Su1195 ENDOSCOPIC ULTRASOUND-GUIDED BILIARY DRAINAGE VS. ERCP IN INOPERABLE MALIGNANT HIGH-GRADE DISTAL BILE DUCT OBSTRUCTION: PROSPECTIVE RANDOMIZED CONTROLLED STUDY: A PRELIMINARY ANALYSIS

2019 ◽  
Vol 89 (6) ◽  
pp. AB309-AB310
Author(s):  
Thanapon Yaowmaneerat ◽  
Nisa Netinatsunton ◽  
Tanawat Pattarapuntakul ◽  
Bancha Ovartlarnporn
Keyword(s):  
Bile Duct ◽  
Endoscopic Ultrasound ◽  
Biliary Drainage ◽  
Preliminary Analysis ◽  
Controlled Study ◽  
High Grade ◽  
Distal Bile Duct ◽  
Ultrasound Guided ◽  
Duct Obstruction ◽  
Randomized Controlled

Endoscopic ultrasound-guided biliary drainage for right hepatic bile duct obstruction: novel technical tips

Endoscopy ◽  
2014 ◽  
Vol 47 (01) ◽  
pp. 72-75 ◽  
Author(s):  
Takeshi Ogura ◽  
Tatsushi Sano ◽  
Saori Onda ◽  
Akira Imoto ◽  
Daisuke Masuda ◽  
...  
Keyword(s):  
Bile Duct ◽  
Endoscopic Ultrasound ◽  
Biliary Drainage ◽  
Bile Duct Obstruction ◽  
Ultrasound Guided ◽  
Hepatic Bile ◽  
Duct Obstruction ◽  
Hepatic Bile Duct

scholarly journals Outcomes of Endoscopic Ultrasound-Guided Biliary Drainage in a General Hospital for Patients with Endoscopic Retrograde Cholangiopancreatography-Difficult Transpapillary Biliary Drainage

2021 ◽  
Vol 10 (18) ◽  
pp. 4105
Author(s):  
Naosuke Kuraoka ◽  
Satoru Hashimoto ◽  
Shigeru Matsui ◽  
Shuji Terai
Keyword(s):  
Bile Duct ◽  
Endoscopic Ultrasound ◽  
Biliary Drainage ◽  
Duodenal Bulb ◽  
Distal Bile Duct ◽  
Ultrasound Guided ◽  
Difficult Patients ◽  
Stent Patency ◽  
Bile Duct Stenosis ◽  
Duct Stenosis

Endoscopic ultrasound-guided biliary drainage (EUS-BD) has been developed as an alternative treatment for percutaneous transhepatic biliary drainage for patients with bile duct stenosis. At specialized hospitals, the high success rate and effectiveness of EUS-BD as primary drainage has been reported. However, the procedure is highly technical and difficult, and it has not been generally performed. In this study, we retrospectively examined the effectiveness of EUS-BD in ERCP-difficult patients with distal bile duct stenosis. We retrospectively examined 24 consecutive cases in which EUS-BD was performed at our hospital for distal bile duct stenosis from October 2018 to December 2020. EUS-guided choledochoduodenostomy (EUS-CDS) was selected for cases that could be approached from the duodenal bulb, and EUS-HGS was selected for other cases. In the EUS-CDS and EUS-HGS groups, the technical success rates were 83.3% (10/12] and 91.7% (11/12], respectively. An adverse event occurred in one case in the EUS-CDS group, which developed severe biliary peritonitis. The stent patency period was 91 and 101 days in the EUS-CDS and EUS-HGS groups, respectively. EUS-BD for ERCP-difficult patients with distal bile duct stenosis is considered to be an effective alternative for biliary drainage that can be performed not only in specialized hospitals but also in general hospitals.

scholarly journals ELEMENT TRIAL: study protocol for a randomized controlled trial on endoscopic ultrasound-guided biliary drainage of first intent with a lumen-apposing metal stent vs. endoscopic retrograde cholangio-pancreatography in the management of malignant distal biliary obstruction

