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Cho SH, Kim SJ, Song TJ, Oh D, Seo D. Comparison of fully versus partially covered metal stents in endoscopic ultrasound-guided hepaticogastrostomy for malignant biliary obstruction (with video). Dig Endosc 2025; 37:532-540. [PMID: 39605291 PMCID: PMC12062555 DOI: 10.1111/den.14952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Accepted: 10/10/2024] [Indexed: 11/29/2024]
Abstract
BACKGROUND Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) using a fully covered metal stent (FCMS) or partially covered metal stent (PCMS) is performed to manage unresectable malignant biliary obstruction (MBO) following unsuccessful endoscopic retrograde cholangiopancreatography. This study aimed to compare FCMS and PCMS for EUS-HGS in patients with MBO. METHODS We reviewed the EUS database to analyze consecutive patients with MBO who underwent EUS-HGS between November 2017 and March 2023. We performed a 1:1 matching using propensity score matching based on potential confounding factors. Stent patency, technical success, clinical success, adverse events, reintervention, and overall survival were assessed. RESULTS The technical success rate of EUS-HGS was 92% (123/134). A total of 80 patients with technical success (40 FCMS, 40 PCMS) were selected after propensity score matching. The two groups showed similar rates of clinical success (90% vs. 88%; P = 0.999), early adverse events (15% vs. 20%; P = 0.556), late adverse events (18% vs. 33%; P = 0.121), reintervention (20% vs. 38%; P = 0.084), and median overall survival (4.1 months [95% confidence interval (CI) 2.6-5.5] vs. 3.8 months [95% CI 1.9-5.7]; P = 0.609). During follow-up, the FCMS group showed higher patency rates (85% vs. 60% at 6 months; 76% vs. 43% at 12 months; P = 0.030). CONCLUSIONS FCMS and PCMS for EUS-HGS in patients with unresectable MBO showed similar rates of clinical success, as well as early and late adverse events. However, the FCMS group showed a higher cumulative stent patency rate compared to the PCMS group.
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Affiliation(s)
- Sung Hyun Cho
- Department of Gastroenterology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulSouth Korea
| | - Seong Je Kim
- Department of Gastroenterology, Gyeongsang National University HospitalGyeongsang National University School of MedicineJinjuSouth Korea
| | - Tae Jun Song
- Department of Gastroenterology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulSouth Korea
| | - Dongwook Oh
- Department of Gastroenterology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulSouth Korea
| | - Dong‐Wan Seo
- Department of Gastroenterology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulSouth Korea
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Yamashige D, Hijioka S, Nagashio Y, Maruki Y, Komori Y, Kuwada M, Fukuda S, Yagi S, Okamoto K, Agarie D, Chatto M, Morizane C, Ueno H, Sugawara S, Sone M, Saito Y, Okusaka T. Metal stent versus plastic stent in endoscopic ultrasound-guided hepaticogastrostomy for unresectable malignant biliary obstruction: Large single-center retrospective comparative study. Dig Endosc 2025; 37:117-129. [PMID: 39544136 PMCID: PMC11718138 DOI: 10.1111/den.14956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Accepted: 10/10/2024] [Indexed: 11/17/2024]
Abstract
OBJECTIVE Whether metal stents (MS) or plastic stents (PS) yield better outcomes for malignant biliary obstruction in endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is controversial. We aimed to compare outcomes of initial EUS-HGS performed with MS or PS. METHODS In this single-center retrospective study, we included patients (MS/PS groups: n = 151/72) with unresectable malignant biliary obstruction and performed multivariable analysis. The landmark date was defined as day 100 and used to evaluate the time to recurrent biliary obstruction (TRBO). RESULTS The clinical success rate was similar in both groups. The mean total bilirubin percentage decrease at week 2 was significantly higher in the MS group than in the PS group (-45.1% vs. -23.7%, P = 0.016). Median TRBO was significantly different between the MS and PS groups (183 and 92 days, respectively; P = 0.017). TRBO within 100 days was comparable in both groups but was significantly shorter only after 100 days in the PS group (adjusted hazard ratio 12.8, P < 0.001). Adverse events were significantly more common in the MS group (23.8% vs. 9.7%, P = 0.012), although they occurred relatively frequently even with PS in the cholangitis subgroup (Pinteraction = 0.034). After endoscopic re-intervention, TRBO tended to be longer with revision PS (hazard ratio 0.40, P = 0.47). CONCLUSIONS Although MS provided early improvement of jaundice and long stent patency, PS provided a better safety profile and comparable stent patency until 100 days. PS might also be an adequate and optimal palliation method in EUS-HGS.
