Skip to main content
main-content

10.08.2022 | Original Article

Endoscopic Ultrasound-Guided Antegrade Stent Placement in Patients with Failed ERCP as a Modality of Preoperative and Palliative Biliary Drainage

verfasst von: Sridhar Sundaram, Kiran Mane, Prachi Patil, Raosaheb Rathod, Aadish Kumar Jain, Unique Tyagi, Shaesta Mehta

Erschienen in: Digestive Diseases and Sciences

Einloggen, um Zugang zu erhalten

Abstract

Background

No large studies have addressed the role of endoscopic-ultrasound biliary drainage (EUS-BD) as preoperative biliary drainage (PBD) for malignant extrahepatic biliary obstruction (MEBO). We aimed to discuss the outcomes of EUS antegrade stent placement (EUS-AG) in the preoperative and palliative setting.

Methods

Retrospective review of patients who underwent EUS-AG for MEBO between December 2019 and December 2021 was done. Primary outcome measures were technical success and clinical success. Secondary outcome measures were number of days of hospitalization postprocedure, adverse events related to EUS-AG procedure, morbidity related to surgery, and 3-month mortality after surgery.

Results

54 patients underwent attempt for EUS-AG (mean age 54.8 ± 12.1 years; female 44.4%). Most common primary cancer was pancreatic cancer in 42.1% (23/54) patients. Indication was palliative in 34 (62.9%) patients and PBD in 20 (37%) patients. Level of block was distal in 35 (64.8%) and proximal in 19 (35.1%) patients. Technical success of EUS-AG was 88.7% (47/53). Clinical success was seen in 95.7% (45/47) patients. Median number of days of hospitalization postprocedure was 1 day. No procedure-related severe adverse events were seen. Of 20 patients who underwent EUS-AG as PBD, 19 had technical success (95%) with clinical success in 94.5% (18/19). Surgery was performed in 11 patients, of whom 10 patients underwent successful PPPD (one intraoperative liver metastasis). Two patients had Clavein–Dindo III/IV complication post-PPPD, with one mortality within 30 days of surgery.

