EUS-guided hepaticogastrostomy combined with fine-gauge antegrade stenting: a pilot study
submitted 11 September 2013
accepted after revision 09 December 2013
26 February 2014 (eFirst)
Background and study aim: To minimize bile leakage and avoid possible death because of stent migration in endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS), we have recently combined EUS-HGS with EUS-guided antegrade stenting (EUS-AS) of the biliary obstruction using a novel uncovered metallic stent with a fine-gauge delivery system. In this pilot study, we evaluated the feasibility and adverse events associated with this combination therapy using the novel stent.
Patients and methods: We performed EUS-guided antegrade stenting and hepaticogastrostomy in 12 consecutive patients.
Results: The novel EUS-AS stent was placed across the ampulla of Vater in 8 patients and above the ampulla in 4. Technical and functional success rates were 100 %. In addition, the insertion of the first stent was achieved in all patients without dilation of the fistula between stomach and intrahepatic bile duct. Although 1 patient experienced mild pancreatitis, adverse events such as bile peritonitis or stent dysfunction did not occur during follow-up (mean 122 days, range 62 – 210 days).
Conclusion: This method appears to safely and effectively avoid adverse events associated with EUS-HGS.
- 1 Yamao K, Bhatia V, Mizuno N et al. EUS-guided choledochoduodenostomy for palliative biliary drainage in patients with malignant biliary obstruction: results of long-term follow-up. Endoscopy 2008; 40: 340-342
- 2 Park do H, Song TJ, Eum J et al. EUS-guided hepaticogastrostomy with fully covered metal stent as the biliary diversion technique for an occluded biliary metal stent after failed ERCP (with video). Gastrointest Endosc 2010; 71: 413-419
- 3 Fogel EL, Sherman S, Devereaux BM et al. Therapeutic biliary endoscopy. Endoscopy 2001; 33: 31-38
- 4 Oh HC, Lee SK, Lee TY et al. Analysis of percutaneous transhepatic cholangioscopy-related complications and the risk factors for those complications. Endoscopy 2007; 39: 731-736
- 5 Maranki J, Hemandez AJ, Arslan B et al. Interventional endoscopic ultrasound cholangiography: long term experience of an emerging alternative to percutaneous transhepatic cholangiography. Endoscopy 2009; 41: 532-538
- 6 Martin FP, Rossini LG, Ferrari AP. Migration of a covered metallic stent following endoscopic ultrasound-guided hepaticogastrostomy: fatal complication. Endoscopy 2010; 42: E126-E127
- 7 Nguyen-Tang T, Binmoeller KF, Sanchez-Yague A et al. Endoscopic ultrasound (EUS)-guided transhepatic anterograde self-expandable metal stent (SEMS) placement across malignant biliary obstruction. Endoscopy 2010; 42: 232-236
- 8 Artifon EL, Safatle-Ribeiro AV, Ferreira FC et al. EUS-guided antegrade transhepatic placement of a self-expandable metal stent in hepatico-jejunal anastomosis. JOP J Pancreas 2011; 12: 610-613
- 9 Iwashita T, Yasuda I, Doi S et al. Endoscopic ultrasound guided antegrade treatments for biliary disorders in patients with surgically altered anatomy. Dig Dis Sci 2013; 58: 2417-2422 (Epub 2013 Mar 28)
- 10 Itoi T, Isayama H, Sofuni A et al. Stent selection and tips on placement technique of EUS-guided biliary drainage: transduodenal and transgastric stenting. J Hepatobiliary Pancreatic Sci 2011; 18: 664-672
- 11 Burmester E, Niehaus J, Leineweber T et al. EUS-cholangio-drainage of the bile duct: report of 4 cases. Gastrointest Endosc 2003; 57: 246-251
- 12 Giovannini M, Dotti M, Bories E et al. Hepaticogastrostomy by echo-endoscopy as a palliative treatment in a patient with metastatic biliary obstruction. Endoscopy 2003; 35: 1076-1078
- 13 Kahaleh M, Hernandez AJ, Tokar J et al. Interventional EUS-guided cholangiography: evaluation of a technique in evolution. Gastrointest Endosc 2006; 64: 52-59
- 14 Will U, Thieme A, Fueldner F et al. Treatment of biliary obstruction in selected patients by endoscopic ultrasonography (EUS)-guided transluminal biliary drainage. Endoscopy 2007; 39: 292-295
- 15 Bories E, Pesenti C, Caillo F et al. Transgastric endoscopic ultrasonography-guided biliary drainage: results of a pilot study. Endoscopy 2007; 39: 287-291
- 16 Maranki J, Hernandez AJ, Arslan B et al. Interventional endoscopic ultrasound cholangiography: long term experience of an emerging alternative to percutaneous transhepatic cholangiography. Endoscopy 2009; 41: 532-538
- 17 Horaguchi J, Fujita N, Noda Y et al. Endosonography-guided biliary drainage in cases with difficult transpapillary endoscopic biliary drainage. Dig Endosc 2009; 21: 239-244
- 18 Park do H, Koo JE, Oh J et al. EUS-guided biliary drainage with one-step placement of a fully covered metal stent for malignant biliary obstruction: a prospective feasibility study. Am J Gastroenterol 2009; 104: 2168-2174
- 19 Iwamuro M, Kawamoto H, Harada R et al. Combined duodenal stent placement and endoscopic ultrasonography-guided biliary drainage for malignant duodenal obstruction with biliary stricture. Dig Endosc 2010; 22: 236-240
- 20 Martin FP, Rossini LG, Ferrari AP. Migration of a covered metallic stent following endoscopic ultrasound-guided hepaticogastrostomy: fatal complication. Endoscopy 2010; 42: E126-127
- 21 Park do H, Jang JW, Lee SS et al. EUS-guided biliary drainage with transluminal stenting after failed ERCP: predictors of adverse events and long-term results. Gastrointest Endosc 2011; 74: 1276-1284
- 22 Ramírez-Luna MA, Téllez-Ávila FI, Giovannini M et al. Endoscopic ultrasound-guided biliodigestive drainage is a good alternative in patients with unresectable cancer. Endoscopy 2011; 43: 826-830
- 23 Attasaranya S, Netinasunton N, Jongboonyanuparp T et al. The Spectrum of Endoscopic Ultrasound Intervention in Biliary Diseases: A Single Center's Experience in 31 Cases. Gastroenterol Res Pract 2012; 2012: 680753
- 24 Kim TH, Kim SH, Oh HJ et al. Endoscopic ultrasound-guided biliary drainage with placement of a fully covered metal stent for malignant biliary obstruction. Worl J Gastroenterol 2012; 18: 2526-2532
- 25 Khashab MA, Fujii LL, Baron TH et al. EUS-guided biliary drainage for patients with malignant biliary obstruction with an indwelling duodenal stent (with videos). Gastrointest Endosc 2012; 76: 209-213
- 26 Park do H, Jeong SU, Lee BU et al. Prospective evaluation of treatment algorithm with enhanced guidewire manipulation protocol for EUS-guided biliary drainage after (with video). Gastrointest Endosc 2013; 78: 91-101
- 27 Kawakubo K, Isayama H, Kato H et al. Multicenter retrospective study of endoscopic ultrasound-guided biliary drainage for malignant biliary obstruction in Japan. J Hepatobiliary Pancreat Sci (Epub ahead of print 11. 9. 2013) DOI: 10.1002/jhbp.27.
- 28 Prachayakul V, Aswakul P et al. A novel technique for endoscopic ultrasound-guided biliary drainage. World J Gastroenterol 2013; 19: 4758-4763