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Binda C, Dajti E, Giuffrida P, Trebbi M, Coluccio C, Cucchetti A, Fugazza A, Perini B, Gibiino G, Anderloni A, Repici A, Fabbri C. Efficacy and safety of endoscopic ultrasound-guided hepaticogastrostomy: a meta-regression analysis. Endoscopy 2024. [PMID: 38447958 DOI: 10.1055/a-2282-3350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
BACKGROUND Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is a valid option for EUS-guided biliary drainage that has been increasingly used in the last decade. The aims of this study were to provide a systematic review with meta-analysis and meta-regression of the features and outcomes of this procedure. METHODS The MEDLINE, Scopus, Web of Science, and Cochrane databases were searched for literature pertinent to EUS-HGS. Meta-analysis of the proportions and meta-regression of potential modifiers of the main outcome measures were applied. The main outcome was technical success; secondary outcomes were clinical success and procedure-related adverse events (AEs). RESULTS 33 studies, including 1644 patients, were included in the meta-analysis. Malignant biliary obstruction (MBO) was the underlying cause in almost all cases (99.6%); the main indications for EUS-HGS were duodenal/papillary invasion (34.8%), surgically altered anatomy (18.4%), and hilar stenosis (16.0%). The pooled technical success of EUS-HGS was 97.7% (95%CI 96.1%-99.0%; I 2 = 0%), the intention-to-treat clinical success rate was 88.1% (95%CI 84.7%-91.2%; I 2 = 33.9%), and procedure-related AEs occurred in 12.0% (95%CI 9.8%-14.5%; I 2 = 20.4%), with cholangitis/sepsis (2.8%) and bleeding (2.3%) the most frequent. The rate of procedure-related AEs was lower with the use of dedicated stents on univariable meta-regression analysis. Meta-regression showed that technical success and clinical success rates were modified by the centers' experience (>4/year). CONCLUSIONS EUS-HGS represents an effective and safe procedure for EUS-guided biliary drainage in patients with MBO. Future studies should address the impact of center experience, patient selection, and the use of dedicated stents to improve performance of this technique.
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Affiliation(s)
- Cecilia Binda
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL della Romagna, Forlì-Cesena, Italy
| | - Elton Dajti
- European Reference Network on Hepatological Diseases, IRCSS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences - DIMEC, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Paolo Giuffrida
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL della Romagna, Forlì-Cesena, Italy
- Section of Gastroenterology & Hepatology, Department of Health Promotion Sciences Maternal and Infant Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, Palermo, Italy
| | - Margherita Trebbi
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL della Romagna, Forlì-Cesena, Italy
| | - Chiara Coluccio
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL della Romagna, Forlì-Cesena, Italy
| | - Alessandro Cucchetti
- Department of Medical and Surgical Sciences - DIMEC, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Alessandro Fugazza
- Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Barbara Perini
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL della Romagna, Forlì-Cesena, Italy
- Gastroenterology Unit, Azienda Ospedale Universita Padova, Padova, Italy
| | - Giulia Gibiino
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL della Romagna, Forlì-Cesena, Italy
| | - Andrea Anderloni
- Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessandro Repici
- Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL della Romagna, Forlì-Cesena, Italy
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Alsakarneh S, Madi MY, Dahiya DS, Jaber F, Kilani Y, Ahmed M, Beran A, Abdallah M, Al Ta’ani O, Mittal A, Numan L, Goyal H, Bilal M, Kiwan W. Is Endoscopic Ultrasound-Guided Hepaticogastrostomy Safe and Effective after Failed Endoscopic Retrograde Cholangiopancreatography?-A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:3883. [PMID: 38999449 PMCID: PMC11242375 DOI: 10.3390/jcm13133883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Revised: 06/22/2024] [Accepted: 06/26/2024] [Indexed: 07/14/2024] Open
Abstract
Background/Objectives: Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) has emerged as an alternative option for biliary drainage in cases of failed endoscopic retrograde cholangiopancreatography (ERCP). Limited data exist on the safety and efficacy of EUS-HGS. In this comprehensive meta-analysis, we aim to study the safety and efficacy of EUS-HGS in cases of failed conventional ERCP. Methods: Embase, PubMed, and Web of Science databases were searched to include all studies that evaluated the efficacy and safety of EUS-HGS. Using the random effect model, the pooled weight-adjusted event rate estimate for clinical outcomes in each group were calculated with 95% confidence intervals (CIs). The primary outcomes were technical and clinical success rates. Secondary outcomes included overall adverse events (AEs), rates of recurrent biliary obstruction (RBO), and rates or re-intervention. Results: Our analysis included 70 studies, with a total of 3527 patients. The pooled technical and clinical success rates for EUS-HGS were 98.1% ([95% CI, 97.5-98.7]; I2 = 40%) and 98.1% ([95% CI, 97.5-98.7]; I2 = 40%), respectively. The pooled incidence rate of AEs with EUS-HGS was 14.9% (95% CI, 12.7-17.1), with bile leakage being the most common (2.4% [95% CI, 1.7-3.2]). The pooled incidence of RBO was 15.8% [95% CI, 12.2-19.4], with a high success rate for re-intervention (97.5% [95% CI, 94.7-100]). Conclusions: Our analysis showed high technical and clinical success rates of EUS-HGS, making it a feasible and effective alternative to ERCP. The ongoing development of dedicated devices and techniques is expected to make EUS-HGS more accessible and safer for patients in need of biliary drainage.
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Affiliation(s)
- Saqr Alsakarneh
- Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA; (S.A.)
| | - Mahmoud Y. Madi
- Department of Gastroenterology and Hepatology, Saint Louis University, Saint Louis, MO 63103, USA
| | - Dushyant Singh Dahiya
- Division of Gastroenterology, Hepatology & Motility, The University of Kansas School of Medicine, Kansas City, KS 66103, USA
| | - Fouad Jaber
- Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA; (S.A.)
| | - Yassine Kilani
- Department of Internal Medicine, Weill Cornell University, New York, NY 10065, USA
| | - Mohamed Ahmed
- Department of Gastroenterology and Hepatology, University of Missouri-Kansas City, Kansas City, MO 64108, USA
| | - Azizullah Beran
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Mohamed Abdallah
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Omar Al Ta’ani
- Department of Internal Medicine, Allegheny General Hospital, Allegheny, PA 15212, USA
| | - Anika Mittal
- Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA; (S.A.)
| | - Laith Numan
- Department of Gastroenterology and Hepatology, Saint Louis University, Saint Louis, MO 63103, USA
| | - Hemant Goyal
- Division of Gastroenterology and Hepatology, Borland Groover, Jacksonville, FL 32207, USA
| | - Mohammad Bilal
- Division of Gastroenterology and Hepatology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Wissam Kiwan
- Department of Gastroenterology and Hepatology, Saint Louis University, Saint Louis, MO 63103, USA
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Binda C, Trebbi M, Coluccio C, Giuffrida P, Perini B, Gibiino G, Fabbri S, Liverani E, Fabbri C. Endoscopic management of malignant biliary obstructions. Ann Gastroenterol 2024; 37:291-302. [PMID: 38779637 PMCID: PMC11107404 DOI: 10.20524/aog.2024.0883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 03/21/2024] [Indexed: 05/25/2024] Open
Abstract
Malignant biliary obstruction (MBO), both distal and hilar, represents an ensemble of different clinical conditions frequently encountered in everyday practice. Given the frequent unresectability of the disease at presentation and the increasing indications for neoadjuvant chemotherapy, endoscopic biliary drainage is generally required during the course of the disease. With the widespread use of interventional endoscopic ultrasound (EUS) and the introduction of dedicated devices, EUS-guided biliary drainage has rapidly gained acceptance, together with transpapillary endoscopic biliary drainage and the percutaneous approach. This comprehensive review describes the current role of endoscopy for distal and hilar MBO supported by evidence, with a focus on the current hot topics in this field.
