BACKGROUND AND AIMS: EUS-guided biliary drainage (EUS-BD) has been offered for more than a decade as an alternative to percutaneous biliary drainage. Multiple approaches have been described. We propose an algorithm for biliary drainage based on patient anatomy. We aim to assess its validity and safety to guide EUS-BD drainage. METHODS: All patients with biliary obstruction who underwent EUS-BD after failed ERCP from July 2011 through November 2015 underwent the drainage procedure according to the novel algorithm and were enrolled in a dedicated prospective registry. Patients with a dilated intrahepatic biliary tree (IHBT) on cross-sectional imaging received an intrahepatic (IH) approach with anterograde biliary stent placement or hepaticogastrostomy stent placement if anterograde placement was not feasible. Patients with a nondilated IHBT on cross-sectional imaging underwent an extrahepatic (EH) approach with a rendezvous (RDV) technique or a transenteric stent placement if the RDV technique was not feasible. If IH drainage was attempted but unsuccessful, conversion to an EH approach was performed. RESULTS: Fifty-two patients (mean age, 68 ± 12 years; 52% men) were included in the registry. Technical success was achieved in 50 patients (96%). Twenty-seven of 52 patients (52%) underwent IH anterograde stent placement, 8 of 52 (15%) underwent hepaticogastrostomy, 11 of 52 (21%) underwent EH drainage with the RDV technique, and 6 of 52 (12%) underwent EH drainage with transenteric stent placement. Adverse events were observed in 5 patients (10%) and included a liver abscess requiring percutaneous drainage (n = 1) and bleeding (n = 4) with 1 postprocedural death secondary to bleeding. CONCLUSIONS: EUS-BD obstruction after failed conventional ERCP is successful and safe when this novel algorithm is used. (Clinical trial registration number: NCT01438385.).
BACKGROUND AND AIMS: EUS-guided biliary drainage (EUS-BD) has been offered for more than a decade as an alternative to percutaneous biliary drainage. Multiple approaches have been described. We propose an algorithm for biliary drainage based on patient anatomy. We aim to assess its validity and safety to guide EUS-BD drainage. METHODS: All patients with biliary obstruction who underwent EUS-BD after failed ERCP from July 2011 through November 2015 underwent the drainage procedure according to the novel algorithm and were enrolled in a dedicated prospective registry. Patients with a dilated intrahepatic biliary tree (IHBT) on cross-sectional imaging received an intrahepatic (IH) approach with anterograde biliary stent placement or hepaticogastrostomy stent placement if anterograde placement was not feasible. Patients with a nondilated IHBT on cross-sectional imaging underwent an extrahepatic (EH) approach with a rendezvous (RDV) technique or a transenteric stent placement if the RDV technique was not feasible. If IH drainage was attempted but unsuccessful, conversion to an EH approach was performed. RESULTS: Fifty-two patients (mean age, 68 ± 12 years; 52% men) were included in the registry. Technical success was achieved in 50 patients (96%). Twenty-seven of 52 patients (52%) underwent IH anterograde stent placement, 8 of 52 (15%) underwent hepaticogastrostomy, 11 of 52 (21%) underwent EH drainage with the RDV technique, and 6 of 52 (12%) underwent EH drainage with transenteric stent placement. Adverse events were observed in 5 patients (10%) and included a liver abscess requiring percutaneous drainage (n = 1) and bleeding (n = 4) with 1 postprocedural death secondary to bleeding. CONCLUSIONS:EUS-BD obstruction after failed conventional ERCP is successful and safe when this novel algorithm is used. (Clinical trial registration number: NCT01438385.).
Authors: Jintao Guo; Marc Giovannini; Anand V Sahai; Adrian Saftoiu; Christoph F Dietrich; Erwin Santo; Pietro Fusaroli; Ali A Siddiqui; Manoop S Bhutani; Anthony Yuen Bun Teoh; Atsushi Irisawa; Brenda Lucia Arturo Arias; Chalapathi Rao Achanta; Christian Jenssen; Dong-Wan Seo; Douglas G Adler; Evangelos Kalaitzakis; Everson Artifon; Fumihide Itokawa; Jan Werner Poley; Girish Mishra; Khek Yu Ho; Hsiu-Po Wang; Hussein Hassan Okasha; Jesse Lachter; Juan J Vila; Julio Iglesias-Garcia; Kenji Yamao; Kenjiro Yasuda; Kensuke Kubota; Laurent Palazzo; Luis Carlos Sabbagh; Malay Sharma; Mitsuhiro Kida; Mohamed El-Nady; Nam Q Nguyen; Peter Vilmann; Pramod Kumar Garg; Praveer Rai; Shuntaro Mukai; Silvia Carrara; Sreeram Parupudi; Subbaramiah Sridhar; Sundeep Lakhtakia; Surinder S Rana; Takeshi Ogura; Todd H Baron; Vinay Dhir; Siyu Sun Journal: Endosc Ultrasound Date: 2018 Nov-Dec Impact factor: 5.628