EUS-guided antegrade metallic stent placement using the stent-in-stent method with a 6-Fr novel slim delivery system in a patient with malignant hilar biliary obstruction

Suenaga, Shigeyuki; Kaino, Seiji; Tsuyama, Takanori; Fujimoto, Yuko; Amano, Shogo; Uekitani, Toshiyuki; Sakaida, Isao

doi:10.4103/eus-d-20-00225

Cited by 5 publications

(5 citation statements)

References 5 publications

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“…36 EUS-HGS-guided bridging stent placement in the hilum with a novel SEMS and 6-Fr delivery system (Niti-S large-cell SR slim delivery; Taewoong Medical) has been described, followed by antegrade stenting using the stent-in-stent technique after balloon dilation through the stent mesh. 37 Recently, two covered metal stent placements have been reported for separated right anterior and posterior hepatic ducts after EUS-HGS with a plastic stent in the left hepatic duct. 38…”

Section: Stent-in-stent and Multi-stent Methodsmentioning

confidence: 99%

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Endoscopic ultrasound-guided intervention for inaccessible papilla in advanced malignant hilar biliary obstruction

Pal

Lakhtakia²

2023

Clin Endosc

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Advanced malignant hilar biliary obstruction (MHBO) with inaccessible papilla poses a significant challenge to endoscopists, as drainage of multiple liver segments may be warranted. Transpapillary drainage may not be feasible in patients with surgically altered anatomy, duodenal stenosis, prior duodenal self-expanding metal stent, and after initial transpapillary drainage, but require re-intervention for draining separated liver segments. Endoscopic ultrasound-guided biliary drainage (EUS-BD) and percutaneous trans-hepatic biliary drainage are the feasible options in this scenario. The major advantages of EUS-BD over percutaneous trans-hepatic biliary drainage include a reduction in patient discomfort and internal drainage away from the tumor, thus reducing the possibility of tissue or tumor ingrowth. With innovations, EUS-BD is helpful not only for bilateral communicating MHBO but also for non-communicating systems with bridging hilar stents or isolated right intra-hepatic duct drainage by hepatico-duodenostomy. EUS-guided multi-stent drainage with specially designed cannulas and guidewires has become a reality. A combined approach with endoscopic retrograde cholangiopancreatography for re-intervention, interventional radiology, and intraductal tumor ablative therapies has been reported. Stent migration and bile leakage can be minimized with proper stent selection and technique, and stent blocks can be managed with EUS-guided interventions in a majority of cases. Future comparative studies are required to establish the role of EUS-guided interventions in MHBO as rescue or primary therapy.

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Section: Stent-in-stent and Multi-stent Methodsmentioning

confidence: 99%

“…EUS-HGS-guided bridging stent placement in the hilum with a novel SEMS and 6-Fr delivery system (Niti‐S large-cell SR slim delivery; Taewoong Medical) has been described, followed by antegrade stenting using the stent-in-stent technique after balloon dilation through the stent mesh. 37 …”

Section: Stent-in-stent and Multi-stent Methodsmentioning

confidence: 99%

Endoscopic ultrasound-guided intervention for inaccessible papilla in advanced malignant hilar biliary obstruction

Pal

Lakhtakia²

2023

Clin Endosc

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“…[ 27 28 ] To expand the clinical role of EUS-HGS/HJS, development of dedicated devices is crucial; such devices should be comparable to the LAMS that are used for EUS-CDS. [ 29 30 ] To date, plastic stents, as well as fully covered and partially covered SEMS, have been used for EUS-HGS/HJS. Plastic stents carry a high risk of bile leak and biliary peritonitis, which is primarily due to the gap between the newly formed fistula and the stent.…”

