Safety and effectiveness of a long, partially covered metal stent for endoscopic ultrasound-guided hepaticogastrostomy in patients with malignant biliary obstruction

Yousuke Nakai; Hiroyuki Isayama; Natsuyo Yamamoto; Saburo Matsubara; Yukiko Ito; Naoki Sasahira; Ryunosuke Hakuta; Gyotane Umefune; Naminatsu Takahara; Tsuyoshi Hamada; Suguru Mizuno; Hirofumi Kogure; Minoru Tada; Kazuhiko Koike

doi:10.1055/s-0042-116595

Endoscopy, Table of Contents

Endoscopy 2016; 48(12): 1125-1128
DOI: 10.1055/s-0042-116595

Innovations and brief communications

Safety and effectiveness of a long, partially covered metal stent for endoscopic ultrasound-guided hepaticogastrostomy in patients with malignant biliary obstruction

Yousuke Nakai

¹Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

,

Hiroyuki Isayama

¹Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

,

Natsuyo Yamamoto

¹Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

,

Saburo Matsubara

¹Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

²Department of Gastroenterology, Tokyo Metropolitan Police Hospital, Tokyo, Japan

,

Yukiko Ito

³Department of Gastroenterology, Japanese Red Cross Medical Center, Tokyo, Japan

,

Naoki Sasahira

⁴Department of Gastroenterology, Tokyo Takanawa Hospital, Tokyo, Japan

,

Ryunosuke Hakuta

¹Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

³Department of Gastroenterology, Japanese Red Cross Medical Center, Tokyo, Japan

,

Gyotane Umefune

¹Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

³Department of Gastroenterology, Japanese Red Cross Medical Center, Tokyo, Japan

,

Naminatsu Takahara

¹Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

,

Tsuyoshi Hamada

¹Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

,

Suguru Mizuno

¹Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

,

Hirofumi Kogure

¹Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

,

Minoru Tada

¹Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

,

Kazuhiko Koike

¹Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

› Author Affiliations

Abstract

Background and study aims: Endoscopic ultrasound (EUS)-guided biliary drainage (EUS-BD) is potentially complicated by bile leak and stent migration. The aim of this study was to evaluate the safety and effectiveness of a long (≥ 10 cm), partially covered metal stent (LP-CMS) for EUS-guided hepaticogastrostomy (EUS-HGS) for malignant biliary obstruction. Both the stent length and the uncovered portion at the proximal end of the LP-CMS are designed to prevent stent migration.

Patients and methods: A total of 33 patients undergoing EUS-HGS using an LP-CMS in four centers were retrospectively studied. Technical and clinical success, adverse events, and recurrent biliary obstruction were evaluated.

Results: Gastric outlet obstruction (76 %) and surgically altered anatomy (15 %) were two major reasons for EUS-HGS. The technical and clinical success rates were 100 %. The median intragastric stent length was 54 mm. The adverse event rate was 9 %. No stent migration was observed. Recurrent biliary obstruction developed in 24 %, with a median cumulative time to recurrence of 8.5 months.

Conclusions: EUS-HGS using an LP-CMS for unresectable malignant biliary obstruction was safe and effective.

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References

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