title: Multicenter retrospective study of endoscopic ultrasound-guided biliary drainage for malignant biliary obstruction in Japan.
abstract: BACKGROUND
  Endoscopic ultrasound-guided biliary drainage (EUS-BD) is considered to be an effective salvage procedure for failed endoscopic retrograde cholangiopancreatography in patients with unresectable malignant biliary obstruction. The aim of this retrospective study was to evaluate the efficacy and feasibility of EUS-BD.
  
  
  METHODS
  From November 2006 to May 2012, a total of 64 patients who underwent EUS-BD (44 EUS-guided choledochoduodenostomy [EUS-CDS] and 20 EUS-guided hepaticogastrostomy [EUS-HGS]) at seven tertiary-care referral centers in Japan were included. The primary outcome was the technical success rate, and the secondary outcomes were the incidence of complications, stent dysfunction rate, time to stent dysfunction, and overall survival.
  
  
  RESULTS
  The technical success rate for both EUS-CDS and EUS-HGS was 95%. The reasons for technical failure were two failed dilations of the anastomosis in EUS-CDS and one puncture failure in EUS-HGS. The stent dysfunction rate and 3-month dysfunction-free patency rate were 21% and 80% for EUS-CDS and 32% and 51% for EUS-HGS. There were 12 (six in EUS-CDS and six in EUS-HGS) procedure-related complications (19%): five cases of bile leakage (3/2), three stent misplacements (1/2), one pneumoperitoneum (1/0), two cases of bleeding (1/1), one perforation (1/0), and one biloma (0/1). Bile leakage was more frequently observed in patients who underwent plastic stent placement (11%) than in those with covered metal stents (4%).
  
  
  CONCLUSIONS
  This Japanese multicenter study revealed a high success rate in EUS-BD. However, the complication rate was as high as that in previous series. Covered metal stents may be useful to reduce bile leakage in EUS-BD.
authors.affiliation: Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan; Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Kazumichi
authors.initials: K
authors.lastname: Kawakubo
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Isayama
authors.forename: Hironari
authors.initials: H
authors.lastname: Kato
authors.forename: Takao
authors.initials: T
authors.lastname: Itoi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kawakami
authors.forename: Keiji
authors.initials: K
authors.lastname: Hanada
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Ishiwatari
authors.forename: Ichiro
authors.initials: I
authors.lastname: Yasuda
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Kawamoto
authors.forename: Fumihide
authors.initials: F
authors.lastname: Itokawa
authors.forename: Masaki
authors.initials: M
authors.lastname: Kuwatani
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Iiboshi
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Hayashi
authors.forename: Shinpei
authors.initials: S
authors.lastname: Doi
authors.forename: Yousuke
authors.initials: Y
authors.lastname: Nakai
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000150:complications; D002779:Cholestasis / Q000209:etiology* / Q000601:surgery*; D004322:Drainage; D019160:Endosonography / Q000379:methods*; D005260:Female; D005706:Gallbladder Neoplasms / Q000150:complications; D006801:Humans; D007564:Japan; D008207:Lymphatic Metastasis; D008297:Male; D010190:Pancreatic Neoplasms / Q000150:complications; D011183:Postoperative Complications; D012189:Retrospective Studies; D016879:Salvage Therapy; D015607:Stents; D016896:Treatment Outcome
keywords: Biliary obstruction; Biliary stent; Endoscopic procedure; Endoscopic ultrasound-guided biliary drainage; Endoscopic ultrasound-guided procedure