open
Abstract
Background Non-Hodgkin lymphoma (NHL) is a rare cause of biliary obstruction. The optimum treatment for these patients is unclear. Lymphoma-associated obstructive jaundice is generally managed with open surgery, Endoscopic retrograde cholangiopancreatography (ERCP), or Percutaneous transhepatic biliary drainage. Here, we present the first description of EUS-guided anterograde common bile duct stenting via the stomach for obstructive jaundice associated with NHL. Patient and methods A 58-year-old male patient who had been undergoing chemotherapy for NHL was admitted to our institution for severe obstructive jaundice. The patient's hepatic function indicators were: alanine aminotransferase 211 U/L, aspartate aminotransferase 301 U/L, total bilirubin 485.6 μmol/L, and direct bilirubin 340.2 μmol/L. Abdominal magnetic resonance imaging showed massive lymphomatous lesions filling the peritoneal cavity. Magnetic resonance cholangiopancreatography revealed an external compressive stricture in the superior middle common bile duct and dilation of the intrahepatic and extrahepatic ducts. ERCP was performed unsuccessfully, due to the stricture at the descending junction of the duodenal bulb caused by lymphoma infiltration. So, EUS-guided anterograde common bile duct stenting via the stomach was performed. Results The patient's bilirubin level decreased significantly in the postoperative period, and no adverse reaction was observed. Computed tomography showed marked shrinking of the abdominal mass after targeted therapy. Conclusions Our report suggests that early relief of biliary obstruction may be more beneficial to subsequent chemotherapy when symptoms of lymphoma-associated jaundice are persistently aggravating. Endoscopic ultrasound-guided biliary drainage is a safe, effective and timely alternative approach to treat biliary obstruction when ERCP fails, especially in cases of malignancy caused by extrahepatic bile duct space-occupying lesions.
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Affiliation(s)
- Lingzhi Yuan
- Department of Gastroenterology, The Third Xiangya Hospital, Central South University, Changsha, China,Hunan Key Laboratory of Non-Resolving Inflammation and Cancer, Central South University, Changsha, China
| | - Xiao Shi
- Department of Gastroenterology, The Third Xiangya Hospital, Central South University, Changsha, China,Hunan Key Laboratory of Non-Resolving Inflammation and Cancer, Central South University, Changsha, China
| | - Hongbo Shan
- Department of Endoscopy, Sun Yat-Sen University Cancer Hospital, Guangzhou, China
| | - Dinghua Xiao
- Department of Gastroenterology, The Third Xiangya Hospital, Central South University, Changsha, China,Hunan Key Laboratory of Non-Resolving Inflammation and Cancer, Central South University, Changsha, China
| | - Xiaoyan Wang
- Department of Gastroenterology, The Third Xiangya Hospital, Central South University, Changsha, China,Hunan Key Laboratory of Non-Resolving Inflammation and Cancer, Central South University, Changsha, China
| | - Fen Wang
- Department of Gastroenterology, The Third Xiangya Hospital, Central South University, Changsha, China,Hunan Key Laboratory of Non-Resolving Inflammation and Cancer, Central South University, Changsha, China,Correspondence: Fen Wang
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Choi KKH, Bonnichsen M, Liu K, Massey S, Staudenmann D, Saxena P, Kaffes AJ. Outcomes of patients with hepaticojejunostomy anastomotic strictures undergoing endoscopic and percutaneous treatment. Endosc Int Open 2023; 11:E24-E31. [PMID: 36618873 PMCID: PMC9812652 DOI: 10.1055/a-1952-2135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 09/20/2022] [Indexed: 01/11/2023] Open
Abstract
Background and study aims The increase in hepaticojejunostomies has led to an increase in benign strictures of the anastomosis. Double balloon enteroscopy-assisted ERCP (DBE-ERCP) and percutaneous transhepatic biliary drainage (PTBD) are treatment options; however, there is lack of long-term outcomes, with no consensus on management. We performed a retrospective study assessing the outcomes of patients referred for endoscopic management of hepaticojejunostomy anastomotic strictures (HJAS). Patients and methods All consecutive patients at a tertiary institution underwent endoscopic intervention for suspected HJAS between 2009 and 2021 were enrolled. Results Eighty-two subjects underwent DBE-ERCP for suspected HJAS. The technical success rate was 77 % (63/82). HJAS was confirmed in 41 patients. The clinical success rate for DBE-ERCP ± PTBD was 71 % (29/41). DBE-ERCP alone achieved clinical success in 49 % of patients (20/41). PTBD was required in 49 % (20/41). Dual therapy was required in 22 % (9/41). Those with liver transplant had less technical success compared to other surgeries (72.1 % vs 82.1 % P = 0.29), less clinical success with DBE-ERCP alone (40 % vs 62.5 % P = 0.16) and required more PTBD (56 % vs 37.5 % P = 0.25). All those with ischemic biliopathy (n = 9) required PTBD for clinical success, required more DBE-ERCP (4.4 vs 2.0, P = 0.004), more PTBD (4.7 vs 0.3, P < 0.0001), longer treatment duration (181.6 vs 99.5 days P = 0.12), and had higher rates of recurrence (55.6 % vs 30.3 % P = 0.18) compared to those with HJAS alone. Liver transplant was the leading cause of ischemic biliopathy (89 %). The overall adverse event rate was 7 %. Conclusions DBE-ERCP is an effective diagnostic and therapeutic tool in those with altered gastrointestinal anatomy and is associated with low complication rates.
