Endoscopic ultrasound‐guided antegrade biliary stenting for unresectable malignant biliary obstruction in patients with surgically altered anatomy: Single‐center prospective pilot study

• DOI: 10.1111/den.12800
• Publication Date: 2017-01-09T07:16:48Z
• Authors: Takuji Iwashita; Ichiro Yasuda; Tsuyoshi Mukai; Keisuke Iwata; Shinpei Doi; Shinya Uemura; Masatoshi Mabuchi; Mitsuru Okuno; Masahito Shimizu
• Keywords: Endoscopic Ultrasound; Percutaneous transhepatic cholangiography; Biliary fistula

Background and Aim Endoscopic retrograde cholangiography (ERCP) with biliary stenting for the treatment of unresectable malignant obstruction (MBO) is challenging among patients surgically altered anatomy. ultrasound‐guided antegrade (EUS‐ABS) was introduced as an alternative drainage method, although it has not yet been well studied. In this single‐center prospective pilot study, we aimed to evaluate feasibility safety EUS‐ABS MBO in Methods attempted EUS‐ABS, bile duct left lobe accessed from intestine under EUS guidance, a guidewire placed. Thereafter, uncovered metallic stent deployed at through fistula. All devices were then removed. Technical, clinical, adverse event rates, patient characteristics procedure details, evaluated. Results Twenty (10 women; median age, 69 years) enrolled present study. Technical clinical success rates both 95% (19/20). one patient, unsuccessful result failed visualization liver salvaged percutaneous drainage. Rate events 20% (4/20), including mild pancreatitis three fever which successfully managed conservatively. Conclusions anatomy feasible safe procedure. Further large scale comparison studies are needed confirm its efficacy (Clinical Trial Registration Number: UMIN000008589).