title: Clinical utility of endoscopic ultrasound-guided biliary drainage as a rescue of re-intervention procedure for high-grade hilar stricture.
abstract: OBJECTIVE
  Re-intervention after stent placement for malignant hepatic hilum obstruction (HBO) is challenging. endoscopic ultrasound-guided biliary drainage (EUS-BD) has been developed as an alternative method for failed endoscopic retrograde cholangiopancreatography (ERCP). In this retrospective study, the clinical utility of EUS-BD as a rescue drainage technique for HBO patients who failed re-intervention under ERCP guidance was evaluated.
  
  
  METHODS
  Between April 2012 and August 2015, patients with HBO were enrolled. Patients' characteristics, kinds of metallic stents, configuration of stent placement, overall survival, stent patency, and results of re-intervention were reviewed, along with the re-intervention technical success rate.
  
  
  RESULTS
  The biliary stricture type was Bismuth type IV in 59% (23/39) and types IIIa and b in 20.5% (8/39) each. Biliary metallic stent placement was bilateral in 38.5% (15/39), and unilateral in 61.5% (24/39). Primary stent dysfunction was observed in 71.8% (28/39) of cases. Planned re-intervention under ERCP guidance was attempted in 26 patients. The technical success rate was 62% (16/26). For the 10 patients who failed re-intervention under ERCP guidance, EUS-BD was planned. The technical success rate was 100% (10/10). The procedure time was 25.8 min. Adverse events were not seen in any patients. Stent patency after re-intervention was not significantly different between ERCP (165 days) guidance and EUS-BD (152 days) guidance (P = 0.463) CONCLUSIONS: In conclusion, EUS-BD as a re-intervention method for metallic stent obstruction was safe and feasible. If ERCP was failed, EUS-BD may be one of option as re-intervention method for high-grade hilar stricture.
authors.affiliation: 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Ogura
authors.affiliation: 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan.
authors.forename: Saori
authors.initials: S
authors.lastname: Onda
authors.affiliation: 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan.
authors.forename: Wataru
authors.initials: W
authors.lastname: Takagi
authors.affiliation: 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan.
authors.forename: Tatsushi
authors.initials: T
authors.lastname: Sano
authors.affiliation: 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Okuda
authors.affiliation: 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Masuda
authors.affiliation: Department of Radiology, Osaka Medical College, Osaka, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Yamamoto
authors.affiliation: 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Miyano
authors.affiliation: 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Kitano
authors.affiliation: 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan.
authors.forename: Toshihisa
authors.initials: T
authors.lastname: Takeuchi
authors.affiliation: 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Fukunishi
authors.affiliation: 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan.
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Higuchi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002780:Cholestasis, Intrahepatic / Q000628:therapy*; D004322:Drainage / Q000379:methods*; D019160:Endosonography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019233:Retreatment / Q000379:methods*; D012189:Retrospective Studies; D015607:Stents; D017211:Treatment Failure
keywords: ERCP; EUS-BD; EUS-FNA; EUS-guided biliary drainage; hepatic hilum