Safety and efficacy of ultra-tapered mechanical dilator for EUS-guided hepaticogastrostomy and pancreatic duct drainage compared with electrocautery dilator (with video)

Honjo, Megumi; Itoi, Takao; Tsuchiya, Takayoshi; Tanaka, Reina; Tonozuka, Ryosuke; Mukai, Shuntaro; Iwasaki, Hidenori; Kanai, Takanori

doi:10.4103/eus.eus_2_18

Cited by 76 publications

(67 citation statements)

References 15 publications

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“…There were no population-based studies. Six studies were based on multicenter data 7 11 13 22 24 26 . The detailed study quality evaluation is presented in Supplementary Table 3 .…”

Section: Resultsmentioning

confidence: 99%

“…The detailed study quality evaluation is presented in Supplementary Table 3 . Based on the New-Castle Ottawa scoring system, five studies 7 10 22 24 27 were considered to be of high quality and 17 studies 6 8 9 11 12 13 14 15 16 17 18 19 20 21 23 25 26 were considered to be of medium quality. There were no low-quality studies.…”

Section: Resultsmentioning

confidence: 99%

“…EUS-PDD can help avoid invasive surgery. Data on the efficacy and safety of EUS-PDD are limited 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 . The aims of this study were to qualitatively and quantitatively appraise the current available data on EUS-PDD by meta-analysis methods.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy and safety of endoscopic ultrasound-guided pancreatic duct drainage (EUS-PDD): A systematic review and meta-analysis of 714 patients

et al. 2020

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Background and study aims Endoscopic ultrasound guided pancreatic duct drainage (EUS-PDD) is a minimal-invasive therapeutic option to surgery and in patients with failed endoscopic retrograde pancreatography (ERP). The aim of this review was to quantitatively appraise the clinical outcomes of EUS-PDD by meta-analysis methods. Methods We searched multiple databases from inception through March 2020 to identify studies that reported on EUS-PDD. Pooled rates of technical success, successful drainage of pancreatic duct, clinical success, and adverse events were calculated. Study heterogeneity was assessed using I2% and 95 % prediction interval. Results A total of 22 studies (714 patients) were included. The pooled rate of technical success in EUS-PDD was 84.8 % (95 % CI 79.1–89.2). The pooled rate of successful PD drained by EUS-PDD was 77.5 % (95 % CI 63.1–87.4). The pooled rate of clinical success of EUS-PDD was 89.2 % (95 % CI 82.1–93.7). The pooled rate of all adverse events was 18.1 % (95 % CI 14.2–22.9). On sub-group analysis, the pooled technical success and clinical success of EUS-PDD from Japanese data were considerably superior (91.2 %, 83–95.6 & 92.5 %, 83.9–96.7, respectively). The pooled rate of post EUS-PDD acute pancreatitis was 6.6 % (95 % CI 4.5–9.4), bleeding was 4.1 % (95 % CI 2.7–6.2), perforation and/or pneumoperitoneum was 3.1 % (95 % CI 1.9–5), pancreatic leak and/or pancreatic fluid collection was 2.3 % (95 % CI 1.4–4), and infection was 2.8 % (95 % CI 1.7–4.6). Conclusion EUS-PDD demonstrates high technical success and clinical success rates with acceptable adverse events. Technical success was especially high for anastomotic strictures.

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“…There were no population-based studies. Six studies were based on multicenter data 7 11 13 22 24 26 . The detailed study quality evaluation is presented in Supplementary Table 3 .…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Efficacy and safety of endoscopic ultrasound-guided pancreatic duct drainage (EUS-PDD): A systematic review and meta-analysis of 714 patients

et al. 2020

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“…Various dilation devices such as mechanical, balloon, or electrocautery dilators are now available. From the viewpoint of adverse events, the risks associated with non-electrocautery-assisted devices include pancreatic leaks, perforation, and bleeding due to radial or axial dilation force [ 16 ]. Indeed, Honjo et al described the risk of bleeding due to this type of device [ 14 ] among 64 patients who underwent EUS-hepaticogastrostomy ( n =49) and EUS-PD ( n =15) [ 16 ].…”