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Affiliation(s)
- Cecilia Binda
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena (Cecilia Binda, Margherita Trebbi, Chiara Coluccio, Paolo Giuffrida, Barbara Perini, Giulia Gibiino, Stefano Fabbri, Elisa Liverani, Carlo Fabbri)
| | - Margherita Trebbi
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena (Cecilia Binda, Margherita Trebbi, Chiara Coluccio, Paolo Giuffrida, Barbara Perini, Giulia Gibiino, Stefano Fabbri, Elisa Liverani, Carlo Fabbri)
| | - Chiara Coluccio
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena (Cecilia Binda, Margherita Trebbi, Chiara Coluccio, Paolo Giuffrida, Barbara Perini, Giulia Gibiino, Stefano Fabbri, Elisa Liverani, Carlo Fabbri)
| | - Paolo Giuffrida
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena (Cecilia Binda, Margherita Trebbi, Chiara Coluccio, Paolo Giuffrida, Barbara Perini, Giulia Gibiino, Stefano Fabbri, Elisa Liverani, Carlo Fabbri)
| | - Barbara Perini
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena (Cecilia Binda, Margherita Trebbi, Chiara Coluccio, Paolo Giuffrida, Barbara Perini, Giulia Gibiino, Stefano Fabbri, Elisa Liverani, Carlo Fabbri)
- Gastroenterology Unit, Azienda Ospedale-Università di Padova (AOUP), Padua (Barbara Perini), Italy
| | - Giulia Gibiino
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena (Cecilia Binda, Margherita Trebbi, Chiara Coluccio, Paolo Giuffrida, Barbara Perini, Giulia Gibiino, Stefano Fabbri, Elisa Liverani, Carlo Fabbri)
| | - Stefano Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena (Cecilia Binda, Margherita Trebbi, Chiara Coluccio, Paolo Giuffrida, Barbara Perini, Giulia Gibiino, Stefano Fabbri, Elisa Liverani, Carlo Fabbri)
| | - Elisa Liverani
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena (Cecilia Binda, Margherita Trebbi, Chiara Coluccio, Paolo Giuffrida, Barbara Perini, Giulia Gibiino, Stefano Fabbri, Elisa Liverani, Carlo Fabbri)
| | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena (Cecilia Binda, Margherita Trebbi, Chiara Coluccio, Paolo Giuffrida, Barbara Perini, Giulia Gibiino, Stefano Fabbri, Elisa Liverani, Carlo Fabbri)
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Yamazaki H, Yamashita Y, Shimokawa T, Minaga K, Ogura T, Kitano M. Endoscopic ultrasound-guided hepaticogastrostomy versus choledochoduodenostomy for malignant biliary obstruction: A meta-analysis. DEN OPEN 2024; 4:e274. [PMID: 37455944 PMCID: PMC10345703 DOI: 10.1002/deo2.274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/23/2023] [Accepted: 07/02/2023] [Indexed: 07/18/2023]
Abstract
Objectives Endoscopic ultrasound (EUS)-guided biliary drainage encompasses techniques such as EUS-guided hepaticogastrostomy (EUS-HGS) and EUS-guided choledochoduodenostomy (EUS-CDS). This meta-analysis compared the efficacy of EUS-CDS with that of EUS-HGS for the treatment of biliary obstruction. Methods A systematic meta-analysis of all relevant articles listed was performed by searching the Cochrane Library, PubMed, and Google Scholar databases. We used random effects or fixed effects models to compare success rates, adverse events, procedure times, and time to recurrent biliary obstruction after EUS-CDS and EUS-HGS. Results This meta-analysis included 18 eligible studies. There was no significant difference between EUS-CDS and EUS-HGS with respect to technical success rate (odds ratio [OR] 1.04; 95% confidence interval [CI] 0.62-1.73) and clinical success rate (OR 0.66; 95% CI 0.43-1.04), or with respect to total procedure-related adverse events (OR 1.39; 95% CI 1.00-1.93). Subgroup analysis of adverse events revealed that the rate of recurrent biliary obstruction (RBO) was significantly higher for EUS-HGS (OR 2.95; 95% CI 1.54-5.64). There was no significant difference between the two methods with respect to time to recurrent biliary obstruction (mean difference -11.93 days; 95% CI -47.77-23.91). However, the procedure time was longer for EUS-HGS (mean difference, 3.21 min; 95% CI 1.24-5.19). Conclusion EUS-CDS and EUS-HGS are comparable in terms of technical success, clinical success, and rate of adverse events; however, EUS-CDS is superior with respect to procedure time and preventing RBO.
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Affiliation(s)
- Hirofumi Yamazaki
- Second Department of Internal MedicineWakayama Medical UniversityWakayamaJapan
| | - Yasunobu Yamashita
- Second Department of Internal MedicineWakayama Medical UniversityWakayamaJapan
| | - Toshio Shimokawa
- Clinical Study Support CenterWakayama Medical University HospitalWakayamaJapan
| | - Kosuke Minaga
- Department of Gastroenterology and HepatologyKindai University Faculty of MedicineOsakaJapan
| | - Takeshi Ogura
- Second Department of Internal MedicineOsaka Medical and Pharmaceutical UniversityOsakaJapan
| | - Masayuki Kitano
- Second Department of Internal MedicineWakayama Medical UniversityWakayamaJapan
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Yasuda T, Hara K, Mizuno N, Haba S, Kuwahara T, Okuno N, Kuraishi Y, Yanaidani T, Ishikawa S, Yamada M, Fukui T. Safety of endoscopic ultrasound-guided hepaticogastrostomy in patients with malignant biliary obstruction and ascites. Clin Endosc 2024; 57:246-252. [PMID: 37743069 PMCID: PMC10984745 DOI: 10.5946/ce.2023.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 04/30/2023] [Accepted: 05/11/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND/AIMS Endoscopic ultrasound (EUS)-guided hepaticogastrostomy (EUS-HGS) is useful for patients with biliary cannulation failure or inaccessible papillae. However, it can lead to serious complications such as bile peritonitis in patients with ascites; therefore, development of a safe method to perform EUS-HGS is important. Herein, we evaluated the safety of EUS-HGS with continuous ascitic fluid drainage in patients with ascites. METHODS Patients with moderate or severe ascites who underwent continuous ascites drainage, which was initiated before EUS-HGS and terminated after the procedure at our institution between April 2015 and December 2022, were included in the study. We evaluated the technical and clinical success rates, EUS-HGS-related complications, and feasibility of re-intervention. RESULTS Ten patients underwent continuous ascites drainage, which was initiated before EUS-HGS and terminated after completion of the procedure. Median duration of ascites drainage before and after EUS-HGS was 2 and 4 days, respectively. Technical success with EUS-HGS was achieved in all 10 patients (100%). Clinical success with EUS-HGS was achieved in 9 of the 10 patients (90 %). No endoscopic complications such as bile peritonitis were observed. CONCLUSION In patients with ascites, continuous ascites drainage, which is initiated before EUS-HGS and terminated after completion of the procedure, may prevent complications and allow safe performance of EUS-HGS.
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Affiliation(s)
- Tsukasa Yasuda
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Kazuo Hara
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Nobumasa Mizuno
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Shin Haba
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Takamichi Kuwahara
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Nozomi Okuno
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yasuhiro Kuraishi
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Takafumi Yanaidani
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Sho Ishikawa
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Masanori Yamada
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Toshitaka Fukui
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
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Caragut RL, Ilie M, Cabel T, Günșahin D, Panaitescu A, Pavel C, Plotogea OM, Rînja EM, Constantinescu G, Sandru V. Updates in Diagnosis and Endoscopic Management of Cholangiocarcinoma. Diagnostics (Basel) 2024; 14:490. [PMID: 38472961 DOI: 10.3390/diagnostics14050490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/10/2024] [Accepted: 02/17/2024] [Indexed: 03/14/2024] Open
Abstract
Cholangiocarcinoma (CCA) is an adenocarcinoma originating from the epithelial cells of the bile ducts/hepatocytes or peribiliary glands. There are three types of cholangiocarcinoma: intrahepatic, perihilar and distal. CCA represents approximately 3% of the gastrointestinal malignancies. The incidence of CCA is higher in regions of the Eastern world compared to the Western countries. There are multiple risk factors associated with cholangiocarcinoma such as liver fluke, primary sclerosing cholangitis, chronic hepatitis B, liver cirrhosis and non-alcoholic fatty liver disease. Endoscopy plays an important role in the diagnosis and management of cholangiocarcinoma. The main endoscopic methods used for diagnosis, biliary drainage and delivering intrabiliary local therapies are endoscopic retrograde cholangiopancreatography and endoscopic ultrasound. The purpose of this review is to analyze the current data found in literature about cholangiocarcinoma, with a focus on the actual diagnostic tools and endoscopic management options.
