Biliary Metal Stents Research Articles

İnoperabl Malign Biliyer Obstrüksiyonlarda Perkütan Transhepatik Kolanjiyografi, Perkütan Biliyer Drenaj ve Metalik Endoprotez Uygulamaları

Objective:We aimed to present the effectiveness of percutaneous transhepatic cholangiography, percutaneous biliary drainage and metallic endoprotesis applications in patients with inoperable biliary obstructions. Materials and Methods: Percutaneous transhepatic cholangiographies(PTC) and percutaneous biliary drainages (PBD) were performed in 44 patients with inoperabl malignant obstructive jaundice who had been hospitalized in the radiology department of our hospital over a three years period. Six patients (13.6%) underwent external biliary drainage(EBD), 27 patients (61.4%) underwent internal-external biliary drainage(I-EBD) and metallic stents were placed in 11 patients (25%) on average 6 days (1-34 days) after I-EBD. The mean total bilirubin(TB), ALP, ALT, AST, GGT values taken before and after drainage in all patients were compared. Results: Biliary drainage was technically successful in all patients.İn the first two weeks after biliary drainage, 38 cases (86%) had a general condition improvement, weakness and itching decreased. The mean TB;19,41 ± 9,09; 9,39 ± 15,34, ALP; 701,27 ± 352,53 ; 357,48 ± 268,70, ALT; 122,45 ± 75,42; 62,91 ± 61,90, AST; 129,14 ± 84,31; 94,93 ± 118,79, GGT; 684,48 ± 428,83; 322,39 ± 253,26 values taken before and after drainage in all patients were compared and a significant decrease was found in the post-procedure values (p<0,050). In the follow-up, minor complications were observed in 10 patients (22.7%). Conclusion: It is necessary to prevent inoperable patients from entering hepato-renal failure in order to prolong life time as much as possible. PBD and stent applications significantly improves impaired liver function, allowing the patients general condition improvement. Low complication rates and quickyl improving general condition of patients without need for another surgery gradually increase the value of this radiological intervention.

Managing occluded stents in biliary obstruction using radiofrequency ablation combined with 125I-strand brachytherapy.

We aimed to assess the effectiveness of percutaneous radiofrequency ablation (PRFA) combined with iodine-125 (125I) seed strand brachytherapy (125I-BT) for treatment of occluded biliary stents. From November 2015 to September 2017, 13 consecutive patients with occluded biliary metal stents, implanted for malignant obstruction, underwent PRFA combined with 125I-BT to reopen the bile duct. Data included clinical and technical success, stent patency, complications, and overall survival. The clinical and technical success rates were both 100%. One month after treatment, the total serum bilirubin level had decreased significantly (P < 0.001). Early complications of cholangitis or hemobilia were experienced by one patient each. Three patients (23.1%) had late complications, including two cases of cholangitis and one case of cholecystitis. During the mean follow-up of 233±82.9 days (range, 88-365 days), the stent patency time was 239±26.5 days (95% CI, 187-291 days), and the 6-month stent patency rate was 68.4%. Five patents died; the mean survival time was 298±30.1 days (95% CI, 239-358 days). The 6-month survival rate was 83%. PRFA therapy combined with 125I-BT is feasible and safe for patients with occluded metal stents placed for malignant biliary obstruction. Nevertheless, randomized controlled trails are needed to confirm the effectiveness of this new approach.

Development of an Online App to Predict Post-Endoscopic Retrograde Cholangiopancreatography Adverse Events Using a Single-Center Retrospective Cohort

Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) is a technically demanding procedure with a high risk for adverse events (AEs). Aim: evaluate patient- and procedure-related risk factors for ERCP-related AEs and develop an online app to estimate risk of AEs. Methods: retrospective study of 1,491 consecutive patients who underwent 1,991 ERCPs between 2012 and 2017 was conducted. AEs definition and severity were classified according to most recent ESGE guidelines. Each variable was tested for association with occurrence of overall AEs, post-ERCP pancreatitis (PEP) and cholangitis. For each outcome, 2 regression models were built, from which an online Shiny-based app was created. Results: Overall AE rate was 15.3%; in 19 procedures, >1 AE occurred. Main post-ERCP AE was PEP (7.5%), followed by cholangitis (4.9%), bleeding (1.3%), perforation (1%), cardiopulmonary events (0.9%), and cholecystitis (0.3%). Seventy-eight percent of AEs were mild/moderate; of severe (n = 55) and fatal (n = 20) AEs, more than half were related to infection, cardiac/pulmonary AEs, and perforation. AE-related mortality rate was 1%. When testing precannulation, procedural covariates, and ERCP findings, AE occurrence was associated with age (odds ratio [OR] 0.991), previous PEP (OR 2.198), ERCP complexity grade III/IV (OR 1.924), standard bile duct cannulation (OR 0.501), sphincterotomy (OR 1.441), metal biliary stent placement (OR 2.014), periprocedural bleeding (OR 3.024), and biliary duct lithiasis (OR 0.673). Conclusion: Our app may allow an optimization of the patients’ care, by helping in the process of decision-making, not only regarding patient or endoscopist’s selection but also definition of an adequate and tailored surveillance plan after the procedure.

Experimental model of occluded biliary metal stent recanalization using irreversible electroporation via a tubular catheter

Purpose To demonstrate the feasibility of irreversible electroporation (IRE) for treating biliary metal stent occlusion in an experimental liver model. Methods and materials IRE was performed using an expandable tubular IRE-catheter placed in nitinol stents in the porcine liver. A 3-electrode IRE-catheter was connected to an IRE-generator and one hundred 100μs pulses of constant voltage (300, 650, 1000, and 1300 V) were applied. Stent occlusion was simulated by insertion of liver tissue both ex vivo (n = 94) and in vivo in 3 pigs (n = 14). Three scenarios of the relationship between the stent, electrodes, and inserted tissue (double contact, single contact, and stent mesh contact) were studied. Electric current was measured and resistance and power calculated. Pigs were sacrificed 72 h post-procedure. Harvested samples (14 experimental, 13 controls) underwent histopathological analysis. Results IRE application was feasible at 300 and 650 V for the single and double contact setup in both ex vivo and in vivo studies. Significant differences in calculated resistance between double contact and single contact settings were observed (ex-vivo p ˂ 0.0001, in-vivo p = 0.02; Mann–Whitney). A mild temperature increase of the surrounding liver parenchyma was noted with increasing voltage (0.9–5.9 °C for 300–1000 V). The extent of necrotic changes in experimental samples in vivo correlated with the measured electric current (r 2 = 0.39, p = 0.01). No complications were observed during or after the in-vivo procedure. Conclusion Endoluminal IRE using an expandable tubular catheter in simulated metal stent occlusion is feasible. The relationship of active catheter electrodes to stent ingrowth tissue can be estimated based on resistance values.

Percutaneous solutions for biliary stent dysfunction: pictorial essay.

Plastic and metal biliary stents can fail to function properly, such failure being due to a positioning error or to the migration, occlusion, or fracture of the stent. An obstructed biliary stent can act as a nidus, causing complications such as recurrent persistent cholangitis. It can also cause vascular complications (such as bleeding and the formation of pseudoaneurysms), perforate the liver capsule (causing biloma or abscess), or, in rare cases, cause intestinal obstruction or perforation. In this pictorial essay, we demonstrate various interventional radiology techniques for the treatment of biliary stent dysfunction in patients with obstructive biliary disease.

Adverse Event Severity Grading System Applied to Percutaneous Transhepatic Biliary Metal Stenting as A One- or Two-Stage Procedure in Patients with Unresectable Malignant Extrahepatic Bile Duct Obstruction

Adverse Event Severity Grading System Applied to Percutaneous Transhepatic Biliary Metal Stenting as A One- or Two-Stage Procedure in Patients with Unresectable Malignant Extrahepatic Bile Duct Obstruction

Use of the Ovesco remOVE DC cutter to trim a metal biliary stent with excess length in the duodenum allowing biliary access for ERCP.

