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Endoscopic ultrasound‐guided antegrade biliary stenting for unresectable malignant biliary obstruction in patients with surgically altered anatomy: Single‐center prospective pilot study
Author(s) -
Iwashita Takuji,
Yasuda Ichiro,
Mukai Tsuyoshi,
Iwata Keisuke,
Doi Shinpei,
Uemura Shinya,
Mabuchi Masatoshi,
Okuno Mitsuru,
Shimizu Masahito
Publication year - 2017
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/den.12800
Subject(s) - medicine , endoscopic ultrasound , stent , radiology , percutaneous transhepatic cholangiography , pancreatitis , cholangiography , biliary fistula , prospective cohort study , bile duct , fistula , common bile duct , percutaneous , adverse effect , surgery
Background and Aim Endoscopic retrograde cholangiography (ERCP) with biliary stenting for the treatment of unresectable malignant biliary obstruction (MBO) is challenging among patients with surgically altered anatomy. Endoscopic ultrasound‐guided antegrade biliary stenting (EUS‐ABS) was introduced as an alternative biliary drainage method, although it has not yet been well studied. In this single‐center prospective pilot study, we aimed to evaluate the feasibility and safety of EUS‐ABS for MBO in patients with surgically altered anatomy. Methods EUS‐ABS for MBO was attempted in patients with surgically altered anatomy. In EUS‐ABS, the bile duct in the left lobe was accessed from the intestine under EUS guidance, and a guidewire was placed. Thereafter, an uncovered metallic stent was deployed at the MBO through the fistula. All devices were then removed. Technical, clinical, and adverse event rates, as well as patient characteristics and procedure details, were evaluated. Results Twenty patients (10 women; median age, 69 years) were enrolled in the present study. Technical and clinical success rates of EUS‐ABS were both 95% (19/20). In one patient, unsuccessful EUS‐ABS as a result of failed visualization of the left lobe of the liver with EUS was salvaged with percutaneous biliary drainage. Rate of adverse events was 20% (4/20), including mild pancreatitis in three patients and mild fever in one patient, which were successfully managed conservatively. Conclusions EUS‐ABS for MBO in patients with surgically altered anatomy was a feasible and safe procedure. Further large scale comparison studies are needed to confirm its efficacy (Clinical Trial Registration Number: UMIN8589).