Endoscopic ultrasonography‐guided choledochoduodenostomy using a newly designed laser‐cut metal stent: Feasibility study in a porcine model

Minaga, Kosuke; Kitano, Masayuki; Gon, Chimyon; Yamao, Kentaro; Imai, Hisao; Miyata, Takeshi; Kamata, Ken; Omoto, Shunsuke; Kudo, Masatoshi

doi:10.1111/den.12741

Cited by 10 publications

(6 citation statements)

References 26 publications

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“…We also performed a preliminary examination of EUS-guided biliary drainage using a conventional biliary SEMS in an animal study using five pigs. We found that at autopsy 1 wk after the procedure, fistulas were created between the bile duct and duodenum in all pigs[ 22 ]. Thus, a strong fistula might develop between the gallbladder and the gastrointestinal tract within 4 wk using a conventional biliary SEMS as well as a LAMS.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic ultrasound-guided gallbladder drainage for acute cholecystitis: Long-term outcomes after removal of a self-expandable metal stent

Kamata¹,

Kitano²,

Omoto³

et al. 2017

WJG

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AIMTo assess the long-term outcomes of this procedure after removal of self-expandable metal stent (SEMS). The efficacy and safety of endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) with SEMS were also assessed.METHODSBetween January 2010 and April 2015, 12 patients with acute calculous cholecystitis, who were deemed unsuitable for cholecystectomy, underwent EUS-GBD with a SEMS. EUS-GBD was performed under the guidance of EUS and fluoroscopy, by puncturing the gallbladder with a needle, inserting a guidewire, dilating the puncture hole, and placing a SEMS. The SEMS was removed and/or replaced with a 7-Fr plastic pigtail stent after cholecystitis improved. The technical and clinical success rates, adverse event rate, and recurrence rate were all measured.RESULTSThe rates of technical success, clinical success, and adverse events were 100%, 100%, and 0%, respectively. After cholecystitis improved, the SEMS was removed without replacement in eight patients, whereas it was replaced with a 7-Fr pigtail stent in four patients. Recurrence was seen in one patient (8.3%) who did not receive a replacement pigtail stent. The median follow-up period after EUS-GBD was 304 d (78-1492).CONCLUSIONEUS-GBD with a SEMS is a possible alternative treatment for acute cholecystitis. Long-term outcomes after removal of the SEMS were excellent. Removal of the SEMS at 4-wk after SEMS placement and improvement of symptoms might avoid migration of the stent and recurrence of cholecystitis due to food impaction.

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Section: Discussionmentioning

confidence: 99%

Endoscopic ultrasound-guided gallbladder drainage for acute cholecystitis: Long-term outcomes after removal of a self-expandable metal stent

Kamata¹,

Kitano²,

Omoto³

et al. 2017

WJG

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“…59 Bile leakage was more frequently observed in patients who underwent plastic (11%) than covered metal stent (4%) deployment. Recent studies have described the development of specially designed and modified stents for EUS-BD, including lumen-apposing metal stents (LAMS); 28,60-62 hybrid metal stents consisting of uncovered proximal portions and covered distal portions; 27,63 hook stents (laser-cut metal stents with anchoring hooks) 64 ; and 8-Fr single-pigtail plastic stents with four flanges dedicated for EUS-HGS. 59 At present, few endoscopic tools and devices are available for EUS-BD, with most devices used adapted from equipment used for ERCP, resulting in device-related shortcomings.…”

Section: Adverse Eventsmentioning

confidence: 99%

“…New comfortable stenting devices that prevent complications related to EUS-BD are therefore needed. Recent studies have described the development of specially designed and modified stents for EUS-BD, including lumen-apposing metal stents (LAMS); 28,60-62 hybrid metal stents consisting of uncovered proximal portions and covered distal portions; 27,63 hook stents (laser-cut metal stents with anchoring hooks) 64 ; and 8-Fr single-pigtail plastic stents with four flanges dedicated for EUS-HGS. 65 These new devices are expected to reduce rates of stent-related adverse events.…”

Section: Adverse Eventsmentioning

confidence: 99%

Recent advances in endoscopic ultrasound‐guided biliary drainage

Minaga

Kitano

2017

Digestive Endoscopy

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Endoscopic ultrasound-guided biliary drainage (EUS-BD) is increasingly used as an alternative in patients with biliary obstruction who fail standard endoscopic retrograde cholangiopancreatography (ERCP). The two major endoscopic approach routes for EUS-BD are the transgastric intrahepatic and the transduodenal extrahepatic approaches. Biliary drainage can be achieved by three different methods, transluminal biliary stenting, transpapillary rendezvous technique, and antegrade biliary stenting. Choice of approach route and drainage method depends on individual anatomy, underlying disease, and location of the biliary stricture. Recent meta-analyses have revealed that cumulative technical success and adverse event rates were 90-94% and 16-23%, respectively. Development of new dedicated devices for EUS-BD would help refine the technical aspects and minimize the possibility of complications, making it a more promising procedure.

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“…After gaining initial experience with draining pancreatic fluid collections, the indication for EUS-guided drainage has expanded to drainage of pelvic abscesses, [52][53][54] and the biliary system, including EUS-guided hepaticogastrostomy, [55][56][57][58][59][60][61][62][63] EUS-guided choledochoduodenostomy, [64][65][66][67] EUS-guided cholecystostomy 68,69 and, last, EUS-guided pancreaticogastrostomy. [70][71][72][73] Many of these developments have been greatly facilitated by the introduction of fully covered expandable lumen-apposing stents, minimizing the risk of post-procedural leakage.…”

Section: Eus To Connect Luminal Spacesmentioning

confidence: 99%

Interventional endoscopic ultrasonography: Where are we headed?

Bruno

2017

Digestive Endoscopy

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Endoscopic ultrasonography (EUS) is an essential endoscopic tool within the diagnostic and therapeutic armamentarium of gastrointestinal and hepatic diseases. EUS-guided tissue acquisition will develop towards facilitating personalized treatment by obtaining large representative tissue specimens for elaborate immunohistochemical and biomolecular typing of the tumor. Intratumoral or intravascular delivery of drugs potentially offers many advantages over systemic injection. Intratumoral application of radiofrequency ablation and photodynamic therapy show promise but need to be explored further.Appositioning and connecting luminal structures within the gastrointestinal tract using fully covered expandable lumenapposing stents will expand its indication far beyond the drainage of (infected) fluid collections and EUS-guided gastrojejunostomy is a particularly exciting development that could have significant impact on the management of gastric outlet obstruction.

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Endoscopic ultrasonography‐guided choledochoduodenostomy using a newly designed laser‐cut metal stent: Feasibility study in a porcine model

Abstract: EUS-CDS using a newly designed metal stent was feasible and effective in this porcine model of biliary dilatation.

Cited by 10 publications

References 26 publications

Endoscopic ultrasound-guided gallbladder drainage for acute cholecystitis: Long-term outcomes after removal of a self-expandable metal stent

Endoscopic ultrasound-guided gallbladder drainage for acute cholecystitis: Long-term outcomes after removal of a self-expandable metal stent

Recent advances in endoscopic ultrasound‐guided biliary drainage

Interventional endoscopic ultrasonography: Where are we headed?

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