Use of the Ovesco remOVE DC cutter to trim a metal biliary stent with excess length in the duodenum allowing biliary access for ERCP.

Endoscopic ultrasonography-fine needle aspiration of solid pancreatic masses: Do we need the fourth pass? A prospective study.

Endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) is important for the differential diagnosis of solid pancreatic lesions. Sample adequacy is related to the number of needle passes, and European guidelines recommend three to four needle passes with a standard EUS-FNA needle. We aimed to evaluate the optimal number of passes with standard EUS-FNA needles in solid pancreatic lesions. Patients with solid pancreatic masses without cystic component >20% on computed tomography scan, and without biliary metallic stents, or coagulation problems were included prospectively. Standard 22G needles were used (maximum four passes); each sample was paraffin-embedded and analyzed separately. Final diagnosis was established by EUS-FNA, repeat EUS-FNA, surgery, or follow-up. Sixty-one of 65 patients were included. The final diagnoses were adenocarcinoma (n = 44, 72%), neuroendocrine tumor (NET) (n = 10, 16%), metastasis (n = 1, 4%) and nonmalignant lesion (n = 6, 10%). Immunohistochemical staining was possible in 17 cases. The diagnosis was established by the first pass in 62% of cases (n = 38), by the second in 15% (n = 9), by the third in 15% (n = 9), and by the fourth in 3% (n = 2). The diagnostic accuracy for all four passes compared to the first three passes was 95% vs 92% (P = .5). The contribution of the fourth pass was not different between adenocarcinoma and NET (2% vs 10%, respectively; P = .667). Three passes with standard EUS-FNA was optimal for a specific diagnosis of solid pancreatic masses, regardless of the histological type of the lesion.

The use of a rescue stent in the management of lumen-apposing metal stent migration during EUS-directed transgastric ERCP with stent-in-stent technique to remove a forgotten metal biliary stent

Roux-en-Y gastric bypass poses a unique set of challenges during ERCP. Conventional approaches include laparoscopic-assisted ERCP and balloon-assisted enteroscopy. Laparoscopic-assisted ERCP is invasive and requires coordination between a surgeon and gastroenterologist. Balloon-assisted ERCP has a lower procedural success rate (60%-80%),1 and the size of the working channel can limit interventions. EUS-directed transgastric ERCP (EDGE) (Fig. 1)2 allows for a same-day or multistep procedure by creating a gastrogastric fistula, allowing endoscopic access to the biliary tree via the excluded stomach.

S1408 A Choledochoduodenal Fistula Masquerading as an Upper GI Bleed

INTRODUCTION: We present a case of a choledochoduodenal fistula (CDF), a rare complication of duodenal peptic ulcer disease (PUD) that was successfully treated using a full-covered metal biliary stent. CASE DESCRIPTION/METHODS: A 62-year-old woman presented with syncope, coffee ground emesis, and chronic abdominal pain. Her hemoglobin was found to be 5.4 g/dL. Subsequently, the patient was admitted for an upper GI bleed and symptomatic anemia. Upper endoscopy demonstrated a 4cm duodenal bulb ulcer. The ulcer was noted to have a “linear transverse slit at the base” and pigmented spots. An abdominal CT showed thickening of the duodenum, consistent with an ulcer that had a contained perforation. The CT scan also noted air within the biliary system and a possible fistula to the common bile duct. An ERCP confirmed a CDF extending into the duodenal bulb ulcer. A fully-covered metal biliary stent was placed to seal off the fistula with plans for follow up. Upon follow up in the office, she reported a quick recovery with complete resolution of her symptoms shortly after her ERCP was completed. Seven months later, the patient returned for an EGD and ERCP without evidence of a persistent ulcer. The metal stent was not visualized on repeat ERCP with assumption that stent had spontaneously migrated. The common and intrahepatic bile ducts appeared normal with no evidence of a persistent fistula. DISCUSSION: Most patients diagnosed with CDF are found to have long-standing biliary tract disease. Common etiologies of CDF include cholelithiasis, duodenal ulcers, or tumors. Although radiographic pneumobilia is suggestive of CDF, direct visualization by endoscopy is confirmatory. CDFs often require surgical intervention for refractory cases. Our case was a rare complication of a duodenal ulcer presenting as an upper GI bleed. CDF was definitively confirmed on endoscopy. While most cases of refractory CDF involve surgical intervention, our choice of treatment for this patient's CDF was a less-invasive approach: endoscopic placement of a fully covered, self expanding metal biliary stent. Repeat EGD and ERCP found complete resolution of the non-healing ulcer and fistulous tract. Upon follow-up, there was complete resolution of her symptoms. The results of this case demonstrate that fully covered metal stents may be an alternative form of therapy and may warrant consideration in suitable patients before proceeding with surgical intervention.Figure 1.: Image from an EGD demonstrating the duodenal ulcer bed with a “linear slit” from where the fistulous tract can be seen.Figure 2.: An Upper GI fluoroscopic series showing the hepatobiliary tree, common duct, and cystic duct. Depicts the folding and irregularity of the duodenum consistent with peptic ulcer disease.Figure 3.: Fluoroscopic image from ERCP before placement of metal stent into the common bile duct.