Conclusion

EUS-AG is safe and effective after failed ERCP in both preoperative and palliative setting.
Literatur
1.
Zurück zum Zitat Kim DC, Moon JH, Choi HJ. The role of endoscopic retrograde cholangiopancreatography at an academic medical center in the era of less-invasive diagnostic tools. Expert Rev Gastroenterol Hepatol. 2012;6:549–551. CrossRef Kim DC, Moon JH, Choi HJ. The role of endoscopic retrograde cholangiopancreatography at an academic medical center in the era of less-invasive diagnostic tools. Expert Rev Gastroenterol Hepatol. 2012;6:549–551. CrossRef
2.
Zurück zum Zitat Born P, Rosch T, Triptrap A et al. Long-term results of percutaneous transhepatic biliary drainage for benign and malignant bile duct strictures. Scand J Gastroenterol 1998;33:544–549. CrossRef Born P, Rosch T, Triptrap A et al. Long-term results of percutaneous transhepatic biliary drainage for benign and malignant bile duct strictures. Scand J Gastroenterol 1998;33:544–549. CrossRef
4.
Zurück zum Zitat Scheufele F, Schorn S, Demir IE et al. Preoperative biliary stenting versus operation first in jaundiced patients due to malignant lesions in the pancreatic head: A meta-analysis of current literature. Surgery. 2017;161:939–950. CrossRef Scheufele F, Schorn S, Demir IE et al. Preoperative biliary stenting versus operation first in jaundiced patients due to malignant lesions in the pancreatic head: A meta-analysis of current literature. Surgery. 2017;161:939–950. CrossRef
5.
Zurück zum Zitat Shaib Y, Rahal MA, Rammal MO, Mailhac A, Tamim H. Preoperative biliary drainage for malignant biliary obstruction: results from a national database. J Hepatobiliary Pancreat Sci. 2017;24:637–642. CrossRef Shaib Y, Rahal MA, Rammal MO, Mailhac A, Tamim H. Preoperative biliary drainage for malignant biliary obstruction: results from a national database. J Hepatobiliary Pancreat Sci. 2017;24:637–642. CrossRef
6.
Zurück zum Zitat Gao Z, Wang J, Shen S et al. The impact of preoperative biliary drainage on postoperative outcomes in patients with malignant obstructive jaundice: a retrospective analysis of 290 consecutive cases at a single medical center. World J Surg Oncol. 2022;20:7. CrossRef Gao Z, Wang J, Shen S et al. The impact of preoperative biliary drainage on postoperative outcomes in patients with malignant obstructive jaundice: a retrospective analysis of 290 consecutive cases at a single medical center. World J Surg Oncol. 2022;20:7. CrossRef
7.
Zurück zum Zitat Saxena P, Kumbhari V, Zein ME, Khashab MA. Preoperative biliary drainage. Dig Endosc. 2015;27:265–277. CrossRef Saxena P, Kumbhari V, Zein ME, Khashab MA. Preoperative biliary drainage. Dig Endosc. 2015;27:265–277. CrossRef
8.
Zurück zum Zitat Sugiyama H, Tsuyuguchi T, Sakai Y et al. Current status of preoperative drainage for distal biliary obstruction. World J Hepatol. 2015;7:2171–2176. CrossRef Sugiyama H, Tsuyuguchi T, Sakai Y et al. Current status of preoperative drainage for distal biliary obstruction. World J Hepatol. 2015;7:2171–2176. CrossRef
9.
Zurück zum Zitat Hameed A, Pang T, Chiou J et al. Percutaneous vs. endoscopic pre-operative biliary drainage in hilar cholangiocarcinoma - a systematic review and meta-analysis. HPB (Oxford) 2016;18:400–410. CrossRef Hameed A, Pang T, Chiou J et al. Percutaneous vs. endoscopic pre-operative biliary drainage in hilar cholangiocarcinoma - a systematic review and meta-analysis. HPB (Oxford) 2016;18:400–410. CrossRef
10.
Zurück zum Zitat Lesmana CRA, Paramitha MS, Gani RA. Therapeutic interventional endoscopic ultrasound in pancreato-biliary disorders: Does it really replace the surgical/percutaneous approach? World J Gastrointest Surg. 2021;13:537–547. CrossRef Lesmana CRA, Paramitha MS, Gani RA. Therapeutic interventional endoscopic ultrasound in pancreato-biliary disorders: Does it really replace the surgical/percutaneous approach? World J Gastrointest Surg. 2021;13:537–547. CrossRef
11.