Section: Eus-guided Hepaticogastrostomy/hepaticojejunostomymentioning

confidence: 99%

How to perform EUS-guided biliary drainage

Dietrich¹,

Braden²,

Burmeister³

et al. 2022

Endosc Ultrasound

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EUS-guided biliary drainage (EUS-BD) has recently gained widespread acceptance as a minimally invasive alternative method for biliary drainage. Even in experienced endoscopy centers, ERCP may fail due to inaccessibility of the papillary region, altered anatomy (particularly postsurgical alterations), papillary obstruction, or neoplastic gastric outlet obstruction. Biliary cannulation fails at first attempt in 5%–10% of cases even in the absence of these factors. In such cases, alternative options for biliary drainage must be provided since biliary obstruction is responsible for poor quality of life and even reduced survival, particularly due to septic cholangitis. The standard of care in many centers remains percutaneous transhepatic biliary drainage (PTBD). However, despite the high technical success rate with experienced operators, the percutaneous approach is more invasive and associated with poor quality of life. PTBD may result in long-term external catheters for biliary drainage and carry the risk of serious adverse events (SAEs) in up to 10% of patients, including bile leaks, hemorrhage, and sepsis. PTBD following a failed ERCP also requires scheduling a second procedure, resulting in prolonged hospital stay and additional costs. EUS-BD may overcome many of these limitations and offer some distinct advantages in accessing the biliary tree. Current data suggest that EUS-BD is safe and effective when performed by experts, although SAEs have been also reported. Despite the high number of clinical reports and case series, high-quality comparative studies are still lacking. The purpose of this article is to report on the current status of this procedure and to discuss the tools and techniques for EUS-BD in different clinical scenarios.

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“…We previously reported a high technical success rate of the SIS method using large-cell stents with an 8.5F stent delivery, 9,19 and this large-cell stent was recently modified with a tapered-tip, 6F delivery system to facilitate stent delivery insertion through the stricture and the stent mesh. [20][21][22] In this retrospective comparative study, we compared SIS methods using new large-cell stents with a slim-delivery system and conventional large-cell stents for unresectable HMBO.…”

Section: Introductionmentioning

confidence: 99%

“…However, multiple stent placement by the SIS method can be technically demanding at the time of the second stent delivery passage through the first stent, and dedicated stents such as large‐cell type or moving cell type 18 stents have been investigated. We previously reported a high technical success rate of the SIS method using large‐cell stents with an 8.5F stent delivery, 9,19 and this large‐cell stent was recently modified with a tapered‐tip, 6F delivery system to facilitate stent delivery insertion through the stricture and the stent mesh 20–22 . In this retrospective comparative study, we compared SIS methods using new large‐cell stents with a slim‐delivery system and conventional large‐cell stents for unresectable HMBO.…”

Section: Introductionmentioning

confidence: 99%

Retrospective comparative study of new slim‐delivery and conventional large‐cell stents for stent‐in‐stent methods for hilar malignant biliary obstruction

Ishigaki

Fukuda

Nakai

et al. 2023

Digestive Endoscopy

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ObjectivesEndoscopic management of unresectable hilar malignant biliary obstruction (HMBO) is technically challenging, and effectiveness of stent‐in‐stent using large‐cell, metal stents was reported. A new, large‐cell stent with a 6F tapered delivery system was recently developed. The aim of this study was to compare clinical outcomes of slim‐delivery and conventional large‐cell stents.MethodsThis was a multicenter retrospective comparative study of stent‐in‐stent methods using slim‐delivery stents (Niti‐S Large Cell SR Slim Delivery [LC slim‐delivery]) and conventional stents (Niti‐S large‐cell D‐type; LCD) for unresectable HMBO.ResultsEighty‐three patients with HMBO were included; 31 LC slim‐delivery and 52 LCD. Overall technical and clinical success rates were 100% and 90% in LC slim‐delivery group and 98% and 88% in LCD group. Use of the LC slim‐delivery was associated with shorter stent placement time in the multiple regression analysis, with a stent placement time of 18 and 23 min in LC slim‐delivery and LCD groups, respectively. The early adverse event (AE) rate of LC slim‐delivery was 10%, with no cholangitis or cholecystitis as compared to 23% in the LCD group. Recurrent biliary obstruction (RBO) rates and time to RBO were comparable between the two groups: 35% and 44%, and 8.5 and 8.0 months in LC slim‐delivery and LCD groups, respectively. The major cause of RBO was tumor ingrowth (82%) in the LC slim‐delivery group and sludge (43%) and ingrowth (48%) in LCD group.ConclusionStent‐in‐stent methods using LC slim‐delivery shortened stent placement time with low early AE rates and comparable time to RBO in patients with HMBO.

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EUS-guided antegrade metallic stent placement using the stent-in-stent method with a 6-Fr novel slim delivery system in a patient with malignant hilar biliary obstruction

Cited by 5 publications

References 5 publications

Endoscopic ultrasound-guided intervention for inaccessible papilla in advanced malignant hilar biliary obstruction

Endoscopic ultrasound-guided intervention for inaccessible papilla in advanced malignant hilar biliary obstruction

How to perform EUS-guided biliary drainage

Retrospective comparative study of new slim‐delivery and conventional large‐cell stents for stent‐in‐stent methods for hilar malignant biliary obstruction

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