Kentaro Yamao1, Masayuki Kitano2, Mamoru Takenaka1, Kosuke Minaga1, Toshiharu Sakurai1, Tomohiro Watanabe1, Takahisa Kayahara3, Tomoe Yoshikawa4, Yukitaka Yamashita4, Masanori Asada5, Yoshihiro Okabe5, Keiji Hanada6, Yasutaka Chiba7, Masatoshi Kudo1. 1. Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan. 2. Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan; Second Department of Internal Medicine, School of Medicine, Wakayama Medical University, Wakayama, Japan. 3. Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, Okayama, Japan. 4. Department of Gastroenterology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan. 5. Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka, Japan. 6. Department of Gastroenterology, Onomichi General Hospital, Onomichi, Japan. 7. Division of Biostatistics, Clinical Research Center, Kinki University Faculty of Medicine, Osaka-Sayama, Japan.
Abstract
BACKGROUND AND AIMS: Gastroduodenal and biliary obstruction may occur synchronously or asynchronously in advanced pancreatic cancer, and endoscopic double stent placement may be required. EUS-guided biliary drainage (EUS-BD) often is performed after unsuccessful placement of an endoscopic transpapillary stent (ETS), and EUS-BD may be beneficial in double stent placement. This retrospective multicenter cohort study compared the outcomes of ETS placement and EUS-BD in patients with an indwelling gastroduodenal stent (GDS). METHODS: We recorded the clinical outcomes of patients at 5 tertiary-care medical centers who required biliary drainage after GDS placement between March 2009 and March 2014. RESULTS: Thirty-nine patients were included in this study. Patients' mean age was 68.5 years; 23 (59.0%) were men. The GDS overlay the papilla in 23 patients (59.0%). The overall technical success rate was significantly higher with EUS-BD (95.2%) than with ETS placement (56.0%; P < .01). Furthermore, the technical success rate was significantly higher with EUS-BD (93.3%) than with ETS placement (22.2%; P < .01) when the GDS overlies the papilla. The overall clinical success rate of EUS-BD also was significantly higher than for ETS placement (90.5% vs 52.0%, respectively; P = .01), and there was no significant difference in the incidence of adverse events (ETS, 32.0% vs EUS-BD, 42.9%; P = .65). CONCLUSION: Endoscopic double stent placement with EUS-BD is technically and clinically superior to ETS placement in patients with an indwelling GDS. EUS-BD should be considered the first-line treatment option for patients with an indwelling GDS that overlies the papilla. ETS placement remains a reasonable alternative when the papilla is not covered by the GDS.
BACKGROUND AND AIMS: Gastroduodenal and biliary obstruction may occur synchronously or asynchronously in advanced pancreatic cancer, and endoscopic double stent placement may be required. EUS-guided biliary drainage (EUS-BD) often is performed after unsuccessful placement of an endoscopic transpapillary stent (ETS), and EUS-BD may be beneficial in double stent placement. This retrospective multicenter cohort study compared the outcomes of ETS placement and EUS-BD in patients with an indwelling gastroduodenal stent (GDS). METHODS: We recorded the clinical outcomes of patients at 5 tertiary-care medical centers who required biliary drainage after GDS placement between March 2009 and March 2014. RESULTS: Thirty-nine patients were included in this study. Patients' mean age was 68.5 years; 23 (59.0%) were men. The GDS overlay the papilla in 23 patients (59.0%). The overall technical success rate was significantly higher with EUS-BD (95.2%) than with ETS placement (56.0%; P < .01). Furthermore, the technical success rate was significantly higher with EUS-BD (93.3%) than with ETS placement (22.2%; P < .01) when the GDS overlies the papilla. The overall clinical success rate of EUS-BD also was significantly higher than for ETS placement (90.5% vs 52.0%, respectively; P = .01), and there was no significant difference in the incidence of adverse events (ETS, 32.0% vs EUS-BD, 42.9%; P = .65). CONCLUSION: Endoscopic double stent placement with EUS-BD is technically and clinically superior to ETS placement in patients with an indwelling GDS. EUS-BD should be considered the first-line treatment option for patients with an indwelling GDS that overlies the papilla. ETS placement remains a reasonable alternative when the papilla is not covered by the GDS.
Authors: Abdul H El Chafic; Janak N Shah; Chris Hamerski; Kenneth F Binmoeller; Shayan Irani; Theodore W James; Todd H Baron; Jose Nieto; Ricardo V Romero; John A Evans; Michel Kahaleh Journal: Dig Dis Sci Date: 2019-06-07 Impact factor: 3.199
Authors: Edoardo Troncone; Alessandro Fugazza; Annalisa Cappello; Giovanna Del Vecchio Blanco; Giovanni Monteleone; Alessandro Repici; Anthony Yuen Bun Teoh; Andrea Anderloni Journal: World J Gastroenterol Date: 2020-04-28 Impact factor: 5.742
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
Authors: Kelly E Hathorn; Ahmad Najdat Bazarbashi; Jordan S Sack; Thomas R McCarty; Thomas J Wang; Walter W Chan; Christopher C Thompson; Marvin Ryou Journal: Endosc Int Open Date: 2019-10-22