Transmural Biliary Drainage Can Be an Alternative to Transpapillary Drainage in Patients with an Indwelling Duodenal Stent

Overview

Journal Dig Dis Sci

Specialty Gastroenterology

Date 2014 May 21

PMID 24839917

Citations 28

Authors

Tsuyoshi Hamada

Hiroyuki Isayama

Yousuke Nakai

Hirofumi Kogure

Natsuyo Yamamoto

Kazumichi Kawakubo

Naminatsu Takahara

Rie Uchino

Suguru Mizuno

Takashi Sasaki

Osamu Togawa

Saburo Matsubara

Yukiko Ito

Kenji Hirano

Takeshi Tsujino

Minoru Tada

Kazuhiko Koike

Affiliations

Soon will be listed here.

Abstract

Background: Self-expandable metal stents (SEMS) are widely utilized to relieve symptoms of malignant gastric outlet obstruction (GOO), but GOO is frequently complicated by nonresectable distal biliary obstruction. The optimal endoscopic approach to biliary drainage in this setting remains controversial and has yet to be resolved.

Aims: To compare the safety and efficacy of endoscopic ultrasound-guided transmural biliary drainage (EUS-BD) and transpapillary drainage in patients with an indwelling duodenal SEMS.

Methods: Patients who underwent EUS-BD or transpapillary drainage for distal malignant biliary obstruction with an indwelling duodenal SEMS between June 2007 and August 2012 at three Japanese tertiary referral centers were identified retrospectively. We compared times to stent dysfunction, causes of dysfunction, and procedural related complications between these two groups.

Results: Twenty patients were included in the study (7 EUS-BD and 13 transpapillary drainage). EUS-BD was performed via hepaticogastrostomy using a SEMS in three patients and via choledochoduodenostomy using a SEMS or a plastic stent in two patients each. Transpapillary drainage was performed using a SEMS in all patients. The stent patency rate in the EUS-BD group was higher than that in the transpapillary drainage group (100 vs. 71% at 1 month and 83 vs. 29% at 3 months, respectively). The rate of stent dysfunction in the EUS-BD group tended to be lower than that in the transpapillary group (14 vs. 54%; P = 0.157). Complication rates were similar between the groups (P = 1.000), with moderate bleeding in one patient in the EUS-BD group and mild pancreatitis in one patient in the transpapillary group.

Conclusion: Endoscopic ultrasound-guided transmural biliary drainage is an alternative to transpapillary drainage in patients with an indwelling duodenal SEMS.

Citing Articles

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Long-term outcomes of endoscopic ultrasound-guided hepaticogastrostomy in patients with malignant biliary obstruction.

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Will Endoscopic-Ultrasound-Guided Choledocoduodenostomy with Electrocautery-Enhanced Lumen-Apposing Metal Stent Placement Replace Endoscopic Retrograde Cholangiopancreatography When Treating Distal Malignant Biliary Obstructions?.

Guilmoteau T, Albouys J, Taibi A, Legros R, Schaefer M, Jacques J Medicina (Kaunas). 2024; 60(2).

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Safety of endoscopic ultrasound-guided hepaticogastrostomy in patients with malignant biliary obstruction and ascites.

Yasuda T, Hara K, Mizuno N, Haba S, Kuwahara T, Okuno N Clin Endosc. 2023; 57(2):246-252.

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