Background and Aims
EUS-guided biliary drainage (EUS-BD) has been used as a rescue procedure after failed
endoscopic retrograde cholangiography (ERC), and there is growing interest in EUS-BD
as a primary therapy for distal malignant biliary obstruction. After EUS-guided needle
puncture of an obstructed bile duct, directional control of wire advancement remains
an area of need, potentially addressed by a new steerable EUS access system. The aim
of this study was to evaluate the safety and efficacy of this novel steerable access
system in patients undergoing EUS-BD after failed ERC.
Methods
We performed a retrospective study of prospectively acquired data at 3 tertiary academic
hospitals. Consecutive patients who had failed ERC followed by EUS-BD using the access
device were included. Primary outcomes were safety and technical feasibility (successful
completion of EUS-BD). Secondary outcomes were clinical success (75% improvement in
liver function tests at 30 days) and device performance.
Results
Twenty-two consecutive patients underwent EUS-BD between October 10, 2018 and March
3, 2019. Needle puncture and selective wire advancement in the intended direction
were both successful in 100% of cases (22/22). Technical success was 95% (21/22).
Fifty-nine percent (13) underwent rendezvous, 32% (7) underwent choledochoduodenostomy,
and 4.5% (1) underwent hepaticogastrostomy. One patient (4.5%) underwent percutaneous
transhepatic cholangiography. There were no cases of wire shearing. The adverse event
rate was 4.5% (mild pancreatitis in 1 patient). There was no bile leak, bleeding,
or death at 30 days' follow-up.
Conclusions
This first clinical experience with a steerable access system for EUS-BD suggests
it is safe and effective, particularly with regard to controlling direction of wire
advancement.
Abbreviations:
CDS (choledochoduodenostomy), ERC (endoscopic retrograde cholaniography), EUS-BD (EUS-guided biliary drainage), FDA (U.S. Food and Drug Administration), HGS (hepaticogastrostomy), PTBD (percutaneous transhepatic biliary drainage), RDV (rendezvous)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: August 10, 2019
Accepted:
July 27,
2019
Received:
June 1,
2019
Footnotes
DISCLOSURE: The following authors disclosed financial relationships relevant to this publication: M. Ryou: Consultant for Covidien/Medtronic, GI Windows, Pentax, Fuji, Olympus, and EnteraSense; research support from Olympus. P. C. Benias: Consultant for Covidien/Medtronic. V. Kumbhari: Consultant for Covidien/Medtronic, Pentax Medical, Boston Scientific, Apollo Endosurgery, and Obalon; research support from Apollo Endosurgery and Erbe USA.
If you would like to chat with an author of this article, you may contact Dr Kumbhari at [email protected]
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© 2020 by the American Society for Gastrointestinal Endoscopy