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Affiliation(s)
- Roxana-Luiza Caragut
- Clinical Department of Gastroenterology, Bucharest Emergency Clinical Hospital, 014461 Bucharest, Romania
| | - Madalina Ilie
- Clinical Department of Gastroenterology, Bucharest Emergency Clinical Hospital, 014461 Bucharest, Romania
- Department of Gastroenterology, University of Medicine and Pharmacy "Carol Davila" Bucharest, 050474 Bucharest, Romania
| | - Teodor Cabel
- Clinical Department of Gastroenterology, Bucharest Emergency Clinical Hospital, 014461 Bucharest, Romania
| | - Deniz Günșahin
- Clinical Department of Gastroenterology, Bucharest Emergency Clinical Hospital, 014461 Bucharest, Romania
| | - Afrodita Panaitescu
- Clinical Department of Gastroenterology, Bucharest Emergency Clinical Hospital, 014461 Bucharest, Romania
| | - Christopher Pavel
- Clinical Department of Gastroenterology, Bucharest Emergency Clinical Hospital, 014461 Bucharest, Romania
- Department of Gastroenterology, University of Medicine and Pharmacy "Carol Davila" Bucharest, 050474 Bucharest, Romania
| | - Oana Mihaela Plotogea
- Clinical Department of Gastroenterology, Bucharest Emergency Clinical Hospital, 014461 Bucharest, Romania
- Department of Gastroenterology, University of Medicine and Pharmacy "Carol Davila" Bucharest, 050474 Bucharest, Romania
| | - Ecaterina Mihaela Rînja
- Clinical Department of Gastroenterology, Bucharest Emergency Clinical Hospital, 014461 Bucharest, Romania
| | - Gabriel Constantinescu
- Clinical Department of Gastroenterology, Bucharest Emergency Clinical Hospital, 014461 Bucharest, Romania
- Department of Gastroenterology, University of Medicine and Pharmacy "Carol Davila" Bucharest, 050474 Bucharest, Romania
| | - Vasile Sandru
- Clinical Department of Gastroenterology, Bucharest Emergency Clinical Hospital, 014461 Bucharest, Romania
- Department of Gastroenterology, University of Medicine and Pharmacy "Carol Davila" Bucharest, 050474 Bucharest, Romania
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Sato H, Kawabata H, Fujiya M. The Lambda stenting technique: a new approach to address EUS-guided biliary drainage-associated adverse events. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2024; 9:107-114. [PMID: 38357020 PMCID: PMC10861941 DOI: 10.1016/j.vgie.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
Background and Aims EUS-guided biliary drainage (EUS-BD) has been performed increasingly worldwide, especially in patients with malignant tumors in which ERCP is difficult, patients with surgically altered GI tracts, and older patients who are at high risk for surgery. EUS-BD requires high-level skills and has limited options for managing adverse events, particularly when stent migration and cholangitis occur. Adverse events, such as persistent bile leakage from the fistula and continuous reflux from the GI tract, are believed to always have a risk of severe exacerbation that could threaten the patient's life. Methods We encountered 2 cases of stent migrations and 1 case with repeated cholangitis in patients with malignant tumors among the patients who underwent EUS-BD. The migrated stent was visualized under EUS in 2 patients with stent migration, and an EUS-guided FNA needle was used to puncture the mesh of the stent. The cannulation catheter was directly inserted into the mesh of the stent in 1 case with repeated retrograde cholangitis, while the stent was visualized with an endoscope. Subsequently, a guidewire was inserted through the puncture site, and a second metal stent was deployed between the meshes of the first stent, bridging the GI wall again (Lambda stenting technique). All procedures were performed with the patient under general anesthesia, and the patients safely completed the intervention. Results Patients' conditions significantly improved after the second stent insertion, allowing for chemotherapy resumption while maintaining their activities of daily living. The second stent remained in place without any migration, and the stent successfully prevented further cholangitis. Conclusions The Lambda stenting technique is considered highly effective for managing stent migration and repeated cholangitis, which is a major EUS-BD adverse event. This procedure helps avoid more invasive surgeries when stent migration and cholangitis occur and contributes to expanding EUS-BD applicability.
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Affiliation(s)
- Hiroki Sato
- Division of Gastroenterology, Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Hidemasa Kawabata
- Division of Gastroenterology, Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Mikihiro Fujiya
- Department of Gastroenterology and Advanced Medical Sciences, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
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Paik WH, Park DH. Endoscopic Management of Malignant Biliary Obstruction. Gastrointest Endosc Clin N Am 2024; 34:127-140. [PMID: 37973224 DOI: 10.1016/j.giec.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is commonly used for managing malignant biliary obstruction; however, it is impossible if the endoscope cannot reach the ampulla of Vater, and it carries a risk of procedure-related pancreatitis. Percutaneous approach is a traditional rescue method when ERCP fails and can be useful in advanced malignant hilar biliary obstruction; however, it is invasive and carries risks of tube dislodgement, recurrent infection, and tract seeding. Endoscopic ultrasound approach may be attempted if ERCP fails and is free from the risk of pancreatitis; however, it is only possible in limited centers, and training is still difficult. Malignant biliary obstruction should be managed by leveraging the complementary strengths of these methods.
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Affiliation(s)
- Woo Hyun Paik
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea
| | - Do Hyun Park
- Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-Gil, Songpa-gu, Seoul 05505, Korea.
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Koutlas NJ, Pawa S, Russell G, Ferris T, Ponnatapura J, Pawa R. EUS-guided hepaticogastrostomy versus percutaneous transhepatic biliary drainage after failed ERCP: A propensity score-matched analysis. Endosc Int Open 2024; 12:E108-E115. [PMID: 38250165 PMCID: PMC10798845 DOI: 10.1055/a-2220-2740] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 11/16/2023] [Indexed: 01/23/2024] Open
Abstract
Background and study aims Percutaneous transhepatic biliary drainage (PTBD) is the traditional second-line option after unsuccessful endoscopic retrograde cholangiopancreatography (ERCP). Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HG) is a viable alternative to PTBD. Our study aimed to compare outcomes of EUS-HG and PTBD for benign and malignant biliary diseases following failed ERCP. Patients and methods This single-center study retrospectively analyzed patients undergoing EUS-HG and PTBD for benign and malignant biliary disorders. A propensity score-matched analysis was performed using age, sex, and Charlson Comorbidity Index. The primary outcome was clinical success, which we defined as a decrease in total bilirubin by ≥ 50% at 2 weeks for malignant disease and resolution of the biliary disorder for benign disease. Results In total, 41 patients underwent EUS-HG and 138 patients underwent PTBD. After propensity score matching in a 1:2 ratio, 32 EUS-HG patients were matched with 64 PTBD. Technical success was achieved in 29 of 32 (91%) for EUS-HG and 63 of 64 (98%) for PTBD ( P =0.11). Clinical success was 100% for EUS-HG and 75% for PTBD ( P =0.0021). EUS-HG was associated with a lower adverse event rate (EUS-HG 13% vs. PTBD 58%, P <0.0001), shorter procedure duration (median 60 vs. 115 minutes, P <0.0001), shorter post-procedure length of stay (median 2 vs. 4 days, P <0.0001), and fewer reinterventions (median 1 vs. 3, P <0.0001). Conclusions Our results suggest that EUS-HG is superior to PTBD in the treatment of benign and malignant biliary disorders after failed ERCP.
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Affiliation(s)
- Nicholas J Koutlas
- Gastroenterology, Wake Forest School of Medicine, Winston-Salem, United States
| | - Swati Pawa
- Gastroenterology, Wake Forest School of Medicine, Winston-Salem, United States
| | - Greg Russell
- Biostatistics, Wake Forest School of Medicine, Winston-Salem, United States
| | - Taylor Ferris
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, United States
| | | | - Rishi Pawa
- Gastroenterology, Wake Forest School of Medicine, Winston-Salem, United States
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10
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Sakamoto S, Sui K, Tabuchi M, Okabayashi T. Duodenojejunostomy for endoscopic management of biliary enteric anastomotic stricture inaccessible via balloon-assisted endoscopy: a case report. Surg Case Rep 2023; 9:82. [PMID: 37199815 DOI: 10.1186/s40792-023-01654-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/27/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Stricture formation is a long-term complication of biliary enteric anastomosis (BEA). BEA stricture often causes recurrent cholangitis and lithiasis, can significantly affect quality of life, and promote the development of life-threatening complications. In this report, duodenojejunostomy and subsequent endoscopic management as an alternative surgical technique for strictures of the BEA is described. CASE PRESENTATION Case 1: An 84-year-old man who underwent left hepatic trisectionectomy for hilar cholangiocarcinoma 6 years prior presented with fever and jaundice. Computed tomography (CT) revealed intrahepatic lithiasis. The patient was diagnosed with postoperative cholangitis secondary to intrahepatic lithiasis. Balloon-assisted endoscopy could not reach the anastomotic site, and stent insertion failed. A biliary access route was hence created via duodenojejunostomy. After the jejunal limb and duodenal bulb were identified, duodenojejunostomy was performed using a side-to-side continuous layer-to-layer suture. The patient was discharged without serious complications. Endoscopic management through duodenojejunostomy was successfully performed, and intrahepatic stones were completely removed. Case 2: A 75-year-old man who underwent bile duct resection for hilar cholangiocarcinoma 6 years prior was diagnosed with postoperative cholangitis due to intrahepatic lithiasis. Removal of the intrahepatic stones was attempted using balloon-assisted endoscopy; however, the endoscope could not reach the anastomotic site. The patient underwent duodenojejunostomy and subsequent endoscopic management. The patient was discharged without complications. Two weeks after the operation, the patient underwent endoscopic retrograde cholangiography through the duodenojejunostomy and the intrahepatic lithiasis was removed. CONCLUSIONS Duodenojejunostomy allows easy endoscopic access to a BEA. Duodenojejunostomy and subsequent endoscopic management may be an alternative treatment option in patients with BEA strictures that are inaccessible via balloon-assisted endoscopy.
