Factors Associated With Successful Fistula Dilation in Endoscopic Ultrasound-guided Biliary Drainage

Abstract

BACKGROUND AND AIMSEndoscopic ultrasound-guided biliary drainage (EUS-BD) is an effective treatment for biliary obstruction comparable to endoscopic transpapillary drainage. However, fistula dilation is a critical step of EUS-BD. In this study, we aimed to identify factors associated with successful fistula dilation. METHODSThis observational study enrolled malignant biliary obstruction patients who underwent EUS-BD between May 2005 and April 2022. The factors (period, past history of gastrectomy, stricture part of biliary duct, method of EUS-BD, diameter of the punctured bile duct, distance of puncture route, needle diameter, guidewire diameter, guidewire position, dilator device, state of the scope and devices) associated with successful fistula dilation were investigated. RESULTSDeep placement of the guidewire into another segment of the bile duct (from the common bile duct [CBD] to the right or left hepatic duct, from B3 or B2 to the right hepatic duct or CBD) was the only factor significantly associated with successful fistula dilation (odds ratio 33.5; 95% CI 2.2-510, P = 0.01) in multivariate analysis. The other factors were not statistically significant. CONCLUSIONFor successful fistula dilation, guidewires should be deeply advanced to another area. In EUS-hepaticoenterostomy, the guidewire should be advanced to the right hepatic duct or CBD. In EUS-choledochoduodenostomy, the guidewire should be advanced to the right or left hepatic duct.