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. 2021 Sep 29;2(1):e56.
doi: 10.1002/deo2.56. eCollection 2022 Apr.

Endoscopic ultrasound-guided choledochoduodenostomy without fistula dilation using a stent with a 5.9-Fr delivery system: Comparison to a conventional procedure with fistula dilation

Takehiko Koga  1 , Susumu Hijioka  1 , Yosikuni Nagashio  1 , Akihiro Ohba  1 , Yuta Maruki  1 , Motohiro Yoshinari  1 , Yuya Hisada  1 , Shota Harai  1 , Hidetoshi Kitamura  1 , Kosuke Maehara  1 , Yumi Murashima  1 , Yuki Kawasaki  1 , Shun Kawahara  1 , Kotaro Takeshita  1 , Natsumi Yamada  1 , Tomoyuki Satake  1 , Shunsuke Kondo  1 , Chigusa Morizane  1 , Hideki Ueno  1 , Takuji Okusaka  1 , Yutaka Saito  2
Affiliations

Endoscopic ultrasound-guided choledochoduodenostomy without fistula dilation using a stent with a 5.9-Fr delivery system: Comparison to a conventional procedure with fistula dilation

Takehiko Koga et al. DEN Open. .

Abstract

Objectives: To evaluate the feasibility and safety of endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) without fistula dilation using a novel self-expandable metal stent (SEMS).

Methods: This retrospective study examined patients who underwent EUS-CDS for malignant distal biliary obstruction between October 2017 and May 2021 at the National Cancer Center, Japan. The primary outcome was a technical success without fistula dilation. Secondary outcomes were the overall technical success, clinical success, adverse events (AEs), procedure time, recurrent biliary obstruction (RBO), and time to RBO (TRBO).

Results: Forty-one patients were enrolled; 31 patients underwent EUS-CDS with fistula dilation using a conventional SEMS with 7.5-8.5-Fr delivery system (conventional SEMS group), and 10 patients underwent EUS-CDS without fistula dilation using the novel SEMS with a 5.9-Fr delivery system (novel SEMS group). In the novel SEMS group, the rate of technical success without fistula dilation was 90%. There were no differences in overall technical success (100% vs. 97%, p = 1.00), clinical success (80% vs. 90%, p = 0.58), and overall AEs (10% vs. 23%, p = 0.65) rates between the novel and conventional SEMS groups. In the novel SEMS group, no early AEs were observed and no bile leakage into the abdominal cavity was observed on the computed tomography scan after the procedure. The median procedure time was significantly shorter in the novel SEMS group (17 min vs. 24 min, p = 0.03). RBO and median TRBO did not differ between the 2 groups.

Conclusions: EUS-CDS without fistula dilation using the novel SEMS with a 5.9-Fr delivery system is technically feasible, straightforward, quick, and safe.

Keywords: EUS; EUS‐BD; EUS‐CDS; endoscopic ultrasound‐guided biliary drainage; endoscopic ultrasound‐guided choledochoduodenostomy.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Fully covered self‐expandable metal stent with a 5.9‐Fr delivery system. (a) The outer sheath of the delivery catheter is sized 5.9 Fr with the tapered tip. (b) The expanded stent with a braiding design
FIGURE 2
FIGURE 2
Imaging findings following endoscopic ultrasound‐guided choledochoduodenostomy without fistula dilation. (a) Endoscopic image. (b) Fluoroscopic image
FIGURE 3
FIGURE 3
Study flow chart of patients undergoing endoscopic ultrasound‐guided choledochoduodenostomy. ERC, endoscopic retrograde cholangiography; EUS‐BD, endoscopic ultrasound‐guided biliary drainage; EUS‐HGS, endoscopic ultrasound‐guided hepaticogastrostomy; EUS‐RV, endoscopic ultrasound‐guided rendezvous technique; EUS‐HJS, endoscopic ultrasound‐guided hepaticojejunostomy; PTBD, percutaneous transhepatic biliary drainage; EUS‐CDS, endoscopic ultrasound‐guided choledochoduodenostomy; ERCP, endoscopic retrograde cholangiopancreatography
FIGURE 4
FIGURE 4
Kaplan–Meier curves with log‐rank test for time to recurrent biliary obstruction in the novel and conventional self‐expandable metal stent (SEMS) groups
FIGURE 5
FIGURE 5
The notches immediately after deployment of the novel self‐expandable metal stent (SEMS) without fistula dilation and conventional braided fully‐covered SEMS with fistula dilation. The notch (arrows) in the novel SEMS. (a) is deeper and steeper than that in the conventional SEMS (b)
See this image and copyright information in PMC

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