Abstract
Background and Study Aims. Endoscopic ultrasound- (EUS-) guided biliary drainage (EUS-BD) is an alternative treatment for biliary obstruction after failed endoscopic retrograde cholangiopancreatography (ERCP). In this study, we present the outcomes of inpatients with obstructive jaundice treated with EUS-BD using a fully covered metallic stent after failed ERCP. Patients and Methods. A total of 21 patients with biliary obstruction due to malignant tumors and prior unsuccessful ERCP underwent EUS via an intra- or extrahepatic approach with fully covered metallic stent between March 2014 and October 2015. A single endoscopist performed all procedures. Results. Seven patients underwent hepatogastrostomy (HGS) and 14 underwent choledochoduodenostomy (CDS). The technical and clinical success rates were both 100%. There was no difference in efficacy between HGS and CDS. Adverse events occurred in three patients, including two in the HGS group (1 bile leakage and 1 sepsis) and one in the CDS group (sepsis). Four patients died as a result of their primary tumors during a median follow-up period of 13 months (range: 3–21 months). No patient presented with stent migration. Conclusion. EUS-BD using a fully covered metallic stent appears to be a safe and effective method for the treatment of obstructive jaundice.
Highlights
Endoscopic retrograde cholangiopancreatography (ERCP) has become the first-line therapy for bile duct drainage [1, 2]
The first case reports of Endoscopic ultrasound- (EUS-)guided transgastric and transduodenal biliary drainage using plastic or metallic stents were published in the early 2000s [10, 11], followed by subsequent case series [12,13,14,15,16]
The current study aimed to report the outcomes of EUSBD using a fully covered metallic stent for the treatment of 21 patients with obstructive jaundice and failed endoscopic retrograde cholangiopancreatography (ERCP)
Summary
Endoscopic retrograde cholangiopancreatography (ERCP) has become the first-line therapy for bile duct drainage [1, 2]. The first case reports of EUS-guided transgastric (hepatogastrostomy, HGS) and transduodenal (choledochoduodenostomy, CDS) biliary drainage using plastic or metallic stents were published in the early 2000s [10, 11], followed by subsequent case series [12,13,14,15,16]. Endoscopic ultrasound- (EUS-) guided biliary drainage (EUS-BD) is an alternative treatment for biliary obstruction after failed endoscopic retrograde cholangiopancreatography (ERCP). We present the outcomes of inpatients with obstructive jaundice treated with EUS-BD using a fully covered metallic stent after failed ERCP. A total of 21 patients with biliary obstruction due to malignant tumors and prior unsuccessful ERCP underwent EUS via an intra- or extrahepatic approach with fully covered metallic stent between March 2014 and October 2015. EUS-BD using a fully covered metallic stent appears to be a safe and effective method for the treatment of obstructive jaundice
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