Usefulness of a laser-cut covered metal stent with a 7F delivery sheath in endoscopic ultrasound-guided biliary drainage without fistula dilation

Abstract

Background and study aims Recently, the utility of endoscopic ultrasound-guided intervention without fistula dilation (EUS-IV WoD) has been reported to prevent adverse events. We clinically evaluated cases in which EUS-IV WoD was attempted using a novel self-expandable metallic stent (SEMS); this is a fully covered, laser-cut SEMS that has a tapered and stiff tip specifically designed for a 0.025-inch guidewire and a relatively thin, 7F delivery system.

Patients and methods We retrospectively evaluated cases wherein EUS-IV WoD was attempted using the novel SEMS between March and December 2021.

Results Treatment of 11 patients by EUS-IV WoD with the novel SEMS was attempted. The technical success rate for EUS-IV was 100 % and the clinical success rate was 100 %; the success rate for EUS-IV WoD was 72.8 %. Of these, the procedural success rate for EUS-IV WoD was 100 % in EUS-biliary drainage (BD) and 57.1 % in non-EUS-BD. Early adverse events were observed in 27.3 % of patients (3/11): mild abdominal pain in two patients and moderate bleeding in one patient. The abdominal pain cases were both cases of EUS-IV WoD failure and required fistula dilation.

Conclusions The novel stent may be useful for EUS-IV WoD, especially in EUS-BD.

Publikationsverlauf

Eingereicht: 16. Oktober 2022

Angenommen nach Revision: 08. Dezember 2022

Artikel online veröffentlicht:
26. Januar 2023

• References

• 1 Moss AC, Morris E, Leyden J. et al. Do the benefits of metal stents justify the costs? A systematic review and meta-analysis of trials comparing endoscopic stents for malignant biliary obstruction. Eur J Gastroenterol Hepatol 2007; 19: 1119-1124
• 2 Dhindsa BS, Mashiana HS, Dhaliwal A. et al. EUS-guided biliary drainage: a systematic review and meta-analysis. Endosc Ultrasound 2020; 9: 101-109
• 3 Park DH, Lee TH, Paik WH. et al. Feasibility and safety of a novel dedicated device for one-step EUS-guided biliary drainage: a randomized trial. J Gastroenterol Hepatol 2015; 30: 1461-1466
• 4 Itonaga M, Kitano M, Hatamaru K. et al. Endoscopic ultrasound-guided choledochoduodenostomy using a thin stent delivery system in patients with unresectable malignant distal biliary obstruction: a prospective multicenter study. Dig Endosc 2019; 31: 291-298
• 5 Maehara K, Hijioka S, Nagashio Y. et al. Endoscopic ultrasound-guided hepaticogastrostomy or hepaticojejunostomy without dilation using a stent with a thinner delivery system. Endosc Int Open 2020; 8: E1034-E1038
• 6 Koga T, Hijioka S, Nagashio Y. et al. Endoscopic ultrasound‐guided choledochoduodenostomy without fistula dilation using a stent with a 5.9‐Fr delivery system: comparison to a conventional procedure with fistula dilation. DEN Open 2021; 2: e56
• 7 Ogura T, Ueno S, Okuda A. et al. Technical feasibility and safety of one-step deployment of EUS-guided hepaticogastrostomy using an 8-mm diameter metal stent with a fine-gauge stent delivery system (with video). Endosc Ultrasound 2021; 10: 355-360
• 8 Isayama H, Hamada T, Yasuda I. et al. TOKYO criteria 2014 for transpapillary biliary stenting. Dig Endosc 2015; 27: 259-264
• 9 Cotton PB, Eisen GM, Aabakken L. et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010; 71: 446-454
• 10 Harai S, Hijioka S, Nagashio Y. et al. Usefulness of the laser-cut, fully covered, self-expandable metallic stent for endoscopic ultrasound-guided hepaticogastrostomy. J Hepatobiliary Pancreat Sci 2022; 29: 1035-1043