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Transmural Biliary Drainage Can Be an Alternative to Transpapillary Drainage in Patients with an Indwelling Duodenal Stent

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Abstract

Background

Self-expandable metal stents (SEMS) are widely utilized to relieve symptoms of malignant gastric outlet obstruction (GOO), but GOO is frequently complicated by nonresectable distal biliary obstruction. The optimal endoscopic approach to biliary drainage in this setting remains controversial and has yet to be resolved.

Aims

To compare the safety and efficacy of endoscopic ultrasound-guided transmural biliary drainage (EUS-BD) and transpapillary drainage in patients with an indwelling duodenal SEMS.

Methods

Patients who underwent EUS-BD or transpapillary drainage for distal malignant biliary obstruction with an indwelling duodenal SEMS between June 2007 and August 2012 at three Japanese tertiary referral centers were identified retrospectively. We compared times to stent dysfunction, causes of dysfunction, and procedural related complications between these two groups.

Results

Twenty patients were included in the study (7 EUS-BD and 13 transpapillary drainage). EUS-BD was performed via hepaticogastrostomy using a SEMS in three patients and via choledochoduodenostomy using a SEMS or a plastic stent in two patients each. Transpapillary drainage was performed using a SEMS in all patients. The stent patency rate in the EUS-BD group was higher than that in the transpapillary drainage group (100 vs. 71 % at 1 month and 83 vs. 29 % at 3 months, respectively). The rate of stent dysfunction in the EUS-BD group tended to be lower than that in the transpapillary group (14 vs. 54 %; P = 0.157). Complication rates were similar between the groups (P = 1.000), with moderate bleeding in one patient in the EUS-BD group and mild pancreatitis in one patient in the transpapillary group.

Conclusion

Endoscopic ultrasound-guided transmural biliary drainage is an alternative to transpapillary drainage in patients with an indwelling duodenal SEMS.

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Acknowledgments

We gratefully acknowledge the assistance of Dr. Keiji Ogura, Tokyo Metropolitan Police Hospital, and Dr. Ryou Nakata, Japanese Red Cross Medical Center.

Conflict of interest

None.

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Authors and Affiliations

  1. Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Tsuyoshi Hamada, Hiroyuki Isayama, Yousuke Nakai, Hirofumi Kogure, Natsuyo Yamamoto, Kazumichi Kawakubo, Naminatsu Takahara, Rie Uchino, Suguru Mizuno, Takashi Sasaki, Osamu Togawa, Kenji Hirano, Minoru Tada & Kazuhiko Koike

  2. Department of Gastroenterology, Tokyo Metropolitan Police Hospital, 4-22-1 Nakano, Nakano-ku, Tokyo, 164-8541, Japan

    Saburo Matsubara

  3. Department of Gastroenterology, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan

    Yukiko Ito & Takeshi Tsujino

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  1. Tsuyoshi Hamada
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  2. Hiroyuki Isayama
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  3. Yousuke Nakai
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Corresponding author

Correspondence to Hiroyuki Isayama.

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Hamada, T., Isayama, H., Nakai, Y. et al. Transmural Biliary Drainage Can Be an Alternative to Transpapillary Drainage in Patients with an Indwelling Duodenal Stent. Dig Dis Sci 59, 1931–1938 (2014). https://doi.org/10.1007/s10620-014-3062-1

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  • DOI: https://doi.org/10.1007/s10620-014-3062-1

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