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Affiliation(s)
- Shinya Sakamoto
- Department of Gastroenterological Surgery, Kochi Health Sciences Center, 2125-1 Ike, Kochi-City, Kochi, 781-8555, Japan
| | - Kenta Sui
- Department of Gastroenterological Surgery, Kochi Health Sciences Center, 2125-1 Ike, Kochi-City, Kochi, 781-8555, Japan
| | - Motoyasu Tabuchi
- Department of Gastroenterological Surgery, Kochi Health Sciences Center, 2125-1 Ike, Kochi-City, Kochi, 781-8555, Japan
| | - Takehiro Okabayashi
- Department of Gastroenterological Surgery, Kochi Health Sciences Center, 2125-1 Ike, Kochi-City, Kochi, 781-8555, Japan.
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11
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Su HJ. Endoscopic ultrasound-guided hepaticogastrostomy in a patient with post esophagectomy and gastric tube reconstruction: a case report. Clin J Gastroenterol 2023; 16:142-145. [PMID: 36576673 DOI: 10.1007/s12328-022-01748-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 12/08/2022] [Indexed: 12/29/2022]
Abstract
A 54-year-old woman with a history of esophageal adenocarcinoma suffered from obstructive jaundice after completing esophagectomy with gastric tube reconstruction and adjuvant concurrent chemoradiotherapy 1 year. An abdominal computed tomography showed that the common bile duct was compressed by metastatic lymphadenopathy. She received endoscopic retrograde cholangiopancreatography first but it was failed in cannulation. Then, endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) was performed with a partially covered metallic stent placed from the stomach to the left intrahepatic duct. Though aspiration pneumonia occurred after the procedure, she recovered on the next day. She resumed oral intake since the third day without fever or abdominal pain and she was discharged on the seventh day after the procedure. This is the second case report of placing a partially covered metallic stent through EUS-HGS in a patient with post esophagectomy and gastric tube reconstruction and it can be an alternative treatment.
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Affiliation(s)
- Hau-Jyun Su
- Department of Internal Medicine, National Taiwan University College of Medicine and Hospital Yunlin Branch, No. 579, Sec. 2, Yunlin Road., Douliu City, Yunlin, Taiwan.
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12
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Paduano D, Facciorusso A, De Marco A, Ofosu A, Auriemma F, Calabrese F, Tarantino I, Franchellucci G, Lisotti A, Fusaroli P, Repici A, Mangiavillano B. Endoscopic Ultrasound Guided Biliary Drainage in Malignant Distal Biliary Obstruction. Cancers (Basel) 2023; 15:cancers15020490. [PMID: 36672438 PMCID: PMC9856645 DOI: 10.3390/cancers15020490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 01/08/2023] [Accepted: 01/09/2023] [Indexed: 01/15/2023] Open
Abstract
Malignant biliary obstruction (MBO) is a challenging medical problem that often negatively impacts the patient's quality of life (QoL), postoperative complications, and survival rates. Endoscopic approaches to biliary drainage are generally performed by ERCP or, in selected cases, with a percutaneous transhepatic biliary drainage (PTBD). Recent advances in therapeutic endoscopic ultrasound (EUS) allow drainage where previous methods have failed. EUS has evolved from a purely diagnostic technique to one that allows a therapeutic approach in the event of ERCP failure in distal MBO. Moreover, the introduction of dedicated accessories and prostheses for EUS-guided transmural biliary drainage (EUS-BD) made these procedures more successful with regard to technical success, clinical outcomes and reduction of adverse events (AEs). Finally, lumen-apposing metal stents (LAMS) have improved the therapeutic role of the EUS. Subsequently, the electrocautery enhanced tip of the LAMS (EC-LAMS) allows a direct access of the delivery system to the target lumen, thereby simplifying and reducing the EUS-BD procedure time. EUS-BD using LAMS and EC-LAMS has proven effective and safe with a low rate of AEs. This review aims to evaluate biliary drainage techniques in malignant obstruction, focusing on the role of EUS biliary drainage by LAMS.
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Affiliation(s)
- Danilo Paduano
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, 21053 Castellanza, Italy
- Correspondence: (D.P.); (B.M.); Tel.: +39-0331-476205 (D.P.)
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia, 71122 Foggia, Italy
- Gastroenterology and Digestive Endoscopy Unit, Department of Medicine, The Pancreas Institute, University Hospital of Verona, 37100 Verona, Italy
| | - Alessandro De Marco
- Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, 20089 Rozzano, Italy
| | - Andrew Ofosu
- Division of Gastroenterology and Hepatology, University of Cincinnati, Cincinnati, OH 45201, USA
| | - Francesco Auriemma
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, 21053 Castellanza, Italy
| | - Federica Calabrese
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, 21053 Castellanza, Italy
| | - Ilaria Tarantino
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT, 90100 Palermo, Italy
| | | | - Andrea Lisotti
- Gastroenterology Unit, Hospital of Imola, University of Bologna, 40121 Bologna, Italy
| | - Pietro Fusaroli
- Gastroenterology Unit, Hospital of Imola, University of Bologna, 40121 Bologna, Italy
| | - Alessandro Repici
- Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, 20089 Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, 20089 Rozzano, Italy
| | - Benedetto Mangiavillano
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, 21053 Castellanza, Italy
- Department of Biomedical Sciences, Humanitas University, 20089 Rozzano, Italy
- Correspondence: (D.P.); (B.M.); Tel.: +39-0331-476205 (D.P.)
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13
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Endoscopic Ultrasound-Guided Hepaticogastrostomy with Antegrade Stenting Without Dilation Device Application for Malignant Distal Biliary Obstruction in Pancreatic Cancer. Dig Dis Sci 2022; 68:2090-2098. [PMID: 36350476 DOI: 10.1007/s10620-022-07749-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 10/26/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Endoscopic ultrasound-guided hepaticogastrostomy with antegrade stenting (EUS-HGAS) is a promising therapeutic option for malignant distal biliary obstruction (MDBO) in the event of transpapillary approach failure. Eliminating the fistula dilation step may further decrease the incidence of adverse events (AE) and simplify the procedure. AIMS This study focused on MDBO associated with pancreatic cancer and aimed to examine the utility of EUS-HGAS without the use of any dilation devices. METHODS This retrospective study investigated consecutive patients in whom the transpapillary approach had failed or was difficult, and who underwent EUS-HGAS without dilation device usage, using a tapered small-diameter catheter, ultrathin delivery system, and tapered dedicated plastic stent. The outcomes of this study included the technical success, clinical success, AE incidence, and recurrent biliary obstruction (RBO) associated with the procedure. RESULTS During the study period, EUS-HGAS without dilation device usage was attempted for 57 patients with MDBO due to pancreatic cancer. The technical and clinical success rates were 91.2% (52/57) each. The median procedural time was 25 min. The rates of early and late AE besides RBO were 3.5% (2/57) and 1.9% (1/52), respectively. The incidence rate of RBO was 30.8% (16/52), and the median time to RBO was 245 days. The rate of successful endoscopic reintervention for RBO via the fistula was 100% (16/16). CONCLUSIONS EUS-HGAS without the use of dilation devices showed good technical feasibility with a low AE rate. It may be a useful option for MDBO associated with pancreatic cancer when the transpapillary approach is difficult.
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Dietrich CF, Braden B, Burmeister S, Aabakken L, Arciadacono PG, Bhutani MS, Götzberger M, Healey AJ, Hocke M, Hollerbach S, Ignee A, Jenssen C, Jürgensen C, Larghi A, Moeller K, Napoléon B, Rimbas M, Săftoiu A, Sun S, Bun Teoh AY, Vanella G, Fusaroli P, Carrara S, Will U, Dong Y, Burmester E. How to perform EUS-guided biliary drainage. Endosc Ultrasound 2022; 11:342-354. [PMID: 36255022 PMCID: PMC9688140 DOI: 10.4103/eus-d-21-00188] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
EUS-guided biliary drainage (EUS-BD) has recently gained widespread acceptance as a minimally invasive alternative method for biliary drainage. Even in experienced endoscopy centers, ERCP may fail due to inaccessibility of the papillary region, altered anatomy (particularly postsurgical alterations), papillary obstruction, or neoplastic gastric outlet obstruction. Biliary cannulation fails at first attempt in 5%-10% of cases even in the absence of these factors. In such cases, alternative options for biliary drainage must be provided since biliary obstruction is responsible for poor quality of life and even reduced survival, particularly due to septic cholangitis. The standard of care in many centers remains percutaneous transhepatic biliary drainage (PTBD). However, despite the high technical success rate with experienced operators, the percutaneous approach is more invasive and associated with poor quality of life. PTBD may result in long-term external catheters for biliary drainage and carry the risk of serious adverse events (SAEs) in up to 10% of patients, including bile leaks, hemorrhage, and sepsis. PTBD following a failed ERCP also requires scheduling a second procedure, resulting in prolonged hospital stay and additional costs. EUS-BD may overcome many of these limitations and offer some distinct advantages in accessing the biliary tree. Current data suggest that EUS-BD is safe and effective when performed by experts, although SAEs have been also reported. Despite the high number of clinical reports and case series, high-quality comparative studies are still lacking. The purpose of this article is to report on the current status of this procedure and to discuss the tools and techniques for EUS-BD in different clinical scenarios.