Trials ◽  
2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Yen-I Chen ◽  
◽  
Kashi Callichurn ◽  
Avijit Chatterjee ◽  
Etienne Desilets ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Biliary Drainage ◽  
Biliary Obstruction ◽  
Locally Advanced ◽  
Endoscopic Drainage ◽  
Metal Stent ◽  
Ultrasound Guided ◽  
Endoscopic Retrograde ◽  
Promising Alternative ◽  
Randomized Controlled

Abstract Background & aims Endoscopic ultrasound guided-biliary drainage (EUS-BD) is a promising alternative to endoscopic retrograde cholangiopancreatography (ERCP); however, its growth has been limited by a lack of multicenter randomized controlled trials (RCT) and dedicated devices. A dedicated EUS-BD lumen- apposing metal stent (LAMS) has recently been developed with the potential to greatly facilitate the technique and safety of the procedure. We aim to compare a first intent approach with EUS-guided choledochoduodenostomy with a dedicated biliary LAMS vs. standard ERCP in the management of malignant distal biliary obstruction. Methods The ELEMENT trial is a multicenter single-blinded RCT involving 130 patients in nine Canadian centers. Patients with unresectable, locally advanced, or borderline resectable malignant distal biliary obstruction meeting the inclusion and exclusion criteria will be randomized to EUS-choledochoduodenostomy using a LAMS or ERCP with traditional metal stent insertion in a 1:1 proportion in blocks of four. Patients with hilar obstruction, resectable cancer, or benign disease are excluded. The primary endpoint is the rate of stent dysfunction needing re-intervention. Secondary outcomes include technical and clinical success, interruptions in chemotherapy, rate of surgical resection, time to stent dysfunction, and adverse events. Discussion The ELEMENT trial is designed to assess whether EUS-guided choledochoduodenostomy using a dedicated LAMS is superior to conventional ERCP as a first-line endoscopic drainage approach in malignant distal biliary obstruction, which is an important and timely question that has not been addressed using an RCT study design. Trial registration Registry name: ClinicalTrials.gov. Registration number: NCT03870386. Date of registration: 03/12/2019.

Endoscopic ultrasound-guided gallbladder drainage as a rescue therapy for unresectable malignant biliary obstruction: a multicenter experience

Endoscopy ◽  
2020 ◽  
Author(s):  
Danny Issa ◽  
Shayan Irani ◽  
Ryan Law ◽  
Shawn Shah ◽  
Sean Bhalla ◽  
...  
Keyword(s):  
Bile Duct ◽  
Success Rate ◽  
Clinical Success ◽  
Rescue Therapy ◽  
Bile Duct Obstruction ◽  
Distal Bile Duct ◽  
Metal Stent ◽  
Ultrasound Guided ◽  
Duct Obstruction ◽  
Gallbladder Drainage

Abstract Background Endoscopic retrograde cholangiopancreatography (ERCP) is often unsuccessful in patients with duodenal stenosis or malignant ampullary infiltration. While endoscopic ultrasound-guided biliary drainage (EUS-BD) has been proposed as an alternative, EUS-guided gallbladder drainage (EUS-GBD) is an attractive option when both approaches fail. We aimed to assess the effectiveness and safety of EUS-GBD as rescue therapy for malignant distal bile duct obstruction. Methods A multicenter retrospective study was performed on patients with unresectable malignant distal bile duct obstruction who underwent EUS-GBD between 2014 and 2019 after unsuccessful ERCP and EUS-BD. Clinical success was defined as a decrease in serum bilirubin of > 50 % within 2 weeks. Results 28 patients were included, with a lumen-apposing metal stent used in 26 (93 %) and a self-expandable metal stent in two (7 %). The technical success rate was 100 %. The clinical success rate was 93 %, with an improvement in bilirubin (7.3 [SD 5.4] pre-procedure vs. 2.8 [SD 1.1] post-procedure; P = 0.001). Delayed adverse events included food impaction of the stent (n = 3), with a further two patients developing cholecystitis and bleeding. Conclusion This study demonstrates the feasibility of gallbladder drainage to relieve malignant distal bile duct obstruction in patients with failed ERCP and EUS-BD.

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