Long-term outcomes of a long, partially covered metal stent for EUS-guided hepaticogastrostomy in patients with malignant biliary obstruction (with video)

Nakai, Yousuke; Shimoda, Tatsuya; Hakuta, Ryunosuke; Ishigaki, Kazunaga; Saito, Kei; Saito, Tomotaka; Takahara, Naminatsu; Hamada, Tsuyoshi; Kogure, Hirofumi; Nogchi, Kensaku; Ito, Yukiko; Isayama, Hiroyuki; Koike, Kazuhiko

doi:10.1016/j.gie.2020.03.3856

Cited by 81 publications

(79 citation statements)

References 34 publications

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“…Concerns about stent migration or side-branch blockage when covered metal stents are placed transhepatically should be further elucidated. No transhepatic stent migration occurred in this study or in a larger recent series on hepaticogastrostomy using a related partially covered metal stent [8]. Tissue hyperplasia in the uncovered hepatic end of the stent provided anchorage.…”

mentioning

confidence: 44%

Combined ERCP and transhepatic endoscopic ultrasound-guided stent placement for biliary drainage in malignant hilar obstruction: not too good to be true

Pérez-Miranda

2020

Endoscopy

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mentioning

confidence: 44%

Combined ERCP and transhepatic endoscopic ultrasound-guided stent placement for biliary drainage in malignant hilar obstruction: not too good to be true

Pérez-Miranda

2020

Endoscopy

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“…In this study involving 10 referral centers, EUS-BD for unresectable MBO with SAA patients was technically and clinically successful in 100% and 95% of enrolled patients, respectively. Previous large-scale studies reported the efficacy of EUS-BD for MBO; 5,9,13,[16][17][18][19][20][21][22][23][24][25] however, these studies included a limited number of patients bearing SAA (Table 3). Compared with these studies, this study aimed to determine the efficacy of EUS-BD specifically for SAA patients.…”

Section: Discussionmentioning

confidence: 99%

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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“…47,58 Recurrent biliary obstruction can occur 5.5-8.5 months after the procedure. 37,56,58 EUS-HGS is primarily performed for malignant obstruction. Recently, it has been used for anastomotic strictures in patients with a surgically altered anatomy 5,59 (Fig.…”

Section: Outcomes and Applicationmentioning

confidence: 99%

“…The technical success rate has increased to 90–100% with refinements in equipment and techniques [ 47 , 58 ]. Recurrent biliary obstruction can occur 5.5–8.5 months after the procedure [ 37 , 56 , 58 ]. EUS-HGS is primarily performed for malignant obstruction.…”

Section: Outcomes and Applicationmentioning

confidence: 99%

What You Need to Know Before Performing Endoscopic Ultrasound-guided Hepaticogastrostomy

2021

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Endoscopic retrograde cholangiopancreatography (ERCP) is the primary treatment modality for bile duct obstruction. When ERCP is unsuccessful, percutaneous transhepatic biliary drainage can be an alternative method. Endoscopic ultrasound-guided biliary drainage (EUS-BD) has emerged as a treatment option for biliary obstruction, especially after ERCP failure. EUS-BD offers transluminal intrahepatic and extrahepatic drainage through a transgastric and transduodenal approach. EUS-guided hepaticogastrostomy (EUS-HGS) is an excellent choice for patients with hilar strictures or those with a surgically altered anatomy. The optimal steps in EUS-HGS are case selection, bile duct visualization, puncture-site selection, wire insertion and manipulation, tract dilation, and stent placement. Caution should be taken at each step to prevent complications. Dedicated devices for EUS-HGS have been developed to improve the technical success rate and reduce complications. This technical review focuses on the essential practical points at each step of EUS-HGS.

show abstract

Long-term outcomes of a long, partially covered metal stent for EUS-guided hepaticogastrostomy in patients with malignant biliary obstruction (with video)

Cited by 81 publications

References 34 publications

Combined ERCP and transhepatic endoscopic ultrasound-guided stent placement for biliary drainage in malignant hilar obstruction: not too good to be true

Combined ERCP and transhepatic endoscopic ultrasound-guided stent placement for biliary drainage in malignant hilar obstruction: not too good to be true

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

What You Need to Know Before Performing Endoscopic Ultrasound-guided Hepaticogastrostomy

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