EUS-guided biliary drainage with a fully covered metal stent as a novel route for natural orifice transluminal endoscopic biliary interventions: a pilot study (with videos).
BACKGROUND
EUS-guided biliary drainage (EUS-BD) with the use of a fully covered metal stent can result in a large-diameter fistula between the bile duct and the duodenum or stomach. This sustainable fistula may constitute a new endoscopic route to the bile duct.


OBJECTIVE
To assess the feasibility of performing endoscopic procedures through EUS-guided choledochoduodenostomy or hepaticogastrostomy with a fully covered self-expandable metal stent (FCSEMS).


METHODS
Observational pilot study.


METHODS
Tertiary-care referral center.


METHODS
This study involved 3 consecutive patients who underwent EUS-BD with an FCSEMS for biliary decompression.


METHODS
One to four weeks after EUS-BD with an FCSEMS, endoscopic procedures for the bile duct were performed through the sinus tract to evaluate and manage intrabiliary lesions.


METHODS
Technical success and procedural complications of endoscopic procedures through EUS-BD with an FCSEMS.


RESULTS
Endoscopic procedures were completed through the sinus tract of EUS-BD. Two patients underwent photodynamic therapy for tumor bleeding in the common bile duct and argon plasma coagulation on the biliary intraductal papillary mucinous neoplasm repeatedly under direct visual guidance. In the other patient, photodynamic therapy was performed on the malignant hilar stricture through EUS-guided hepaticogastrostomy with an FCSEMS.


CONCLUSIONS
Small sample size, pilot study.


CONCLUSIONS
EUS-BD with an FCSEMS may result in a large-diameter sustainable fistula. Endoscopic intervention through this fistula seems to be feasible and useful for the management of intrabiliary lesions.
Eum
Junbum
J
Department of Internal Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea.
Park
Do Hyun
DH
Ryu
Choong Heon
CH
Kim
Hong Jun
HJ
Lee
Sang Soo
SS
Seo
Dong Wan
DW
Lee
Sung Koo
SK
Kim
Myung-Hwan
MH
D000328:Adult; D000368:Aged; D057908:Argon Plasma Coagulation; D001650:Bile Duct Neoplasms / Q000628:therapy; D001653:Bile Ducts, Intrahepatic; D002291:Carcinoma, Papillary / Q000628:therapy; D002760:Cholangiopancreatography, Endoscopic Retrograde; D020099:Coated Materials, Biocompatible; D003138:Common Bile Duct Neoplasms / Q000628:therapy; D004322:Drainage / Q000379:methods*; D019160:Endosonography / Q000379:methods*; D005260:Female; D006431:Hemobilia / Q000628:therapy; D006801:Humans; D018285:Klatskin Tumor / Q000628:therapy; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D010778:Photochemotherapy / Q000379:methods; D010865:Pilot Projects; D015607:Stents; D018084:Ultrasonography, Interventional / Q000379:methods*
D020099:Coated Materials, Biocompatible