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Affiliation(s)
- Daiki Yamashige
- Department of Hepatobiliary and Pancreatic OncologyNational Cancer Center HospitalTokyoJapan
| | - Susumu Hijioka
- Department of Hepatobiliary and Pancreatic OncologyNational Cancer Center HospitalTokyoJapan
| | - Yoshikuni Nagashio
- Department of Hepatobiliary and Pancreatic OncologyNational Cancer Center HospitalTokyoJapan
| | - Yuta Maruki
- Department of Hepatobiliary and Pancreatic OncologyNational Cancer Center HospitalTokyoJapan
| | - Yasuhiro Komori
- Department of Hepatobiliary and Pancreatic OncologyNational Cancer Center HospitalTokyoJapan
| | - Masaru Kuwada
- Department of Hepatobiliary and Pancreatic OncologyNational Cancer Center HospitalTokyoJapan
| | - Soma Fukuda
- Department of Hepatobiliary and Pancreatic OncologyNational Cancer Center HospitalTokyoJapan
| | - Shin Yagi
- Department of Hepatobiliary and Pancreatic OncologyNational Cancer Center HospitalTokyoJapan
| | - Kohei Okamoto
- Department of Hepatobiliary and Pancreatic OncologyNational Cancer Center HospitalTokyoJapan
| | - Daiki Agarie
- Department of Hepatobiliary and Pancreatic OncologyNational Cancer Center HospitalTokyoJapan
| | - Mark Chatto
- Section of Gastroenterology, Department of MedicineMakati Medical CenterManilaPhilippines
| | - Chigusa Morizane
- Department of Hepatobiliary and Pancreatic OncologyNational Cancer Center HospitalTokyoJapan
| | - Hideki Ueno
- Department of Hepatobiliary and Pancreatic OncologyNational Cancer Center HospitalTokyoJapan
| | - Shunsuke Sugawara
- Department of Diagnostic RadiologyNational Cancer Center HospitalTokyoJapan
| | - Miyuki Sone
- Department of Diagnostic RadiologyNational Cancer Center HospitalTokyoJapan
| | - Yutaka Saito
- Endoscopy DivisionNational Cancer Center HospitalTokyoJapan
| | - Takuji Okusaka
- Department of Hepatobiliary and Pancreatic OncologyNational Cancer Center HospitalTokyoJapan
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Ogura T, Ueno S, Okuda A, Nishioka N, Sakamoto J, Yamada M, Yamamura M, Uba Y, Tomita M, Hattori N, Nakamura J, Bessho K, Nishikawa H. Impact of self-expandable metal stent deployment site on stent dysfunction during EUS-guided hepaticogastrostomy. Endosc Ultrasound 2025; 14:26-32. [PMID: 40151600 PMCID: PMC11939943 DOI: 10.1097/eus.0000000000000100] [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: 03/03/2024] [Accepted: 12/03/2024] [Indexed: 03/29/2025] Open
Abstract
Background and Objectives Hyperplasia at the distal side of an EUS-guided hepaticogastrostomy (HGS) stent is one of the most frequent causes of stent dysfunction. However, risk factors for hyperplasia during EUS-HGS remain unclear. The aim of the present study was to determine the most appropriate stent site during EUS-HGS to obtain prolonged stent patency. Method This study included 100 consecutive patients who underwent successful EUS-HGS using a partially covered, self-expandable, metal stent (PCSEMS) between January 2017 and September 2022. The patients were divided into 2 groups according to the distal site of the PCSEMS at the intrahepatic bile duct, the peripheral side group and the central side group. Results There were 30 patients in the peripheral side group and 70 in the central side group. The diameter of the intrahepatic bile duct at the PCSEMS deployment site was significantly greater in the central side group (mean 7.90 mm) than in the peripheral side group (mean 4.25 mm; P < 0.05). Stent patency was significantly longer in the central side group than in the peripheral side group (median, 60 days vs. 144 days, P = 0.011), although overall survival was not significantly different. Hyperplasia was significantly more frequent in the peripheral side group. On multivariate analysis, the site of the PCSEMS (peripheral) was the only risk factor for stent dysfunction. Conclusions In conclusion, the distal site of the PCSEMS deployed at the hepatic hilar site from the confluence between B2 and B3 might play a role in obtaining longer stent patency.