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Affiliation(s)
- Kevin Kyung Ho Choi
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, Australia,Sydney Medical School, University of Sydney, Sydney, Australia
| | - Mark Bonnichsen
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, Australia
| | - Ken Liu
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, Australia,Sydney Medical School, University of Sydney, Sydney, Australia
| | - Saniya Massey
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Dominic Staudenmann
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, Australia
| | - Payal Saxena
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, Australia,Sydney Medical School, University of Sydney, Sydney, Australia
| | - Arthur John Kaffes
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, Australia,Sydney Medical School, University of Sydney, Sydney, Australia
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DA-SILVA RODRIGORODARODRIGUES, MAFRA LUCASGALLODEALVARENGA, BRUNALDI VITOROTTOBONI, ALMEIDA LETÍCIAFRANÇADE, ARTIFON EVERSONLUIZDEALMEIDA. Drenagem biliar endoscópica ecoguiada: revisão da literatura. Rev Col Bras Cir 2023. [DOI: 10.1590/0100-6991e-20233414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
RESUMO Neoplasias da confluência biliopancreática podem cursar com obstrução da via biliar, levando a icterícia, prurido e colangite. Nesses casos a drenagem da via biliar é imperativa. A colangiopancreatografia endoscópica retrógrada (CPER) com colocação de prótese coledociana constitui tratamento eficaz em cerca de 90% dos casos mesmo em mãos experientes. Nos casos de insucesso da CPER, tradicionalmente as opções terapêuticas incluem a derivação cirúrgica por hepaticojejunostomia (HJ) ou drenagem percutânea transparietohepática (DPTH). Nos últimos anos as técnicas endoscópicas ecoguiadas de drenagem biliar ganharam espaço por serem menos invasivas, eficazes e apresentarem incidência aceitável de complicações. A drenagem endoscópica ecoguiada da via biliar pode ser realizada pelo estômago (hepatogastrostomia), duodeno (coledocoduodenostomia) ou pela técnica de drenagem anterógrada. Alguns serviços consideram a drenagem ecoguiada da via biliar o procedimento de escolha no caso de insucesso da CPER. O objetivo desta revisão é apresentar os principais tipos de drenagem biliar endoscópica ecoguiada e confrontá-los com outras técnicas.
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Dell'Anna G, Ogura T, Vanella G, Nishikawa H, Lakhtakia S, Arcidiacono PG. Endoscopic ultrasound guided biliary interventions. Best Pract Res Clin Gastroenterol 2022; 60-61:101810. [PMID: 36577530 DOI: 10.1016/j.bpg.2022.101810] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 11/10/2022] [Indexed: 11/17/2022]
Abstract
Endoscopic Retrograde Cholangiopancreatography (ERCP), even in expert hands, may fail in 5-10% of cases, especially in cases of papillary infiltration, malignant gastric outlet obstruction, or surgically altered anatomy. Percutaneous transhepatic biliary drainage (PTBD) has represented the traditional rescue therapy, despite associated with high rate of adverse events, need for re-interventions and an inferior quality of life. The evolution of Endoscopic Ultrasound (EUS) from a diagnostic to a therapeutic tool offers an effective and safe alternative for internal biliary drainage (BD) into the stomach or the duodenum. EUS-BD is reported to have similar or even improved efficacy and increased safety when compared to PTBD and can be performed in the same session of a failed ERCP. This review summarizes technical aspects of intra-hepatic and extra-hepatic EUS-BD (including hepatico-gastrostomy, choledocho-duodenostomy and rendezvous) together with current evidence and future perspectives that steadily cements EUS-BD's place in multidisciplinary management of bilio-pancreatic diseases.
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Affiliation(s)
- Giuseppe Dell'Anna
- Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Takeshi Ogura
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Giuseppe Vanella
- Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
| | - Hiroki Nishikawa
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Sundeep Lakhtakia
- Department of Gastroenterology, Asian Institute of Gastroenterology, AIG Hospitals, Hyderabad, India
| | - Paolo Giorgio Arcidiacono
- Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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Takahashi K, Ohyama H, Ouchi M, Kan M, Nagashima H, Iino Y, Kusakabe Y, Okitsu K, Ohno I, Takiguchi Y, Kato N. Feasibility of endoscopic ultrasound-guided hepaticogastrostomy using a 22-gauge needle. Medicine (Baltimore) 2022; 101:e31545. [PMID: 36343043 PMCID: PMC9646514 DOI: 10.1097/md.0000000000031545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
This study aimed to evaluate the feasibility of performing endoscopic ultrasound-guided hepaticogastrostomy using a 22-gauge fine-needle aspiration needle. This was a single-center retrospective study. Fourteen patients who underwent endoscopic ultrasound-guided hepaticogastrostomy with a 22-gauge fine-needle aspiration needle were examined. Fourteen eligible patients were included in this study. The age of patients ranged from 55 to 93 years, with a median of 76 years. Of patients with existing underlying diseases, there were 8 cases of pancreatic cancer (57.1%), 2 cases of metastatic liver tumor (14.3%), 2 cases of bile duct stones (14.3%), 1 case of hilar cholangiocarcinoma (7.1%), and 1 case of gallbladder cancer (7.1%). Regarding gastrointestinal anatomy, there were 11 cases (78.6%) of normal and 3 cases (21.4%) of gastric resection with Roux-en-Y. Reasons for endoscopic ultrasound-guided hepaticogastrostomy were duodenal obstruction in 7 cases (50.0%), surgically altered anatomy in 3 cases (21.4%), and 4 cases (28.6%) of failed endoscopic retrograde cholangiopancreatography. Technical success was achieved in 11 cases (78.6%). Subsequently, 11 cases of technical success were analyzed. There were 5 cases of puncturing B2 (45.5%). The puncture bile duct diameter ranged from 3.1 to 5.7 mm, with a median of 4.4 mm. endoscopic ultrasound-guided antegrade procedures was combined with endoscopic ultrasound-guided hepaticogastrostomy in 2 cases (18.2%). Clinical success was achieved in all the cases. The procedure time ranged from 15 to 93 minutes, with a median duration of 35 minutes. Regarding the type of stent placed in hepaticogastrostomy, a plastic stent was placed in 10 cases (90.9%) and a metal stent was placed in 1 case (9.1%). Early adverse events occurred in 4 cases (36.4%), and all of these cases developed biliary peritonitis, late adverse events occurred in 1 case (9.1%), this was biloma. A change to a 0.025-inch guidewire during the procedure was required in 8 cases (72.7%). Esophageal puncture was not performed. endoscopic ultrasound-guided hepaticogastrostomy using a 22-gauge fine-needle aspiration needle is effective. However, in 72.7% of the cases started using the 0.018-inch guidewire, the guidewire was exchanged for a 0.025-inch guidewire during procedure.
