Efficacy of the 6‐mm fully covered self‐expandable metal stent during endoscopic ultrasound‐guided hepaticogastrostomy as a primary biliary drainage for the cases estimated difficult endoscopic retrograde cholangiopancreatography: A prospective clinical study

Okuno, Nozomi; Hara, Kazuo; Mizuno, Nobumasa; Kuwahara, Takamichi; Iwaya, Hiromichi; Ito, Ayako; Kuraoka, Naosuke; Matsumoto, Shimpei; Polmanee, Petcharee; Niwa, Yasumasa

doi:10.1111/jgh.14112

Cited by 42 publications

(48 citation statements)

References 35 publications

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“…To further examine this, a recent prospective study deployed smaller, 6 mm diameter CSEMS using the HGS method, and reported that 50% (10/20) of patients experienced obstruction due to biliary sludge (n=6) and stent dislocation (n=4). 51 Reassuringly, a new stent was successfully inserted in 9/10 cases. While this was not a direct comparison to ERCP methods, this additional data provide further support that in scenarios in which there is papillary inaccessibility or failed cannulation secondary to duodenal obstruction or altered anatomy, EUS-BD can indeed serve as a reliable salvage method, and potentially a primary modality, in managing MBO.…”

Section: Eus-bd Techniquesmentioning

confidence: 99%

Relief of biliary obstruction: choosing between endoscopic ultrasound and endoscopic retrograde cholangiopancreatography

Canakis

Baron

2020

BMJ Open Gastroenterol

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Endoscopic ultrasound (EUS) was originally devised as a novel diagnostic technique to enable endoscopists to stage malignancies and acquire tissue. However, it rapidly advanced toward therapeutic applications and has provided gastroenterologists with the ability to effectively treat and manage advanced diseases in a minimally invasive manner. EUS-guided biliary drainage (EUS-BD) has gained considerable attention as an approach to provide relief in malignant and benign biliary obstruction for patients when endoscopic retrograde cholangiopancreatography (ERCP) fails or is not feasible. Such instances occur in those with surgically altered anatomy, gastroduodenal obstruction, periampullary diverticulum or prior transampullary duodenal stenting. While ERCP remains the gold standard, a multitude of studies are showing that EUS-BD can be used as an alternative modality even in patients who could successfully undergo ERCP. This review will shed light on recent EUS-guided advancements and techniques in malignant and benign biliary obstruction.

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Section: Eus-bd Techniquesmentioning

confidence: 99%

Relief of biliary obstruction: choosing between endoscopic ultrasound and endoscopic retrograde cholangiopancreatography

Canakis

Baron

2020

BMJ Open Gastroenterol

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“…reported usefulness of primary EUS-guided hepaticogastrostomy (EUS-HGS) for estimated difficult ERCP cases. [3] They also reported the safety of 6 mm bore fully covered metal stents. Kawakubo et al .…”

Section: Results In Published Papersmentioning

confidence: 99%

“…[7] Reintervention of EUS-BD is much easier than ERCP. [3] Ascites are commonly seen in advanced malignant patients. After pooling ascites, EUS-BD is not a safe procedure due to the possibility of infectious peritonitis.…”

Section: Discussionmentioning

confidence: 99%

De novo EUS-guided biliary drainage

2019

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“…, altered anatomy, duodenal obstruction, and previous duodenal stent) [24–28] . Okuno et al [27] published a prospective study of 20 patients undergoing EUS-guided hepa-ticogastrostomy with a 6-mm self-expanding metallic stent. The rates of technical success, clinical success, and adverse events were 100%, 95%, and 15%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic ultrasound-guided vs endoscopic retrograde cholangiopancreatography biliary drainage for obstructed distal malignant biliary strictures: A systematic review and meta-analysis

Logiudice

Bernardo

Galetti

et al. 2019

WJGE

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BACKGROUND For palliation of malignant biliary obstruction (MBO), the gold-standard method of biliary drainage is endoscopic retrograde cholangiopancreatography (ERCP) with the placement of metallic stents. Endoscopic ultrasound (EUS)-guided drainage is an alternative that is typically reserved for cases of ERCP failure. Recently, however, there have been robust randomized clinical trials (RCTs) comparing EUS-guided drainage and ERCP as primary approaches to MBO. AIM To compare EUS guidance and ERCP in terms of their effectiveness and safety in palliative biliary drainage for MBO. METHODS This was a systematic review and meta-analysis, in which we searched the MEDLINE, Excerpta Medica , and Cochrane Central Register of Controlled Trials databases. Only RCTs comparing EUS and ERCP for primary drainage of MBO were eligible. All of the studies selected provided data regarding the rates of technical and clinical success, as well as the duration of the procedure, adverse events, and stent patency. We assessed the risk of biases using the Jadad score and the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation criteria. RESULTS The database searches yielded 5920 records, from which we selected 3 RCTs involving a total of 222 patients (112 submitted to EUS and 110 submitted to ERCP). In the EUS and ERCP groups, the rate of technical success was 91.96% and 91.81%, respectively, with a risk difference (RD) of 0.00% (95%CI: -0.07, 0.07; P = 0.97; I 2 = 0%). The clinical success was 84.81% and 85.53% in the EUS and ERCP groups, respectively, with an RD of −0.01% (95%CI: -0.12, 0.10; P = 0.90; I 2 = 0%). The mean difference (MD) for the duration of the procedure was -0.12% (95%CI: -8.20, 7.97; P = 0.98; I 2 = 84%). In the EUS and ERCP groups, there were 14 and 25 adverse events, respectively, with an RD of -0.06% (95%CI: -0.23, 0.12; P = 0.54; I 2 = 77%). The MD for stent patency was 9.32% (95%CI: -4.53, 23.18; P = 0.19; I 2 = 44%). The stent dysfunction rate was significantly lower in the EUS group (MD = -0.22%; 95CI:-0.35, -0.08; P = 0.001; I 2 = 0%). CONCLUSION EUS represents an interesting alternative to ERCP for MBO drainage, demonstrating lower stent dysfunction rates compared with ERCP. Technical and clinical success, duration, adverse events and patency rates were similar.

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Efficacy of the 6‐mm fully covered self‐expandable metal stent during endoscopic ultrasound‐guided hepaticogastrostomy as a primary biliary drainage for the cases estimated difficult endoscopic retrograde cholangiopancreatography: A prospective clinical study

Abstract: The 6-mm fully covered self-expandable metal stent is safe and effective, especially for avoiding serious adverse events and allowing easy re-intervention. (UMIN000006785).

Cited by 42 publications

References 35 publications

Relief of biliary obstruction: choosing between endoscopic ultrasound and endoscopic retrograde cholangiopancreatography

Relief of biliary obstruction: choosing between endoscopic ultrasound and endoscopic retrograde cholangiopancreatography

De novo EUS-guided biliary drainage

Endoscopic ultrasound-guided vs endoscopic retrograde cholangiopancreatography biliary drainage for obstructed distal malignant biliary strictures: A systematic review and meta-analysis

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