Usefulness of the Novel Snare-over-the-Guidewire Method for Transpapillary Plastic Stent Replacement (with Video).

Akihiro Yoshida,Ayana Okamoto,Atsushi Nakai,Kosuke Minaga,Shunsuke Omoto,Mamoru Takenaka,Yoriaki Komeda,Ken Kamata,Naoshi Nishida,Tomohiro Yamazaki,Hidekazu Tanaka,Kota Takashima,Masatoshi Kudo,Kentaro Yamao

doi:10.3390/jcm10132858

Abstract

Unsuccessful stent replacement in transpapillary biliary drainage with plastic stents (PSs) has a significant impact on patient prognosis; thus, a safe and reliable replacement method is required. We aimed to compare the snare-over-the-guidewire (SOG) method, wherein the PS lumen is used as an access route to the biliary tract and the PS is removed with a snare inserted via the inserted guidewire, with the conventional side-of-stent (SOS) method, wherein the biliary approach is performed from the side of the PS. This retrospective single-center study included 244 consecutive patients who underwent biliary PS replacement between January 2018 and July 2020. The procedural success rates were compared between the two methods. A predictive analysis of unsuccessful PS replacement was also performed. The procedural success rate in the SOG group was significantly higher than that in the SOS group (p = 0.026). In the proximal biliary stenosis lesion, the same trend was observed (p = 0.025). Multivariate analysis also showed that the SOS method (p = 0.0038), the presence of proximal biliary stenosis (p < 0.0001), and parapapillary diverticulum (p = 0.0007) were predictors of unsuccessful PS replacement. The SOG method may be useful for biliary PS replacement, especially in cases of proximal hilar bile duct stenosis.

Highlights

Among the endoscopic retrograde cholangiopancreatography (ERCP)-related procedures, transpapillary drainage is one of the basic techniques routinely performed in a wide range of institutions, from high-volume centers to general hospitals [1,2,3,4,5,6]
Unsuccessful Plastic stents (PSs) replacement may require a change in the drainage route, such as percutaneous transhepatic biliary drainage or endoscopic ultrasound-guided biliary drainage (EUS-BD), and may have a significant impact on the patient’s prognosis, especially in cases of malignant disease
Multivariate analysis showed that the SOS method (odds ratio (OR) 3.64, 95% confidence interval (CI) 1.48–10.46, p = 0.0038) and the presence of proximal biliary stenosis and parapapillary diverticulum were predictive factors for unsuccessful PS replacement (Table 5)

Summary

Introduction

Among the endoscopic retrograde cholangiopancreatography (ERCP)-related procedures, transpapillary drainage is one of the basic techniques routinely performed in a wide range of institutions, from high-volume centers to general hospitals [1,2,3,4,5,6]. Plastic stents (PSs), which can be used in both malignant and benign cases, are inexpensive, extensively used worldwide, and remain the gold standard for transpapillary biliary drainage 40 years after its introduction [7]. In cases of severe bile duct stenosis or flexion, the possibility of unsuccessful replacement is increased. Unsuccessful PS replacement may require a change in the drainage route, such as percutaneous transhepatic biliary drainage or endoscopic

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