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Affiliation(s)
- Christoph F. Dietrich
- Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China,Department of Allgemeine Innere Medizin der Kliniken (DAIM) Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland,Address for correspondence Dr. Christoph F. Dietrich, Department Allgemeine Innere Medizin, Kliniken Hirslanden Beau Site, Salem und Permancence, Bern, Switzerland. E-mail:
| | - Barbara Braden
- Translational Gastroenterology Unit, Oxford University Hospitals, Oxford, UK
| | - Sean Burmeister
- Hepato-Pancreatico-Biliary Unit, Groote Schuur Hospital, Cape Town, South Africa
| | - Lars Aabakken
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Paolo Giorgio Arciadacono
- Division of Pancreatobiliary Endoscopy and Endosonography, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Manoop S. Bhutani
- Department of Gastroenterology Hepatology and Nutrition, UTMD Anderson Cancer Center, Houston, Texas, USA
| | - Manuela Götzberger
- Department of Gastroenterology and Hepatology, München Klinik Neuperlach und Harlaching, Munich, Germany
| | | | - Michael Hocke
- Medical Department II, Helios Klinikum Meiningen, Meiningen, Germany
| | - Stephan Hollerbach
- Department of Gastroenterology, Allgemeines Krankenhaus Celle, Celle, Germany
| | - André Ignee
- Caritas-Krankenhaus, Bad Mergentheim, Germany
| | - Christian Jenssen
- Medical Department, Krankenhaus Maerkisch-Oderland, Strausberg and Brandenburg Institute of Clinical Ultrasound at Medical University Brandenburg, Neuruppin, Germany
| | | | - Alberto Larghi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Kathleen Moeller
- Department of Medical I/Gastroenterology, SANA Hospital Lichtenberg, Berlin, Germany
| | | | - Mihai Rimbas
- Department of Gastroenterology, Clinic of Internal Medicine, Colentina Clinical Hospital, Carol Davila University of Medicine, Bucharest, Romania
| | - Adrian Săftoiu
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, Craiova, Romania
| | - Siyu Sun
- Department of Endoscopy Center, Shengjing Hospital of China Medical University, Liaoning Province, China
| | - Anthony Yuen Bun Teoh
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Giuseppe Vanella
- Division of Pancreatobiliary Endoscopy and Endosonography, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Pietro Fusaroli
- Department of Medical and Surgical Sciences, Gastrointestinal Unit, University of Bologna/Hospital of Imola, Imola, Italy
| | - Silvia Carrara
- Division of Gastroenterology, Humanitas Clinical and Research Center, Digestive Endoscopy Unit, Milan, Italy
| | - Uwe Will
- Department of Gastroenterology, SRH Klinikum Gera, Gera, Germany
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Eike Burmester
- Medizinische Klinik I, Sana Kliniken Luebeck, Luebeck, Germany
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15
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Monino L, Barthet M. Futures perspectives and therapeutic applications. Best Pract Res Clin Gastroenterol 2022; 60-61:101816. [PMID: 36577535 DOI: 10.1016/j.bpg.2022.101816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Laurent Monino
- Department of Hepatogastroenterology, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille Université, Hôpital Nord, Marseille, France; Department of Hepatogastroenterology, Université catholique de Louvain, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Marc Barthet
- Department of Hepatogastroenterology, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille Université, Hôpital Nord, Marseille, France.
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16
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Fugazza A, Colombo M, Spadaccini M, Vespa E, Gabbiadini R, Capogreco A, Repici A, Anderloni A. Relief of jaundice in malignant biliary obstruction: When should we consider endoscopic ultrasonography-guided hepaticogastrostomy as an option? Hepatobiliary Pancreat Dis Int 2022; 21:234-240. [PMID: 35304087 DOI: 10.1016/j.hbpd.2022.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 02/23/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Since it was first described in 2001, endoscopic ultrasonography-guided biliary drainage (EUS-BD) has emerged as an alternative procedure for achieving an endoscopic internal drainage in case of endoscopic retrograde cholangiopancreatography (ERCP) failure. Biliary drainage can be achieved by either a transduodenal extrahepatic approach through EUS-guided choledochoduodenostomy (EUS-CDS), or a transgastric intrahepatic approach, namely EUS-guided hepaticogastrostomy (EUS-HGS) which already holds a remarkable place in the treatment of patients with malignant biliary obstruction. DATA SOURCES For this review we did a comprehensive search of PubMed/MEDLINE from inception to May 31, 2021 for papers with a significant sample size (at least 20 patients enrolled) dealing with EUS-HGS. Data on technical success, clinical success and rate of adverse events were collected. RESULTS A total of 22 studies with different design, comprising 874 patients, were included. Technical success was achieved in about 96% of cases (ranging from 65% to 100%). Clinical success was obtained in almost 91% of cases (ranging from 76% to 100%). Overall rate of adverse events was 19% (ranging from 0% to 35%). Abdominal pain, self-limiting pneumoperitoneum, bile leak, cholangitis, bleeding, perforation and intraperitoneal migration of the stent were the most common. CONCLUSIONS Despite both safety and efficacy profile, at the moment HGS still remains a challenging procedure at every single step and must therefore be conducted by a very experienced endoscopist in interventional EUS and ERCP procedures, who is able to deal with the possible severe adverse events of this procedure. A rapid introduction in clinical practice of dedicated devices is desiderable.
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Affiliation(s)
- Alessandro Fugazza
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital - IRCCS, Milan, Italy.
| | - Matteo Colombo
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital - IRCCS, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Marco Spadaccini
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital - IRCCS, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Edoardo Vespa
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital - IRCCS, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Roberto Gabbiadini
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital - IRCCS, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Antonio Capogreco
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital - IRCCS, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Alessandro Repici
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital - IRCCS, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Andrea Anderloni
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital - IRCCS, Milan, Italy
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17
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Harai S, Hijioka S, Nagashio Y, Ohba A, Maruki Y, Sone M, Saito Y, Okusaka T, Fukasawa M, Enomoto N. Usefulness of the laser-cut fully covered self-expandable metallic stent for endoscopic ultrasound-guided hepaticogastrostomy. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2022; 29:1035-1043. [PMID: 35561015 DOI: 10.1002/jhbp.1165] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 02/24/2022] [Accepted: 04/02/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND/PURPOSE Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) has many associated adverse events. We evaluated the clinical efficacy and safety of the laser-cut fully covered self-expandable metallic stent (FCSEMS) for this procedure. METHODS This single-center, retrospective study included cases where EUS-HGS with a laser-cut FCSEMS was performed for malignant biliary obstruction. Technical and clinical success, time to recurrent biliary obstruction (TRBO), procedure time, adverse events, and re-interventions were evaluated. RESULTS There were 95 eligible cases. Technical and clinical success rates were 100.0% and 95.8%, respectively. Median TRBO was 398 days. RBO causes were hyperplasia (7.4%), debris (3.2%), and migration (4.2%). Adverse events occurred in nine cases (9.5%). Non-occlusion and focal cholangitis occurred in four cases (4.2%) each. Nineteen patients (20%) underwent combined EUS-HGS (CH) procedures: antegrade stenting, bridging methods, plastic stent anchoring in SEMS, and EUS-hepaticoduodenostomy. The solely EUS-HGS (SH) group had significantly longer median TRBO than the CH group (398 vs. 246 days; P=0.04). There were no significant differences in adverse events between the two groups. Re-intervention was performed in 29 cases (technical success rate: 100.0%). CONCLUSIONS Laser-cut FCSEMS can be safely placed in the bile duct and easily applied during re-intervention, making it useful in EUS-HGS.
