Abstract
Purpose. Endoscopic ultrasound-guided biliary drainage (EUS-BD) has been increasingly reported worldwide. However, studies concerning EUS-BD from Mainland China are sporadic. This study aims to investigate the feasibility, efficacy, and safety of EUS-BD using SEMS in a single center from Mainland China. Methods. Between November 2011 and August 2015, 24 patients underwent EUS-BD using a standardized algorithm. Results. Three patients underwent rendezvous technique (RV), 4 underwent hepaticogastrostomy (HGS), and 17 underwent choledochoduodenostomy (CDS). The technical and clinical success rates were 95.8% (23/24) and 100% (23/23), respectively. Mean procedure time for the CDS group (35.9 ± 5.0 min) or HGS group (39.3 ± 5.0 min) was significantly shorter than that for the RV group (64.7 ± 9.1 min) (P < 0.05). Complications (13%) included (1) cholangitis and (2) postprocedure hemorrhage. During the follow-up periods (mean 6.4 months), 22 (91.7%) patients died of tumor progression with mean stent patency of 5.8 ± 2.2 months. Stent occlusion occurred in 2 (8.7%) patients. Conclusion. EUS-BD using SEMS is a feasible, effective, and safe alternative for biliary decompression after failed ERCP. EUS-RV may not be the first-line choice for EUS-BD in a medium volume center. Further evaluation and experience of this method are needed.
Highlights
Endoscopic retrograde cholangiopancreatography (ERCP) is a well-established procedure for the management of malignant biliary obstruction [1,2,3]
fully covered SEMS (FCSEMS) is characteristic by better biliary drainage, prolonged stent patency, and easy stent revision, which may be a promising option for EUS-guided biliary drainage (EUS-BD) [9, 11, 14]
Since its first description in 2001, EUS-BD has been reported by multiple authors with high success and acceptable complication rate, suggesting it is an effective alternative to Percutaneous transhepatic biliary drainage (PTBD) or biliary bypass surgery after failed ERCP [9,10,11,12,13, 16, 17]
Summary
Endoscopic retrograde cholangiopancreatography (ERCP) is a well-established procedure for the management of malignant biliary obstruction [1,2,3]. Percutaneous transhepatic biliary drainage (PTBD) or surgical bypass has been selected as the salvage procedure in such circumstances. Surgical bypass is rarely performed because of its significant risk of postoperative morbidity and mortality, especially in patients with advanced malignant biliary obstruction [7]. Plastic stents were initially used for EUS-BD but similar to their transpapillary biliary application, there were concerns regarding duration of stent patency [9, 14]. This led to the introduction of self-expandable metal stents (SEMS), especially the fully covered SEMS (FCSEMS) [9]. FCSEMS is characteristic by better biliary drainage, prolonged stent patency, and easy stent revision, which may be a promising option for EUS-BD [9, 11, 14]
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