Endoscopic ultrasound-guided biliary drainage with placement of a fully covered metal stent for malignant biliary obstruction

• Published in: World journal of gastroenterology : WJG Vol. 18; no. 20; pp. 2526 - 2532
• Main Authors: Kim, Tae Hyeon, Kim, Seong Hun, Oh, Hyo Jeong, Sohn, Young Woo, Lee, Seung Ok
• Format: Journal Article
• Language: English
• Published: United States Baishideng Publishing Group Co., Limited 28-05-2012
• Subjects: Aged, 80 and over; Anastomosis, Surgical; Bile Duct Neoplasms - complications; Bile Ducts, Intrahepatic; Brief; Cholangiocarcinoma - complications; Choledochostomy; Cholestasis - etiology; Cholestasis - surgery; Common Bile Duct Neoplasms - complications; Drainage - methods; Endosonography; Female; Hepatic Duct, Common - surgery; Humans; Klatskin Tumor - complications; Male; Middle Aged; Palliative Care; Pancreatic Neoplasms - complications; Stents; Stomach - surgery; Ultrasonography, Interventional; 内镜; 完全覆盖; 引导; 恶性; 胆管; 金属支架; 阻性; 黄疸; Biliary drainage; Biliary obstruction; Endoscopic ultrasound-guided; Metal stent
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.v18.i20.2526

AIM：To determine the utility of endoscopic ultrasoundguided biliary drainage（EUS-BD）with a fully covered self-expandable metal stent for managing malignant biliary stricture. METHODS：We collected data from 13 patients who presented with malignant biliary obstruction and underwent EUS-BD with a nitinol fully covered selfexpandable metal stent when endoscopic retrograde cholangiopancreatography（ERCP）fails.EUS-guided choledochoduodenostomy（EUS-CD）and EUS-guided hepaticogastrostomy（EUS-HG）was performed in 9 patients and 4 patients,respectively. RESULTS：The technical and functional success rate was 92.3%（12/13）and 91.7%（11/12）,respectively. Using an intrahepatic approach（EUS-HG,n=4）,there was mild peritonitis（n=1）and migration of the metal stent to the stomach（n=1）.With an extrahepatic approach（EUS-CD,n=10）,there was pneumoperitoneum（n=2）,migration（n=2）,and mild peritonitis （n=1）.All patients were managed conservatively with antibiotics.During follow-up（range,1-12 mo）,there was re-intervention（4/13 cases,30.7%）necessitated by stent migration（n=2）and stent occlusion（n=2）. CONCLUSION：EUS-BD with a nitinol fully covered self-expandable metal stent may be a feasible and effective treatment option in patients with malignant biliary obstruction when ERCP fails.