A multi-institution consensus on how to perform EUS-guided biliary drainage for malignant biliary obstruction

Guo, Jintao; Giovannini, Marc; Sahai, Anand V.; Săftoiu, Adrian; Dietrich, Christoph F.; Santo, Erwin; Fusaroli, Pietro; Siddiqui, Ali A.; Bhutani, Manoop S.; Teoh, Anthony Yuen Bun; Irisawa, Atsushi; Arias, Brenda Lucía Arturo; Achanta, Chalapathi Rao; Jenssen, Christian; Seo, Dong Wan; Adler, Douglas G.; Kalaitzakis, Evangelos; Artifon, Everson Luiz de Almeida; Itokawa, Fumihide; Poley, Jan Werner; Mishra, Girish; Ho, Khek Yu; Wang, Hsiu Po; Okasha, Hussein Hassan; Lachter, Jesse; Vila, Juan J.; Iglesias‐García, Julio; Yamao, Kenji; Yasuda, Kenjiro; Kubota, Kensuke; Palazzo, Laurent; Sabbagh, Luis; Sharma, Malay; Kida, Mitsuhiro; Elnady, Mohamed; Nguyen, Nam Q.; Vilmann, Peter; Garg, Pramod Kumar; Rai, Praveer; Mukai, Shuntaro; Carrara, Sandro; Parupudi, Sreeram; Sridhar, Subbaramiah; Lakhtakia, Sundeep; Rana, Surinder Singh; Ogura, Takeshi; Baron, Todd H.; Dhir, Vinay; Sun, Siyu

doi:10.4103/eus.eus_53_18

Cited by 57 publications

(20 citation statements)

References 48 publications

(53 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Actually, all post-procedure migrated stent occurred in HGS group using partially covered self-expandable metal stents (PC-SEMS) 8cm in length (Wallflex, Boston Scientific, Natick, MA, USA). This could be related to (38). In the randomized, multicenter trial by Schmidt et al, on 37 patients (39) stent patency and complication rates were compared between a winged type plastic stent and SEMS.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic ultrasound-guided biliary drainage for distal malignant biliary obstruction: a prospective 3-year multicenter Egyptian study

Ragab¹,

Abdel-Hameed²,

Gouda³

et al. 2023

AGEB

View full text Add to dashboard Cite

Background/Aim: Malignant biliary obstruction (MBO) is often diagnosed at late stages with mostly unresectable lesions. Recently, EUS-guided biliary drainage (EUS-BD) has gained wide acceptance and appears to be a feasible and safe backup option after ERCP failure in such patients. Herein, we aimed to represent a 3-year multi-center Egyptian experience in the application of this challenging procedure for distal MBO as a salvage technique after failed ERCP. Patients and methods: This was a prospective multi-center study of patients underwent EUS-BD for distal MBO in the duration between December 2018 and December 2021, after ERCP failure. Results: Ninety-one patients (59 males, median age: 61 years) were included in the study. EUS-guided extrahepatic approach including choledocho-duodenostomy (CDS) was done for 48 patients (52.8%), followed by choledecho-antrostomy (CAS) in 4 patients (4.4%). The intrahepatic approach included hepaticogastrostomy (HGS) for 35 patients (38.5%) and antegrade stenting (AG) stenting in 2 patients (2.2%), while Rendezvous (RV) approach was performed in 2 patients (2.2%). Technical and Clinical success were achieved in the majority of cases; 93.4% and 94.1% respectively. Adverse events occurred in 13.2% of patients which were mostly mild (8.2%) to moderate (2.4%). Only one patient died within 48h after the procedure with progression of preceding sepsis and organ failure. Conclusion: EUS-BD is a feasible option, even in developing countries, after a failed ERCP, and it is a relatively safe option in patients with MBO once experienced team and resources were present. Majority of cases in our study have achieved technical and clinical success with relatively low incidence of adverse events

show abstract

Section: Discussionmentioning

confidence: 99%

Endoscopic ultrasound-guided biliary drainage for distal malignant biliary obstruction: a prospective 3-year multicenter Egyptian study

