Endoscopic ultrasound-guided biliary drainage with placement of a fully covered metal stent for malignant biliary obstruction.
OBJECTIVE
To determine the utility of endoscopic ultrasound-guided 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 self-expandable 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).


CONCLUSIONS
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.
Department of Internal Medicine, School of Medicine, Wonkwang University, Iksan, Chonbuk 570-749, South Korea. kth@wonkwang.ac.kr
Tae Hyeon
TH
Kim
Seong Hun
SH
Kim
Hyo Jeong
HJ
Oh
Young Woo
YW
Sohn
Seung Ok
SO
Lee
D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D001650:Bile Duct Neoplasms / Q000150:complications; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000150:complications; D002768:Choledochostomy; D002779:Cholestasis / Q000209:etiology / Q000601:surgery*; D003138:Common Bile Duct Neoplasms / Q000150:complications*; D004322:Drainage / Q000379:methods*; D019160:Endosonography; D005260:Female; D006500:Hepatic Duct, Common / Q000601:surgery; D006801:Humans; D018285:Klatskin Tumor / Q000150:complications; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000150:complications*; D015607:Stents; D013270:Stomach / Q000601:surgery; D018084:Ultrasonography, Interventional