Section: Technical Review Of Eus-pdmentioning

confidence: 99%

Endoscopic Ultrasound-Guided Pancreatic Transmural Stenting and Transmural Intervention

2020

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Endoscopic ultrasound (EUS)-guided pancreatic access is an emergent method that can be divided into the two main techniques of EUS-guided rendezvous and pancreatic transmural stenting (PTS). While many reports have described EUS-guided procedures, the indications, technical tips, clinical effects, and safety of EUS-guided pancreatic duct drainage (EUS-PD) remain controversial. This review describes the current status of and problems associated with EUS-PD, particularly PTS. We reviewed clinical data derived from a total of 334 patients. Rates of technical and clinical success ranged from 63% to 100% and 76% to 100%, respectively. In contrast, the rate of procedure-related adverse events was high at 26.7% (89/334). The most frequent adverse events comprised abdominal pain (n=38), acute pancreatitis (n=15), bleeding (n=9), and issues associated with pancreatic juice leakage such as perigastric fluid, pancreatic fluid collection, or pancreatic juice leaks (n=8). In conclusion, indications for EUS-PTS are limited, as is the evidence of its viability, due to the scarcity of expert operators. Despite improvements made to various devices, EUS-PTS remains technically challenging. Therefore, a long-term, large-scale, multicenter study is required to establish this technique as a viable alternative drainage method. Clin Endosc 2020;53:429-435

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“…Recently, to make the dilation process safer and easier, various dilation techniques using electrocautery, non-electrocautery dilator, or dilation balloon have been proposed 5 6 7 . Moreover, there have been a few reports of EUS-BD that eliminated the dilation process 3 4 8 .…”

Section: Introductionmentioning

confidence: 99%

Endoscopic ultrasound-guided hepaticogastrostomy or hepaticojejunostomy without dilation using a stent with a thinner delivery system

Maehara¹,

Hijioka²,

Nagashio³

et al. 2020

Endosc Int Open

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Background and study aim Use of endoscopic ultrasound-guided biliary drainage (EUS-BD) has recently increased. In EUS-BD, after puncturing the bile duct, dilation is performed and the stent is deployed. Due to adverse events (AEs) such as unexpected displacement of the guidewire, simplified procedures are required. Currently, stents with small-diameter delivery systems are being rapidly developed, expanding the possibilities for of EUS-BD without dilation. In this retrospective study, we aimed to evaluate the success rates and AEs in patients who underwent EUS-guided hepaticogastrostomy (EUS-HGS) or EUS-guided hepaticojejunostomy (EUS-HJS) without dilation. Patients and methods Six consecutive patients with malignant biliary obstruction and failed transpapillary BD underwent EUS-HGS or EUS-HJS without dilation, deploying a 6-mm fully-covered self-expandable metallic stent with a 6-Fr delivery system. Results The technical and clinical success rates were 100 %. There was one case each of stent migration and stent occlusion, and no other AEs were noted. Conclusions EUS-HGS or EUS-HJS without dilation using a stent with a 6-Fr delivery system had high technical and clinical success rates; however, additional cases are required to validate the study findings.

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Safety and efficacy of ultra-tapered mechanical dilator for EUS-guided hepaticogastrostomy and pancreatic duct drainage compared with electrocautery dilator (with video)

Abstract: The novel ultra-tapered MD designed for interventional EUS appears to be safe and useful as it reduced postprocedure bleeding with a high technical success rate compared with the conventional electrocautery dilator.

Cited by 76 publications

References 15 publications

Efficacy and safety of endoscopic ultrasound-guided pancreatic duct drainage (EUS-PDD): A systematic review and meta-analysis of 714 patients

Efficacy and safety of endoscopic ultrasound-guided pancreatic duct drainage (EUS-PDD): A systematic review and meta-analysis of 714 patients

Endoscopic Ultrasound-Guided Pancreatic Transmural Stenting and Transmural Intervention

Endoscopic ultrasound-guided hepaticogastrostomy or hepaticojejunostomy without dilation using a stent with a thinner delivery system

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