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Affiliation(s)
- Koji Takahashi
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
- Department of Medical Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
- * Correspondence: Koji Takahashi, Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan; and Department of Medical Oncology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan (e-mail: )
| | - Hiroshi Ohyama
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Mayu Ouchi
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Motoyasu Kan
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hiroki Nagashima
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yotaro Iino
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yuko Kusakabe
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kohichiroh Okitsu
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Izumi Ohno
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
- Department of Medical Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yuichi Takiguchi
- Department of Medical Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Naoya Kato
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
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The Clinical Benefit of Percutaneous Transhepatic Biliary Drainage for Malignant Biliary Tract Obstruction. Cancers (Basel) 2022; 14:cancers14194673. [PMID: 36230596 PMCID: PMC9563508 DOI: 10.3390/cancers14194673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/30/2022] [Accepted: 09/22/2022] [Indexed: 11/23/2022] Open
Abstract
Percutaneous transhepatic biliary drainage (PTBD) is a decompression procedure for malignant proximal biliary obstruction. In this research, over a six-year period, 89 patients underwent PTBD procedure for jaundice caused by malignant disease to restart chemotherapy or for palliative intent. Clinical outcomes after PTBD procedure in the two groups of patients, according to the adequate bilirubin decline (ABD) needed for subsequent chemotherapy, are presented in this paper. Survival and logistic regression were plotted and compared using Kaplan−Meier survival multivariate analysis with a long-range test. Results were processed by MEDCALC software. In the series, 58.4% (52/89) of patients were in good performance status (ECOG 0/1), and PTBD was performed with the intention to (re)start chemotherapy. The normalization of the bilirubin level was seen in 23.0% (12/52), but only 15.4% (8/52) received chemotherapy. The median survival time after PTBD was 9 weeks. In patients with ABD that received chemotherapy, the median survival time was 64 weeks, with 30-day mortality of 27.7%, and 6.4% of death within 7 days. The best outcome was in patients with good performance status (ECOG 0−1), low bilirubin (<120 µmol/L) and LDH (<300 µmol/L) levels and elevated leukocytes at the time of the procedures. PTBD is considered in ABD patients who are candidates for chemotherapy.
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Ogura T, Okuda A, Ueno S, Nishioka N, Miyano A, Ueshima K, Yamamoto Y, Higuchi K. Prospective comparison study between 19-gauge needle with .025-inch guidewire and 22-gauge needle with novel .018-inch guidewire during EUS-guided transhepatic biliary drainage (with video). Gastrointest Endosc 2022; 96:262-268.e1. [PMID: 35300970 DOI: 10.1016/j.gie.2022.03.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 03/09/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS If the diameter of the intrahepatic bile duct is much less dilated, bile duct puncture with a 19-gauge needle can be challenging during EUS-guided biliary drainage (EUS-BD). These characteristics can decrease the difficulty of bile duct puncture, but use of a 22-gauge needle is less feasible because of poor visibility, maneuverability, and stiffness of the conventional .018-inch guidewire. A novel, improved .018-inch guidewire has recently become available. We conducted a prospective study to evaluate the technical feasibility and safety of EUS-BD in patients with insufficient bile duct dilatation using a 22-gauge needle and the new .018-inch guidewire. METHODS A 22-gauge needle was used as the puncture needle for intrahepatic bile ducts of diameters <1.5 mm, and a 19-gauge needle was selected for diameters ≥1.5 mm. As the primary endpoint of the study, the technical success rate of EUS-BD using a 22-gauge needle with the novel .018-inch guidewire was evaluated in patients with insufficient dilation of the intrahepatic bile duct. RESULTS Forty-one patients who required EUS-BD were enrolled (22-gauge needle group, n = 18; 19-gauge needle group, n = 23). Technical success was obtained in all patients in the 19-gauge needle group. In the 22-gauge needle group, technical failure occurred in 2 patients because of nonidentification of the intrahepatic bile duct on EUS (technical success rate, 88.9%), and puncture of the bile duct itself was not performed in these patients. Mean procedure time was similar between the groups. Adverse events were observed in 16.7% of patients (3/16) in the 22-gauge needle group and in 34.8% of patients (8/23) in the 19-gauge needle group. CONCLUSIONS Outcomes of using a 22-gauge needle with a novel .018-inch guidewire were comparable with a 19-gauge needle with a .025-inch guidewire, even in the case of insufficient intrahepatic bile duct dilatation. These results require verification in a prospective, randomized trial comparing 22-gauge and 19-gauge needles with a larger sample size. (Clinical trial registration number: UMIN000044441.).
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Affiliation(s)
- Takeshi Ogura
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Atsushi Okuda
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Saori Ueno
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Nobu Nishioka
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Akira Miyano
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Kazuya Ueshima
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Yoshitaro Yamamoto
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Kazuhide Higuchi
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
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Rana SS, Shah J, Bhujade H, Gorsi U, Kang M, Gupta R. Prevention of Serious Complications during Endoscopic Ultrasound-Guided Biliary Drainage: A Case-Based Technical Review. JOURNAL OF DIGESTIVE ENDOSCOPY 2022. [DOI: 10.1055/s-0042-1743519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
AbstractEndoscopic ultrasound-guided biliary drainage (EUS-BD) has a potential risk of clinically significant adverse events including fatal complications. Learning from complications improves the results from interventional procedures especially the high-risk procedure like EUS-BD. The various complications that have been reported following EUS-BD include bile leak, bleeding, cholangitis, peritonitis, stent migration both internal and external as well as in the peritoneal cavity and fatal perforations. In this technical review, we discuss technical strategies to prevent serious adverse events during EUS-BD using a case based approach.