S1908 Use of Biliary Stent in Premature Infant With Severe Esophageal Anastomotic Stricture After Esophageal Atresia Repair

INTRODUCTION: Anastomotic strictures following surgical repair of esophageal atresia is common. Symptomatic strictures may require periodic dilation or, in refractory cases, surgery. Placement of an endoscopic metal stent is a less invasive alternative to surgical revision. Few cases describe an early, proactive approach to stent placement in premature infants who have increased risk for complications. CASE DESCRIPTION/METHODS: A 31 week-old 1.3 kg female presented with hypoxia after birth. Type C esophageal atresia was identified and tracheoesophageal fistula division was completed but anastomosis was deferred for ∼3.5 weeks given proximal-distal esophageal gap. GJ tube placed for feeds. Patient had ongoing, episodic hypoxic episodes requiring HFNC. Bronchoscopy and laryngoscopy were largely unremarkable. Attempt at EGD was unsuccessful, and gastroscope was unable to be advanced secondary to esophageal stenosis. Esophagram revealed severe anastomotic stenosis. Attempt at wire guided dilation via radiology was unsuccessful. Therefore, combined anterograde-retrograde EGD was attempted and luminal continuity was achieved via guidewire using transillumination. The tract was sequentially dilated to 9 Fr and a fully covered 8 mm metal biliary stent was placed. Within one week, the patient discharged, tolerating feeds without apnea. On repeat EGD, four weeks later, the lumen was patent and the stent was exchanged for another fully covered 8 mm biliary stent to assist with further healing. No further dilation was required. Six weeks from initial EGD, the biliary stent was removed with a widely patent lumen. Repeat esophagram revealed no stricture, leak or fistula. DISCUSSION: Stent placement for anastomotic stricture in pediatrics is traditionally reserved for patients who fail serial balloon dilations or surgical revision. Although balloon dilation therapy has good safety and efficacy profiles, the vast majority of patients require serial dilations and 20% of patients experience ineffective symptom relief. In this patient, in consideration of young age and risk for repeated procedures, it was opted for early intervention via esophageal stent. Lumen patency was achieved within 6 weeks and therapy for oral ingestion could take place. This case represents an important clinical scenario where esophageal stenting should be considered initially and is one of the earliest successful uses of biliary stent in the management of severe esophageal stricture after esophageal atresia repair.Figure 1.: A series of endoscopic images revealing successful guidewire placement through severe anastomotic stricture (Image 1) followed by metal biliary stent placement (Image 2) using combined anterograde-retrograde endoscopy. On repeat endoscopy six weeks later, the metal biliary stent (Image 3) was removed revealing a widely patent lumen (Image 4) and resolution of the esophageal stricture.Figure 2.: Left image: Initial esophagram revealing a patulous proximal esophageal pouch with no obvious luminal continuity with the distal esophagus. Right image: Esophagram after esophageal stent removal revealing mild proximal esophageal dilation and no evidence of contrast extravasation or residual tracheoesophageal fistula.

