Endoscopic ultrasound-guided hepaticogastrostomy using a 6-F cystotome and 12-cm covered metal stent

Mandai, Koichiro; Uno, Koji; Okada, Yusuke; Suzuki, Azumi; Yasuda, Kenjiro

doi:10.1055/s-0041-111502

Cited by 6 publications

(8 citation statements)

References 10 publications

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“…The cystotome as an accessory has been described for drainage of pancreatic pseudocysts internally via gastric or duodenal routes and that is where it is still most commonly used 9 . Recently, its use has been extended to endoscopic ultrasound (EUS)-guided pancreatic cyst/necrotic collections drainage, as well as EUS-guided bile duct drainage 10 . For this purpose, routinely, 10 Fr cystotome assemblies are employed to create fistulas between pancreatic cysts and the gastric wall.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic management of difficult benign biliary and pancreatic strictures using a wire-guided cystotome: experience with 25 cases

et al. 2018

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Background and study aims Endoscopic management using standard accessories is the preferred modality for treatment of benign biliary strictures. However, with difficult strictures, there is frequently failure of endoscopic therapy. We are reporting our experience regarding use of a standard diathermic dilator (cystotome) to aid in stricture dilatation and stent placement in patients with difficult strictures. Patients and methods Data were analyzed from January 2014 to January 2017 at a single tertiary care center in North India. Total 25 patients were included. Results The mean age was 45 years (varying from 38 – 55 years). Of the 25 patients with difficult strictures, 14 (56 %) were male and 11 (44 %) were female. Further, of these, 19 had biliary and 6 had pancreatic strictures. The average time of diathermic current application was 3.5 seconds (ranging 3 – 5 seconds). Technical and clinical success were achieved in 100 % of cases. None of the patients had any procedure-related (early or delayed) major complications. Conclusion The cystotome is an extremely safe and useful accessory in benign biliary and pancreatic strictures, whereas conventional methods to negotiate stricture have failed.

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Section: Discussionmentioning

confidence: 99%

Endoscopic management of difficult benign biliary and pancreatic strictures using a wire-guided cystotome: experience with 25 cases

et al. 2018

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“…For hepaticogastrostomy, long stents may decrease the risk of stent migration. Indeed, a stent length ≥3 cm in the intraluminal portion was shown to be associated with a lower risk of stent migration in a retrospective study including 51 patients [6] and a small study including 4 patients reported no migration when ≥10 cm stents (total length) were used [4]. Choosing a stent with a large diameter is also important to decrease the risk of stent dysfunction due to granulation tissue in the hepatic side of the stent, although the ideal diameter is not well established.…”

Section: Discussionmentioning

confidence: 98%

“…Bile leak is the most frequent adverse event, although other early and late complications can occur. Early complications include cholangitis, bleeding, stent misplacement, and bile leaks [4]. Dilation of the tract before stent insertion is recommended to decrease the risk of bile leaks since it avoids frequent device exchange and decreases procedural time.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Ultrasound-Guided Biliary Drainage in Two Patients with Difficult Biliary Access

Libânio

Giestas

Martı́nez-Ares

et al. 2017

GE Port J Gastroenterol

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Introduction: Endoscopic retrograde cholangiopancreatography is the method of choice for biliary drainage, although in some cases standard biliary access is difficult or even impossible. Endoscopic ultrasound (EUS)-guided endoluminal procedures are an alternative in these cases, although experience with these techniques is still limited. Clinical Case: We present two cases of successful EUS-guided biliary drainage. In the first case, a hepaticogastrostomy was performed in a patient with stage IV gastric adenocarcinoma with obstructive jaundice due to compression of the hilum, where malignant gastric stenosis and previous palliative gastrojejunostomy precluded access to the second part of the duodenum. In the second case, a patient with a pancreatic head adenocarcinoma with duodenal invasion that precluded major papillae identification was submitted to a choledochoduodenostomy. Both procedures occurred without immediate or delayed adverse events, with technical and clinical success. Discussion: Although experience with EUS-guided biliary drainage is still limited, its efficacy and safety is favorable when compared with percutaneous and surgical drainage, and should be considered an alternative to these techniques where sufficient expertise exists.

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“…Reports have presented a case in which a 6-cm covered metallic stent migrated with a fatal outcome and a case in which an 8-cm covered metallic stent migrated, necessitating surgical treatment [ 3 , 4 ]. Moreover, a recent report described a significantly shorter median stent patency duration in patients who underwent EUS-HGS with an intragastric stent < 3 cm in length than in those who underwent EUS-HGS with an intragastric stent ≥ 3 cm in length [ 5 ]; therefore, we believe that stents measuring 10 cm or longer should be used [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Relationship Between the Intraperitoneal Stent Length in Endoscopic Ultrasound-Guided Hepaticogastrostomy and Surgically Altered Upper Gastrointestinal Anatomy in Patients With Malignant Biliary Obstruction

2018

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BackgroundEndoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is associated with a relatively high proportion of adverse events, and this is attributable to the lack of standardized protocols and specialized equipment. Although the outcomes of EUS-HGS may differ between patients with and those without surgically altered upper gastrointestinal anatomy, there have been no reports on this topic. The present study aimed to evaluate the efficacy and safety of EUS-HGS using our standardized method and to compare the outcomes between patients with and those without surgically altered upper gastrointestinal anatomy.MethodsIn EUS-HGS, we used a long partially covered metal stent, and we kept the gastric wall pressed with the scope tip until the stent was deployed more than 1 cm inside the working channel of the scope to minimize free space between the liver and gastric wall (the intraperitoneal stent length). A total of 12 patients who underwent EUS-HGS using our method were retrospectively studied. Procedural success and adverse events were evaluated, and the outcomes of EUS-HGS were compared between six patients with and six without surgically altered upper gastrointestinal anatomy.ResultsThe procedural success rate was 100%. Additionally, stent migration or dislocation was not noted in any of the patients. The intraperitoneal stent length was significantly greater in patients without surgically altered upper gastrointestinal anatomy than in those with surgically altered upper gastrointestinal anatomy (19.8 mm vs. 11.6 mm; 95% confidence interval, 2.185 - 14.147; P = 0.012).ConclusionsEUS-HGS using our method was safe. Our findings suggested that special attention should be paid to stent migration or dislocation in patients without surgically altered upper gastrointestinal anatomy.

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Endoscopic ultrasound-guided hepaticogastrostomy using a 6-F cystotome and 12-cm covered metal stent

Cited by 6 publications

References 10 publications

Endoscopic management of difficult benign biliary and pancreatic strictures using a wire-guided cystotome: experience with 25 cases

Endoscopic management of difficult benign biliary and pancreatic strictures using a wire-guided cystotome: experience with 25 cases

Endoscopic Ultrasound-Guided Biliary Drainage in Two Patients with Difficult Biliary Access

Relationship Between the Intraperitoneal Stent Length in Endoscopic Ultrasound-Guided Hepaticogastrostomy and Surgically Altered Upper Gastrointestinal Anatomy in Patients With Malignant Biliary Obstruction

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