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Affiliation(s)
- Surinder Singh Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | | | - Harish Bhujade
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ujjwal Gorsi
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Mandeep Kang
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rajesh Gupta
- Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Di Mitri R, Amata M, Mocciaro F, Conte E, Bonaccorso A, Scrivo B, Scimeca D. EUS-guided biliary drainage with LAMS for distal malignant biliary obstruction when ERCP fails: single-center retrospective study and maldeployment management. Surg Endosc 2022; 36:4553-4569. [PMID: 34724586 DOI: 10.1007/s00464-021-08808-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 10/17/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND EUS-guided biliary drainage (EUS-BD) with Lumen Apposing Metal Stent (LAMS) is a mini-invasive approach for jaundice palliation in distal malignant biliary obstruction (D-MBO) not amenable to ERCP, with good efficacy and not exiguous adverse events. AIMS AND METHODS From January 2015 to December 2019, we retrospectively enrolled all the EUS-BD with electrocautery-enhanced LAMS for biliary decompression in unresectable D-MBO and failed ERCP. Primary study aims were to evaluate technical/clinical success and AEs rate. In case of maldeployment, we estimated the efficacy of an intra-operative rescue therapy. Secondary aims were to assess the jaundice recurrence and gastric outlet obstruction symptoms. RESULTS Thirty-six EUS-BD were enrolled over a cohort of 738 patients (ERCP cannulation failure rate was 2.6%): 31 choledocho-duodenostomy and 5 cholecystogastrostomy. A pre-loaded guidewire through the LAMS was systematically used in case of common bile duct ≤ 15 mm or scope instability for a safe/preventive biliary entryway in case of intra-procedural complications. Technical success was 80.6% (29/36 patients). Seven cases of LAMS maldeployment during EUS-guided choledocho-duodenostomy were successfully treated with RT by an over-the-wire fully-covered Self-Expandable Metal Stent (FC-SEMS). The FC-SEMS was released through the novel fistula tract in endoscopic fashion in 5/7 cases and transpapillary in percutaneous-transhepatic-endoscopic rendezvous (1/7) and laparoscopic-endoscopic rendezvous (1/7) in the two remaining cases. The total efficacy of rescue therapy was 100%. Same-session duodenal SEMS was placed in 17 patients with optimal gastric outlet obstruction management. Final clinical success was 100% and no other late adverse events or FC-SEMS migration were observed. CONCLUSION EUS-BD with LAMS is effective for jaundice palliation after ERCP failure but with considerable adverse events. Maldeployment remains a serious complication with fatal evolution if not correctly recognized/managed. Rescue therapy must be promptly applied especially in tertiary-care centers with highly skilled endoscopists, interventional radiologist and dedicated surgeon.
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Affiliation(s)
- Roberto Di Mitri
- Gastroenterology and Endoscopy Unit, ARNAS Civico-Di Cristina-Benfratelli Hospital, Piazza Nicola Leotta 4, 901200, Palermo, Italy
| | - Michele Amata
- Gastroenterology and Endoscopy Unit, ARNAS Civico-Di Cristina-Benfratelli Hospital, Piazza Nicola Leotta 4, 901200, Palermo, Italy.
| | - Filippo Mocciaro
- Gastroenterology and Endoscopy Unit, ARNAS Civico-Di Cristina-Benfratelli Hospital, Piazza Nicola Leotta 4, 901200, Palermo, Italy
| | - Elisabetta Conte
- Gastroenterology and Endoscopy Unit, ARNAS Civico-Di Cristina-Benfratelli Hospital, Piazza Nicola Leotta 4, 901200, Palermo, Italy
| | - Ambra Bonaccorso
- Gastroenterology and Endoscopy Unit, ARNAS Civico-Di Cristina-Benfratelli Hospital, Piazza Nicola Leotta 4, 901200, Palermo, Italy
| | - Barbara Scrivo
- Gastroenterology and Endoscopy Unit, ARNAS Civico-Di Cristina-Benfratelli Hospital, Piazza Nicola Leotta 4, 901200, Palermo, Italy
| | - Daniela Scimeca
- Gastroenterology and Endoscopy Unit, ARNAS Civico-Di Cristina-Benfratelli Hospital, Piazza Nicola Leotta 4, 901200, Palermo, Italy
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Tanikawa T, Ishii K, Katsumata R, Urata N, Nishino K, Suehiro M, Kawanaka M, Haruma K, Kawamoto H. Efficacy of primary drainage by endoscopic ultrasound‐guided biliary drainage for unresectable pancreatic adenocarcinoma. JGH OPEN 2022; 6:251-256. [PMID: 35475205 PMCID: PMC9021712 DOI: 10.1002/jgh3.12732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/15/2022] [Accepted: 03/17/2022] [Indexed: 11/05/2022]
Abstract
Background and Aim Obstructive jaundice induced by pancreatic adenocarcinoma is typically treated with biliary drainage with endoscopic retrograde cholangiopancreatography (ERCP)‐guided biliary drainage (ERCP‐BD). Recently, endoscopic ultrasonography‐guided biliary drainage (EUS‐BD) was employed as an alternative method after ERCP‐BD failed. We aimed to determine the efficacy and safety of EUS‐BD for primary biliary drainage. Methods Between December 2011 and February 2019, at Kawasaki General Medical Center, we retrospectively enrolled 33 patients who had undergone endoscopic biliary drainage with a metal stent, in a first attempt to relieve obstructive jaundice caused by unresectable pancreatic adenocarcinoma. We compared the technical and clinical outcomes between ERCP‐BD and EUS‐BD. Results Twenty‐three patients underwent ERCP‐BD and 10 underwent EUS‐BD. Both groups achieved 100% technical success. The clinical success rates were similar between the groups: 91% (21/23 patients) for ERCP‐BD and 100% (10/10 patients) for EUS‐BD (P = 0.48). Biliary obstruction recurred in 6/23 patients (26%) treated with ERCP‐BD and 1/10 patients (10%) treated with EUS‐BD (P = 0.40). Other adverse events occurred in 4/23 patients (17%) in the ERCP‐BD group and 1/10 patients (10%) in the EUS‐BD group (P = 0.99). Conclusion We suggest that EUS‐BD could be employed for primary biliary drainage in patients with obstructive jaundice caused by unresectable pancreatic adenocarcinoma.