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Affiliation(s)
- Takeshi Ogura
- Endoscopy Center, Osaka Medical and Pharmaceutical University, Osaka, Japan
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Saori Ueno
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Atsushi Okuda
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Nobu Nishioka
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Jun Sakamoto
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Masanori Yamada
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Masahiro Yamamura
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Yuki Uba
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Mitsuki Tomita
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Nobuhiro Hattori
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Junichi Nakamura
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Kimi Bessho
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Hiroki Nishikawa
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
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Ogata T, Kurita Y, Sato T, Yagi S, Hasegawa S, Hosono K, Kobayashi N, Endo I, Kubota K, Nakajima A. Thin Delivery Stents Can Obviate the Need for Additional Fistula Dilatation of Large Diameter in Endoscopic Ultrasound-Guided Hepaticogastrostomy. J Clin Med 2024; 13:6328. [PMID: 39518467 PMCID: PMC11546826 DOI: 10.3390/jcm13216328] [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: 09/16/2024] [Revised: 10/10/2024] [Accepted: 10/18/2024] [Indexed: 11/16/2024] Open
Abstract
Background/Objectives: Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) often requires fistula dilation owing to the placement of a large diameter of the delivery stent. The recently developed delivery devices, which are as thin as 5.9/6.0 Fr, may save the need for fistula dilation. Therefore, we investigated whether large fistula dilation would be required or not in the case of this newly developed thin-diameter delivery stents. Methods: We conducted a retrospective study involving 33 patients implemented with a self-expandable metal stent (SEMS) during EUS-HGS. The patients were categorized based on the delivery device diameter into thin (n = 13; delivery device diameter: 5.9/6.0 Fr) and thick (n = 20; delivery device diameter: 8.5 Fr) groups. We compared the initial rate of success, technical success, and clinical success between the thin and thick groups. The initial rate of success was defined as successful stent placement without a balloon or large diameter mechanical dilation. Results: The rate of the initial stenting success was significantly higher in the thin group (100% [13/13]) compared with that in the thick group (65.0% [13/20]) (p = 0.027). In the thick group, seven cases with technical difficulty in terms of stent placement could be successfully completed with additional fistula dilation with a 9 Fr bougie dilator or 4 mm balloon dilator; this resulted in a technical success of 100% in both groups ultimately. The rate of clinical success was 100% and 95.0% in the thin and thick groups, respectively (p = 1.00). Conclusions: Thin delivery stents may facilitate stent placement without the need for a balloon fistula or large-diameter mechanical dilation.
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Affiliation(s)
- Tomoki Ogata
- Department of Gastroenterology and Hepatology, Yokohama City University, Yokohama 236-0004, Japan; (T.O.); (T.S.); (S.Y.); (S.H.); (K.H.); (K.K.); (A.N.)
| | - Yusuke Kurita
- Department of Gastroenterology and Hepatology, Yokohama City University, Yokohama 236-0004, Japan; (T.O.); (T.S.); (S.Y.); (S.H.); (K.H.); (K.K.); (A.N.)
| | - Takamitsu Sato
- Department of Gastroenterology and Hepatology, Yokohama City University, Yokohama 236-0004, Japan; (T.O.); (T.S.); (S.Y.); (S.H.); (K.H.); (K.K.); (A.N.)
