Endoscopic ultrasonography-guided choledochoduodenostomy using a newly designed laser-cut metal stent: Feasibility study in a porcine model.
OBJECTIVE
Endoscopic ultrasonography (EUS)-guided choledochoduodenostomy (EUS-CDS) is increasingly used in the treatment of malignant distal biliary obstruction. Standardized use of this technique requires improvements in instruments, including more convenient and safer devices. The present study was designed to evaluate the resistance force to migration (RFM) of a newly designed laser-cut metal stent and the feasibility of EUS-CDS using this stent.


METHODS
This experimental study used a porcine model of biliary dilatation involving five male pigs. The new stent is a fully covered laser-cut stent with anti-migration anchoring hooks. The RFM of the new stents was compared with those of three commercially available covered metal stents using a phantom model. In the animal study, after ligation of Vater's ampulla with endoscopic clips, the dilated common bile duct was punctured under EUS guidance, followed by EUS-CDS using the new stent. One week after the procedure, the stents were removed endoscopically and the fistulas were assessed after the pigs were killed. Technical feasibility and clinical outcomes were evaluated.


RESULTS
Among the four stents, the new stent had the highest RFM. Metal stent placement was successful in all five pigs, with no procedure-related complications occurring during and 1 week after endoscopic intervention. All stents remained in place without migration and were removed easily using a snare. At necropsy, fistulas were created between the bile duct and duodenum in all pigs.


CONCLUSIONS
EUS-CDS using a newly designed metal stent was feasible and effective in this porcine model of biliary dilatation.
Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan.
Kosuke
K
Minaga
Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan.|Second Department of Internal Medicine, Wakayama Medical University School of Medicine, Wakayama, Japan.
Masayuki
M
Kitano
Research and Development Center, Zeon Corporation, Toyama, Japan.
Chimyon
C
Gon
Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan.
Kentaro
K
Yamao
Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan.
Hajime
H
Imai
Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan.
Takeshi
T
Miyata
Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan.
Ken
K
Kamata
Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan.
Shunsuke
S
Omoto
Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan.
Mamoru
M
Takenaka
Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan.
Masatoshi
M
Kudo
D000818:Animals; D002768:Choledochostomy; D003137:Common Bile Duct Diseases / Q000601:surgery*; D004195:Disease Models, Animal; D019160:Endosonography; D005240:Feasibility Studies; D008297:Male; D000069322:Self Expandable Metallic Stents; D013552:Swine
EUS-guided biliary drainage; EUS-guided choledochoduodenostomy; anti-migration; endoscopic ultrasonography (EUS); metal stent