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Affiliation(s)
- Tomohiro Tanikawa
- Department of General Internal Medicine 2 Kawasaki Medical School Okayama Japan
| | - Katsunori Ishii
- Department of General Internal Medicine 2 Kawasaki Medical School Okayama Japan
| | - Ryo Katsumata
- Department of General Internal Medicine 2 Kawasaki Medical School Okayama Japan
| | - Noriyo Urata
- Department of General Internal Medicine 2 Kawasaki Medical School Okayama Japan
| | - Ken Nishino
- Department of General Internal Medicine 2 Kawasaki Medical School Okayama Japan
| | - Mitsuhiko Suehiro
- Department of General Internal Medicine 2 Kawasaki Medical School Okayama Japan
| | - Miwa Kawanaka
- Department of General Internal Medicine 2 Kawasaki Medical School Okayama Japan
| | - Ken Haruma
- Department of General Internal Medicine 2 Kawasaki Medical School Okayama Japan
| | - Hirofumi Kawamoto
- Department of General Internal Medicine 2 Kawasaki Medical School Okayama Japan
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Koga T, Hijioka S, Nagashio Y, Ohba A, Maruki Y, Yoshinari M, Hisada Y, Harai S, Kitamura H, Maehara K, Murashima Y, Kawasaki Y, Kawahara S, Takeshita K, Yamada N, Satake T, Kondo S, Morizane C, Ueno H, Okusaka T, Saito Y. Endoscopic ultrasound‐guided choledochoduodenostomy without fistula dilation using a stent with a 5.9‐Fr delivery system: Comparison to a conventional procedure with fistula dilation. DEN OPEN 2022; 2:e56. [PMID: 35310726 PMCID: PMC8828169 DOI: 10.1002/deo2.56] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/19/2021] [Accepted: 08/22/2021] [Indexed: 11/24/2022]
Abstract
Objectives To evaluate the feasibility and safety of endoscopic ultrasound‐guided choledochoduodenostomy (EUS‐CDS) without fistula dilation using a novel self‐expandable metal stent (SEMS). Methods This retrospective study examined patients who underwent EUS‐CDS for malignant distal biliary obstruction between October 2017 and May 2021 at the National Cancer Center, Japan. The primary outcome was a technical success without fistula dilation. Secondary outcomes were the overall technical success, clinical success, adverse events (AEs), procedure time, recurrent biliary obstruction (RBO), and time to RBO (TRBO). Results Forty‐one patients were enrolled; 31 patients underwent EUS‐CDS with fistula dilation using a conventional SEMS with 7.5–8.5‐Fr delivery system (conventional SEMS group), and 10 patients underwent EUS‐CDS without fistula dilation using the novel SEMS with a 5.9‐Fr delivery system (novel SEMS group). In the novel SEMS group, the rate of technical success without fistula dilation was 90%. There were no differences in overall technical success (100% vs. 97%, p = 1.00), clinical success (80% vs. 90%, p = 0.58), and overall AEs (10% vs. 23%, p = 0.65) rates between the novel and conventional SEMS groups. In the novel SEMS group, no early AEs were observed and no bile leakage into the abdominal cavity was observed on the computed tomography scan after the procedure. The median procedure time was significantly shorter in the novel SEMS group (17 min vs. 24 min, p = 0.03). RBO and median TRBO did not differ between the 2 groups. Conclusions EUS‐CDS without fistula dilation using the novel SEMS with a 5.9‐Fr delivery system is technically feasible, straightforward, quick, and safe.
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Affiliation(s)
- Takehiko Koga
- Department of Hepatobiliary and Pancreatic Oncology National Cancer Center Hospital Tokyo Japan
| | - Susumu Hijioka
- Department of Hepatobiliary and Pancreatic Oncology National Cancer Center Hospital Tokyo Japan
| | - Yosikuni Nagashio
- Department of Hepatobiliary and Pancreatic Oncology National Cancer Center Hospital Tokyo Japan
| | - Akihiro Ohba
- Department of Hepatobiliary and Pancreatic Oncology National Cancer Center Hospital Tokyo Japan
| | - Yuta Maruki
- Department of Hepatobiliary and Pancreatic Oncology National Cancer Center Hospital Tokyo Japan
| | - Motohiro Yoshinari
- Department of Hepatobiliary and Pancreatic Oncology National Cancer Center Hospital Tokyo Japan
| | - Yuya Hisada
- Department of Hepatobiliary and Pancreatic Oncology National Cancer Center Hospital Tokyo Japan
| | - Shota Harai
- Department of Hepatobiliary and Pancreatic Oncology National Cancer Center Hospital Tokyo Japan
| | - Hidetoshi Kitamura
- Department of Hepatobiliary and Pancreatic Oncology National Cancer Center Hospital Tokyo Japan
| | - Kosuke Maehara
- Department of Hepatobiliary and Pancreatic Oncology National Cancer Center Hospital Tokyo Japan
| | - Yumi Murashima
- Department of Hepatobiliary and Pancreatic Oncology National Cancer Center Hospital Tokyo Japan
| | - Yuki Kawasaki
- Department of Hepatobiliary and Pancreatic Oncology National Cancer Center Hospital Tokyo Japan
| | - Shun Kawahara
- Department of Hepatobiliary and Pancreatic Oncology National Cancer Center Hospital Tokyo Japan
| | - Kotaro Takeshita
- Department of Hepatobiliary and Pancreatic Oncology National Cancer Center Hospital Tokyo Japan
| | - Natsumi Yamada
- Department of Hepatobiliary and Pancreatic Oncology National Cancer Center Hospital Tokyo Japan
| | - Tomoyuki Satake
- Department of Hepatobiliary and Pancreatic Oncology National Cancer Center Hospital Tokyo Japan
| | - Shunsuke Kondo
- Department of Hepatobiliary and Pancreatic Oncology National Cancer Center Hospital Tokyo Japan
| | - Chigusa Morizane
- Department of Hepatobiliary and Pancreatic Oncology National Cancer Center Hospital Tokyo Japan
| | - Hideki Ueno
- Department of Hepatobiliary and Pancreatic Oncology National Cancer Center Hospital Tokyo Japan
| | - Takuji Okusaka
- Department of Hepatobiliary and Pancreatic Oncology National Cancer Center Hospital Tokyo Japan
| | - Yutaka Saito