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Affiliation(s)
- Shota Harai
- National Cancer Center Japan, Department of Hepatobiliary and Pancreatic Oncology.,University of Yamanashi, Faculty of Medicine Graduate School of Medicine, First Department of Internal medicine
| | - Susumu Hijioka
- National Cancer Center Japan, Department of Hepatobiliary and Pancreatic Oncology
| | - Yoshikuni Nagashio
- National Cancer Center Japan, Department of Hepatobiliary and Pancreatic Oncology
| | - Akihiro Ohba
- National Cancer Center Japan, Department of Hepatobiliary and Pancreatic Oncology
| | - Yuta Maruki
- National Cancer Center Japan, Department of Hepatobiliary and Pancreatic Oncology
| | - Miyuki Sone
- National Cancer Center Japan, Department of Diagnostic Radiology
| | - Yutaka Saito
- National Cancer Center Japan, Department of Endoscopy
| | - Takuji Okusaka
- National Cancer Center Japan, Department of Hepatobiliary and Pancreatic Oncology
| | - Mitsuharu Fukasawa
- University of Yamanashi, Faculty of Medicine Graduate School of Medicine, First Department of Internal medicine
| | - Nobuyuki Enomoto
- University of Yamanashi, Faculty of Medicine Graduate School of Medicine, First Department of Internal medicine
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18
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Matsubara S, Nakagawa K, Suda K, Otsuka T, Oka M, Nagoshi S. Practical Tips for Safe and Successful Endoscopic Ultrasound-Guided Hepaticogastrostomy: A State-of-the-Art Technical Review. J Clin Med 2022; 11:jcm11061591. [PMID: 35329917 PMCID: PMC8949311 DOI: 10.3390/jcm11061591] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 03/09/2022] [Indexed: 02/04/2023] Open
Abstract
Currently, endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is widely performed worldwide for various benign and malignant biliary diseases in cases of difficult or unsuccessful endoscopic transpapillary cholangiopancreatography (ERCP). Furthermore, its applicability as primary drainage has also been reported. Although recent advances in EUS systems and equipment have made EUS-HGS easier and safer, the risk of serious adverse events such as bile leak and stent migration still exists. Physicians and assistants need not only sufficient skills and experience in ERCP-related procedures and basic EUS-related procedures such as fine needle aspiration and pancreatic fluid collection drainage, but also knowledge and techniques specific to EUS-HGS. This technical review mainly focuses on EUS-HGS with self-expandable metal stents for unresectable malignant biliary obstruction and presents the latest and detailed tips for safe and successful performance of the technique.
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Affiliation(s)
- Saburo Matsubara
- Correspondence: ; Tel.: +81-49-228-3400 (ext. 7839); Fax: +81-49-226-5284
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19
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Li J, Tang J, Liu F, Fang J. Comparison of Choledochoduodenostomy and Hepaticogastrostomy for EUS-Guided Biliary Drainage: A Meta-Analysis. Front Surg 2022; 9:811005. [PMID: 35356500 PMCID: PMC8959983 DOI: 10.3389/fsurg.2022.811005] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/07/2022] [Indexed: 12/29/2022] Open
Abstract
Background Although endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) or hepaticogastrostomy (EUS-HGS) has emerged as an option for patients of failed endoscopic retrograde cholangiopancreatography (ERCP), there has no agreement on which approach is preferred. Therefore, a meta-analysis was performed to examine the two methods. Methods We performed a comprehensive search in databases of PubMed, Embase, and Cochrane library to find relevant studies reporting the efficacy and safety of the two EUS-guided biliary drainage methods. Results In total, 12 studies with 623 patients (EUS-CDS: 303 and EUS-HGS: 320) were included. The cumulative technical success and clinical success for EUS-CDS and EUS-HGS was 95.0% (288/303), 93.1% (268/288), and 96.6% (309/320), 91.3% (282/309), respectively. Compared with EUS-HGS, the pooled odds ratio (OR) was 0.74 (95% CI 0.33–1.65; p = 0.46) for EUS-CDS technical success and 0.94 (95% CI 0.56–1.59; p = 0.83) for clinical success. The pooled difference in means of procedure time of EUS-CDS and EUS-HGS was −2.68 (95% CI −5.12 to −0.24; p = 0.03). The cumulative early adverse events for EUS-CDS and EUS-HGS was 12.2% (37/303) and 17.5% (56/320), respectively. Compared with EUS-HGS, the pooled OR of early adverse events for EUS-CDS was 0.58 (95% CI: 0.36–0.93; p = 0.02). Conclusion This meta-analysis further suggests EUS-CDS and EUS-HGS have equal high technical and clinical success, but EUS-CDS with a slightly short procedure time and with less early adverse events compared to EUS-HGS.
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Affiliation(s)
- Jiasu Li
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jian Tang
- Digestive Endoscopy Center, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Feng Liu
- Digestive Endoscopy Center, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
- *Correspondence: Feng Liu
| | - Jun Fang
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China
- Jun Fang
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van Wanrooij RLJ, Bronswijk M, Kunda R, Everett SM, Lakhtakia S, Rimbas M, Hucl T, Badaoui A, Law R, Arcidiacono PG, Larghi A, Giovannini M, Khashab MA, Binmoeller KF, Barthet M, Pérez-Miranda M, van Hooft JE, van der Merwe SW. Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review. Endoscopy 2022; 54:310-332. [PMID: 35114696 DOI: 10.1055/a-1738-6780] [Citation(s) in RCA: 65] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
1: ESGE recommends a prolonged course of a prophylactic broad-spectrum antibiotic in patients with ascites who are undergoing therapeutic endoscopic ultrasound (EUS) procedures.Strong recommendation, low quality evidence. 2: ESGE recommends placement of partially or fully covered self-expandable metal stents during EUS-guided hepaticogastrostomy for biliary drainage in malignant disease.Strong recommendation, moderate quality evidence. 3: ESGE recommends EUS-guided pancreatic duct (PD) drainage should only be performed in high volume expert centers, owing to the complexity of this technique and the high risk of adverse events.Strong recommendation, low quality evidence. 4: ESGE recommends a stepwise approach to EUS-guided PD drainage in patients with favorable anatomy, starting with rendezvous-assisted endoscopic retrograde pancreatography (RV-ERP), followed by antegrade or transmural drainage only when RV-ERP fails or is not feasible.Strong recommendation, low quality evidence. 5: ESGE suggests performing transduodenal EUS-guided gallbladder drainage with a lumen-apposing metal stent (LAMS), rather than using the transgastric route, as this may reduce the risk of stent dysfunction.Weak recommendation, low quality evidence. 6: ESGE recommends using saline instillation for small-bowel distension during EUS-guided gastroenterostomy.Strong recommendation, low quality evidence. 7: ESGE recommends the use of saline instillation with a 19G needle and an electrocautery-enhanced LAMS for EUS-directed transgastric endoscopic retrograde cholangiopancreatography (EDGE) procedures.Strong recommendation, low quality evidence. 8: ESGE recommends the use of either 15- or 20-mm LAMSs for EDGE, with a preference for 20-mm LAMSs when considering a same-session ERCP.Strong recommendation, low quality evidence.
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Affiliation(s)
- Roy L J van Wanrooij
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam, AGEM Institute, Amsterdam, The Netherlands
| | - Michiel Bronswijk
- Department of Gastroenterology and Hepatology, Imelda General Hospital, Bonheiden, Belgium.,Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Rastislav Kunda
- Department of Surgery, Department of Gastroenterology and Hepatology, and Department of Advanced Interventional Endoscopy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Simon M Everett
- Department of Gastroenterology and Hepatology, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - Sundeep Lakhtakia
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology Hospitals, Gachibowli, Hyderabad, India
| | - Mihai Rimbas
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
| | - Tomas Hucl
- Department of Gastroenterology and Hepatology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Abdenor Badaoui
- Department of Gastroenterology and Hepatology, Université catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
| | - Ryan Law
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Paolo Giorgio Arcidiacono
- Pancreatobiliary Endoscopy and Endosonography Division, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Larghi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, and Center for Endoscopic Research Therapeutics and Training, Catholic University, Rome, Italy
| | - Marc Giovannini
- Paoli-Calmettes Institute, Department of Gastrointestinal Disease, Marseille, France
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Kenneth F Binmoeller
- Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, California, USA
| | - Marc Barthet
- Department of Gastroenterology, Aix-Marseille Université, APHM, Hôpital Nord, Marseille, France
| | - Manuel Pérez-Miranda
- Gastroenterology Department, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Schalk W van der Merwe
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
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21
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Double anchor lock fixing method to prevent stent displacement in endoscopic ultrasound-guided gastroenterostomy: a porcine study. Surg Endosc 2021; 36:4854-4861. [PMID: 34859303 DOI: 10.1007/s00464-021-08834-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 10/19/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is widely used in patients with gastric outlet obstruction (GOO). Recurrence of obstruction symptoms caused by stent migration is the major reason for reintervention in EUS-GE. To solve this problem, we proposed developing a double anchor lock (DAL) fixing stent method for EUS-GE. The safety and efficacy of the DAL fixing stent method were evaluated in this study. METHODS Sixteen Bama miniature pigs were randomly divided into an experimental group (n = 8) and a control group (n = 8). A gastric outlet obstruction model was established for all the pigs. The experimental group was treated with the DAL fixing stent method for EUS-GE, while the control group was treated with EUS-GE. Three-month stent migration rate, remission rate of GOO, re-occlusion intervention rate, weight change, and incidence of procedure-related complications of EUS-GE were analyzed and estimated in the two groups. RESULTS EUS-GE was successfully completed in every subject in both groups. Symptoms of digestive tract obstruction can be relieved in all animals. The stent existence rate in the 3 months was higher in the experimental group than in the control group (87.5% vs. 12.5%, P = 0.012). Except for one animal in the experimental group in which there was pneumoperitoneum due to a stent insertion failure, no animal experienced bleeding or perforation. CONCLUSION The DAL fixing stent method, which can effectively prevent stent migration, is safe and simple. EUS-GE can effectively relieve the symptoms of digestive tract obstruction.
