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Multicenter retrospective study of endoscopic ultrasound‐guided biliary drainage for malignant biliary obstruction in J apan
Author(s) -
Kawakubo Kazumichi,
Isayama Hiroyuki,
Kato Hironari,
Itoi Takao,
Kawakami Hiroshi,
Hanada Keiji,
Ishiwatari Hirotoshi,
Yasuda Ichiro,
Kawamoto Hirofumi,
Itokawa Fumihide,
Kuwatani Masaki,
Iiboshi Tomohiro,
Hayashi Tsuyoshi,
Doi Shinpei,
Nakai Yousuke
Publication year - 2014
Publication title -
journal of hepato‐biliary‐pancreatic sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 1868-6974
DOI - 10.1002/jhbp.27
Subject(s) - medicine , endoscopic retrograde cholangiopancreatography , endoscopic ultrasound , stent , perforation , radiology , retrospective cohort study , surgery , complication , materials science , pancreatitis , metallurgy , punching
Background Endoscopic ultrasound‐guided biliary drainage ( EUS‐BD ) is considered to be an effective salvage procedure for failed endoscopic retrograde cholangiopancreatography in patients with unresectable malignant biliary obstruction. The aim of this retrospective study was to evaluate the efficacy and feasibility of EUS‐BD . Methods From N ovember 2006 to M ay 2012, a total of 64 patients who underwent EUS‐BD (44 EUS ‐guided choledochoduodenostomy [ EUS‐CDS ] and 20 EUS ‐guided hepaticogastrostomy [ EUS‐HGS ]) at seven tertiary‐care referral centers in J apan were included. The primary outcome was the technical success rate, and the secondary outcomes were the incidence of complications, stent dysfunction rate, time to stent dysfunction, and overall survival. Results The technical success rate for both EUS‐CDS and EUS‐HGS was 95%. The reasons for technical failure were two failed dilations of the anastomosis in EUS‐CDS and one puncture failure in EUS‐HGS . The stent dysfunction rate and 3‐month dysfunction‐free patency rate were 21% and 80% for EUS‐CDS and 32% and 51% for EUS‐HGS . There were 12 (six in EUS‐CDS and six in EUS‐HGS ) procedure‐related complications (19%): five cases of bile leakage (3/2), three stent misplacements (1/2), one pneumoperitoneum (1/0), two cases of bleeding (1/1), one perforation (1/0), and one biloma (0/1). Bile leakage was more frequently observed in patients who underwent plastic stent placement (11%) than in those with covered metal stents (4%). Conclusions This Japanese multicenter study revealed a high success rate in EUS‐BD . However, the complication rate was as high as that in previous series. Covered metal stents may be useful to reduce bile leakage in EUS‐BD .