EUS-guided hepaticogastrostomy with a fully covered metal stent as the biliary diversion technique for an occluded biliary metal stent after a failed ERCP (with videos)

• Published in: Gastrointestinal endoscopy 2010-02, Vol.71 (2), p.413-419
• Main Authors: Park, Do Hyun, MD, PhD, Song, Tae-Jun, MD, Eum, Junbum, MD, Moon, Sung-Hoon, MD, Lee, Sang Soo, MD, PhD, Seo, Dong-Wan, MD, PhD, Lee, Sung-Koo, MD, PhD, Kim, Myung-Hwan, MD, PhD
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Cholangiopancreatography, Endoscopic Retrograde - adverse effects; Cholangiopancreatography, Endoscopic Retrograde - instrumentation; Cholangiopancreatography, Endoscopic Retrograde - methods; Cholestasis, Intrahepatic - diagnostic imaging; Cholestasis, Intrahepatic - surgery; Device Removal; Digestive system; Digestive system. Abdomen; Drainage - instrumentation; Endoscopy; Endosonography - methods; Female; Follow-Up Studies; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Gastrostomy - methods; Humans; Investigative techniques, diagnostic techniques (general aspects); Liver - surgery; Male; Medical sciences; Middle Aged; Palliative Care; Prosthesis Failure; Quality of Life; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Risk Assessment; Sampling Studies; Stents; Treatment Outcome
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2009.10.015

Background Percutaneous transhepatic biliary drainage (PTBD) may be the last resort for an occluded biliary metal stent when the ERCP was unsuccessful. Objective Because an EUS-guided biliary drainage has been proposed as an effective alternative for PTBD after a failed ERCP, we conducted this study to determine the feasibility and usefulness of an EUS-guided hepaticogastrostomy (EUS-HG) with a fully covered self-expandable metal stent (FCSEMS) for an occluded biliary metal stent after a failed ERCP. Design A case study. Setting A tertiary referral center. Patients and Interventions Five patients who had an occluded biliary metal stent inserted after a hilar bilateral metal stent or a combined duodenal and biliary metal stent insertion and for whom reinterventional ERCP was unsuccessful underwent an EUS-HG with an FCSEMS for alternative PTBD. Main Outcome Measurements Technical and functional success, procedural complications, reinterventional rate after EUS-HG with an FCSEMS, and short-term stent patency. Results In all 5 patients, an EUS-HG with an FCSEMS was technically successful. No procedural complications, such as bile peritonitis, cholangitis, and pneumoperitoneum, were observed. Functional success was also 100% (5/5). During the follow-up period (median 152 days, range 64-184 days), no late complications, such as stent migration and occlusion, were observed. Thus, no biliary reintervention was performed during the follow-up period. Limitations A small series of patients without a control group. Conclusions The EUS-HG with an FCSEMS may be feasible, effective, and an alternative PTBD for an occluded biliary metal stent after a failed ERCP.