Zurück zum Zitat van der Merwe SW, van Wanrooij RLJ, Bronswijk M et al. Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2022;54:185–205. CrossRef van der Merwe SW, van Wanrooij RLJ, Bronswijk M et al. Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2022;54:185–205. CrossRef
13.
Zurück zum Zitat Moole H, Bechtold ML, Forcione D, Puli SR. A meta-analysis and systematic review: Success of endoscopic ultrasound guided biliary stenting in patients with inoperable malignant biliary strictures and a failed ERCP. Medicine (Baltimore). 2017;96:e5154. CrossRef Moole H, Bechtold ML, Forcione D, Puli SR. A meta-analysis and systematic review: Success of endoscopic ultrasound guided biliary stenting in patients with inoperable malignant biliary strictures and a failed ERCP. Medicine (Baltimore). 2017;96:e5154. CrossRef
14.
Zurück zum Zitat 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. CrossRef 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. CrossRef
15.
Zurück zum Zitat Clavien PA, Barkun J, de Oliveira ML et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187–196. CrossRef Clavien PA, Barkun J, de Oliveira ML et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187–196. CrossRef
16.
Zurück zum Zitat Nguyen-Tang T, Binmoeller KF, Sanchez-Yague A et al. Endoscopic ultrasound (EUS)-guided transhepatic anterograde self-expandable metal stent (SEMS) placement across malignant biliary obstruction. Endoscopy. 2010;42:232–236. CrossRef Nguyen-Tang T, Binmoeller KF, Sanchez-Yague A et al. Endoscopic ultrasound (EUS)-guided transhepatic anterograde self-expandable metal stent (SEMS) placement across malignant biliary obstruction. Endoscopy. 2010;42:232–236. CrossRef
17.
Zurück zum Zitat Iwashita T, Doi S, Yasuda I. Endoscopic ultrasound-guided biliary drainage: A review. Clin J Gastroenterol. 2014;7:94–102. CrossRef Iwashita T, Doi S, Yasuda I. Endoscopic ultrasound-guided biliary drainage: A review. Clin J Gastroenterol. 2014;7:94–102. CrossRef
18.
Zurück zum Zitat Dhir V, Itoi T, Khashab MA et al. Multicenter comparative evaluation of endoscopic placement of expandable metal stents for malignant distal common bile duct obstruction by ERCP or EUS-guided approach. Gastrointest Endosc. 2015;81:913–923. CrossRef Dhir V, Itoi T, Khashab MA et al. Multicenter comparative evaluation of endoscopic placement of expandable metal stents for malignant distal common bile duct obstruction by ERCP or EUS-guided approach. Gastrointest Endosc. 2015;81:913–923. CrossRef
22.
Zurück zum Zitat Iwashita T, Uemura S, Mita N et al. Endoscopic ultrasound guided-antegrade biliary stenting vs percutaneous transhepatic biliary stenting for unresectable distal malignant biliary obstruction in patients with surgically altered anatomy. J Hepatobiliary Pancreat Sci. 2020;27:968–976. CrossRef Iwashita T, Uemura S, Mita N et al. Endoscopic ultrasound guided-antegrade biliary stenting vs percutaneous transhepatic biliary stenting for unresectable distal malignant biliary obstruction in patients with surgically altered anatomy. J Hepatobiliary Pancreat Sci. 2020;27:968–976. CrossRef
23.
Zurück zum Zitat Ogura T, Kitano M, Takenaka M et al. Multicenter prospective evaluation study of endoscopic ultrasound-guided hepaticogastrostomy combined with antegrade stenting (with video). Dig Endosc. 2018;30:252–259. CrossRef Ogura T, Kitano M, Takenaka M et al. Multicenter prospective evaluation study of endoscopic ultrasound-guided hepaticogastrostomy combined with antegrade stenting (with video). Dig Endosc. 2018;30:252–259. CrossRef
24.
Zurück zum Zitat Imai H, Takenaka M, Omoto S et al. Utility of Endoscopic Ultrasound-Guided Hepaticogastrostomy with Antegrade Stenting for Malignant Biliary Obstruction after Failed Endoscopic Retrograde Cholangiopancreatography. Oncology. 2017;93:69–75. CrossRef Imai H, Takenaka M, Omoto S et al. Utility of Endoscopic Ultrasound-Guided Hepaticogastrostomy with Antegrade Stenting for Malignant Biliary Obstruction after Failed Endoscopic Retrograde Cholangiopancreatography. Oncology. 2017;93:69–75. CrossRef
25.