Ragab¹,

Abdel-Hameed²,

Gouda³

et al. 2023

AGEB

View full text Add to dashboard Cite

show abstract

“…In recent years, LAMS have changed the approach to MBO. EUS-BD is currently performed as a rescue therapy for jaundice palliation after ERCP failure 20 ; however, recent RCTs have shown non-superiority of ERCP vs EUS-BD as first intention for biliary drainage 6 7 8 . The procedure has been described as safe and effective with a low rate of complications 21 .…”

Section: Discussionmentioning

confidence: 99%

Lumen-apposing metal stent through the meshes of duodenal metal stents for palliation of malignant jaundice

et al. 2021

View full text Add to dashboard Cite

Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) is the gold standard procedure for malignant jaundice palliation; however, it can be challenging when a duodenal self-expandable metal stent (SEMS) is already in place. Patients and methods The primary aim of our study was to evaluate the technical feasibility of the placement of a lumen apposing metal stent (LAMS) through the mesh (TTM) of duodenal stents. The secondary aims were to evaluate clinical outcomes and adverse events (AEs) related to the procedures. Results Data from 23 patients (11 F and 12 M; mean age: 69.5 ± 11 years old) were collected. In 17 patients (73.9 %) TTM LAMS placement was performed as first intention, while in six patients (26.1 %) it was performed after a failed ERCP. Thirteen patients (56.5 %) underwent the procedure due to advanced pancreatic head neoplasia. One technical failure was experienced (4.3 %). The TTM LAMS placement led to a significant decrease in the serum levels of bilirubin, ALP, GGT, WBC and CRP. No cases of duodenal SEMS occlusion occurred and no other AEs were observed during the follow-up. Conclusions Concomitant malignant duodenal and biliary obstruction is a challenging condition. Palliation of jaundice using TTM LAMS in patients already treated with duodenal stent is associated to promising technical and clinical outcomes.

show abstract

“…There are two common segment-puncture sites: segment III bile duct (B3) and segment II bile duct (B2). [ 18 ] Some studies recommend B3 as the preferred puncture point site over B2 for transgastric stenting. [ 19 ] Because B2-approach puncture is performed in the proximal part of the stomach, esophageal gastric junction, or distal part of the esophagus.…”

Section: Pitfalls and Tips In Eus-guided Drainagementioning

confidence: 99%

Pitfalls in interventional EUS procedures and coping strategies for endoscopy assistants (with video)

Wang

Guo

et al. 2021

Endosc Ultrasound

Self Cite

View full text Add to dashboard Cite

In recent years, the application of EUS in the diagnosis and treatment has become increasingly popular due to the rapid technological advancements in this field. With the application of new technologies, EUS assistants encounter various problems or “pitfalls” during clinical operations, which may pose challenges to the successful completion of relevant procedures. For example, a needle tip may not be visualized by ultrasonography during EUS-FNA; a stiff fine needle may not be introduced through the working channel of the endoscope in the duodenum, and withdrawal of a guidewire in a needle may be associated with tearing and peeling of the guidewire in EUS-guided biliary drainage. In view of these commonly encountered problems, this article summarizes the countermeasures that EUS assistants can take for EUS-FNA and EUS-guided drainage to improve the efficiency of the procedures and reduce the occurrence of adverse events.

show abstract

A multi-institution consensus on how to perform EUS-guided biliary drainage for malignant biliary obstruction

Cited by 57 publications

References 48 publications

Endoscopic ultrasound-guided biliary drainage for distal malignant biliary obstruction: a prospective 3-year multicenter Egyptian study

Endoscopic ultrasound-guided biliary drainage for distal malignant biliary obstruction: a prospective 3-year multicenter Egyptian study

Lumen-apposing metal stent through the meshes of duodenal metal stents for palliation of malignant jaundice

Pitfalls in interventional EUS procedures and coping strategies for endoscopy assistants (with video)

Contact Info

Product

Resources

About