Clinical evaluation of physician-controlled guidewire manipulation during endoscopic ultrasound-guided hepaticogastrostomy (with video)

Nishiguchi, Kyohei; Ogura, Takeshi; Nishioka, Nobu; Ueno, Shinji; Okuda, Atsushi; Yamada, Tsuyoshi; Yamada, Masakazu; Ueshima, Kazuya; Higuchi, Kazuhide

doi:10.1055/a-1336-3132

Cited by 8 publications

(5 citation statements)

References 22 publications

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“…EUS-CDS and HGS have the advantage of reducing the risk of tumor ingrowth and postprocedural pancreatitis since the stent does not cross the malignant stricture and the pancreatic duct orifice. Previous studies from high-volume centers reported a high technical and clinical success rate of CDS[111–121] and HGS [122–125,126 ▪ ,127 ▪ ] for distal MBO. Furthermore, CDS and HGS are reported as comparable in efficacy and safety [113,128–132].…”

Section: Endoscopic Approach For Malignant Biliary Obstructionmentioning

confidence: 91%

Current endoscopic approaches to biliary strictures

Shimoda

Nakai

Fujishiro

2022

Current Opinion in Gastroenterology

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Purpose of reviewTo summarize the current status and future perspectives of the endoscopic management of biliary strictures.Recent findingsIn addition to conventional diagnostic modalities, such as cross-sectional imaging and endoscopic ultrasonography (EUS), per-oral cholangioscopy is helpful for indeterminate biliary strictures. It allows direct visualization of the biliary tract and targeted biopsy. For distal malignant biliary obstruction (MBO), a self-expandable metal stent (SEMS) via endoscopic retrograde cholangiopancreatography (ERCP) is a standard of care. EUS-guided biliary drainage (EUS-BD) is an emerging alternative to percutaneous transhepatic biliary drainage in cases with failed ERCP. EUS-BD is also an effective salvage option for perihilar MBO, which can not be managed via ERCP or percutaneous transhepatic biliary drainage. Preoperative drainage is necessary for most jaundiced patients as neoadjuvant chemotherapy is widely administered for resectable and borderline resectable pancreatic cancer, and a SEMS is preferred in this setting, too. For benign biliary strictures, a covered SEMS can improve stricture resolution and reduce the number of endoscopic sessions as compared to plastic stents.SummaryERCP and EUS play a central role in the diagnosis and drainage for both malignant and benign biliary strictures.

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Section: Endoscopic Approach For Malignant Biliary Obstructionmentioning

confidence: 91%

Current endoscopic approaches to biliary strictures

Shimoda

Nakai

Fujishiro

2022

Current Opinion in Gastroenterology

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“…However, guidewire manipulation in the liver impaction technique must be performed by an experienced assistant or controlled by the physician. 18 Finally, this study has several limitations, including its singlecenter design and retrospective nature. It is necessary to conduct a further prospective comparison study with another technique.…”

Section: Therapeutic Advances In Gastroenterologymentioning

confidence: 95%

Liver impaction technique improves technical success rate of guidewire insertion during EUS-guided hepaticogastrostomy (with video)

Nakamura,

Ogura,

Ueno

et al. 2023

Therap Adv Gastroenterol

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Background: If the guidewire becomes kinked by the needle, guidewire manipulation may be difficult, and can cause complications such as guidewire shearing or injury during endoscopic ultrasound (EUS)-guided hepaticogastrostomy (HGS). To overcome this matter, we have previously described a technical tip for preventing guidewire injury, termed ‘liver impaction technique’. However, its technical feasibility has been not reported in the setting of a large patient cohort. Objectives: The aim of study was to evaluate the clinical usefulness of the liver impaction technique during EUS-HGS. Design: Retrospective, single-center study. Methods: This retrospective study included consecutive patients who underwent EUS-HGS between April 2018 and September 2022. The primary outcome of this study was the technical success rate of guidewire insertion using the liver impaction technique. Results: A total of 166 patients were enrolled in this study. Initial successful guidewire insertion without using liver impaction technique was obtained in 108 patients (65.1%). Among 58 patients in whom guidewire insertion failed initially, guidewire advancement into the periphery of the bile duct was observed in 32 patients (55.2%) and into a non-interest bile duct branch was observed in 26 patients (44.8%). Liver impaction technique contributed to increasing the technical success rate of guidewire insertion from 65.1% to 95.8%. Overall, adverse events were observed in 12 patients (7.2%; bile peritonitis n = 9, cholangitis n = 3), and these adverse events were Grade I. Among patients who underwent liver impaction technique ( n = 58), adverse events were observed in two patients (3.4%; bile peritonitis). Also, guidewire sharing was not observed in any patients during liver impaction technique. Conclusions: In conclusion, the liver impaction technique may be helpful during EUS-HGS to obtain successful guidewire insertion into the biliary tract of interest.

