Feasibility and Safety of Endoscopic Ultrasound-Guided Biliary Drainage (EUS-BD) for Malignant Biliary Obstruction Associated with Ascites: Results of a Pilot Study

Alvarez-Sánchez, María Victoria; Luna, Olivia B.; Oria, Ines; Marchut, K; Fumex, Fabien; Singier, G; Salgado, Andrés Álvarez; Napoléon, Bertrand

doi:10.1007/s11605-018-3731-z

Cited by 14 publications

(10 citation statements)

References 26 publications

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“…In addition, a recent pilot study found that EUS-BD was technically feasible and clinically effective and safe even in patients with ascites. 34 In this study, the presence of a small amount of perihepatic ascites was observed in seven patients (17.5%) on CT obtained prior to EUS-BD. However, similar to the previous report, EUS-BD could be safely performed without severe AEs, including bile peritonitis.…”

Section: Discussionmentioning

confidence: 50%

Endoscopic ultrasound-guided biliary drainage for malignant biliary obstruction with surgically altered anatomy: a multicenter prospective registration study

Minaga

Takenaka

Ogura

et al. 2020

Therap Adv Gastroenterol

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Background: Endoscopic treatment for malignant biliary obstruction (MBO) in patients bearing surgically altered anatomy (SAA) is not well-established. Although endoscopic ultrasound-guided biliary drainage (EUS-BD) has emerged as a new treatment option for MBO, limited data are available regarding the efficacy and safety of EUS-BD in patients with SAA. We conducted a multicenter prospective registration study to evaluate the efficacy and safety of EUS-BD in this population. Methods: This study involved 10 referral centers in Japan. Patients with SAA who were scheduled to receive EUS-BD for unresectable MBO between May 2016 and September 2018 were prospectively registered. The primary endpoint was technical success and the secondary outcomes were clinical success, procedure time, procedure-related adverse events (AEs), stent patency, and overall survival. Results: In total, 40 patients were prospectively enrolled. The surgical reconstruction methods were gastrectomy with Roux-en-Y reconstruction (47.5%), gastrectomy with Billroth-II reconstruction (15%), pancreaticoduodenectomy (27.5%), and hepaticojejunostomy with Roux-en-Y reconstruction (10%). EUS-BD was performed for primary biliary drainage in 31 patients and for rescue biliary drainage in nine patients. Transmural stenting alone (60%), antegrade stenting alone (5%), and a combination of the two techniques (35%) were selected for patients treated with EUS-BD. Technical and clinical success rates were 100% (95% confidence interval, 91.2–100.0%) and 95% (95% confidence interval, 83.1–99.4%), respectively. Mean procedure time was 36.5 min. Early AEs were noted in six patients (15%): three self-limited bile leak, one bile peritonitis, and two pneumoperitonea. Late AEs occurred in six patients (15%): one jejunal ulcer and five stent occlusions. Stent patency rate after 3 months of survival was 95.7% (22/23). Median overall survival was 96 days. Conclusion: EUS-BD for MBO in patients with SAA appears to be effective and safe not only as a rescue drainage technique after failed endoscopic retrograde cholangiography but also as a primary drainage technique. Clinical Trial Registration: UMIN000022101

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Section: Discussionmentioning

confidence: 50%

Endoscopic ultrasound-guided biliary drainage for malignant biliary obstruction with surgically altered anatomy: a multicenter prospective registration study

Minaga

Takenaka

Ogura

et al. 2020

Therap Adv Gastroenterol

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“…The volume of ascites or duodenal stents was also not associated with adverse events. Alvarez et al 29 also reported that EUS-BD was technically and clinically effective and safe in patients with ascites. In this study, two patients with ascites on the puncture line were withdrawn before puncture because the fistula was not formed and the risk of bile leakage or peritonitis may be increased if ascites are present on the puncture line.…”

Section: Discussionmentioning

confidence: 95%

Risk factor analysis for adverse events and stent dysfunction of endoscopic ultrasound‐guided choledochoduodenostomy

Matsumoto

Hara²,

Mizuno³

et al. 2020

Digestive Endoscopy

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Background and Aims Although the technique of endoscopic ultrasound‐guided choledochoduodenostomy (EUS‐CDS) is becoming standardized, its safety issues have not been sufficiently investigated. Therefore, we aimed to identify factors associated with adverse events and stent patency in EUS‐CDS. Methods Consecutive patients who underwent EUS‐CDS between September 2003 and July 2017 were included. Technical/clinical success, adverse events and stent dysfunctions were analyzed retrospectively. Results A total of 151 patients underwent EUS‐CDS. In nine patients, procedures were discontinued before puncture. Technical and clinical success rates were 96.5% (137/142) and 98.5% (135/137), respectively. The adverse event rate was 20.4% (29/142). As a risk factor for peritonitis, plastic stents (PS) showed a significantly high odds ratio (OR) compared with covered self‐expandable metal stents (CSEMS; OR, 4.31; P = 0.030). CSEMS cases showed a significantly longer patency period than PS cases (329 vs 89 days; HR, 0.35; P < 0.001). As a risk factor for early stent dysfunction (within 14 days), stent direction to the oral side showed a significantly high OR (OR, 43.47; P < 0.001). In cases with oblique‐viewing EUS, double penetration of the duodenum occurred at significantly higher frequency than in cases with forward‐viewing EUS (7.0 vs 0.0%; P = 0.024). Conclusions Plastic stents and stent direction to the oral side were risk factors for peritonitis and early stent dysfunction, respectively. Using covered self‐expandable metal stents and changing stent direction to the anal side seemed appropriate to prevent peritonitis and early stent dysfunction.

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“…Also, a study has shown that it is better in patients who have ascites. 225 Q54. When is surgical biliary drainage indicated?…”

Section: Remarksmentioning

confidence: 99%

Indian College of Radiology and Imaging Evidence-Based Guidelines for Percutaneous Image-Guided Biliary Procedures

Madhusudhan

Valakkada

Keshava

2021

Indian J Radiol Imaging

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Percutaneous biliary interventions are among the commonly performed nonvascular radiological interventions. Most common of these interventions is the percutaneous transhepatic biliary drainage for malignant biliary obstruction. Other biliary procedures performed include percutaneous cholecystostomy, biliary stenting, drainage for bile leaks, and various procedures like balloon dilatation, stenting, and large-bore catheter drainage for bilioenteric or post-transplant anastomotic strictures. Although these procedures are being performed for ages, no standard guidelines have been formulated. This article attempts at preparing guidelines for performing various percutaneous image-guided biliary procedures along with discussion on the published evidence in this field.

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Feasibility and Safety of Endoscopic Ultrasound-Guided Biliary Drainage (EUS-BD) for Malignant Biliary Obstruction Associated with Ascites: Results of a Pilot Study

Abstract: EUS-BD is technically feasible in patients with ascites. Our results suggest that EUS-BD may be a clinically effective and safe alternative after failed ERCP in patients with ascites.

Cited by 14 publications

References 26 publications

Endoscopic ultrasound-guided biliary drainage for malignant biliary obstruction with surgically altered anatomy: a multicenter prospective registration study

Endoscopic ultrasound-guided biliary drainage for malignant biliary obstruction with surgically altered anatomy: a multicenter prospective registration study

Risk factor analysis for adverse events and stent dysfunction of endoscopic ultrasound‐guided choledochoduodenostomy

Indian College of Radiology and Imaging Evidence-Based Guidelines for Percutaneous Image-Guided Biliary Procedures

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