Long-term outcomes of a newly developed hybrid metal stent for EUS-guided biliary drainage (with videos).

Although fully covered self-expandable metal stents (FCSEMSs) have been commonly used for EUS-guided biliary drainage (EUS-BD), FCSEMS migration is a main limitation of this procedure. In the present study we evaluated the technical and clinical success rates, adverse events, and long-term outcomes of a newly developed hybrid stent that has been customized for EUS-BD. From September 2011 to May 2015, 54 consecutive patients with biliary obstruction were enrolled in this prospective, observational study. These patients were candidates for alternative BD techniques because of failed ERCP. The hybrid metal stent used for EUS-BD in this study was partially covered, had anchoring flaps, and is commercially available in Korea. EUS-guided hepaticogastrostomy (EUS-HGS) was performed in 21 patients and EUS-guided choledochoduodenostomy (EUS-CDS) in 33 patients. The technical and clinical success rates of EUS-BD were 100% (54/54) and 94.4% (51/54), respectively. Immediate adverse events developed after EUS-BD in 9 patients (16.6%; cholangitis in 3, bleeding in 2, self-limited pneumoperitoneum in 3, and abdominal pain in 1). Proximal or distal stent migration was not observed during the follow-up period (median, 148.5 days; IQR, 79.7-244), and the mean stent patency duration was 166.3 days and 329.1 days in the EUS-HGS and EUS-CDS groups, respectively. EUS-BD with the hybrid metal stent is technically feasible and can effectively treat biliary obstruction after failed ERCP. EUS-BD with the hybrid metal stent can reduce stent-related adverse events, especially stent migration.

Cho DH ，Lee SS ，Oh D ，Song TJ ，Park DH ，Seo DW ，Lee SK ，Kim MH ... -  《-》

Preliminary report on a new hybrid metal stent for EUS-guided biliary drainage (with videos).

EUS-guided biliary drainage (EUS-BD) may be a feasible and useful alternative in patients with malignant biliary obstruction after failed ERCP. One of the main limitations of EUS-BD is the lack of devices specifically tailored to this technique. To evaluate a newly developed hybrid metal stent customized for EUS-BD. A prospective, observational study. A tertiary academic referral center. A total of 27 consecutive patients with malignant biliary obstruction who were candidates for alternative techniques for biliary drainage because of failed ERCP were enrolled. EUS-BD with a newly developed hybrid metal stent. The technical and clinical success rates and adverse events, including proximal or distal stent migration and cholangitis. EUS-guided hepaticogastrostomy was performed in 10 patients, and EUS-guided choledochoduodenostomy was performed in 17 patients. The technical success rate of EUS-BD with the hybrid metal stent was 100% (27/27), and clinical success was achieved in 96.3% (26/27) of the cases. Adverse events developed in 5 patients (5/27, 18.5%), including a self-limited pneumoperitoneum in 3 patients, minor bleeding in 1 patient, and abdominal pain in 1 patient. During the follow-up period (median 134 days), proximal or distal stent migration was not observed. This study was performed at a single center by a single experienced operator with a relatively small number of patients. EUS-BD with a hybrid metal stent is technically feasible and can be an effective treatment for malignant biliary obstruction after failed ERCP. Hybrid metal stents may be used safely in EUS-BD, and they can prevent stent-related adverse events.

Song TJ ，Lee SS ，Park DH ，Seo DW ，Lee SK ，Kim MH ... -  《-》

EUS-guided hepaticogastrostomy with a fully covered metal stent as the biliary diversion technique for an occluded biliary metal stent after a failed ERCP (with videos).

Park DH ，Song TJ ，Eum J ，Moon SH ，Lee SS ，Seo DW ，Lee SK ，Kim MH ... -  《-》

A newly designed plastic stent for EUS-guided hepaticogastrostomy: a prospective preliminary feasibility study (with videos).

There are currently no dedicated plastic stents for EUS-guided hepaticogastrostomy (EUS-HGS). We prospectively evaluated the feasibility and the technical and functional success rates of our newly designed plastic stent for EUS-HGS. Prospective preliminary feasibility study. A tertiary-care referral center. Twenty-three consecutive patients were treated. The reasons for requiring EUS-HGS were periampullary tumor invasion (n=9), altered anatomy (n=7), failed duodenal intubation (n=3), and previous ERCP failure (n=4). An 8F single-pigtail plastic stent with 4 flanges was placed for EUS-HGS. Technical success, clinical success, and adverse events according to the American Society for Gastrointestinal Endoscopy lexicon. All stents were successfully deployed without procedural adverse events (100% technical success rate). Bleeding from the punctured gastric wall occurred in 1 patient 3 days postoperatively. We exchanged the plastic stent for a fully covered self-expandable metal stent. A mild adverse event of self-limited abdominal pain occurred in 3 patients. Treatment success was achieved in all patients. The occlusion rate was 13.7% (3/22) during the median follow-up period (5.0 months, range 0.5-12.5 months). The median duration of stent patency was 4.0 months (range 0.5-9.0 months). There was no stent migration or dislocation during the follow-up period. Small number of patients and lack of a control group. This newly designed single-pigtail plastic stent dedicated for EUS-HGS was technically feasible and can possibly be used for highly selected patients with advanced malignancy or benign stricture. ( http://www.umin.ac.jp/english/: UMIN000012993.).

Umeda J ，Itoi T ，Tsuchiya T ，Sofuni A ，Itokawa F ，Ishii K ，Tsuji S ，Ikeuchi N ，Kamada K ，Tanaka R ，Tonozuka R ，Honjo M ，Mukai S ，Fujita M ，Moriyasu F ... -  《-》

EUS-guided biliary drainage with transluminal stenting after failed ERCP: predictors of adverse events and long-term results.

EUS-guided biliary drainage (EUS-BD) has been proposed as an effective alternative for percutaneous transhepatic biliary drainage (PTBD) after failed ERCP. To date, the risk factors for adverse events and long-term outcomes of EUS-BD with transluminal stenting (EUS-BDS) have not been fully explored. To evaluate risk factors for adverse events and long-term outcomes of EUS-BDS. Prospective follow-up study. Tertiary-care academic center. This study involved 57 consecutive patients with malignant or benign biliary obstruction undergoing EUS-BDS after failed ERCP. EUS-guided hepaticogastrostomy (EUS-HGS) and EUS-guided choledochoduodenostomy with transluminal stenting (EUS-CDS). Risk factors for postprocedure and late adverse events and clinical outcomes of EUS-BDS. The overall technical and functional success rates, respectively, in the EUS-BDS group were 96.5% (intention-to-treat, n = 55/57) and 89% (per-protocol, n = 49/55). Postprocedure adverse events developed after EUS-BDS in 11 patients (20%, n = 11/55). This included bile peritonitis (n = 2), mild bleeding (n = 2), and self-limited pneumoperitoneum (n = 7). In multivariate analysis, needle-knife use was the single risk factor for postprocedure adverse events after EUS-BDS (odds ratio 12.4; P = .01). A late adverse event in EUS-BDS was distal stent migration (7%, n = 4/55). The mean stent patencies with EUS-HGS and EUS-CDS were 132 days and 152 days, respectively. Single-operator performed, nonrandomized study. EUS-HGS and EUS-CDS may be relatively safe and can be used as an alternative to PTBD after failed ERCP. Both techniques offer durable and comparable stent patency. The use of a needle-knife for fistula dilation in EUS-BDS should be avoided if possible.

Park DH ，Jang JW ，Lee SS ，Seo DW ，Lee SK ，Kim MH ... -  《-》