title: Long-term outcomes of a newly developed hybrid metal stent for EUS-guided biliary drainage (with videos).
abstract: OBJECTIVE
  Although fully covered self-expandable metal stents (FCSEMSs) have been commonly used for EUS-guided biliary drainage (EUS-BD), FCSEMS migration is a main limitation of this procedure. In the present study we evaluated the technical and clinical success rates, adverse events, and long-term outcomes of a newly developed hybrid stent that has been customized for EUS-BD.
  
  
  METHODS
  From September 2011 to May 2015, 54 consecutive patients with biliary obstruction were enrolled in this prospective, observational study. These patients were candidates for alternative BD techniques because of failed ERCP. The hybrid metal stent used for EUS-BD in this study was partially covered, had anchoring flaps, and is commercially available in Korea.
  
  
  RESULTS
  EUS-guided hepaticogastrostomy (EUS-HGS) was performed in 21 patients and EUS-guided choledochoduodenostomy (EUS-CDS) in 33 patients. The technical and clinical success rates of EUS-BD were 100% (54/54) and 94.4% (51/54), respectively. Immediate adverse events developed after EUS-BD in 9 patients (16.6%; cholangitis in 3, bleeding in 2, self-limited pneumoperitoneum in 3, and abdominal pain in 1). Proximal or distal stent migration was not observed during the follow-up period (median, 148.5 days; IQR, 79.7-244), and the mean stent patency duration was 166.3 days and 329.1 days in the EUS-HGS and EUS-CDS groups, respectively.
  
  
  CONCLUSIONS
  EUS-BD with the hybrid metal stent is technically feasible and can effectively treat biliary obstruction after failed ERCP. EUS-BD with the hybrid metal stent can reduce stent-related adverse events, especially stent migration.
authors.affiliation: Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Dong Hui
authors.initials: DH
authors.lastname: Cho
authors.affiliation: Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Sang Soo
authors.initials: SS
authors.lastname: Lee
authors.affiliation: Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Dongwook
authors.initials: D
authors.lastname: Oh
authors.affiliation: Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Tae Jun
authors.initials: TJ
authors.lastname: Song
authors.affiliation: Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Do Hyun
authors.initials: DH
authors.lastname: Park
authors.affiliation: Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Dong Wan
authors.initials: DW
authors.lastname: Seo
authors.affiliation: Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Sung Koo
authors.initials: SK
authors.lastname: Lee
authors.affiliation: Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Myung-Hwan
authors.initials: MH
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001653:Bile Ducts, Intrahepatic / Q000601:surgery*; D001662:Biliary Tract Surgical Procedures / Q000295:instrumentation / Q000379:methods; D002768:Choledochostomy / Q000295:instrumentation* / Q000379:methods; D002780:Cholestasis, Intrahepatic / Q000601:surgery*; D004322:Drainage / Q000295:instrumentation* / Q000379:methods; D019160:Endosonography; D005260:Female; D005774:Gastrostomy / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D008099:Liver / Q000601:surgery; D008297:Male; D008670:Metals; D008875:Middle Aged; D011446:Prospective Studies; D015607:Stents; D025321:Surgery, Computer-Assisted / Q000379:methods; D016896:Treatment Outcome
chemical_list: D008670:Metals