EUS-Guided Antegrade Biliary Stenting Using a Novel Fully Covered Metal Stent (with Video)

Abstract

Background

Recently, endoscopic ultrasound (EUS)-guided hepaticogastrostomy (HGS) combined with antegrade stenting (AS) has been reported to be associated with longer stent patency and reduced procedure-related adverse events. In EUS-AS, an uncovered metal stent is usually selected to prevent stent misplacement or dislocation. However, because patient survival has improved with advances in chemotherapy, longer stent patency may be required.

Aim

The technical feasibility and safety of EUS-guided transhepatic biliary drainage combined with EUS-AS using a novel covered metal stent were evaluated.

Methods

Patients with malignant biliary obstruction leading to obstructive jaundice, in whom standard ERCP had failed or was contraindicated, were enrolled in this study between July 2015 and October 2017. As the control group, patients undergoing EUS-AS using an uncovered metal stent were enrolled between October 2014 and June 2015.

Results

A total of 39 patients were enrolled in this study. Among them, EUS-AS using a covered metal stent was performed in 17 patients and using an uncovered metal stent in the remaining 22 patients. Median stent patency including stent dysfunction and patient death was longer in the covered metal stent group (153 days) compared with that of the uncovered metal stent group (108 days) although there were no significant differences (P = 0.06). In only cases with stent dysfunction was median stent patency of the covered metal stent group significantly longer than that of the uncovered metal stent group (not available vs 150 days, P = 0.02).

Conclusions

In conclusion, EUS-guided transluminal biliary drainage combined with EUS-AS using a covered metal stent may be feasible and safe, although the indications for this procedure should be carefully considered.

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Author information

Affiliations

Authors

Contributions

Masanori Yamada and Takeshi Ogura wrote the paper. Takeshi Ogura, Akira Miyano, Rieko Kamiyama, Nobu Nishioka, Tadahiro Yamada, and Kazuhide Higuchi interpreted the data for the work, revising it critically for important intellectual content, final approval of the version to be published, and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Takeshi Ogura.

Ethics declarations

This pilot study was approved by the institutional review board of Osaka Medical College. Written, informed consent was obtained from all patients.

Conflict of Interest

The authors declare that they have no conflicts of interest.

Electronic Supplementary Material

The intrahepatic bile duct is punctured using 19G FNA needle, and the contrast medium is injected. Then, the 0.025-in. guidewire is inserted into the biliary tract, and also ERCP catheter is inserted. After the guidewire is advanced into the intestine across the uncovered duodenal metal stent, antegrade stent placement is performed using novel metal stent. Finally, EUS-guided hepaticogastrostomy is successfully performed. (AVI 16065 kb)

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Yamada, M., Ogura, T., Kamiyama, R. et al. EUS-Guided Antegrade Biliary Stenting Using a Novel Fully Covered Metal Stent (with Video). J Gastrointest Surg 23, 192–198 (2019). https://doi.org/10.1007/s11605-018-3914-7

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Keywords

  • EUS
  • EUS-guided biliary drainage
  • EUS-guided antegrade stenting
  • ERCP