- Endoscopy Division National Cancer Center Hospital Tokyo Japan
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Zhang Y, Wang X, Sun K, Chen J, Zhang Y, Shi L, Fan Z, Liu L, Chen B, Ding Y. Application of endoscopic ultrasound-guided hepaticogastrostomy combined with antegrade stenting in patients with malignant biliary obstruction after failed ERCP. Surg Endosc 2022; 36:5930-5937. [PMID: 35178592 DOI: 10.1007/s00464-022-09117-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 02/07/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND This study was aimed at comparing the safety and effectiveness of endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) and EUS-HGS combined with antegrade stenting (EUS-HGAS) in patients with malignant biliary obstruction (MBO) after failed endoscopic retrograde cholangiopancreatography (ERCP). METHODS Patients diagnosed with MBO and receiving EUS-HGS or EUS-HGAS from September 2015 to October 2020 were enrolled in this study. Clinical success, complications, reintervention rate, post-operative hospital stay, time to stent dysfunction, and patient death were compared. RESULTS A total of 45 patients (21 in the EUS-HGAS group and 24 in the EUS-HGS group) were enrolled in this study. In the EUS-HGAS group, 21 patients all achieved clinical success (100%); in the EUS-HGS group, 24 patients also achieved technical success (100%) (P > 0.05). The differences between pre- and post-operative TB and ALT and AST levels were greater in the single-step EUS-HGAS group (P < 0.05). The incidence of complications was 2 of 21 (9.5%) in the EUS-HGAS group and 5 of 24 (20.8%) in the EUS-HGS group (P > 0.05). The reintervention rate was 0 in the EUS-HGAS group and 1 (4.2%) in the EUS-HGS group (P > 0.05). Time to stent dysfunction or patient death was longer in the EUS-HGAS group (P < 0.05). The post-operative hospital stay was longer and the total cost was higher in the EUS-HGAS group. CONCLUSION EUS-HGAS was superior to EUS-HGS in terms of biliary drainage effectiveness and time to stent dysfunction or patient death in patients with MBO after failed ERCP. Furthermore, two-step EUS-HGAS may be safer in some patients.
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Affiliation(s)
- Yin Zhang
- Department of Gastroenterology, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, No.185 Juqianjie Road, Changzhou, 213003, Jiangsu, China
| | - Xiaohong Wang
- Department of Gastroenterology, The Second Affiliated Hospital of Xuzhou Medical University, General Hospital of XuZhou Mining Group, Xuzhou, China
| | - Kewen Sun
- Department of Gastroenterology, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, No.185 Juqianjie Road, Changzhou, 213003, Jiangsu, China
| | - Jianping Chen
- Department of Gastroenterology, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, No.185 Juqianjie Road, Changzhou, 213003, Jiangsu, China
| | - Yue Zhang
- Department of Hepatopancreatobiliary Surgery, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Longqing Shi
- Department of Hepatopancreatobiliary Surgery, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Zhining Fan
- Digestive Endoscopy Department, Jiangsu Provincial People's Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Li Liu
- Digestive Endoscopy Department, Jiangsu Provincial People's Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Bingfang Chen
- Department of Gastroenterology, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, No.185 Juqianjie Road, Changzhou, 213003, Jiangsu, China
| | - Yanbo Ding
- Department of Gastroenterology, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, No.185 Juqianjie Road, Changzhou, 213003, Jiangsu, China.
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Yamamura M, Ogura T, Ueno S, Okuda A, Nishioka N, Yamada M, Ueshima K, Matsuno J, Yamamoto Y, Higuchi K. Partially covered self-expandable metal stent with antimigratory single flange plays important role during EUS-guided hepaticogastrostomy. Endosc Int Open 2022; 10:E209-E214. [PMID: 35178339 PMCID: PMC8847065 DOI: 10.1055/a-1729-0048] [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: 09/10/2021] [Accepted: 10/19/2021] [Indexed: 12/13/2022] Open
Abstract
Background and study aims Stent migration into the abdominal cavity, which can occur due to stent shortening or stomach mobility, is a critical adverse event (AE) in EUS-HGS. To prevent this AE due to stent shortening, a novel, partially covered self-expandable metal stent with an antimigratory single flange has recently become available in Japan. The present study evaluated the clinical feasibility and safety of EUS-HGS using this novel stent. Patients and methods We measured stent length in the abdominal cavity and the luminal portion after EUS-HGS using computed tomography (CT) performed 1 day after EUS-HGS (early phase). To evaluate stent shortening and the influence of stomach mobility, we also measured stent length at the same sites on CT performed at least 7 days after EUS-HGS (late phase). Results Thirty-one patients successfully underwent EUS-HGS using this stent. According to CT in the early phase, stent length in the abdominal cavity was 7.13 ± 2.11 mm and the length of the luminal portion was 53.3 ± 6.27 mm. Conversely, according to CT in the late phase, stent length in the abdominal cavity was 8.55 ± 2.36 mm and the length of the luminal portion was 50.0 ± 8.36 mm. Stent shortening in the luminal portion was significantly greater in the late phase than in the early phase ( P = 0.04). Conclusions CT showed that stent migration can occur even with successful stent deployment, due to various factors such as stent shortening. The antimigratory single flange may be helpful to prevent stent migration, but further prospective comparative studies are needed to confirm our results.
