One-step Placement of a Fully-covered Metal Stent in Endosonography-guided Biliary Drainage for Malignant Biliary Obstruction

Abstract

Background Although reports on endosonography-guided biliary drainage (ESBD) have been increasing, only a few discuss deployment of a self-expandable metal stent (SEMS) in the first session. Objective To evaluate the safety and efficacy of ESBD with the one-step placement of a newly designed fully-covered SEMS. Patient and MethodsFive patients with malignant biliary obstruction in whom one-step placement of an anti-migration designed SEMS in the first session of ESBD had been attempted between January 2007 and October 2009 were included in this study. Main outcome measurements were technical and clinical successes, early complications, and short-term results. Results ESBD was attempted to bridge the extrahepatic bile duct and the duodenum and one-step SEMS placement was successful in all cases. There were no early complications related to ESBD and excellent biliary decompression was obtained in all cases. SEMS dysfunction such as stent migration and occlusion was not seen during the follow-up period (mean follow-up 138 days, range 102-184 days). Conclusion One-step placement of a fully-covered SEMS in ESBD is possibly a safe and effective treatment for biliary obstruction.

Metallic stent deployment in endosonography‐guided biliary drainage: Long‐term follow‐up results in patients with bilio‐enteric anastomosis

“…We used a fully covered SEMS with a special design to prevent stent migration in the one‐step technique. This stent has a wavy contour with an uneven outer surface, 8 which contributes to prevention of stent migration. A very low shortening rate, which facilitates accurate deployment of the stent, is another characteristic.…”

“…Although complications such as peritonitis are sometimes encountered in ESBD, its safety and efficacy in the short term have been reported 6 . Recently, one‐step placement of a self‐expandable metal stent (SEMS) in ESBD has been reported 7,8 . However, there have been few data on the safety and efficacy of SEMS deployment in ESBD or long‐term results in patients with bilio‐enteric anastomosis (BEA) using a SEMS 9 .…”

“…6 Recently, one-step placement of a self-expandable metal stent (SEMS) in ESBD has been reported. 7,8 However, there have been few data on the safety and efficacy of SEMS deployment in ESBD or long-term results in patients with bilio-enteric anastomosis (BEA) using a SEMS. 9 The aim of the present study was to assess the efficacy of SEMS deployment in ESBD and the long-term results, especially in patients with SEMS deployment in a BEA method.…”

Patent choledochoduodenal fistula created by endosonography‐guided biliary drainage after migration of a metallic stent

“…ESBD is a new biliary drainage technique and is applied in cases with difficult transpapillary endoscopic biliary drainage . Data on the safety and efficacy of SEMS deployment in ESBD and its long‐term results have increasingly been reported . In the present case, a large choledochoduodenal fistula the same as a surgical choledochoduodenostomy was maintained at the site of SEMS deployment even after migration of the stent.…”

Usefulness of the laser‐cut, fully covered, self‐expandable metallic stent for endoscopic ultrasound‐guided hepaticogastrostomy

“…However, we think that the laser-cut FCSEMS is useful in EUS-HGS for the following reasons: the absence of shortening allows it to be easily positioned accurately 21 ; the external surface of the stent is wavy and zigzag-shaped, preventing stent migration 21,22 ; and they can be removed for FCSEMS. 23,24 No previous studies have discussed the clinical outcomes and details of re-intervention using EUS-HGS with laser-cut FCSEMS (X-SUIT NIR; Olympus).…”