S2352 A Tale of Two Stents: Rescue of a Migrated Lumen-Apposing Stent During EUS-Guided Cystogastrostomy

INTRODUCTION: Pancreatic pseudocysts are a common complication of pancreatitis. Both percutaneous and endoscopic therapeutic avenues have been developed for the drainage of symptomatic cysts. Surgical management is associated with higher rates of morbidity and, therefore, trans-gastric and trans-duodenal endoscopic drainage have become widely utilized treatments for the definitive management of pancreatic pseudocysts. Following tract creation and dilation, plastic pigtail stents, self-expanding metal stents, and now lumen-apposing covered self-expanding metal stents (LAMS) are used to maintain patency of the tract and allow for drainage of cysts. Though LAMS reduce the risk of stent migration, we report a case of a 28-year old female undergoing endoscopic ultrasound (EUS)-guided trans-gastric cystogastrostomy complicated by intra-procedural stent migration. CASE DESCRIPTION/METHODS: The patient had a two year history of abdominal pain that began after a cholecystectomy for gallstone disease. Computerized tomography (CT) imaging from May of 2019 demonstrated a large, thin-walled cyst within the head of the pancreas (Figure 1). The patient was scheduled to undergo EUS-guided drainage. A trans-gastric approach was utilized for tract creation. A 10 mm × 10 mm LAMS stent was deployed across the tract. The distal flange opened appropriately, however the proximal flange did not completely open. Because the tract was slightly longer than the length of the stent, while attempting to retract and reposition the stent, the proximal end migrated into the tract. To ensure maintained patency of the tract, a 10 mm × 80 mm covered metal biliary stent was placed inside of the LAMS stent to completely and securely bridge the cyst and the stomach. Final stent position was confirmed with fluoroscopy (Figure 2). The patient remained asymptomatic in the time between discharge and follow-up visit. The stents were removed without complication and no necrosis or bleeding was noted at the tract site. DISCUSSION: The use of lumen-apposing covered metal stents for pancreatic fluid collection drainage is a relatively novel technique offering a convenient, single step method of deployment. Though these large-lumen, dumbell-shaped devices reduce the risk of stent migration, we report a unique complication of the procedure in which, during stent deployment, one end of the LAMS stent migrated into the tract. Placement of a biliary metal stent proved to be an effective and safe rescue technique in this patient.Figure 1.: Large, thin-walled fluid-filled cyst in head of pancreas.Figure 2.: Fluoroscopic image demonstrating biliary metal stent contained within lumen-apposing metal stent bridging cyst to stomach.

S1405 Bronchobiliary Fistula in a Patient With Remote Hepatectomy Treated With Biliary Stent by ERCP