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Affiliation(s)
- Masahiro Yamamura
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Takeshi Ogura
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Saori Ueno
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Atsushi Okuda
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Nobu Nishioka
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Masanori Yamada
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Kazuya Ueshima
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Jun Matsuno
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Yoshitaro Yamamoto
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Kazuhide Higuchi
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
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Abstract
If endoscopic retrograde cholangiopancreatography (ERCP) fails in cases of biliary obstruction and jaundice, percutaneous drains have been traditionally the current second-line option. Endoscopic ultrasonography-guided biliary drainage (EUS-BD) with choledocoduodenostomy or hepaticogastrostomy is alternative modality that have shown equivalent or better technical and clinical success compared with percutaneous drainage. Similarly, EUS-guided gallbladder drainage has emerged as a therapeutic option in acute cholecystitis as well. Furthermore, EUS-BD avoids some of the pitfalls of percutaneous drainage. Current research in EUS-BD involves optimizing devices to improve technical and clinical success. In centers with advanced endoscopists trained in these procedures, EUS-BD is an excellent second-line modality.
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Affiliation(s)
- Shyam Vedantam
- Department of Medicine, University of Miami, Miami, FL, USA
| | - Sunil Amin
- Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami, 1120 NW 14th Street, Clinical Research Building, Suite 11145 (D-49), Miami, FL 33136, USA.
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Bang JY, Hawes R, Varadarajulu S. Endoscopic biliary drainage for malignant distal biliary obstruction: Which is better - endoscopic retrograde cholangiopancreatography or endoscopic ultrasound? Dig Endosc 2022; 34:317-324. [PMID: 34748675 PMCID: PMC9299777 DOI: 10.1111/den.14186] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/03/2021] [Accepted: 11/05/2021] [Indexed: 12/13/2022]
Abstract
Presently, following endoscopic ultrasound (EUS)-guided biopsy, an endoscopic retrograde cholangiopancreatography (ERCP) with transpapillary stenting is performed for palliation of malignant distal biliary obstruction (MDBO). However, technical failure and postprocedure pancreatitis are limitations to ERCP. Endoscopic ultrasonography-guided biliary drainage (EUS-BD) after a failed ERCP has a 90% technical success rate and has been shown to be superior when compared to percutaneous methods, making EUS an increasingly recognized option for biliary drainage. Supporting this approach, findings from recently concluded randomized trials suggest that the safety profile and technical outcomes for EUS-BD are comparable or even superior to that of ERCP for primary biliary decompression in patients with MDBO. Also, EUS-BD is increasingly being utilized in patients with altered surgical anatomy in lieu of percutaneous techniques and balloon-assisted enteroscopy. A growing body of evidence supports the notion that, in the future, EUS may become the primary modality by which biliary decompression is undertaken in the majority of patients with MDBO. The roadmap to this eventuality may require further optimization of procedural techniques, technological innovations, and cost reduction.
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Affiliation(s)
| | - Robert Hawes
- Digestive Health InstituteOrlando HealthOrlandoUSA
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Ogura T, Ueno S, Okuda A, Nishioka N, Yamada M, Ueshima K, Matsuno J, Yamamoto Y, Higuchi K. Expanding indications for endoscopic ultrasound-guided hepaticogastrostomy for patients with insufficient dilatation of the intrahepatic bile duct using a 22G needle combined with a novel 0.018-inch guidewire (with video). Dig Endosc 2022; 34:222-227. [PMID: 34351029 DOI: 10.1111/den.14101] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/27/2021] [Accepted: 08/02/2021] [Indexed: 12/11/2022]
Abstract
A prerequisite for endoscopic ultrasound (EUS)-guided hepaticogastrostomy (HGS) is adequate dilation of the intrahepatic bile duct. Compared with a 19G needle, the 22G needle offers more flexible manipulation and superior ability to achieve bile duct puncture. However, evidence regarding EUS-HGS using a 22G needle remains limited. The present study evaluated the feasibility and safety of EUS-HGS using a novel 0.018-inch guidewire and 22G needle for patients with insufficient intrahepatic bile duct dilation. If the bile duct diameter was <1.5 mm, a 22G needle was used, and the diameter was ≥1.5 mm; puncture with a 19G needle was first attempted, with the 22G needle being inserted if initial bile duct puncture failed. EUS-HGS using the 22G needle was attempted in a total of 10 patients, including one patient with failed insertion of a 19G needle. Median diameter of the puncture site was 1.2 mm (range 0.5-2.5 mm). Bile duct puncture using the 22G needle was successful in all patients. Insertion of the novel 0.018-inch guidewire was also successful in all patients. However, since tract dilation using an ultra-tapered mechanical dilator failed in two patients, tract dilation was performed using a balloon dilator. Finally, stent deployment was successfully performed in all patients. EUS-HGS using a 22G needle with a novel 0.018-inch guidewire appears safe and feasible.
