New methods
Clinical endoscopy
Preliminary report on a new hybrid metal stent for EUS-guided biliary drainage (with videos)

https://doi.org/10.1016/j.gie.2014.05.327Get rights and content

Background

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.

Objective

To evaluate a newly developed hybrid metal stent customized for EUS-BD.

Design

A prospective, observational study.

Setting

A tertiary academic referral center.

Patients

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.

Interventions

EUS-BD with a newly developed hybrid metal stent.

Main Outcome Measurements

The technical and clinical success rates and adverse events, including proximal or distal stent migration and cholangitis.

Results

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.

Limitations

This study was performed at a single center by a single experienced operator with a relatively small number of patients.

Conclusion

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.

Section snippets

Methods

We obtained permission from the Institutional Review Board of Asan Medical Center and performed a prospective data collection. A total of 27 consecutive patients were included between September 2011 and August 2013. Our inclusion criteria were (1) the presence of a malignant biliary obstruction and (2) failed conventional ERCP stenting. Our exclusion criteria were (1) advanced heart or lung disease precluding adequate sedation and (2) a lack of informed consent. These 27 patients included 13

Results

The patient baseline characteristics and outcomes of EUS-BD are summarized in Table 1. EUS-HG was performed in 10 patients, and EUS-CD 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. The median procedure time was 20.0 minutes (range 15-40 minutes). One patient who had undergone EUS-CD had jaundice that failed to improve after 3 days, and a repeat endoscopy revealed

Discussion

EUS-BD is increasingly used as a minimally invasive alternative to percutaneous drainage or surgery after a failed ERCP. Although previous studies suggested that EUS-BD is feasible and effective, concerns have been raised regarding the potential risks of serious adverse events, particularly stent-related adverse events.9 For example, proximal stent migration caused by a shortening of the metal stent after deployment may lead to bile leakage into the peritoneal cavity through the migrated stent

References (13)

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DISCLOSURE: All authors disclosed no financial relationships relevant to this article.

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