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. 2024 Mar 7;12(3):E377-E384.
doi: 10.1055/a-2261-2968. eCollection 2024 Mar.

EUS-BD for calibration of benign stenosis of the bile duct in patients with altered anatomy or inaccessible papilla

Fabrice Caillol  1 , Sébastien Godat  2 , Alexey Solovyev  3 , Amina Harouchi  1 , Sarra Oumrani  4 , Mariola Marx  1 , Solene Hoibian  1 , Yanis Dahel  1 , Jean-Philippe Ratone  5 , Marc Giovannini  6
Affiliations

EUS-BD for calibration of benign stenosis of the bile duct in patients with altered anatomy or inaccessible papilla

Fabrice Caillol et al. Endosc Int Open. .

Abstract

Background and study aims In cases of inaccessible papilla, EUS-guided biliary drainage (EUS-BD) has been described as an alternative to calibrate benign biliary stenosis. However, few studies are available. Patients and methods This tw-center, retrospective study was designed to evaluate technical success and clinical success at 1 year. All patients who underswent EUS-BD without the rendezvous technique used for calibration of benign biliary stenosis were included from 2016 to 2022. Patients underwent EUS-hepaticogastrostomy (EUS-HGS) during the first session. Then, HGS was used to access the bile duct, allowing calibration of the stenosis: Dilation of the biliary stenosis and placement of double pigtail stents through the stenosis for 1 year. Results Thirty-six patients were included. Technical success was 89% (32/36), with four failures to cross the stenosis but EUS-HGS was performed in 100% of the cases. Nine patients were excluded during calibration because of oncological relapse in six and complex stenosis in three. Three patients had not yet reached 1 year of follow-up. Twenty patients had a calibration for at least 1 year. Clinical success after stent placement was considered in all cases after 1 year of follow-up. Thirteen patients underwent stent removal and no relapse occurred after 435 days of follow-up (SD=568). Global morbidity was 41.7% (15/36) with only one serious complication (needing intensive care), including seven cases of cholangitis due to intrabiliary duct obstruction and five stent migrations. No deaths were reported. Conclusions EUS-BD for calibration in case of benign biliary stenosis is an option. Dedicated materials are needed to decrease morbidity.

Keywords: Biliary tract; Endoscopic ultrasonography; Intervention EUS; Pancreatobiliary (ERCP/PTCD); Strictures.

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Conflict of interest statement

Conflict of Interest The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Patient selection flowchart.
Fig. 2
Fig. 2
Opacified IHBD after puncture. Wire not crossing HJA. IHBD=Intra Heptaic Biliary Duct; HJA=Hepatic Jejunal Anastomosis.
Fig. 3
Fig. 3
Metal stent after 1st HGS.
Fig. 4
Fig. 4
Metal stent with double flare to prevent migration.
Fig. 5
Fig. 5
Placement of 3 pigtail plastic stents to calibrate HJA.
Fig. 6
Fig. 6
Iatrogenic cholangitis with dilation of IHBD due to obstruction of IHBD.
Fig. 7
Fig. 7
Iatrogenic cholangitis due to dilation of IHBD obstructed by metal stent.
Fig. 8
Fig. 8
Results of included patients.
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