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“…Various techniques have been described to facilitate guidewire manipulation, such as the “liver impaction” technique to prevent wire shearing, 51 the “moving endoscope” technique to change the needle-scope angle, 52 the “jumping technique” of guidewire manipulation, 53 and the physician-controlled guidewire manipulation. 54 A few other factors, such as the minimum ductal diameter and optimum hepatic parenchyma length, have been systematically evaluated during the ductal puncture. A study of 174 HGS cases noted that a ductal diameter of ≤5 mm was associated with low technical success.…”

Section: Methodsmentioning

confidence: 99%

Society of Gastrointestinal Endoscopy of India Consensus Guidelines on Endoscopic Ultrasound-Guided Biliary Drainage: Part II (Technical Aspects)

Samanta

Udawat

Chowdhary

et al. 2023

Journal of Digestive Endoscopy

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Endoscopic management of bile duct obstruction is a key aspect in gastroenterology practice and has evolved since the first description of biliary cannulation by McCune et al in 1968. Over many decades, the techniques and accessories have been refined, and currently, the first-line management for extrahepatic biliary obstruction is endoscopic retrograde cholangiopancreatography (ERCP). However, even in expert hands, the success rate of ERCP reaches up to 95%. In almost 4 to 16% cases, failure to cannulate the bile duct may necessitate other alternatives such as surgical bypass or, more commonly, percutaneous transhepatic biliary drainage (PTBD). While surgery is associated with high morbidity and mortality, PTBD has a very high reintervention and complication rate (∼80%) and poor quality of life. Almost parallelly, endoscopic ultrasound (EUS) has come a long way from a mere diagnostic tool to a substantial therapeutic option in various pancreaticobiliary diseases. Biliary drainage using EUS-guidance (EUS-BD) has gained momentum since the first report published by Giovannini et al in 2001. The concept of accessing the bile duct through a different route than the papilla, circumventing the shortcomings of PTBD, and sometimes bypassing the actual obstruction have enthused a lot of interest in this novel strategy. The three key methods of EUS-BD entail transluminal, antegrade, and rendezvous approach. Over the past decade, with growing experience, EUS-BD has been found to be equivalent to ERCP or PTBD for malignant obstruction with better success rates. EUS-BD, however, is not devoid of adverse events and can carry fatal adverse events. However, neither the technique of EUS-BD nor the accessories and stents for EUS-BD have been standardized. Additionally, different countries and regions have different availability of the accessories, making generalizability a difficult task. Thus, technical aspects of this evolving therapy need to be outlined. For these reasons, Society of Gastrointestinal Endoscopy of India (SGEI) deemed it appropriate to develop technical consensus statements for performing safe and successful EUS-BD.

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Clinical evaluation of physician-controlled guidewire manipulation during endoscopic ultrasound-guided hepaticogastrostomy (with video)

Cited by 8 publications

References 22 publications

Current endoscopic approaches to biliary strictures

Current endoscopic approaches to biliary strictures

Liver impaction technique improves technical success rate of guidewire insertion during EUS-guided hepaticogastrostomy (with video)

Society of Gastrointestinal Endoscopy of India Consensus Guidelines on Endoscopic Ultrasound-Guided Biliary Drainage: Part II (Technical Aspects)

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