Download PDF
Endoscopy 2014; 46(05): 416-421
DOI: 10.1055/s-0034-1365020
Innovations and brief communications
© Georg Thieme Verlag KG Stuttgart · New York

EUS-guided hepaticogastrostomy combined with fine-gauge antegrade stenting: a pilot study

Authors

  • Takeshi Ogura

    1   Division of Gastroenterology and Hepatology, Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan

  • Daisuke Masuda

    1   Division of Gastroenterology and Hepatology, Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan

  • Akira Imoto

    1   Division of Gastroenterology and Hepatology, Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan

  • Toshihisa Takeushi

    1   Division of Gastroenterology and Hepatology, Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan

  • Rieko Kamiyama

    1   Division of Gastroenterology and Hepatology, Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan

  • Malak Mohamed

    2   Gastroenterology and Hepatology Unit, Department of Internal Medicine, Sohag University Hospital, Sohag, Egypt

  • Eiji Umegaki

    1   Division of Gastroenterology and Hepatology, Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan

  • Kazuhide Higuchi

    1   Division of Gastroenterology and Hepatology, Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan
Further Information

Publication History

submitted 11 September 2013

accepted after revision 09 December 2013

Publication Date:
26 February 2014 (online)

Also available at
   Permissions and Reprints
Preview

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.

 

  • References

  • 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
    Thieme ConnectPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 3 Fogel EL, Sherman S, Devereaux BM et al. Therapeutic biliary endoscopy. Endoscopy 2001; 33: 31-38
    Thieme ConnectPubMedSearch in Google Scholar
  • 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
    Thieme ConnectPubMedSearch in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Thieme ConnectPubMedSearch in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 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)
    CrossrefPubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Thieme ConnectPubMedSearch in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    Thieme ConnectPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    Thieme ConnectPubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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)
    PubMed
  • 28 Prachayakul V, Aswakul P et al. A novel technique for endoscopic ultrasound-guided biliary drainage. World J Gastroenterol 2013; 19: 4758-4763
    CrossrefPubMedSearch in Google Scholar