title: Preliminary report on a new hybrid metal stent for EUS-guided biliary drainage (with videos).
abstract: BACKGROUND
  EUS-guided biliary drainage (EUS-BD) may be a feasible and useful alternative in patients with malignant biliary obstruction after failed ERCP. One of the main limitations of EUS-BD is the lack of devices specifically tailored to this technique.
  
  
  OBJECTIVE
  To evaluate a newly developed hybrid metal stent customized for EUS-BD.
  
  
  METHODS
  A prospective, observational study.
  
  
  METHODS
  A tertiary academic referral center.
  
  
  METHODS
  A total of 27 consecutive patients with malignant biliary obstruction who were candidates for alternative techniques for biliary drainage because of failed ERCP were enrolled.
  
  
  METHODS
  EUS-BD with a newly developed hybrid metal stent.
  
  
  METHODS
  The technical and clinical success rates and adverse events, including proximal or distal stent migration and cholangitis.
  
  
  RESULTS
  EUS-guided hepaticogastrostomy was performed in 10 patients, and EUS-guided choledochoduodenostomy was performed in 17 patients. The technical success rate of EUS-BD with the hybrid metal stent was 100% (27/27), and clinical success was achieved in 96.3% (26/27) of the cases. Adverse events developed in 5 patients (5/27, 18.5%), including a self-limited pneumoperitoneum in 3 patients, minor bleeding in 1 patient, and abdominal pain in 1 patient. During the follow-up period (median 134 days), proximal or distal stent migration was not observed.
  
  
  CONCLUSIONS
  This study was performed at a single center by a single experienced operator with a relatively small number of patients.
  
  
  CONCLUSIONS
  EUS-BD with a hybrid metal stent is technically feasible and can be an effective treatment for malignant biliary obstruction after failed ERCP. Hybrid metal stents may be used safely in EUS-BD, and they can prevent stent-related adverse events.
authors: Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors: Tae Jun
authors: TJ
authors: Song
authors: Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors: Sang Soo
authors: SS
authors: Lee
authors: Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors: Do Hyun
authors: DH
authors: Park
authors: Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors: Dong Wan
authors: DW
authors: Seo
authors: Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors: Sung Koo
authors: SK
authors: Lee
authors: Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors: Myung-Hwan
authors: MH
authors: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000379:methods; D002768:Choledochostomy / Q000379:methods; D002779:Cholestasis / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D004322:Drainage / Q000379:methods*; D019160:Endosonography / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods; D011446:Prospective Studies; D011474:Prosthesis Design; D011788:Quality of Life; D012086:Reoperation / Q000379:methods; D018570:Risk Assessment; D012720:Severity of Illness Index; D015607:Stents; D062606:Tertiary Care Centers; D016896:Treatment Outcome
chemical_list: D008670:Metals