Efficacy of a newly developed dilator for endoscopic ultrasound-guided biliary drainage

Abstract

AIMTo evaluate the efficacy of a newly developed dilator for endoscopic ultrasound (EUS)-guided drainage (ES Dilator).METHODSFourteen consecutive patients who had undergone EUS-guided choledochoduodenostomy (EUS-CDS) with the ES Dilator were identified from a prospectively maintained database and enrolled in the study group. Fourteen other patients who had undergone EUS-CDS without the dilator just prior to its introduction were analyzed as the control group. A historical cohort study was carried out comparing the two groups. The main outcome measurement was the procedure time. The technical success rate and early AE rate were also compared between the two groups.RESULTSThere were no significant differences in age, sex and etiology of biliary obstruction. The utilization rate of a plastic stent was higher in the control group (36% vs 0%). The technical success rate was 100% in both groups. The mean procedure time was significantly shorter in the study group than in the control group (27 ± 7 min vs 44 ± 26 min, P = 0.026). Additionally, there were no patients who required more than 40 min for the procedure in the study group. Early adverse events occurred in 29% (4/14) of the control group whereas none in the study group. The adverse events in all 4 patients was bile peritonitis, including pan-peritonitis in one patient. All patients recovered with conservative treatment by medication.CONCLUSIONThe newly developed dilator was found to be useful for shortening procedure time and would prevent adverse events related to bile leakage in EUS-CDS.

Endoscopic ultrasound‐guided choledochoduodenostomy using a thin stent delivery system in patients with unresectable malignant distal biliary obstruction: A prospective multicenter study

“…Kanno et al . reported the X‐suit NIR stent (Olympus Medical Systems) . This stent has a 7.5‐Fr delivery system and is made of laser‐cut wire.…”

“…Kanno et al reported the X-suit NIR stent (Olympus Medical Systems). 24 This stent has a 7.5-Fr delivery system and is made of laser-cut wire. However, it is not equipped with an antimigration flare or a delivery system with a tapered tip.…”

Palliation of Obstructive Jaundice: Endoscopic Ultrasound‑guided Choledochoduodenostomy in the Presence of Bleeding Duodenal Infiltration Due to Metastatic Urinary Bladder Cancer

“…Since 2001, when Giovannini et al [8] first reported new technique of EUS-guided bilioduodenal anastomosis, there has been a gradual improvement in technique as well as accessories, and now EUS-BD is being increasingly performed in cases where ERCP is not possible. [1][2][3][4][5][6][7] A systematic review of 42 studies with 1192 patients reported that the technical success rate and functional success rate of EUS BD are high (94.71% and 91.66%, respectively). [9] However, it is also associated with high adverse events with frequency as high as 23.32%.…”

“…(iii) Antegrade transpapillary stent placement following intrahepatic bile duct puncture. [1][2][3][4][5][6][7] The advantage of EUS-BD over percutaneous BD is that it maintains internal BD. However, in contrast to ERCP and PTBD, it is associated with high complication rates of up to 26% with bile leak being an important complication.…”

“…However, in cases where ERCP is not possible due to various factors such as failed cannulation, obstructed/altered upper gastrointestinal tract anatomy, distorted ampulla, and large periampullary diverticulum, endoscopic ultrasound-guided biliary drainage (EUS-BD) is being increasingly performed as an alternative to percutaneous transhepatic BD (PTBD). [1][2][3][4][5][6][7] There are three ways of performing EUS-BD: (i) rendezvous technique, in which guidewire is passed through the papilla through a punctured intrahepatic or extrahepatic bile duct and retrieved by to gastrointestinal bleed and severe pruritus along with obstructive jaundice and was successfully managed with initial argon plasma coagulation (APC) of bleeding duodenal lesions followed by ECD.…”