title: Endoscopic ultrasound-guided antegrade biliary stenting for unresectable malignant biliary obstruction in patients with surgically altered anatomy: Single-center prospective pilot study.
abstract: OBJECTIVE
  Endoscopic retrograde cholangiography (ERCP) with biliary stenting for the treatment of unresectable malignant biliary obstruction (MBO) is challenging among patients with surgically altered anatomy. Endoscopic ultrasound-guided antegrade biliary stenting (EUS-ABS) was introduced as an alternative biliary drainage method, although it has not yet been well studied. In this single-center prospective pilot study, we aimed to evaluate the feasibility and safety of EUS-ABS for MBO in patients with surgically altered anatomy.
  
  
  METHODS
  EUS-ABS for MBO was attempted in patients with surgically altered anatomy. In EUS-ABS, the bile duct in the left lobe was accessed from the intestine under EUS guidance, and a guidewire was placed. Thereafter, an uncovered metallic stent was deployed at the MBO through the fistula. All devices were then removed. Technical, clinical, and adverse event rates, as well as patient characteristics and procedure details, were evaluated.
  
  
  RESULTS
  Twenty patients (10 women; median age, 69 years) were enrolled in the present study. Technical and clinical success rates of EUS-ABS were both 95% (19/20). In one patient, unsuccessful EUS-ABS as a result of failed visualization of the left lobe of the liver with EUS was salvaged with percutaneous biliary drainage. Rate of adverse events was 20% (4/20), including mild pancreatitis in three patients and mild fever in one patient, which were successfully managed conservatively.
  
  
  CONCLUSIONS
  EUS-ABS for MBO in patients with surgically altered anatomy was a feasible and safe procedure. Further large scale comparison studies are needed to confirm its efficacy (Clinical Trial Registration Number: UMIN000008589).
authors.affiliation: First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan.
authors.forename: Takuji
authors.initials: T
authors.lastname: Iwashita
authors.affiliation: Department of Gastroenterology, Teikyo University Mizonokuchi Hospital, Kanagawa, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Yasuda
authors.affiliation: First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Mukai
authors.affiliation: First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Iwata
authors.affiliation: Department of Gastroenterology, Teikyo University Mizonokuchi Hospital, Kanagawa, Japan.
authors.forename: Shinpei
authors.initials: S
authors.lastname: Doi
authors.affiliation: First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Uemura
authors.affiliation: Department of Gastroenterology, Teikyo University Mizonokuchi Hospital, Kanagawa, Japan.
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Mabuchi
authors.affiliation: First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Okuno
authors.affiliation: First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan.
authors.forename: Masahito
authors.initials: M
authors.lastname: Shimizu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001653:Bile Ducts, Intrahepatic / Q000000981:diagnostic imaging* / Q000601:surgery; D001662:Biliary Tract Surgical Procedures / Q000379:methods*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D002780:Cholestasis, Intrahepatic / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D004322:Drainage / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D015607:Stents; D013274:Stomach Neoplasms / Q000150:complications; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*
keywords: antegrade biliary stenting; biliary drainage; endoscopic ultrasound; malignant biliary obstruction; surgically altered anatomy