| | - Shin Yagi
- Department of Gastroenterology and Hepatology, Yokohama City University, Yokohama 236-0004, Japan; (T.O.); (T.S.); (S.Y.); (S.H.); (K.H.); (K.K.); (A.N.)
| | - Sho Hasegawa
- Department of Gastroenterology and Hepatology, Yokohama City University, Yokohama 236-0004, Japan; (T.O.); (T.S.); (S.Y.); (S.H.); (K.H.); (K.K.); (A.N.)
| | - Kunihiro Hosono
- Department of Gastroenterology and Hepatology, Yokohama City University, Yokohama 236-0004, Japan; (T.O.); (T.S.); (S.Y.); (S.H.); (K.H.); (K.K.); (A.N.)
| | | | - Itaru Endo
- Department of Gastroenterological Surgery, Yokohama City University Hospital, Yokohama 236-0004, Japan;
| | - Kensuke Kubota
- Department of Gastroenterology and Hepatology, Yokohama City University, Yokohama 236-0004, Japan; (T.O.); (T.S.); (S.Y.); (S.H.); (K.H.); (K.K.); (A.N.)
| | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, Yokohama City University, Yokohama 236-0004, Japan; (T.O.); (T.S.); (S.Y.); (S.H.); (K.H.); (K.K.); (A.N.)
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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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Oh D, Han SY, Lee SH, Kim SH, Paik WH, Chon HK, Song TJ, Park SW, Cho JH. Comparison of long-term outcomes of endoscopic ultrasound-guided hepaticogastrostomy and choledochoduodenostomy for distal malignant biliary obstruction: a multicenter retrospective study. Therap Adv Gastroenterol 2024; 17:17562848241239551. [PMID: 38510458 PMCID: PMC10953094 DOI: 10.1177/17562848241239551] [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: 11/26/2023] [Accepted: 02/27/2024] [Indexed: 03/22/2024] Open
Abstract
Background Endoscopic ultrasound-guided biliary drainage (EUS-BD), classified as choledochoduodenostomy (CDS) and hepaticogastrostomy (HGS), is a feasible and effective alternative for distal malignant biliary obstruction (MBO) in failed endoscopic retrograde cholangiopancreatography. However, the preferred technique for better outcomes has not yet been evaluated. Objectives We compared the long-term outcomes between the techniques. Design Retrospective comparative study. Methods We reviewed consecutive patients who underwent EUS-CDS or EUS-HGS with transmural stent placement for distal MBO between 2009 and 2022. The primary outcome was the stent patency. The secondary outcomes were technical and clinical success, adverse events (AEs) of each technique, and independent risk factors for stent dysfunction. Results In all, 115 patients were divided into EUS-CDS (n = 56) and EUS-HGS (n = 59) groups. Among them, technical success was achieved in 98.2% of EUS-CDS and 96.6% of EUS-HGS groups. Furthermore, clinical success was 96.4% in EUS-CDS and 88.1% in EUS-HGS groups, without significant difference (p = 0.200). The mean duration of stent patency for EUS-CDS was 770.3 days while that for EUS-HGS was 164.9 days (p = 0.010). In addition, the only independent risk factor for stent dysfunction was systematic treatment after EUS-BD [hazard ratio and 95% confidence interval 0.238 (0.066-0.863), p = 0.029]. The incidence of stent dysfunction of EUS-HGS was higher than EUS-CDS (35.1% versus 18.2%, 0.071), despite no significant differences even in late AEs. Conclusion In distal MBO, EUS-CDS may be better than EUS-HGS with longer stent patency and fewer AEs. Furthermore, systematic treatment after EUS-BD is recommended for the improvement of stent patency.
