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. 2021 Dec;28(12):1130-1137.
doi: 10.1002/jhbp.1011. Epub 2021 Jul 8.

Initial experience of endoscopic ultrasound-guided antegrade covered stent placement with long duodenal extension for malignant distal biliary obstruction (with video)

Hoonsub So  1 , Dongwook Oh  2 , Mamoru Takenaka  3 , Kosuke Minaga  3 , Shinya Uemura  4 , Takuji Iwashita  4 , Tomotaka Saito  5 , Yousuke Nakai  5   6 , Seon Ok Kim  7 , Do Hyun Park  2
Affiliations

Initial experience of endoscopic ultrasound-guided antegrade covered stent placement with long duodenal extension for malignant distal biliary obstruction (with video)

Hoonsub So et al. J Hepatobiliary Pancreat Sci. 2021 Dec.

Abstract

Background/purpose: This study aimed to evaluate the feasibility of endoscopic ultrasound (EUS)-guided antegrade covered stent placement with long duodenal extension (EASL) for malignant distal biliary obstruction (MDBO) with duodenal obstruction (DO) or surgically altered anatomy (SAA) after failed endoscopic retrograde cholangiopancreatography (ERCP).

Methods: Outcomes were technical and clinical success, reintervention rate, adverse events, stent patency, and overall survival. Inverse probability of treatment weighting (IPTW) and competing-risk analysis were performed to compare with conventional EUS-BD.

Results: Twenty-five patients (DO, n = 18; SAA, n = 7) were included. The technical and clinical success rates were 96% and 84%, respectively. Reintervention occurred in two patients (8.3%). Adverse events occurred in six patients (24%; two cholangitis, 16%; four mild postprocedural pancreatitis [24% (n = 4/17) in patients with non-pancreatic cancers]). The median patency was 9.4 months, and the overall survival was 2.73 months. After IPTW adjustment, the median patency in the EASL (n = 25) and conventional EUS-BD (n = 29) were 10.1 and 6.5 months, respectively (P = .018).

Conclusions: EASL has acceptable clinical outcomes with a low reintervention rate but higher rate of postprocedural pancreatitis in patients with non-pancreatic cancers. Randomized trials comparing EASL and conventional EUS-BD for MDBO with pancreatic cancers and DO/SAA after failed ERCP are needed to validate our findings.

Keywords: EUS-guided biliary drainage; Endoscopic ultrasound; duodenal obstruction; malignant biliary obstruction; surgically altered anatomy.

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Conflict of interest statement

All authors disclose no financial relationships relevant to this article.

Figures

FIGURE 1
FIGURE 1
Stent for endoscopic ultrasound‐guided antegrade covered stent placement with long duodenal extension. (A) A fully covered self‐expanding metal stent (silicone‐covered and nitinol‐wired, 8 mm in diameter, 11‐13 cm in length; Standard Sci Tech, Seoul, Korea). (B) An 8‐Fr‐diameter stent introducer
FIGURE 2
FIGURE 2
Steps for stent placement in endoscopic ultrasound (EUS)‐guided antegrade covered stent placement with long duodenal extension (EASL). (A) The dilated left intrahepatic duct was punctured with a 19‐gauge EUS needle. (B) After crossing the distal bile duct stricture, the guidewire was straightened in the bile duct and coiled in the distal duodenum for pushability and for an easier procedure. (C) Endoscopic papillary balloon dilation with a 4‐mm Hurricane balloon for 30 s. (D) At least 5 cm length of the stent was secured in the distal duodenum. (E) Computed tomography scan taken after the EASL procedure showing decompression of the bile duct and the well‐placed biliary stent
FIGURE 3
FIGURE 3
Fluoroscopic image of the side‐by‐side placement of the biliary and duodenal metal stent (A‐C) showing no contrast reflux into the covered biliary metal stent with long duodenal extension after injecting contrast via the duodenal metal stent (D)
FIGURE 4
FIGURE 4
Adjusted Kaplan‐Meier curve showing patency difference between EASL group and other EUS‐guided drainage procedures (P =.018)
See this image and copyright information in PMC

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