INTRODUCTION: Bronchobiliary fistula (BBF) is a rare condition where an abnormal connection is formed between the biliary system and the bronchial tree. Causes include amoebic diseases of the liver, trauma, biliary obstruction, and hepatobiliary surgery. Patients often present with biliptysis, which is pathognomonic for this condition. Importantly, BBF is associated with high morbidity and mortality rates. The management of this entity is challenging due to the rarity of the disease. We present a case of BBF successfully treated with deployment of a fully covered self-expandable metallic biliary stent during ERCP. CASE DESCRIPTION/METHODS: The patient is a 55-year-old woman with a history of well differentiated neuroendocrine tumor of the liver treated with transcatheter arterial chemoembolization, complicated by development of a liver abscess and then a biliary cutaneous fistula, s/p segment 4 liver resection, who presented to an outside facility for a 3 week history of RUQ abdominal pain, shortness of breath and biliptysis. She underwent a HIDA scan for evaluation of her RUQ pain and was found to have a BBF. An unsuccessful ERCP attempt was made and the patient was transferred to our center for surgical evaluation. Our team was consulted, and she underwent successful ERCP with a clear demonstration of a fistulous communication between the distal left hepatic system and the bronchial tree on cholangiogram. A 10Fr x80mm covered metal stent was deployed with complete resolution of the patient’s symptoms. She was seen weeks later in clinic and remained symptom free. DISCUSSION: The pathogenesis of BBF formation has not been completely understood, increased pressure within the biliary tree with local inflammation appears to be two major factors that contribute to its development. Diagnosis can be made with CT imaging or HIDA scan, as well as with interventional techniques, such as ERCP, percutaneous transhepatic cholangiography, bronchoscopy or fistulography. In our case, multiple causes are suspected to have provoked the formation of the fistula in this patient, including liver tumor, chemoembolization, abscess and hepatectomy. Due to its low incidence, there is no clear consensus on the treatment of this uncommon complication. According to published literature, best clinical outcomes were seen with surgical management. Our patient was successfully treated endoscopically with deployment of a biliary stent, thus providing a least invasive alternative to surgery when performed by a skilled gastroenterologist.Figure 1.: Cholangiogram showing bronchobiliary fistula at the distal left hepatic duct.Figure 2.: After deployment of fully covered self-expandable metallic biliary stent.Figure 3.: Endoscopic view of metal stent.

S0968 Use of Fully Covered Self-Expanding Metal Biliary Stents for Managing Endoscopic Biliary Sphincterotomy-Related Bleeding

S0968 Use of Fully Covered Self-Expanding Metal Biliary Stents for Managing Endoscopic Biliary Sphincterotomy-Related Bleeding

Percutaneous endoscopic removal of a biliary metal stent retained in the jejunum using a digital cholangioscope.

Percutaneous endoscopic removal of a biliary metal stent retained in the jejunum using a digital cholangioscope.

Single-center experience demonstrating low adverse events and high efficacy with self-expandable metal esophageal and biliary stents for pseudocyst and walled off necrosis drainage.

Background and study aims Lumen-apposing metal stents (LAMS) have been designed as proprietary stents for the management of pseudocysts (PC)/walled off necrosis (WON). There has been concern about adverse events (AEs) with LAMS including bleeding, buried stent syndrome and migration. Prior to LAMS becoming available, fully-covered self-expandable metal esophageal and biliary stents (FCSEMSs) were used off-label for management of PC/WON with many centers demonstrating low rates of AEs. The primary aim of this study was to study the safety and efficacy of FCSEMS for the management of pseudocysts/WON. Patients and methods This was a retrospective review of all endoscopic ultrasound (EUS)-guided placement of FCSEMSs for drainage of PC/WON cases performed at our institution over 4-year period. The primary outcomes studied were technical success, AEs, PC/WON resolution, and salvage surgical/radiologic intervention. Results Technical success achieved in 65 of 65 (100 %) study patients. An AE occurred 0 of 25 patients (0 %) with PC, and in 10 of 40 patients (25 %) with WON: bleeding (3 %), migration (5 %) and stent dysfunction/infection (18 %). There was resolution in 25 of 25 patients (100 %) with a PC and 31 of 40 patients (78 %) with a WON. Salvage therapy by interventional radiology or surgery was performed in nine of 40 patients (22 %). Conclusions This single-center 4-year experience in the pre-LAMS era showed that FCSEMS was safe and effective in all patients with PC and over 75 % of patients with WON. Given the large cost differential between LAMS and FCSEMS and the efficacy and safety shown with FCSEMS, we believe that FCSEMS should still be considered a first-line option for patients with pancreatic fluid collections, particularly in patients with PCs.

Feasibility and efficacy evaluation of metallic biliary stents eluting gemcitabine and cisplatin for extrahepatic cholangiocarcinoma.