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Affiliation(s)
- Dongwook Oh
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung Yong Han
- Division of Gastroenterology and Hepatology, Internal Medicine and Biomedical Research Institute, Pusan National University Hospital and school of medicine, Pusan National University, Busan, Republic of korea
| | - Sang Hyub Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seong-Hun Kim
- Department of Internal Medicine, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Woo Hyun Paik
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyung-Ku Chon
- Division of Gastroenterology, Department of Internal Medicine, Wonkwang University College of Medicine, Iksan, Republic of Korea
| | - Tae Jun Song
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Se Woo Park
- Division of Gastroenterology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, 7, Keunjaebong-gil, Hwaseong-si, Gyeonggi-do 18450, Republic of Korea
| | - Jae Hee Cho
- Division of Gastroenterology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul 03722, Republic of Korea
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Takahashi K, Ohyama H, Ohno I, Takiguchi Y, Kato N. Asymptomatic Pneumoperitoneum With a Large Amount of Gas Appeared During Endoscopic Ultrasound-Guided Biliary Drainage. Cureus 2024; 16:e54330. [PMID: 38500944 PMCID: PMC10944802 DOI: 10.7759/cureus.54330] [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] [Accepted: 02/15/2024] [Indexed: 03/20/2024] Open
Abstract
We report a case in which a large amount of intraperitoneal free gas developed during endoscopic ultrasound-guided biliary drainage with the rendezvous technique. A 62-year-old woman presented with obstructive jaundice caused by a pancreatic head tumor. Endoscopic retrograde cholangiopancreatography was attempted but failed due to difficulty cannulating the bile duct. Consequently, endoscopic ultrasound-guided hepaticogastrostomy was performed using a fully covered metal stent. Subsequently, the rendezvous technique was employed to access the biliary system and perform an endoscopic sphincterotomy. Finally, a fully covered metal stent was placed transpapillary. Fluoroscopic imaging during the procedure revealed a large amount of gas between the liver and diaphragm. Despite the pneumoperitoneum, the patient experienced no abdominal pain or fever. One week later, a computed tomography scan confirmed the disappearance of free air in the intraperitoneal cavity. The patient's subsequent clinical course remained uneventful, and she was discharged from the hospital. This case highlights the potential for pneumoperitoneum to develop during endoscopic ultrasound-guided biliary drainage, particularly when using the rendezvous technique. It is crucial to differentiate this finding from gastrointestinal perforation based on clinical presentation and imaging features.
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Affiliation(s)
- Koji Takahashi
- Department of Gastroenterology, Chiba University, Chiba, JPN
| | - Hiroshi Ohyama
- Department of Gastroenterology, Chiba University, Chiba, JPN
| | - Izumi Ohno
- Department of Gastroenterology, Chiba University, Chiba, JPN
| | | | - Naoya Kato
- Department of Gastroenterology, Chiba University, Chiba, JPN
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8
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Bazaga S, García-Alonso FJ, Aparicio Tormo JR, Martinez Moreno B, Sanchiz V, Gornals JB, Loras C, Terán Á, Vazquez-Sequeiros E, Pedraza Sanz R, Súbtil JC, Pérez-Millan A, Uceda Porta F, Vila JJ, de la Serna-Higuera C, Couto-Worner I, Guarner-Argente C, Perez-Miranda M. Endoscopic ultrasound-guided gallbladder drainage with long-term lumen-apposing metal stent indwell: 1-year results from a prospective nationwide observational study. J Gastroenterol Hepatol 2024; 39:360-368. [PMID: 37920889 DOI: 10.1111/jgh.16392] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND AND AIM This study aimed to determine safety and risk factors for adverse events (AEs) of endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) with long-term indwell of lumen-apposing metal stents (LAMS). METHODS This study is a multicenter prospective observational study on consecutive high surgical-risk patients requiring gallbladder drainage who underwent EUS-GBD with LAMS over 12 months. Centralized telephone follow-up interviews were conducted every 3 months for 1 year. Patients were censored at LAMS removal, cholecystectomy, or death. AE-free survival was determined using log-rank tests. Cumulative risks were estimated using life-table analysis. RESULTS Eighty-two patients were included (53.7% male, median [interquartile range] age of 84.6 [76.5-89.8] years, and 85.4% with acute cholecystitis). Technical success was achieved in 79 (96.3%), and clinical success in 73 (89%). No patient was lost to follow-up; 45 patients (54.9%) completed 1-year follow-up with in situ LAMS. Median (interquartile range) LAMS indwell time was 364 (47-367) days. Overall, 12 (14.6%) patients presented 14 AEs, including 5 (6.1%) recurrent biliary events (3 acute cholangitis, 1 mild acute pancreatitis, and 1 acute cholecystitis). Patients with pancreatobiliary malignancy had an increased risk of recurrent biliary events (33% vs 1.5%, P = 0.001). The overall 1-year cumulative risk of recurrent biliary events was 9.7% (4.1-21.8%). The 1-year risk of AEs and of severe AEs was 18.8% (11-31.2%) and 7.9% (3.3-18.2%), respectively. Pancreatobiliary malignancy was the single risk factor for recurrent biliary events; LAMS misdeployment was the strongest risk factor for AEs. CONCLUSIONS Long-term LAMS indwell does not increase the risk of delayed AEs following EUS-GBD.
