Clinical utility of endoscopic ultrasound‐guided biliary drainage as a rescue of re‐intervention procedure for high‐grade hilar stricture

Ogura, Takeshi; Onda, Saori; Takagi, Wataru; Sano, Tastsushi; Okuda, Atsushi; Masuda, Daisuke; Yamamoto, Kazuhide; Miyano, Akira; Kitano, Masayuki; Takeuchi, Toshihisa; Fukunishi, Shinya; Higuchi, Kazuhide

doi:10.1111/jgh.13437

Cited by 28 publications

(26 citation statements)

References 30 publications

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“…Ogura et al. reported successful re‐intervention using EUS‐BD in patients with malignant hilar biliary obstruction and stent failure; the success rate of re‐intervention by ERC was 62% (16/26), and EUS‐BD was successful in all 10 cases of ERC failure. These cases may have relative indication for EUS‐BD because the procedure has not yet been established, and such patients frequently have a complex pathology.…”

Section: Questions and Clinical Questions Of The Guidelinesmentioning

confidence: 99%

Clinical practice guidelines for safe performance of endoscopic ultrasound/ultrasonography‐guided biliary drainage: 2018

Isayama

Nakai

Itoi

et al. 2019

J Hepato Biliary Pancreat

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112

127

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Endoscopic ultrasound/ultrasonography‐guided biliary drainage (EUS‐BD) is a relatively new modality for biliary drainage after failed or difficult transpapillary biliary cannulation. Despite its clinical utility, EUS‐BD can be complicated by severe adverse events such as bleeding, perforation, and peritonitis. The aim of this paper is to provide practice guidelines for safe performance of EUS‐BD as well as safe introduction of the procedure to non‐expert centers. The guidelines comprised patient–intervention–comparison–outcome‐formatted clinical questions (CQs) and questions (Qs), which are background statements to facilitate understanding of the CQs. A literature search was performed using the PubMed and Cochrane Library databases. Statement, evidence level, and strength of recommendation were created according to the GRADE system. Four committees were organized: guideline creation, expert panelist, evaluation, and external evaluation committees. We developed 13 CQs (methods, device selection, supportive treatment, management of adverse events, education and ethics) and six Qs (definition, indication, outcomes and adverse events) with statements, evidence levels, and strengths of recommendation. The guidelines explain the technical aspects, management of adverse events, and ethics of EUS‐BD and its introduction to non‐expert institutions.

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Section: Questions and Clinical Questions Of The Guidelinesmentioning

confidence: 99%

Clinical practice guidelines for safe performance of endoscopic ultrasound/ultrasonography‐guided biliary drainage: 2018

Isayama

Nakai

Itoi

et al. 2019

J Hepato Biliary Pancreat

Self Cite

112

127

View full text Add to dashboard Cite

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“…The literature supports the superiority of EUS in terms of clinical efficacy and reduced AEs and reinterventions, but usually does not make distinctions between HGs and CDs [22,29] and is focused on distal MBO, explicitly excluding hilar/intrahepatic stenosis [30,31]. Only initial experience has been published on EUS-IBD for hilar strictures [32,33], so that no evidence exists on EUS-IBD vs. PTBD for patients for whom this decision is most relevant.…”

Section: Variablementioning

confidence: 99%

EUS-guided intrahepatic biliary drainage: a large retrospective series and subgroup comparison between percutaneous drainage in hilar stenoses or postsurgical anatomy

et al. 2020

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Background and study aims Endoscopic ultrasound-guided intrahepatic biliary drainage (EUS-IBD) struggles to find a place in management algorithms, especially compared to percutaneous drainage (PTBD). In the setting of hilar stenoses or postsurgical anatomy data are even more limited. Patients and methods All consecutive EUS-IBDs performed in our tertiary referral center between 2012 – 2019 were retrospectively evaluated. Rendez-vous (RVs), antegrade stenting (AS) and hepatico-gastrostomies (HGs) were compared. The predefined subgroup of EUS-IBD patients with proximal stenosis/surgically-altered anatomy was matched 1:1 with PTBD performed for the same indications. Efficacy, safety and events during follow-up were compared. Results One hundred four EUS-IBDs were included (malignancies = 87.7 %). These consisted of 16 RVs, 43 ASs and 45 HGs. Technical and clinical success rates were 89.4 % and 96.2 %, respectively. Any-degree, severe and fatal adverse events (AEs) occurred in 23.3 %, 2.9 %, and 0.9 % respectively. Benign indications were more common among RVs while proximal stenoses, surgically-altered anatomy, and disconnected left ductal system among HGs. Procedures were shorter with HGs performed with specifically designed stents (25 vs. 48 minutes, P = 0.004) and there was also a trend toward less dysfunction with those stents (6.7 % vs. 30 %, P = 0.09) compared with previous approaches. Among patients with proximal stenosis/surgically-altered anatomy, EUS-IBD vs. PTBD showed higher rates of clinical success (97.4 % vs. 79.5 %, P = 0.01), reduced post-procedural pain (17.8 % vs. 44.4 %, p = 0.004), shorter median hospital stay (7.5 vs 11.5 days, P = 0.01), lower rates of stent dysfunction (15.8 % vs. 42.9 %, P = 0.01), and the mean number of reinterventions was lower (0.4 vs. 2.8, P < 0.0001). Conclusions EUS-IBD has high technical and clinical success with an acceptable safety profile. HGs show comparable outcomes, which are likely to further improve with dedicated tools. For proximal strictures and surgically-altered anatomy, EUS-IBD seems superior to PTBD.

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“…For example, EUS-CDS is not suitable for proximal (hilar) biliary obstruction, where an intrahepatic EUS-BD approach is required. In the specific situation of hilar malignancy EUS-guided HGS was found to be safe and effective[52,53], although the duration of efficacy was limited[40] and lower clinical success rates were demonstrated than for distal obstruction[41].…”

Section: Indicationsmentioning

confidence: 99%

Endoscopic ultrasound-guided drainage of the biliary system: Techniques, indications and future perspectives

Hindryckx¹,

Degroote²,

Tate³

et al. 2019

WJGE

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Over the last decade, endoscopic ultrasound-guided biliary drainage (EUS-BD) has evolved into a widely accepted alternative to the percutaneous approach in cases of biliary obstruction with failed endoscopic retrograde cholangiopancreaticography (ERCP). The available evidence suggests that, in experienced hands, EUS-BD might even replace ERCP as the first-line procedure in specific situations such as malignant distal bile duct obstruction. The aim of this review is to summarize the available data on EUS-BD and propose an evidence-based algorithm clarifies the role of the different EUS-BD techniques in the management of benign and malignant biliary obstructive disease.

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Clinical utility of endoscopic ultrasound‐guided biliary drainage as a rescue of re‐intervention procedure for high‐grade hilar stricture

Cited by 28 publications

References 30 publications

Clinical practice guidelines for safe performance of endoscopic ultrasound/ultrasonography‐guided biliary drainage: 2018

Clinical practice guidelines for safe performance of endoscopic ultrasound/ultrasonography‐guided biliary drainage: 2018

EUS-guided intrahepatic biliary drainage: a large retrospective series and subgroup comparison between percutaneous drainage in hilar stenoses or postsurgical anatomy

Endoscopic ultrasound-guided drainage of the biliary system: Techniques, indications and future perspectives

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