BACKGROUNDEffective endoscopic management is fundamental for the treatment of extrahepatic cholangiocarcinoma (ECC). However, current biliary stents that are widely used in clinical practice showed no antitumor effect. Drug-eluting stents (DESs) may achieve a combination of local chemotherapy and biliary drainage to prolong stent patency and improve prognosis.AIMTo develop novel DESs coated with gemcitabine (GEM) and cisplatin (CIS)-coloaded nanofilms that can maintain the continuous and long-term release of antitumor agents in the bile duct to inhibit tumor growth and reduce systemic toxicity.METHODSStents coated with different drug-eluting components were prepared by the mixed electrospinning method, with poly-L-lactide-caprolactone (PLCL) as the drug-loaded nanofiber membrane and GEM and/or CIS as the antitumor agents. Four different DESs were manufactured with four drug-loading ratios (5%, 10%, 15%, and 20%), including bare-loaded (PLCL-0), single-drug-loaded (PLCL-GEM and PLCL-CIS), and dual-drug-loaded (PLCL-GC) stents. The drug release property, antitumor activity, and biocompatibility were evaluated in vitro and in vivo to confirm the feasibility and efficacy of this novel DES for ECC.RESULTSThe in vitro drug release study showed the stable, continuous release of both GEM and CIS, which was sustained for over 30 d without an obvious initial burst, and a higher drug-loaded content induced a lower release rate. The drug-loading ratio of 10% was used for further experiments due to its ideal inhibitory efficiency and relatively low toxicity. All drug-loaded nanofilms effectively inhibited the growth of EGI-1 cells in vitro and the tumor xenografts of nude mice in vivo; in addition, the dual-loaded nanofilm (PLCL-GC) had a significantly better effect than the single-drug-loaded nanofilms (P < 0.05). No significant differences in the serological analysis (P > 0.05) or histopathological changes were observed between the single-loaded and drug-loaded nanofilms after stent placement in the normal porcine biliary tract.CONCLUSIONThis novel PLCL-GEM and CIS-eluting stent maintains continuous, stable drug release locally and inhibits tumor growth effectively in vitro and in vivo. It can also be used safely in normal porcine bile ducts. We anticipate that it might be considered an alternative strategy for the palliative therapy of ECC patients.

Management of a necrosed bile duct by combination of a fully covered metal biliary stent and endoscopic ultrasound-guided gastrojejunostomy.

Management of a necrosed bile duct by combination of a fully covered metal biliary stent and endoscopic ultrasound-guided gastrojejunostomy.

Endoscopic ultrasound-guided placement of biliary lumen-apposing metal stent through a duodenal stent.

Endoscopic ultrasound-guided placement of biliary lumen-apposing metal stent through a duodenal stent.

Diagnostic yield of endoscopic ultrasound-guided tissue acquisition of solid pancreatic lesions after inconclusive percutaneous ultrasound-guided tissue acquisition

Introduction After a failed percutaneous ultrasound (US)-guided sampling, it is recommended that endoscopic ultrasound (EUS)-guided tissue acquisition (TA) be performed for non-resectable solid pancreatic lesions according to the European Federation of Societies for Ultrasound in Medicine and Biology. However, the diagnostic performance of EUS-guided TA in this setting is unknown. Methods We retrospectively analyzed the performance and safety of EUS-guided TA in patients with a previous failed percutaneous biopsy. We also evaluated the diagnostic delays between the percutaneous approach and EUS diagnosis. Results Over a period of 2 years, 49 patients were identified (29 males, mean age 65 years). The reasons for failure of percutaneous sampling were inadequate samples in 25 (52.1%) cases and lesions that were not visible or targetable in 24 (47.9%) cases. In one case, EUS-guided TA was not performed because of the interposition of a metallic biliary stent. No adverse events were recorded for both the percutaneous and EUS approaches. The median diagnostic delay was 12 days. Overall, the sensitivity and accuracy of EUS-guided TA were 92.7 and 93.7%, respectively. A subgroup analysis examined cases with inadequate samples obtained with the percutaneous approach, and the sensitivity and accuracy of EUS-guided TA were 85.7 and 88%, respectively. Conclusion EUS-guided TA is safe and accurate for the diagnosis of pancreatic lesions after a previous inconclusive percutaneous approach.