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22
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Jia Y, Dietrich CF, Sun S. EUS-guided cell transplantation: Planting seeds of hope. Endosc Ultrasound 2021; 10:401-403. [PMID: 34975038 PMCID: PMC8785668 DOI: 10.4103/eus-d-21-00220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Yunbo Jia
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Christoph F Dietrich
- Department of Allgemeine Innere Medizin, Kliniken Hirslanden Bern, Beau Site, Salem and Permanence, Bern, Switzerland
| | - Siyu Sun
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
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Hanscom M, Anders S, Hakimian S, Dudekala A, Rau P, Singh A, Zivny J, Churrango G, Bhattacharya K, Marshall C, Marya NB. Novel dilation technique and stent selection to reduce periprocedural adverse events in left hepaticogastrostomy. VideoGIE 2021; 6:460-463. [PMID: 34667912 PMCID: PMC8505228 DOI: 10.1016/j.vgie.2021.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
Video 1Video demonstration of left hepaticogastrostomy with the assistance of an angioplasty balloon.
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Affiliation(s)
- Mark Hanscom
- Division of Gastroenterology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Stephen Anders
- Division of Gastroenterology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Shahrad Hakimian
- Division of Gastroenterology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Anwar Dudekala
- Division of Gastroenterology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Prashanth Rau
- Division of Gastroenterology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Anupam Singh
- Division of Gastroenterology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Jaroslav Zivny
- Division of Gastroenterology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Gustavo Churrango
- Division of Gastroenterology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Kanishka Bhattacharya
- Division of Gastroenterology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Christopher Marshall
- Division of Gastroenterology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Neil B Marya
- Division of Gastroenterology, University of Massachusetts Medical School, Worcester, Massachusetts
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24
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Ogura T, Ueno S, Okuda A, Nishioka N, Yamada M, Matsuno J, Ueshima K, Yamamoto Y, Higuchi K. Technical feasibility and safety of one-step deployment of EUS-guided hepaticogastrostomy using an 8-mm diameter metal stent with a fine-gauge stent delivery system (with video). Endosc Ultrasound 2021; 10:355-360. [PMID: 34427190 PMCID: PMC8544008 DOI: 10.4103/eus-d-20-00206] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 05/06/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Adverse events (AEs) such as bile peritonitis or pneumoperitoneum might occur during procedural steps for EUS-guided hepaticogastrostomy (HGS), such as during device exchange and after fistula dilation until stent deployment. Reducing the steps to the EUS-HGS procedure might therefore be ideal to prevent the occurrence of AEs. Recently, a novel, fully covered self-expandable metal stent (FCSEMS) has become available. Because of the fine-gauge stent delivery system (5.9Fr), fistula dilation might not be needed before stent deployment during EUS-HGS. The aim of this pilot study was to evaluate the technical feasibility and safety of one-step EUS-HGS using a novel 8-mm diameter FCSEMS. PATIENTS AND METHODS The primary outcome in this study was technical success, and the secondary outcomes were procedure- and stent-related AEs and clinical success. The technical success of one-step EUS-HGS was defined as successful FCSEMS deployment without any fistula dilation. Procedure time was measured from scope insertion to successful FCSEMS deployment. RESULTS One-step EUS-HGS using the novel FCSEMS was attempted on 14 patients. Technical success with a short procedure time (median: 7 min) and clinical success were obtained in all patients. In addition, procedure-related AEs such as bleeding, bile peritonitis, and stent migration during the procedure were not observed in any patients. CONCLUSIONS One-step EUS-HGS using the novel FCSEMS with a fine-gauge stent delivery system is technically feasible and shortens the procedure time with no requirement for additional fistula dilation, resulting in a potential reduction in procedure-related AEs.
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Affiliation(s)
- Takeshi Ogura
- 2 Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Saori Ueno
- 2 Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Atsushi Okuda
- 2 Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Nobu Nishioka
- 2 Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Masanori Yamada
- 2 Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Jun Matsuno
- 2 Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Kazuya Ueshima
- 2 Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | | | - Kazuhide Higuchi
- 2 Department of Internal Medicine, Osaka Medical College, Osaka, Japan
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Chantarojanasiri T, Ratanachu-Ek T, Pausawasdi N. What You Need to Know Before Performing Endoscopic Ultrasound-guided Hepaticogastrostomy. Clin Endosc 2021; 54:301-308. [PMID: 34082486 PMCID: PMC8182256 DOI: 10.5946/ce.2021.103] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 04/25/2021] [Indexed: 02/07/2023] Open
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is the primary treatment modality for bile duct obstruction. When ERCP is unsuccessful, percutaneous transhepatic biliary drainage can be an alternative method. Endoscopic ultrasound-guided biliary drainage (EUS-BD) has emerged as a treatment option for biliary obstruction, especially after ERCP failure. EUS-BD offers transluminal intrahepatic and extrahepatic drainage through a transgastric and transduodenal approach. EUS-guided hepaticogastrostomy (EUS-HGS) is an excellent choice for patients with hilar strictures or those with a surgically altered anatomy. The optimal steps in EUS-HGS are case selection, bile duct visualization, puncture-site selection, wire insertion and manipulation, tract dilation, and stent placement. Caution should be taken at each step to prevent complications. Dedicated devices for EUS-HGS have been developed to improve the technical success rate and reduce complications. This technical review focuses on the essential practical points at each step of EUS-HGS.
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Affiliation(s)
| | | | - Nonthalee Pausawasdi
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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26
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Primary Needle-Knife Sphincterotomy for Biliary Access in Patients at High Risk of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis. Gastroenterol Res Pract 2021; 2021:6662000. [PMID: 34054945 PMCID: PMC8149254 DOI: 10.1155/2021/6662000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 03/04/2021] [Accepted: 04/13/2021] [Indexed: 01/19/2023] Open
Abstract
Methods Forty patients with one or more risk factors for PEP were prospectively enrolled between June 2018 and November 2019. The cannulation was conducted in all patients using NKS as the primary cannulation technique. Success rate of biliary cannulation, biliary cannulation time, and adverse event rate were assessed. Results Of the 40 patients enrolled, 34 patients underwent primary NKS after the screening. Nine patients had 1 risk factor for PEP, 7 had 2, 8 had 3, 7 had 4, and 3 had 5. The success rate of biliary access by NKS was 94.1% (32/34). The median procedure time for NKS and the total procedure time for stone removal or biliary drainage were 4.1 minutes (range, 0.5-25.2) and 11.3 minutes (range, 3.8–40.4), respectively. Adverse events occurred in two patients (minor bleeding, n = 1; hyperamylasemia, n = 1). No patient experienced PEP or perforation. Conclusion NKS might be feasible as a primary cannulation procedure in patients at high risk of PEP. This trial is registered with KCT0004886 (03/06/2018).
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Vanella G, Bronswijk M, Maleux G, van Malenstein H, Laleman W, Van der Merwe S. EUS-guided intrahepatic biliary drainage: a large retrospective series and subgroup comparison between percutaneous drainage in hilar stenoses or postsurgical anatomy. Endosc Int Open 2020; 8:E1782-E1794. [PMID: 33269311 PMCID: PMC7671754 DOI: 10.1055/a-1264-7511] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background and study aims Endoscopic ultrasound-guided intrahepatic biliary drainage (EUS-IBD) struggles to find a place in management algorithms, especially compared to percutaneous drainage (PTBD). In the setting of hilar stenoses or postsurgical anatomy data are even more limited. Patients and methods All consecutive EUS-IBDs performed in our tertiary referral center between 2012 - 2019 were retrospectively evaluated. Rendez-vous (RVs), antegrade stenting (AS) and hepatico-gastrostomies (HGs) were compared. The predefined subgroup of EUS-IBD patients with proximal stenosis/surgically-altered anatomy was matched 1:1 with PTBD performed for the same indications. Efficacy, safety and events during follow-up were compared. Results One hundred four EUS-IBDs were included (malignancies = 87.7 %). These consisted of 16 RVs, 43 ASs and 45 HGs. Technical and clinical success rates were 89.4 % and 96.2 %, respectively. Any-degree, severe and fatal adverse events (AEs) occurred in 23.3 %, 2.9 %, and 0.9 % respectively. Benign indications were more common among RVs while proximal stenoses, surgically-altered anatomy, and disconnected left ductal system among HGs. Procedures were shorter with HGs performed with specifically designed stents (25 vs . 48 minutes, P = 0.004) and there was also a trend toward less dysfunction with those stents (6.7 % vs . 30 %, P = 0.09) compared with previous approaches. Among patients with proximal stenosis/surgically-altered anatomy, EUS-IBD vs. PTBD showed higher rates of clinical success (97.4 % vs. 79.5 %, P = 0.01), reduced post-procedural pain (17.8 % vs. 44.4 %, p = 0.004), shorter median hospital stay (7.5 vs 11.5 days, P = 0.01), lower rates of stent dysfunction (15.8 % vs. 42.9 %, P = 0.01), and the mean number of reinterventions was lower (0.4 vs. 2.8, P < 0.0001). Conclusions EUS-IBD has high technical and clinical success with an acceptable safety profile. HGs show comparable outcomes, which are likely to further improve with dedicated tools. For proximal strictures and surgically-altered anatomy, EUS-IBD seems superior to PTBD.