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Affiliation(s)
- Sergio Bazaga
- Department of Gastroenterology, Hospital Universitario Rio Hortega, Valladolid, Spain
- Department of Medicine, Universitat Autónoma de Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | | | | | - Joan B Gornals
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Barcelona, Spain
| | - Carme Loras
- Department of Gastroenterology, Hospital Universitari Mútua Terrassa, Fundació per la Recerca Mútua Terrassa, Terrassa, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Álvaro Terán
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Enrique Vazquez-Sequeiros
- Endoscopy Unit, Department of Gastroenterology and Hepatology, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain
| | | | - José Carlos Súbtil
- Department of Gastroenterology, Endoscopy Unit, University of Navarra Clinic, University of Navarra, Pamplona, Spain
| | | | | | - Juan J Vila
- Complejo Hospitalario de Navarra, Pamplona, Spain
| | | | | | - Carlos Guarner-Argente
- Department of Medicine, Universitat Autónoma de Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Perez-Miranda
- Department of Gastroenterology, Hospital Universitario Rio Hortega, Valladolid, Spain
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Spadaccini M, Giacchetto CM, Fiacca M, Colombo M, Andreozzi M, Carrara S, Maselli R, Saccà F, De Marco A, Franchellucci G, Khalaf K, Koleth G, Hassan C, Anderloni A, Repici A, Fugazza A. Endoscopic Biliary Drainage in Surgically Altered Anatomy. Diagnostics (Basel) 2023; 13:3623. [PMID: 38132207 PMCID: PMC10742737 DOI: 10.3390/diagnostics13243623] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/04/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023] Open
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is considered the preferred method for managing biliary obstructions. However, the prevalence of surgically modified anatomies often poses challenges, making the standard side-viewing duodenoscope unable to reach the papilla in most cases. The increasing instances of surgically altered anatomies (SAAs) result from higher rates of bariatric procedures and surgical interventions for pancreatic malignancies. Conventional ERCP with a side-viewing endoscope remains effective when there is continuity between the stomach and duodenum. Nonetheless, percutaneous transhepatic biliary drainage (PTBD) or surgery has historically been used as an alternative for biliary drainage in malignant or benign conditions. The evolving landscape has seen various endoscopic approaches tailored to anatomical variations. Innovative methodologies such as cap-assisted forward-viewing endoscopy and enteroscopy have enabled the performance of ERCP. Despite their utilization, procedural complexities, prolonged durations, and accessibility challenges have emerged. As a result, there is a growing interest in novel enteroscopy and endoscopic ultrasound (EUS) techniques to ensure the overall success of endoscopic biliary drainage. Notably, EUS has revolutionized this domain, particularly through several techniques detailed in the review. The rendezvous approach has been pivotal in this field. The antegrade approach, involving biliary tree puncturing, allows for the validation and treatment of strictures in an antegrade fashion. The EUS-transmural approach involves connecting a tract of the biliary system with the GI tract lumen. Moreover, the EUS-directed transgastric ERCP (EDGE) procedure, combining EUS and ERCP, presents a promising solution after gastric bypass. These advancements hold promise for expanding the horizons of comprehensive and successful biliary drainage interventions, laying the groundwork for further advancements in endoscopic procedures.
