Prospective clinical study of endoscopic ultrasound-guided choledochoduodenostomy with direct metallic stent placement using a forward-viewing echoendoscope

Abstract

A prospective clinical study was conducted to evaluate the safety, feasibility, and efficacy of endoscopic ultrasound (EUS)-guided choledochoduodenostomy (CDS) with direct metallic stent placement using a prototype forward-viewing echoendoscope. The indication for EUS - CDS in this study was lower biliary obstruction only, and not failed endoscopic biliary drainage, because the aim was to evaluate EUS - CDS for first-line biliary drainage therapy. The technical and functional success rates were 94 % (17 /18) and 94 % (16 /17), respectively. Early complications (focal peritonitis) were encountered in two patients (11 %). No patients developed late complications. EUS - CDS with direct metallic stent placement using a forward-viewing echoendoscope was generally feasible and effective for malignant distal biliary tract obstruction. The forward-viewing echoendoscope was useful, especially for deploying the metallic stent.

Forward-viewing versus oblique-viewing echoendoscopes in the diagnosis of upper GI subepithelial lesions with EUS-guided FNA: a prospective, randomized, crossover study

“…[17][18][19][20][21][22][23][24][25][26] The advantage of the forward-viewing echoendoscope is that the target is punctured in a straight line with the endoscope, and the puncture site can be readily visible, especially in the pancreatic head from the bulb and the pancreatic uncinate and ampulla from the second portion of the duodenum. [17][18][19][20][21][22][23][24][25][26][27] Also, our results showed that the use of the forwardviewing echoendoscope facilitated the puncture of lesions associated with strictures by lesions and of lesions that were located at the fornix, which are sites difficult to access with the oblique-viewing echoendoscope. In addition, attaching a transparent hood to the tip was shown to expand the capabilities of the endoscope by fixing the target, especially small GI subepithelial lesions.…”

“…The advantages of the forward-viewing echoendoscope for the treatment of pancreatobiliary disease were noted in several reports. [17][18][19][20][21][22][23][24][25] A few reports described the diagnostic accuracy of forward-viewing echoendoscopes compared with oblique-viewing echoendoscopes. 20,23,26 More recently, Larghi et al 27 reported extraordinary results by using the forward-viewing echoendoscope for subepithelial lesions.…”

Interventional Therapy for Pancreatic Cancer

“…Recently, EUS-guided biliary drainage has emerged as an alternative procedure for relieving biliary obstruction in cases in which ERCP has failed. EUS-guided biliary drainage broadly includes EUS-guided rendezvous technique, EUS-guided choledochoduodenostomy, EUS-guided hepaticogastrostomy, EUS-guided antegrade stenting, and EUS-guided gallbladder drainage [36,37,38,39,40]. A system review conducted by our group has recently shown that the technical success rate and functional success rate of EUS-guided biliary drainage for malignant obstruction were 94.55 and 92.49%, respectively [41].…”

Development of a new reagent for endoscopic ultrasound-guided celiac plexus neurolysis and tumor ablation therapy

“…In particular, EUS-guided drainage has been developed as an alternative to percutaneous and surgical approaches. [1][2][3] The usefulness of EUS-guided biliary drainage, EUS-guided gallbladder drainage, EUS-guided drainage of pancreatic fluid collections, EUS-guided pancreatic duct drainage, and EUS-guided drainage of abdominal and pelvic collections have already been reported. Moreover, the utility of EUS-guided injection of various materials has also been described.…”