Tsuyoshi Hamada1, Yousuke Nakai1, James Y Lau2, Jong Ho Moon3, Tsuyoshi Hayashi4,5, Ichiro Yasuda6,7, Bing Hu8, Dong-Wan Seo9, Hiroshi Kawakami10,11, Masaki Kuwatani10, Akio Katanuma12, Masayuki Kitano13, Shomei Ryozawa14, Keiji Hanada15, Takuji Iwashita6, Yukiko Ito16, Hiroshi Yagioka17, Osamu Togawa18, Iruru Maetani19, Hiroyuki Isayama1. 1. a Department of Gastroenterology, Graduate School of Medicine , The University of Tokyo , Tokyo , Japan. 2. b Department of Surgery , Prince of Wales Hospital, The Chinese University of Hong Kong , Shatin , Hong Kong SAR. 3. c Department of Internal Medicine, Digestive Disease Center and Research Institute , Soon Chun Hyang University School of Medicine , Seoul , Korea. 4. d Department of Medical Oncology and Hematology , Sapporo Medical University Hokkaido , Japan. 5. e Department of Gastroenterology , Hokkaido Cancer Center , Hokkaido , Japan. 6. f First Department of Internal Medicine , Gifu University Hospital , Gifu , Japan. 7. g Department of Gastroenterology , Teikyo University Mizonokuchi Hospital , Kanagawa , Japan. 8. h Department of Endoscopy , Eastern Hepatobiliary Hospital, Second Military Medical University , Shanghai , P.R. China. 9. i Department of Gastroenterology , Asan Medical Center, University of Ulsan College of Medicine , Seoul , Korea. 10. j Department of Gastroenterology and Hepatology , Hokkaido University Hospital , Hokkaido , Japan. 11. k Department of Gastroenterology and Hepatology , Center for Digestive Disease University of Miyazaki , Miyazaki , Japan. 12. l Center for Gastroenterology, Teine Keijin-kai Hospital , Hokkaido , Japan. 13. m Department of Gastroenterology and Hepatology , Kinki University Faculty of Medicine , Osaka , Japan. 14. n Department of Gastroenterology , Saitama Medical University International Medical Center , Saitama , Japan. 15. o Department of Gastroenterology , Onomichi General Hospital , Hiroshima , Japan. 16. p Department of Gastroenterology , Japanese Red Cross Medical Center , Tokyo , Japan. 17. q Department of Gastroenterology , Tokyo Metropolitan Police Hospital , Tokyo , Japan. 18. r Department of Gastroenterology , Kanto Central Hospital , Tokyo , Japan. 19. s Division of Gastroenterology and Hepatology, Department of Internal Medicine , Toho University Ohashi Medical Center , Tokyo , Japan.
Abstract
OBJECTIVE: Endoscopic transpapillary or endoscopic ultrasound (EUS)-guided stent placement is used for nonresectable distal malignant biliary obstruction. We conducted a retrospective study to evaluate endoscopic biliary drainage in patients with duodenal obstruction. METHODS: We included consecutive patients who underwent endoscopic biliary drainage combined with a duodenal stent at 16 referral centers in four Asian countries. The primary outcome was time to recurrent biliary obstruction (TRBO). We assessed TRBO according to the sequence of biliary and duodenal obstruction (group 1/2/3, biliary obstruction first/concurrent/duodenal obstruction first, respectively) or the location of duodenal obstruction (type I/II/III, proximal to/affecting/distal to the ampulla, respectively). We also evaluated functional success and adverse events. RESULTS: We included 110 patients (group1/2/3, 67/29/14 patients; type I/II/III, 45/46/19 patients; endoscopic retrograde cholangiopancreatography [ERCP]/EUS-guided choledocoduodenostomy/EUS-guided hepaticogastrostomy, 90/10/10 patients, respectively). The median TRBO of all cases was 450 days (interquartile range, 212-666 days) and functional success was achieved in 105 cases (95%). The TRBO did not differ significantly by the timing or location of duodenal obstruction (p = .30 and .79, respectively). The TRBO of metal stents (n = 96) tended to be longer compared with plastic stents (n = 14, p = .083). Compared with ERCP, EUS-guided biliary drainage was associated with a higher rate of adverse events. CONCLUSION: Transpapillary or transmural endoscopic biliary drainage with a duodenal stent was effective, irrespective of the timing or location of duodenal obstruction. A prospective study is required considering the tradeoff of technical success rate, stent patency, and adverse events (ClinicalTrials.gov number, NCT02376907).
OBJECTIVE: Endoscopic transpapillary or endoscopic ultrasound (EUS)-guided stent placement is used for nonresectable distal malignant biliary obstruction. We conducted a retrospective study to evaluate endoscopic biliary drainage in patients with duodenal obstruction. METHODS: We included consecutive patients who underwent endoscopic biliary drainage combined with a duodenal stent at 16 referral centers in four Asian countries. The primary outcome was time to recurrent biliary obstruction (TRBO). We assessed TRBO according to the sequence of biliary and duodenal obstruction (group 1/2/3, biliary obstruction first/concurrent/duodenal obstruction first, respectively) or the location of duodenal obstruction (type I/II/III, proximal to/affecting/distal to the ampulla, respectively). We also evaluated functional success and adverse events. RESULTS: We included 110 patients (group1/2/3, 67/29/14 patients; type I/II/III, 45/46/19 patients; endoscopic retrograde cholangiopancreatography [ERCP]/EUS-guided choledocoduodenostomy/EUS-guided hepaticogastrostomy, 90/10/10 patients, respectively). The median TRBO of all cases was 450 days (interquartile range, 212-666 days) and functional success was achieved in 105 cases (95%). The TRBO did not differ significantly by the timing or location of duodenal obstruction (p = .30 and .79, respectively). The TRBO of metal stents (n = 96) tended to be longer compared with plastic stents (n = 14, p = .083). Compared with ERCP, EUS-guided biliary drainage was associated with a higher rate of adverse events. CONCLUSION: Transpapillary or transmural endoscopic biliary drainage with a duodenal stent was effective, irrespective of the timing or location of duodenal obstruction. A prospective study is required considering the tradeoff of technical success rate, stent patency, and adverse events (ClinicalTrials.gov number, NCT02376907).
Entities:
Keywords:
Common bile duct; endoscopic retrograde cholangiopancreatography; endoscopic ultrasound; gastric outlet obstruction; stent
Authors: Giuseppe Vanella; Giuseppe Dell'Anna; Michiel Bronswijk; Roy L J van Wanrooij; Gianenrico Rizzatti; Paraskevas Gkolfakis; Alberto Larghi; Schalk van der Merwe; Paolo Giorgio Arcidiacono Journal: Ann Gastroenterol Date: 2022-07-15
Authors: Giuseppe Vanella; Michiel Bronswijk; Roy Lj van Wanrooij; Giuseppe Dell'Anna; Wim Laleman; Hannah van Malenstein; Rogier P Voermans; Paul Fockens; Schalk Van der Merwe; Paolo Giorgio Arcidiacono Journal: DEN open Date: 2022-06-14
Authors: Anna Fábián; Renáta Bor; Noémi Gede; Péter Bacsur; Dániel Pécsi; Péter Hegyi; Barbara Tóth; Zsolt Szakács; Áron Vincze; István Ruzsics; Zoltán Rakonczay; Bálint Erőss; Róbert Sepp; Zoltán Szepes Journal: Clin Transl Gastroenterol Date: 2020-04 Impact factor: 4.396