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Affiliation(s)
- Marco Spadaccini
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital-IRCCS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (M.S.); (C.M.G.); (M.F.); (M.C.); (M.A.); (S.C.); (R.M.); (F.S.); (A.D.M.); (G.F.); (C.H.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
| | - Carmelo Marco Giacchetto
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital-IRCCS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (M.S.); (C.M.G.); (M.F.); (M.C.); (M.A.); (S.C.); (R.M.); (F.S.); (A.D.M.); (G.F.); (C.H.)
| | - Matteo Fiacca
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital-IRCCS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (M.S.); (C.M.G.); (M.F.); (M.C.); (M.A.); (S.C.); (R.M.); (F.S.); (A.D.M.); (G.F.); (C.H.)
| | - Matteo Colombo
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital-IRCCS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (M.S.); (C.M.G.); (M.F.); (M.C.); (M.A.); (S.C.); (R.M.); (F.S.); (A.D.M.); (G.F.); (C.H.)
| | - Marta Andreozzi
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital-IRCCS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (M.S.); (C.M.G.); (M.F.); (M.C.); (M.A.); (S.C.); (R.M.); (F.S.); (A.D.M.); (G.F.); (C.H.)
| | - Silvia Carrara
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital-IRCCS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (M.S.); (C.M.G.); (M.F.); (M.C.); (M.A.); (S.C.); (R.M.); (F.S.); (A.D.M.); (G.F.); (C.H.)
| | - Roberta Maselli
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital-IRCCS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (M.S.); (C.M.G.); (M.F.); (M.C.); (M.A.); (S.C.); (R.M.); (F.S.); (A.D.M.); (G.F.); (C.H.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
| | - Fabio Saccà
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital-IRCCS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (M.S.); (C.M.G.); (M.F.); (M.C.); (M.A.); (S.C.); (R.M.); (F.S.); (A.D.M.); (G.F.); (C.H.)
| | - Alessandro De Marco
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital-IRCCS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (M.S.); (C.M.G.); (M.F.); (M.C.); (M.A.); (S.C.); (R.M.); (F.S.); (A.D.M.); (G.F.); (C.H.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
| | - Gianluca Franchellucci
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital-IRCCS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (M.S.); (C.M.G.); (M.F.); (M.C.); (M.A.); (S.C.); (R.M.); (F.S.); (A.D.M.); (G.F.); (C.H.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
| | - Kareem Khalaf
- Department of Gastroenterology, Saint Michael’s Hospital, University of Toronto, Toronto, ON M5B 1W8, Canada;
| | - Glenn Koleth
- Hospital Sultan Ismail, Malaysian Ministry of Health, Johor Bahru 81100, Malaysia;
| | - Cesare Hassan
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital-IRCCS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (M.S.); (C.M.G.); (M.F.); (M.C.); (M.A.); (S.C.); (R.M.); (F.S.); (A.D.M.); (G.F.); (C.H.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
| | - Andrea Anderloni
- Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Alessandro Repici
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital-IRCCS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (M.S.); (C.M.G.); (M.F.); (M.C.); (M.A.); (S.C.); (R.M.); (F.S.); (A.D.M.); (G.F.); (C.H.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
| | - Alessandro Fugazza
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital-IRCCS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (M.S.); (C.M.G.); (M.F.); (M.C.); (M.A.); (S.C.); (R.M.); (F.S.); (A.D.M.); (G.F.); (C.H.)