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Affiliation(s)
- Takeshi Ogura
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Saori Ueno
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Atsushi Okuda
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Nobu Nishioka
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Masanori Yamada
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Kazuya Ueshima
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Jun Matsuno
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Yoshitaro Yamamoto
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Kazuhide Higuchi
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
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Karagyozov PI, Tishkov I, Boeva I, Draganov K. Endoscopic ultrasound-guided biliary drainage-current status and future perspectives. World J Gastrointest Endosc 2021; 13:607-618. [PMID: 35070022 PMCID: PMC8716984 DOI: 10.4253/wjge.v13.i12.607] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/17/2021] [Accepted: 11/25/2021] [Indexed: 02/06/2023] Open
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) with stenting is the treatment modality of choice for patients with benign and malignant bile duct obstruction. ERCP could fail in cases of duodenal obstruction, duodenal diverticulum, ampullary neoplastic infiltration or surgically altered anatomy. In these cases percutaneous biliary drainage (PTBD) is traditionally used as a rescue procedure but is related to high morbidity and mortality and lower quality of life. Endoscopic ultrasound-guided biliary drainage (EUS-BD) is a relatively new interventional procedure that arose due to the development of curvilinear echoendoscope and the various endoscopic devices. A large amount of data is already collected that proves its efficacy, safety and ability to replace PTBD in cases of ERCP failure. It is also possible that EUS-BD could be chosen as a first-line treatment option in some clinical scenarios in the near future. Several EUS-BD techniques are developed EUS-guided transmural stenting, antegrade stenting and rendezvous technique and can be personalized depending on the individual anatomy. EUS-BD is normally performed in the same session from the same endoscopist in case of ERCP failure. The lack of training, absence of enough dedicated devices and lack of standardization still makes EUS-BD a difficult and not very popular procedure, which is related to life-threatening adverse events. Developing training models, dedicated devices and guidelines hopefully will make EUS-BD easier, safer and well accepted in the future. This paper focuses on the technical aspects of the different EUS-BD procedures, available literature data, advantages, negative aspects and the future perspectives of these modalities.
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Affiliation(s)
- Petko Ivanov Karagyozov
- Department of Interventional Gastroenterology, Clinic of Gastroenterology, Acibadem City Clinic Tokuda Hopsital, Sofia 1407, Bulgaria
| | - Ivan Tishkov
- Department of Interventional Gastroenterology, Clinic of Gastroenterology, Acibadem City Clinic Tokuda Hopsital, Sofia 1407, Bulgaria
| | - Irina Boeva
- Department of Interventional Gastroenterology, Clinic of Gastroenterology, Acibadem City Clinic Tokuda Hopsital, Sofia 1407, Bulgaria
| | - Kiril Draganov
- Clinic of Liver, Biliary, Pancreatic and General Surgery, Acibadem City Clinic Tokuda Hospital, Sofia 1407, Bulgaria
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Abstract
PURPOSE OF REVIEW To update on recent advances in interventional endoscopic ultrasound (INVEUS) techniques. RECENT FINDINGS The introduction of linear echoendoscopes with larger instrument channels and the combined development of new tools and devices have enabled various new applications of minimally invasive endoscopic ultrasound (EUS)-guided transluminal interventions of the pancreas, biliary system and peri-gastrointestinal structures. In this review, EUS-guided interventions are discussed and evaluated: drainage of peripancreatic fluid collections, access and drainage of bile ducts, gallbladder and pancreatic duct, treatment of gastrointestinal haemorrhage, coeliac plexus block and coeliac plexus neurolysis, fiducial placement, solid and cystic tumour ablation, drug delivery and brachytherapy, gastroenterostomy, angiotherapy and other EUS-guided applications. The EUS-guided interventions are classified based on the available evidence as established or experimental, standardized or nonstandardized procedures in common or rare diseases with well or little known complications and their established or nonestablished treatment. SUMMARY Some EUS-guided interventions have sparse published evidence with only single-centre studies, case series or individual case reports, others like drainage of peripancreatic fluid collections have become widely accepted practice. INVEUS has been accepted as an alternative to several surgical approaches, EUS-guided techniques result in faster recovery times, shorter hospital stay and lower costs.
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Affiliation(s)
- Christoph F Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permanence, Switzerland
| | - Barbara Braden
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Christian Jenssen
- Department of Internal Medicine, Krankenhaus Maerkisch-Oderland, D-15344 Strausberg and Brandenburg Institute of Clinical Ultrasound at Medical University Brandenburg, Germany
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Ogura T, Itoi T. Technical tips and recent development of endoscopic ultrasound-guided choledochoduodenostomy. DEN OPEN 2021; 1:e8. [PMID: 35310149 PMCID: PMC8828248 DOI: 10.1002/deo2.8] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/01/2021] [Accepted: 03/02/2021] [Indexed: 12/11/2022]
Abstract
Various efforts to improve technical success rates and decrease adverse event rates have also been described in endoscopic ultrasound (EUS)-guided choledochoduodenostomy (CDS). In particular, lumen-apposing metal stents (LAMS) may open novel opportunities in EUS-biliary drainage (BD). To date, various studies have been reported with EUS-CDS using LAMS, so we should clarify the benefits and limitations of recent EUS-CDS based on developments in both techniques and devices. In this review, we provide technical tips and describe recent developments in EUS-CDS, along with a review of the recent literature (between 2015 and 2020). The overall technical success rate is 95.0% (939/988), and the overall clinical success rate is 97.0% (820/845). The most frequent adverse event is cholangitis or cholecystitis (24.5%, 27/110). According to previous review, pneumoperitoneum (28%, 9/34) or peritonitis associated with bile leak (23.5%, 8/34) was most commonly observed. This difference might be based on improvements in dilation devices or the use of covered metal stents. Several randomized controlled trials comparing EUS-CDS and endoscopic retrograde cholangiopancreatography (ERCP) for malignant biliary obstruction have recently been reported. To summarize, overall technical success rates for ERCP and EUS-CDS were 92.7% (101/109) and 91.1% (72/79), respectively (p = 0.788). Overall clinical success rates for ERCP and EUS-CDS were 94.1% (96/102) and 93.6% (72/78), respectively (p = 0.765). Further high-quality evidence is needed to establish EUS-CDS as a primary drainage technique.
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Affiliation(s)
- Takeshi Ogura
- 2nd Department of Internal Medicine Osaka Medical College Osaka Japan
| | - Takao Itoi
- Depaertment of Gastroenterology and Hepatology Tokyo Medical University Tokyo Japan
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