EUS-guided gastrojejunostomy and hepaticogastrostomy for malignant duodenal and biliary obstruction

Platt, Kevin D.; Bhalla, Sean; Sondhi, Arjun; Millet, John D.; Law, Ryan

doi:10.1016/j.vgie.2020.10.013

Cited by 7 publications

(7 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our study reported a 100% technical success rate for single session EUS-HG and 95.6% for EUS-GJ in patients with combined gastroduodenal and biliary obstruction when performed by experienced advanced endoscopists at two large academic medical centers in the United States. While smaller case reports have demonstrated the feasibility of this technique, 12,13 this is the largest cohort of patients undergoing this same session therapeutic approach. Our study is unique in that we demonstrated the technical feasibility, safety and associated clinical success of a dual EUS-guided approach in a larger number of patients.…”

Section: Discussionmentioning

confidence: 96%

Single session endoscopic ultrasound‐guided double bypass (hepaticogastrostomy and gastrojejunostomy) for concomitant duodenal and biliary obstruction: A case series

Canakis

Hathorn

Irani

et al. 2021

J Hepato Biliary Pancreat

View full text Add to dashboard Cite

Background Concomitant malignant biliary and gastric outlet obstruction can be difficult to manage endoscopically with traditional endoscopic retrograde cholangiopancreatography (ERCP) and luminal stenting. Endoscopic ultrasound (EUS)‐guided hepaticogastrostomy (HG) and gastrojejunostomy (GJ) are novel techniques that can relieve both obstructions in a single session. This study aims to describe the outcomes of combined, single session EUS‐HG and EUS‐GJ. Methods This is a two‐center retrospective study of consecutive patients who underwent same session EUS‐HG and EUS‐GJ. The primary outcome was technical success. Secondary outcomes included adverse events (AE), reduction in total serum bilirubin, length of hospital stay (LOS), and re‐intervention rates. Results A total of 23 patients underwent EUS‐HG and EUS‐GJ (12 males, mean age 66.4 years). Twenty‐one were performed for malignant obstruction. Technical success was 100% and 95.6% for HG and GJ, respectively. All patients subsequently tolerated a soft diet and 72.7% (16/22) of patients had a 50% reduction in bilirubin post‐procedure. The median LOS for the 17 patients who were not discharged home immediately following the procedure was 2 (range 1‐20) days. There were five AEs (2 mild, 3 moderate). Only three patients required reintervention (interventional radiology‐guided biliary drainage, stent exchange for a benign biliary stricture, and placement of a second stent through an occluded distal common bile duct stent) over a median follow‐up of 78 days. One patient with pancreatic cancer underwent successful tumor resection. Conclusion Single session EUS‐guided double bypass (HG and GJ) is technically feasible and safe when conducted by experienced endosonographers. Larger, comparative studies are needed.

show abstract

Section: Discussionmentioning

confidence: 96%

Single session endoscopic ultrasound‐guided double bypass (hepaticogastrostomy and gastrojejunostomy) for concomitant duodenal and biliary obstruction: A case series

Canakis

Hathorn

Irani

et al. 2021

J Hepato Biliary Pancreat

View full text Add to dashboard Cite

show abstract

“…Only a few articles have reported examples in which multiple therapeutic EUS techniques are applied in a single session. 5,6 When performing these procedures (especially in sequence), it is important to consider a few points. In our case, we chose to work distally-to-proximally to maintain efficiency and to avoid disrupting lumen-apposing metal stent (LAMS) placement.…”

Section: Discussionmentioning

confidence: 99%

“…Only a few articles have reported examples in which multiple therapeutic EUS techniques are applied in a single session. 5 , 6 …”

Section: Discussionmentioning

confidence: 99%

Single-session EUS-guided gastroenterostomy and EUS-guided gallbladder drainage in a patient with concomitant gastric outlet obstruction and acalculous cholecystitis

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Several case reports have also described the efficacy of EUS-GE in combination with EUS-BD for the management of combined biliary and duodenal obstruction [ 69 , 70 , 71 ]. Important advantages of these EUS-guided procedures are the ability to bypass the tumor, reducing the risk of stent occlusion due to tumor ingrowth/overgrowth.…”

Section: Treatment Options For Combined Malignant Biliary and Duodenal Obstructionmentioning

confidence: 99%

Endoscopic Double Stenting for the Management of Combined Malignant Biliary and Duodenal Obstruction

Takeda

Sasaki

Okamoto

et al. 2021

JCM

View full text Add to dashboard Cite

Periampullary cancers are often diagnosed at advanced stages and can cause both biliary and duodenal obstruction. As these two obstructions reduce patients’ performance status and quality of life, appropriate management of the disease is important. Combined malignant biliary and duodenal obstruction is classified according to the location and timing of the duodenal obstruction, which also affect treatment options. Traditionally, surgical bypass (gastrojejunostomy and hepaticojejunostomy) has been performed for the treatment of unresectable periampullary cancer. However, it has recently been substituted by less invasive endoscopic procedures due to its high morbidity and mortality. Thus, endoscopic double stenting (transpapillary stenting and enteral stenting) has become the current standard of care. Limitations of transpapillary stenting include its technical difficulty and the risk of duodenal-biliary reflux. Recently, endoscopic ultrasound-guided procedures have emerged as a novel platform and have been increasingly utilized in the management of biliary and duodenal obstruction. As the prognosis of periampullary cancer has improved due to recent advances in chemotherapy, treatment strategies for biliary and duodenal obstruction are becoming more important. In this article, we review the treatment strategies for combined malignant biliary and duodenal obstruction based on the latest evidence.

show abstract

EUS-guided gastrojejunostomy and hepaticogastrostomy for malignant duodenal and biliary obstruction

Cited by 7 publications

References 9 publications

Single session endoscopic ultrasound‐guided double bypass (hepaticogastrostomy and gastrojejunostomy) for concomitant duodenal and biliary obstruction: A case series

Single session endoscopic ultrasound‐guided double bypass (hepaticogastrostomy and gastrojejunostomy) for concomitant duodenal and biliary obstruction: A case series

Single-session EUS-guided gastroenterostomy and EUS-guided gallbladder drainage in a patient with concomitant gastric outlet obstruction and acalculous cholecystitis

Endoscopic Double Stenting for the Management of Combined Malignant Biliary and Duodenal Obstruction

Contact Info

Product

Resources

About