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Fukasawa Y, Fukasawa M, Takano S, Kawakami S, Hayakawa H, Harai S, Enomoto N. Guidewire malposition outside the bile duct during endoscopic ultrasound-guided hepaticogastrostomy. Endoscopy 2023; 55:E894-E895. [PMID: 37442180 PMCID: PMC10344610 DOI: 10.1055/a-2113-9777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Affiliation(s)
- Yoshimitsu Fukasawa
- Department of Gastroenterology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Mitsuharu Fukasawa
- Department of Gastroenterology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Shinichi Takano
- Department of Gastroenterology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Satoshi Kawakami
- Department of Gastroenterology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Hiroshi Hayakawa
- Department of Gastroenterology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Shota Harai
- Department of Gastroenterology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Nobuyuki Enomoto
- Department of Gastroenterology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
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11
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Chon HK, Irani S, Kim TH. The writing on the wall: self-expandable stents for endoscopic ultrasound-guided hepaticogastrostomy? Clin Endosc 2023; 56:741-743. [PMID: 37915189 PMCID: PMC10665623 DOI: 10.5946/ce.2023.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/12/2023] [Accepted: 09/13/2023] [Indexed: 11/03/2023] Open
Affiliation(s)
- Hyung Ku Chon
- Division of Biliopancreas, Department of Internal Medicine, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea
| | - Shayan Irani
- Department of Gastroenterology, Virginia Mason Medical Center, Seattle, WA, USA
| | - Tae Hyeon Kim
- Division of Biliopancreas, Department of Internal Medicine, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea
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12
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Giri S, Mohan BP, Jearth V, Kale A, Angadi S, Afzalpurkar S, Harindranath S, Sundaram S. Adverse events with EUS-guided biliary drainage: a systematic review and meta-analysis. Gastrointest Endosc 2023; 98:515-523.e18. [DOI: https:/doi.org/10.1016/j.gie.2023.06.055] [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: 04/13/2025]
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13
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Giri S, Mohan BP, Jearth V, Kale A, Angadi S, Afzalpurkar S, Harindranath S, Sundaram S. Adverse events with EUS-guided biliary drainage: a systematic review and meta-analysis. Gastrointest Endosc 2023; 98:515-523.e18. [PMID: 37392952 DOI: 10.1016/j.gie.2023.06.055] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/01/2023] [Accepted: 06/20/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND AND AIMS Multiple meta-analyses have evaluated the technical and clinical success of EUS-guided biliary drainage (BD), but meta-analyses concerning adverse events (AEs) are limited. The present meta-analysis analyzed AEs associated with various types of EUS-BD. METHODS A literature search of MEDLINE, Embase, and Scopus was conducted from 2005 to September 2022 for studies analyzing the outcome of EUS-BD. The primary outcomes were incidence of overall AEs, major AEs, procedure-related mortality, and reintervention. The event rates were pooled using a random-effects model. RESULTS One hundred fifty-five studies (7887 patients) were included in the final analysis. The pooled clinical success rates and incidence of AEs with EUS-BD were 95% (95% confidence interval [CI], 94.1-95.9) and 13.7% (95% CI, 12.3-15.0), respectively. Among early AEs, bile leak was the most common followed by cholangitis with pooled incidences of 2.2% (95% CI, 1.8-2.7) and 1.0% (95% CI, .8-1.3), respectively. The pooled incidences of major AEs and procedure-related mortality with EUS-BD were .6% (95% CI, .3-.9) and .1% (95% CI, .0-.4), respectively. The pooled incidences of delayed migration and stent occlusion were 1.7% (95% CI, 1.1-2.3) and 11.0% (95% CI, 9.3-12.8), respectively. The pooled event rate for reintervention (for stent migration or occlusion) after EUS-BD was 16.2% (95% CI, 14.0-18.3; I2 = 77.5%). CONCLUSIONS Despite a high clinical success rate, EUS-BD may be associated with AEs in one-seventh of the cases. However, major AEs and mortality incidence remain less than 1%, which is reassuring.
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Affiliation(s)
- Suprabhat Giri
- Department of Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Babu P Mohan
- Department of Gastroenterology, University of Utah, Salt Lake City, Utah, USA
| | - Vaneet Jearth
- Department of Gastroenterology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Aditya Kale
- Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Sumaswi Angadi
- Department of Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Shivaraj Afzalpurkar
- Department of Gastroenterology, Nanjappa Multispecialty Hospital, Davanagere, India
| | - Sidharth Harindranath
- Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Sridhar Sundaram
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
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