Endoscopic Ultrasound-Guided Hepaticogastrostomy: Technical Review and Tips to Prevent Adverse Events

Abstract Background and study aims Endoscopic ultrasound guided pancreatic duct drainage (EUS-PDD) is a minimal-invasive therapeutic option to surgery and in patients with failed endoscopic retrograde pancreatography (ERP). The aim of this review was to quantitatively appraise the clinical outcomes of EUS-PDD by meta-analysis methods. Methods We searched multiple databases from inception through March 2020 to identify studies that reported on EUS-PDD. Pooled rates of technical success, successful drainage of pancreatic duct, clinical success, and adverse events were calculated. Study heterogeneity was assessed using I2% and 95 % prediction interval. Results A total of 22 studies (714 patients) were included. The pooled rate of technical success in EUS-PDD was 84.8 % (95 % CI 79.1–89.2). The pooled rate of successful PD drained by EUS-PDD was 77.5 % (95 % CI 63.1–87.4). The pooled rate of clinical success of EUS-PDD was 89.2 % (95 % CI 82.1–93.7). The pooled rate of all adverse events was 18.1 % (95 % CI 14.2–22.9). On sub-group analysis, the pooled technical success and clinical success of EUS-PDD from Japanese data were considerably superior (91.2 %, 83–95.6 & 92.5 %, 83.9–96.7, respectively). The pooled rate of post EUS-PDD acute pancreatitis was 6.6 % (95 % CI 4.5–9.4), bleeding was 4.1 % (95 % CI 2.7–6.2), perforation and/or pneumoperitoneum was 3.1 % (95 % CI 1.9–5), pancreatic leak and/or pancreatic fluid collection was 2.3 % (95 % CI 1.4–4), and infection was 2.8 % (95 % CI 1.7–4.6). Conclusion EUS-PDD demonstrates high technical success and clinical success rates with acceptable adverse events. Technical success was especially high for anastomotic strictures.

Download Full-text

Peroral cholecystoscopy using a multibending ultraslim endoscope through a lumen-apposing metal stent for endoscopic ultrasound-guided gallbladder drainage: a feasibility study

Endoscopy ◽

10.1055/a-1518-7039 ◽

2021 ◽

Author(s):

Hae Won Yoo ◽

Jong Ho Moon ◽

Yun Nah Lee ◽

Yeon Han Song ◽

Jae Kook Yang ◽

...

Keyword(s):

Adverse Events ◽

Endoscopic Ultrasound ◽

Primary Outcome ◽

Narrow Band Imaging ◽

Endoscopic Examination ◽

Metal Stent ◽

Technical Success ◽

Ultrasound Guided ◽

Gallbladder Drainage ◽

Technical Success Rate

Background Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) using a lumen-apposing metal stent (LAMS) has rendered endoscopic gallbladder assessment through a stent possible, but an appropriate endoscope is required. We assessed the feasibility of peroral cholecystoscopy (POCC) using a multibending ultraslim endoscope passed through a LAMS after EUS-GBD. Methods 14 patients with a LAMS for EUS-GBD who consecutively underwent POCC were included. POCC was performed using a multibending endoscope inserted through the LAMS. The primary outcome was the technical success rate, defined as complete endoscopic examination of the gallbladder from the orifice of the cystic duct to the fundus. The types of intervention and adverse events were recorded. Results 17 POCCs were performed in 14 patients. Of the 17 POCCs, 15 (88.2 %) were technically successful. Narrow-band imaging endoscopy was performed in 12 procedures (70.6 %), and cholecystoscopy-guided target biopsies were obtained in six. Gallstone extraction was performed in two patients. After POCC, all LAMSs remained stable and no adverse events were observed. Conclusions POCC using a multibending ultraslim endoscope can be effectively and safely performed through a LAMS after EUS-GBD.

Download Full-text

Adverse Events of Endoscopic Ultrasound Guided Fine Needle Aspiration (EUS-FNA) of Lower Gastrointestinal Tract: 10 Year, Single-Center Experience

The American Journal of Gastroenterology ◽

10.14309/00000434-201810001-00493 ◽

2018 ◽

Vol 113 (Supplement) ◽

pp. S284

Author(s):

Adriana A. Luzuriaga Chavez ◽

Irina M. Cazacu ◽

Brian R. Weston ◽

William Ross ◽

Jeffrey H. Lee ◽

...

Keyword(s):

Gastrointestinal Tract ◽

Adverse Events ◽

Endoscopic Ultrasound ◽

Fine Needle Aspiration ◽

Needle Aspiration ◽

Lower Gastrointestinal Tract ◽

Single Center ◽

Ultrasound Guided ◽

Fine Needle ◽

Single Center Experience

Download Full-text

Endoscopic ultrasound-guided gallbladder drainage reduces adverse events compared with percutaneous cholecystostomy in patients who are unfit for cholecystectomy

Endoscopy ◽

10.1055/s-0042-119036 ◽

2016 ◽

Vol 49 (02) ◽

pp. 130-138 ◽

Cited By ~ 10

Author(s):

Anthony Teoh ◽

Carlos Serna ◽

Irene Penas ◽

Charing Chong ◽

Manuel Perez-Miranda ◽

...