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Affiliation(s)
- Giuseppe Vanella
- Department of Gastroenterology and Hepatology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium
- Pancreatobiliary Endoscopy and Endosonography Division, IRCSS San Raffaele Scientific Institute, Milan, Italy
| | - Michiel Bronswijk
- Department of Gastroenterology and Hepatology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium
| | - Geert Maleux
- Department of Interventional Radiology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium
| | - Hannah van Malenstein
- Department of Gastroenterology and Hepatology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium
| | - Wim Laleman
- Department of Gastroenterology and Hepatology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium
| | - Schalk Van der Merwe
- Department of Gastroenterology and Hepatology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium
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Which Are the Most Suitable Stents for Interventional Endoscopic Ultrasound? J Clin Med 2020; 9:jcm9113595. [PMID: 33171627 PMCID: PMC7695190 DOI: 10.3390/jcm9113595] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 10/28/2020] [Accepted: 11/05/2020] [Indexed: 02/06/2023] Open
Abstract
Endoscopic ultrasound (EUS)-guided interventions provide easy access to structures adjacent to the gastrointestinal tract, effectively targeting them for therapeutic purposes. They play an important role in the management of pancreatic fluid collections (PFC) and bile duct (BD) and pancreatic duct (PD) drainage in cases of failed endoscopic retrograde cholangiopancreatography (ERCP) or gallbladder (GB) drainage. Specially designed stents and delivery systems for EUS-guided transluminal interventions allow various new applications and improve the efficacy and safety of these procedures. In fact, EUS-guided drainage has emerged as the treatment of choice for the management of PFC, and recent innovations such as fully covered metal stents (including lumen-apposing metal stents) have improved outcomes in patients with walled-off necrosis. Similarly, EUS-guided BD and PD drainage with specially designed stents can be beneficial for patients with failed ERCP due to an inaccessible papilla, gastric outlet obstruction, or surgically altered anatomy. EUS-guided GB drainage is also performed using dedicated stents in patients with acute cholecystitis who are not fit for surgery. Although the field of dedicated stents for interventional EUS is rapidly advancing with increasing innovations, the debate on the most appropriate stent for EUS-guided drainage has resurfaced. Furthermore, some important questions remain unaddressed, such as which stent improves clinical outcomes and safety in EUS-guided drainage. Herein, the current status and problems of the available stents are reviewed, including the applicable indications, long-term clinical outcomes, comparison between each stent, and their future prospects.
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30
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Kunda R. Recent development of endoscopic ultrasound-guided biliary drainage. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2020. [DOI: 10.18528/ijgii200047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Rastislav Kunda
- Department of Surgery, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Gastroenterology-Hepatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Advanced Interventional Endoscopy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
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Liao Y, Giovannini M, Zhong N, Xiao T, Sheng S, Wu Y, Zhang J, Wang S, Liu X, Sun S, Guo J. Comparison of endoscopic ultrasound-guided hepaticogastrostomy and the antegrade technique in the management of unresectable malignant biliary obstruction: study protocol for a prospective, multicentre, randomised controlled trial. Trials 2020; 21:817. [PMID: 32993731 PMCID: PMC7525949 DOI: 10.1186/s13063-020-04758-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 09/22/2020] [Indexed: 11/10/2022] Open
Abstract
Background Endoscopic ultrasound-guided biliary drainage (EUS-BD) is used after failed endoscopic retrograde cholangiopancreatography. Based on existing studies, intrahepatic (IH) approaches are preferred in patients with dilated IH bile ducts. Both ultrasound-guided hepaticogastrostomy (EUS-HGS) and ultrasound-guided antegrade treatment (EUS-AG) are appropriate for patients with unreachable papillae. Nevertheless, there have been no direct comparisons between these two approaches. Therefore, we aim to evaluate and compare the safety and efficiency of EUS-HGS and EUS-AG in patients with an unreachable papilla. Methods This is a prospective, randomised, controlled, multicentre study with two parallel groups without masking. One hundred forty-eight patients from three hospitals who met the inclusion criteria will be randomly assigned (1:1) to undergo either EUS-HGS or EUS-AG for relief of malignant biliary obstruction. The final study follow-up is scheduled at 1 year postoperatively. The primary endpoint is efficiency, described by technical and clinical success rates of EUS-HGS and EUS-AG in patients with unreachable papillae. The secondary endpoints include stent patency, overall survival rates, complication rates, length of hospital stays, and hospitalisation expenses. The chi-square test, Kaplan–Meier methods, log-rank test, and Cox regression analysis will be used to analyse the data. Discussion To our knowledge, this is the first study to compare these two EUS-BD approaches directly using a multicentre, randomised, controlled trial design. The clinical economic indexes will also be compared, as they may also affect the patient’s choice. The result may contribute to establishing a strategic guideline for choosing IH EUS-BD approaches. Trial registration Chinese Clinical Trial Registry (ChiCTR) ChiCTR1900020737. Registered on 15 January 2019
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Affiliation(s)
- Ye Liao
- Department of gastroenterology, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Shenyang, 110004, China
| | - Marc Giovannini
- Endoscopy Unit, Paoli Calmettes Institute, 232 bd Ste Marguerite, 13009, Marseille, France
| | - Ning Zhong
- Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Tingyue Xiao
- The Sixth People's Hospital of Shenyang, Shenyang, 110006, China
| | - Shiyun Sheng
- Department of gastroenterology, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Shenyang, 110004, China
| | - Yufan Wu
- Department of gastroenterology, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Shenyang, 110004, China
| | - Jingjing Zhang
- Department of gastroenterology, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Shenyang, 110004, China
| | - Sheng Wang
- Department of gastroenterology, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Shenyang, 110004, China
| | - Xiang Liu
- Department of gastroenterology, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Shenyang, 110004, China
| | - Siyu Sun
- Department of gastroenterology, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Shenyang, 110004, China.
| | - Jintao Guo
- Department of gastroenterology, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Shenyang, 110004, China.
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Ogura T, Yamada M, Nishioka N, Yamada T, Higuchi K. One-step stent deployment of EUS-guided hepaticogastrostomy using a novel covered metal stent with a fine-gauge stent delivery system (with video). Endosc Ultrasound 2020; 9:267-269. [PMID: 32687071 PMCID: PMC7528996 DOI: 10.4103/eus.eus_38_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/19/2020] [Indexed: 01/29/2023] Open
Affiliation(s)
- Takeshi Ogura
- 2 Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Masanori Yamada
- 2 Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Nobu Nishioka
- 2 Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Tadahiro Yamada
- 2 Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Kazuhide Higuchi
- 2 Department of Internal Medicine, Osaka Medical College, Osaka, Japan
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Khoo S, Do NDT, Kongkam P. Efficacy and safety of EUS biliary drainage in malignant distal and hilar biliary obstruction: A comprehensive review of literature and algorithm. Endosc Ultrasound 2020; 9:369-379. [PMID: 33318375 PMCID: PMC7811708 DOI: 10.4103/eus.eus_59_20] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Malignant biliary obstruction (MBO) encompasses a variety of malignancies arising from the pancreaticobiliary system. This can be divided into malignant hilar biliary obstruction (MHBO) or malignant distal biliary obstruction (MDBO) biliary obstruction to which clinical outcomes and technical considerations of various biliary drainage methods may differ. EUS biliary drainage (EUS-BD) has been increasingly influential in the management of MBO together with other familiar biliary drainage methods such as ERCP and percutaneous transhepatic biliary drainage (PTBD). Conventionally, ERCP has always been the primary choice of endoscopic biliary drainage in both MHBO and MDBO and that PTBD or EUS-BD is used as a salvage method when ERCP fails for which current guidelines recommends PTBD, especially for MHBO. This review was able to show that with today's evidence, EUS-BD is equally efficacious and possesses a better safety profile in the management of MBO and should be on the forefront of endoscopic biliary drainage. Therefore, EUS-BD could be used either as a primary or preferred salvage biliary drainage method in these cases.
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Affiliation(s)
- Stanley Khoo
- Department of Medicine, Gastroenterology and Hepatology Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nhan Duc Tri Do
- Department of Endoscopy, Can Tho General Hospital, Can Tho; Department of General Surgery, Can Tho General Hospital, Can Tho, Vietnam
| | - Pradermchai Kongkam
- Department of Medicine, Division of Gastroenterology, Gastrointestinal Endoscopy Excellence Center, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok; Pancreas Research Unit, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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