Long-term outcomes of EUS-guided transluminal stent deployment for benign biliary disease: Multicenter clinical experience (with videos)

Abstract

Background and Objectives:Biliary drainage (BD) under EUS guidance is usually indicated for malignant biliary obstruction. Recently, EUS-guided transluminal treatment has been applied to benign biliary disease (BBD). This multicenter retrospective study evaluated the clinical impact of EUS-guided transluminal stent deployment for BBD with long-term follow-up.Patients and Methods:This retrospective study investigated patients treated between September 2015 and October 2016 at participating hospitals in the therapeutic endoscopic group. The inclusion criteria comprised complications with BBD obstructive jaundice or cholangitis and failed endoscopic retrograde cholangiopancreatography or inaccessible ampulla of Vater.Results:Twenty-six patients underwent EUS-guided transluminal stent deployment. Indications for EUS-guided transluminal stent deployment comprised anastomotic biliary stricture (n = 17), bile duct stones (n = 5), inflammatory biliary stricture (n = 3), and acute pancreatitis prevention (n = 1). Thirteen of these 26 patients underwent scheduled reintervention, with technical success achieved in all 13 patients. None of the deployed stents became dysfunctional. Among the 13 patients who underwent reintervention on demand, stents had become dysfunctional in six patients (stent patency: 48, 90, 172, 288, 289, and 608 days). Reintervention was successfully performed in all patients. During follow-up (median, 749 days), severe adverse events were not seen in any patients.Conclusion:We concluded that EUS-guided transluminal stent deployment for BBD is feasible and safe. Because metal stent dysfunction was more frequent when deployed on demand, such stents should be exchanged for plastic stents in a scheduled manner if a metal stent is used.

EUS-guided hepaticoenterostomy with using a dedicated plastic stent for the benign pancreaticobiliary diseases: A single-center study of a large case series

“…[ 11 12 13 14 ] Recently, EUS-BD has been utilized for the treatment of benign pancreaticobiliary diseases. [ 2 15 16 17 ] We previously proposed the current treatment algorithm of benign biliary diseases in patients with SAA. [ 5 ] For nonlarge bile duct stones or nonsevere anastomotic strictures, one-step EUS-guided antegrade intervention is recommended.…”

What You Need to Know Before Performing Endoscopic Ultrasound-guided Hepaticogastrostomy

“…EUS-HGS is primarily performed for malignant obstruction. Recently, it has been used for anastomotic strictures in patients with a surgically altered anatomy [ 5 , 59 ] ( Fig. 5 ) and as a portal for direct cholangioscopic-guided lithotripsy of IHD stones [ 60 - 62 ].…”

“…The technical success rate for benign conditions is similar to that for malignant obstruction, but stent dysfunction occurs frequently when metallic stents are used. Therefore, they should be changed for plastic stents in a scheduled manner; however, the reintervention rate is high because of stent dysfunction [ 59 ]. Data on long-term outcomes in benign conditions are still lacking.…”

Interventional endoscopic ultrasound

“…Primarily developed as rescue tool in obstructive jaundice because of malignant distal bile duct obstruction after failed endoscopic retrograde cholangiography (ERC) [21,24,27], EUS-guided transmural bile duct drainage techniques (EUS-BDD) is now also established for benign indications [29,30,31 & ] with data on long-term stent function [31 & ]. According to several meta-analyses, EUS-BDD has advantages in comparison to percutaneous transhepatic biliary drainage (PTCD).…”