Keyword(s):

Adverse Events ◽

Endoscopic Ultrasound ◽

Percutaneous Cholecystostomy ◽

Ultrasound Guided ◽

Gallbladder Drainage

Download Full-text

Endoscopic ultrasound-guided transmural approach versus ERCP-guided transpapillary approach for primary decompression of malignant biliary obstruction: a meta-analysis

Endoscopy ◽

10.1055/a-0901-7343 ◽

2019 ◽

Vol 51 (10) ◽

pp. 950-960 ◽

Cited By ~ 4

Author(s):

Kirles Bishay ◽

Devon Boyne ◽

Mohammad Yaghoobi ◽

Mouen A. Khashab ◽

Risa Shorr ◽

...

Keyword(s):

Adverse Events ◽

Endoscopic Ultrasound ◽

Biliary Obstruction ◽

Clinical Success ◽

Meta Analysis ◽

Malignant Biliary Obstruction ◽

Sensitivity Analyses ◽

Ultrasound Guided ◽

Number Of Patients ◽

Significant Difference

Abstract Background Primary decompression in patients with malignant biliary obstruction can be achieved via endoscopic retrograde cholangiopancreatography (ERCP) with transpapillary stenting, or, more recently, via transmural endoscopic ultrasound-guided biliary drainage (EUS-BD). It is unclear whether either approach is superior in terms of clinical success or adverse events in the primary setting. Methods A comprehensive systematic electronic search was performed for studies comparing EUS-BD and ERCP as the primary approach with respect to clinical success and any other outcome(s). Pooled relative risks (RRs) and weighted mean differences were obtained as appropriate using DerSimonian and Laird random effects models. Sensitivity analyses were also performed. Results 5 out of 776 studies with a total of 396 patients were included. Overall clinical success was not significantly different between EUS-BD and ERCP (RR 0.98, 95 % confidence interval [CI] 0.93 to 1.03). There was no significant difference in overall adverse events (RR 0.84, 95 %CI 0.35 to 2.01), though results suggested that EUS-BD may be associated with a reduced risk of pancreatitis (RR 0.22, 95 %CI 0.05 to 1.02). There were no significant differences between EUS-BD and ERCP in terms of procedure time or the risk of stent occlusion. Conclusions EUS-BD had similar clinical success rates and occlusion rates to ERCP in the primary decompression of malignant biliary obstruction from meta-analysis including a modest number of patients. EUS-BD may be a practical alternative to the ERCP-guided approach in such patients, but further well-designed prospective studies with larger numbers of patients are required to more clearly delineate potential differences in adverse events and cost.

Download Full-text

Optimal biliary access point and learning curve for endoscopic ultrasound-guided hepaticogastrostomy with transmural stenting

Therapeutic Advances in Gastroenterology ◽

10.1177/1756283x16671671 ◽

2016 ◽

Vol 10 (1) ◽

pp. 42-53 ◽

Cited By ~ 31

Author(s):

Dongwook Oh ◽

Do Hyun Park ◽

Tae Jun Song ◽

Sang Soo Lee ◽

Dong-Wan Seo ◽

...

Keyword(s):

Bile Duct ◽

Adverse Events ◽

Learning Curve ◽

Endoscopic Ultrasound ◽

Access Point ◽

Learning Curves ◽

Procedure Time ◽

Ultrasound Guided ◽

Bile Duct Wall ◽

Duct Diameter

Background: Although endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) with transmural stenting has increased for biliary decompression in patients with an inaccessible papilla, the optimal biliary access point and the learning curve of EUS-HGS have not been studied. We evaluated the optimal biliary access point and learning curve for technically successful EUS-HGS. Methods: 129 consecutive patients (male n = 81, 62.3%; malignant n = 113, 87.6%) who underwent EUS-HGS due to an inaccessible papilla were enrolled. EUS finding and procedure times according to each needle puncture attempt in EUS-HGS were prospectively measured. Learning curves of EUS-HGS were calculated for two main outcome measurements (procedure time and adverse events) by using the moving average method and cumulative sum (CUSUM) analysis, respectively. Results: A total of 174 EUS-HGS attempts were performed in 129 patients. The mean number of needle punctures was 1.35 ± 0.57. Using the logistic regression model, bile duct diameter of the puncture site ⩽ 5 mm [odds ratio (OR) 3.7, 95% confidence interval (CI): 1.71–8.1, p < 0.01] and hepatic portion length [linear distance from the mural wall to the punctured bile duct wall on EUS; mean hepatic portion length was 27 mm (range 10–47 mm)] > 3 cm (OR 5.7, 95% CI: 2.7–12, p < 0.01) were associated with low technical success. Procedure time and adverse events were shorter after 24 cases, and stabilized at 33 cases of EUS-HGS, respectively. Conclusions: Our data suggest that a bile duct diameter > 5 mm and hepatic portion length 1 cm to ⩽ 3 cm on EUS may be suitable for successful EUS-HGS. In our learning curve analysis, over 33 cases might be required to achieve the plateau phase for successful EUS-HGS.

Download Full-text