Zurück zum Zitat Almadi MA, Barkun A, Martel M. Plastic vs. Self-Expandable Metal Stents for Palliation in Malignant Biliary Obstruction: A Series of Meta-Analyses. Am J Gastroenterol. 2017;112:260–273. CrossRef Almadi MA, Barkun A, Martel M. Plastic vs. Self-Expandable Metal Stents for Palliation in Malignant Biliary Obstruction: A Series of Meta-Analyses. Am J Gastroenterol. 2017;112:260–273. CrossRef
26.
Zurück zum Zitat Liu P, Lin H, Chen Y, Wu YS, Tang M, Liu C. Comparison of Metal and Plastic Stents for Preoperative Biliary Drainage in Resectable and Borderline Resectable Periampullary Cancer: A Meta-Analysis and System Review. J Laparoendosc Adv Surg Tech A. 2018;28:1074–1082. CrossRef Liu P, Lin H, Chen Y, Wu YS, Tang M, Liu C. Comparison of Metal and Plastic Stents for Preoperative Biliary Drainage in Resectable and Borderline Resectable Periampullary Cancer: A Meta-Analysis and System Review. J Laparoendosc Adv Surg Tech A. 2018;28:1074–1082. CrossRef
27.
Zurück zum Zitat Tringali A, Hassan C, Rota M, Rossi M, Mutignani M, Aabakken L. Covered vs. uncovered self-expandable metal stents for malignant distal biliary strictures: a systematic review and meta-analysis [published correction appears in Endoscopy. 2018 Jun; 50(6):C5]. Endoscopy 2018;50:631–641. CrossRef Tringali A, Hassan C, Rota M, Rossi M, Mutignani M, Aabakken L. Covered vs. uncovered self-expandable metal stents for malignant distal biliary strictures: a systematic review and meta-analysis [published correction appears in Endoscopy. 2018 Jun; 50(6):C5]. Endoscopy 2018;50:631–641. CrossRef
28.
Zurück zum Zitat Bang JY, Navaneethan U, Hasan M, Hawes R, Varadarajulu S. Stent placement by EUS or ERCP for primary biliary decompression in pancreatic cancer: a randomized trial (with videos). Gastrointest Endosc. 2018;88:9–17. CrossRef Bang JY, Navaneethan U, Hasan M, Hawes R, Varadarajulu S. Stent placement by EUS or ERCP for primary biliary decompression in pancreatic cancer: a randomized trial (with videos). Gastrointest Endosc. 2018;88:9–17. CrossRef
29.
Zurück zum Zitat Fabbri C, Fugazza A, Binda C et al. Beyond palliation: using EUS-guided choledochoduodenostomy with a lumen-apposing metal stent as a bridge to surgery. a case series. J Gastrointestin Liver Dis. 2019;28:125–128. PubMed Fabbri C, Fugazza A, Binda C et al. Beyond palliation: using EUS-guided choledochoduodenostomy with a lumen-apposing metal stent as a bridge to surgery. a case series. J Gastrointestin Liver Dis. 2019;28:125–128. PubMed
30.
Zurück zum Zitat Vanella G, Tamburrino D, Dell’Anna G et al. Endoscopic ultrasound-guided gastrojejunostomy does not prevent pancreaticoduodenectomy after long-term symptom-free neoadjuvant treatment. Endoscopy. 2022;54:E143–E145. CrossRef Vanella G, Tamburrino D, Dell’Anna G et al. Endoscopic ultrasound-guided gastrojejunostomy does not prevent pancreaticoduodenectomy after long-term symptom-free neoadjuvant treatment. Endoscopy. 2022;54:E143–E145. CrossRef
31.
Zurück zum Zitat Koutlas N J, LePage E M, Lucioni T, et al. Preoperative Endoscopic Ultrasound-Guided Hepaticogastrostomy Facilitates Decompression and Diagnosis in Patients With Suspected Malignant Biliary Obstruction: A Case Series. Cureus 14: e23209. Koutlas N J, LePage E M, Lucioni T, et al. Preoperative Endoscopic Ultrasound-Guided Hepaticogastrostomy Facilitates Decompression and Diagnosis in Patients With Suspected Malignant Biliary Obstruction: A Case Series. Cureus 14: e23209.
Metadaten
Titel
Endoscopic Ultrasound-Guided Antegrade Stent Placement in Patients with Failed ERCP as a Modality of Preoperative and Palliative Biliary Drainage
verfasst von
Sridhar Sundaram
Kiran Mane
Prachi Patil
Raosaheb Rathod
Aadish Kumar Jain
Unique Tyagi
Shaesta Mehta
Publikationsdatum
10.08.2022
Verlag
Springer US
Erschienen in
Digestive Diseases and Sciences
Print ISSN: 0163-2116
Elektronische ISSN: 1573-2568
DOI
https://doi.org/10.1007/s10620-022-07655-w

Neu im Fachgebiet Innere Medizin

Newsletter

Bestellen Sie unseren kostenlosen Newsletter Update Innere Medizin und bleiben Sie gut informiert – ganz bequem per eMail.