Therapeutic Biliary Endoscopy

Fogel, Evan L.; McHenry, Lee; Sherman, Stuart; Watkins, J; Lehman, Glen A.

doi:10.1055/s-2004-826146

Cited by 50 publications

(9 citation statements)

References 26 publications

(26 reference statements)

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“…E NDOSCOPIC BILIARY STENTING under endoscopic retrograde cholangiopancreatography (ERCP) is the first-line therapeutic modality to decompress biliary obstruction; however, it has been noticed to fail in up to 10% of patients, usually as a result of anatomical variations, duodenal strictures, and previous gastrointestinal surgeries. 1,2 Since its first report in 2001, 3 endoscopic ultrasound-guided biliary drainage (EUS-BD) has emerged as a new biliary decompression procedure and has been increasingly used as an effective alternative for biliary obstruction patients with failed ERCP. 4,5 In the last decade, EUS-BD has been attracting considerable attention and various endoscopic techniques have been described for its implementation.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the efficacy and safety of endoscopic ultrasound‐guided choledochoduodenostomy and hepaticogastrostomy for malignant distal biliary obstruction: Multicenter, randomized, clinical trial

Minaga

Ogura

Shiomi

et al. 2019

Digestive Endoscopy

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Background and Aim Endoscopic ultrasound‐guided biliary drainage (EUS‐BD) can be carried out by two different approaches: choledochoduodenostomy (CDS) and hepaticogastrostomy (HGS). We compared the efficacy and safety of these approaches in malignant distal biliary obstruction (MDBO) patients using a prospective, randomized clinical trial. Methods Patients with malignant distal biliary obstruction after failed endoscopic retrograde cholangiopancreatography were randomly selected for either CDS or HGS. The procedures were carried out at nine tertiary centers from September 2013 to March 2016. Primary endpoint was technical success rate, and the noninferiority of HGS to CDS was examined with a one‐sided significance level of 5%, where the noninferiority margin was set at 15%. Secondary endpoints were clinical success, adverse events (AE), stent patency, survival time, and overall technical success including alternative EUS‐BD procedures. Results Forty‐seven patients (HGS, 24; CDS, 23) were enrolled. Technical success rates were 87.5% and 82.6% in the HGS and CDS groups, respectively, where the lower limit of the 90% confidence interval of the risk difference was −12.2% (P = 0.0278). Clinical success rates were 100% and 94.7% in the HGS and CDS groups, respectively (P = 0.475). Overall AE rate, stent patency, and survival time did not differ between the groups. Overall technical success rates were 100% and 95.7% in the HGS and CDS groups, respectively (P = 0.983). Conclusions This study suggests that HGS is not inferior to CDS in terms of technical success. When one procedure is particularly challenging, readily switching to the other could increase technical success.

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Section: Introductionmentioning

confidence: 99%

Comparison of the efficacy and safety of endoscopic ultrasound‐guided choledochoduodenostomy and hepaticogastrostomy for malignant distal biliary obstruction: Multicenter, randomized, clinical trial

Minaga

Ogura

Shiomi

et al. 2019

Digestive Endoscopy

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“…S TENT PLACEMENT UNDER endoscopic retrograde cholangiopancreatography (ERCP) is the gold standard method of treating malignant biliary obstruction. 1 This method may be contraindicated for duodenal obstruction or surgical anatomy such as Roux-en-Y reconstruction because the endoscope cannot be advanced into Vater's ampulla. As an alternative method, percutaneous transhepatic biliary drainage (PTBD) is widely carried out.…”

Section: Introductionmentioning

confidence: 99%

Multicenter prospective evaluation study of endoscopic ultrasound‐guided hepaticogastrostomy combined with antegrade stenting (with video)

Ogura

Kitano

Takenaka³

et al. 2017

Digestive Endoscopy

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“…Endoscopic retrograde cholangiopancreatography (ERCP) is the standard procedure, with a high success rate, for the treatment of biliary obstruction [Fogel et al 2001; Freeman and Guda, 2005]. However, ERCP may not be possible in patients with selective cannulation failure or an inaccessible papilla due to a surgically altered anatomy or duodenal obstruction [Park et al 2011; Ogura et al 2014].…”

Section: Introductionmentioning

confidence: 99%

Optimal biliary access point and learning curve for endoscopic ultrasound-guided hepaticogastrostomy with transmural stenting

Park

Song

et al. 2016

Therap Adv Gastroenterol

110

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Background:Although endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) with transmural stenting has increased for biliary decompression in patients with an inaccessible papilla, the optimal biliary access point and the learning curve of EUS-HGS have not been studied. We evaluated the optimal biliary access point and learning curve for technically successful EUS-HGS.Methods:129 consecutive patients (male n = 81, 62.3%; malignant n = 113, 87.6%) who underwent EUS-HGS due to an inaccessible papilla were enrolled. EUS finding and procedure times according to each needle puncture attempt in EUS-HGS were prospectively measured. Learning curves of EUS-HGS were calculated for two main outcome measurements (procedure time and adverse events) by using the moving average method and cumulative sum (CUSUM) analysis, respectively.Results:A total of 174 EUS-HGS attempts were performed in 129 patients. The mean number of needle punctures was 1.35 ± 0.57. Using the logistic regression model, bile duct diameter of the puncture site ⩽ 5 mm [odds ratio (OR) 3.7, 95% confidence interval (CI): 1.71–8.1, p < 0.01] and hepatic portion length [linear distance from the mural wall to the punctured bile duct wall on EUS; mean hepatic portion length was 27 mm (range 10–47 mm)] > 3 cm (OR 5.7, 95% CI: 2.7–12, p < 0.01) were associated with low technical success. Procedure time and adverse events were shorter after 24 cases, and stabilized at 33 cases of EUS-HGS, respectively.Conclusions:Our data suggest that a bile duct diameter > 5 mm and hepatic portion length 1 cm to ⩽ 3 cm on EUS may be suitable for successful EUS-HGS. In our learning curve analysis, over 33 cases might be required to achieve the plateau phase for successful EUS-HGS.

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Therapeutic Biliary Endoscopy

Cited by 50 publications

References 26 publications

Comparison of the efficacy and safety of endoscopic ultrasound‐guided choledochoduodenostomy and hepaticogastrostomy for malignant distal biliary obstruction: Multicenter, randomized, clinical trial

Comparison of the efficacy and safety of endoscopic ultrasound‐guided choledochoduodenostomy and hepaticogastrostomy for malignant distal biliary obstruction: Multicenter, randomized, clinical trial

Multicenter prospective evaluation study of endoscopic ultrasound‐guided hepaticogastrostomy combined with antegrade stenting (with video)

Optimal biliary access point and learning curve for endoscopic ultrasound-guided hepaticogastrostomy with transmural stenting

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