Top

Published in:

01-12-2021 | Ultrasound

Bile aspiration during EUS-guided hepaticogastrostomy is associated with lower risk of postprocedural adverse events: a retrospective single-center study

Authors: Hirotoshi Ishiwatari, Tatsunori Satoh, Junya Sato, Junichi Kaneko, Hiroyuki Matsubayashi, Yohei Yabuuchi, Yoshihiro Kishida, Masao Yoshida, Sayo Ito, Noboru Kawata, Kenichiro Imai, Kohei Takizawa, Kinichi Hotta, Hiroyuki Ono

Published in: Surgical Endoscopy | Issue 12/2021

Abstract

Background

In endoscopic retrograde cholangiopancreatography (ERCP), reduction of pressure inside of the bile duct by bile aspiration is a well-known method to lower the rate of adverse events (AEs) including cholangitis. Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) has been introduced as an alternative to ERCP. The use of self-expandable metallic stents is recommended in EUS-HGS to reduce bile leak; however, other methods to reduce the rate of AEs including bile leak, abdominal pain, fever, and sepsis, have not been elucidated yet. This study investigated whether bile aspiration during EUS-HGS decreased the rate of postprocedural AEs.

Methods

Consecutive patients who underwent EUS-HGS between July 2016 and April 2020 were retrospectively evaluated in this study. EUS-HGS was performed at a tertiary cancer center. Patient characteristics, site of biliary obstruction, the quantity of bile aspirated during EUS-HGS, type of stent, whether or not antegrade stenting (AS) was performed, procedure time, and AEs were assessed based on a prospectively recorded institutional endoscopy database. Logistic regression analysis was performed to identify factors affecting postprocedural AEs.

Results

Ninety-six patients were included in the study. EUS-guided HGS with and without AS was performed in 45 and 51 patients, respectively. Bile was aspirated in 71 patients (74%). The quantity of bile aspirated was 0–10 mL and > 10 mL in 40 and 56 patients, respectively. AEs including fever, abdominal pain, postprocedural cholangitis, sepsis, acute pancreatitis, and bleeding occurred in 45 patients (47%). The AE rates were 65% (26/40) and 34% (19/56), for 0–10 mL and > 10 mL bile, respectively (p = 0.004). Using multivariate analysis, the only independent factor affecting the occurrence of AEs was found to be an aspirated bile amount of 0–10 mL (odds ratio: 4.16; 95% CI 1.6–10.8).

Conclusions

Bile aspiration of more than 10 mL during EUS-HGS contributes to reducing the rate of postprocedural AEs.

Ekkelenkamp VE, de Man RA, Ter Borg F, Borg PC, Bruno MJ, Groenen MJ, Hansen BE, van Tilburg AJ, Rauws EA, Koch AD (2015) Prospective evaluation of ERCP performance: results of a nationwide quality registry. Endoscopy 47:503–507CrossRef

Baron TH, Petersen BT, Mergener K, Chak A, Cohen J, Deal SE, Hoffman B, Jacobson BC, Petrini JL, Safdi MA, Faigel DO, Pike IM (2006) Quality indicators for endoscopic retrograde cholangiopancreatography. Gastrointest Endosc 63:S29–S34CrossRef

Teoh AYB, Dhir V, Kida M, Yasuda I, Jin ZD, Seo DW, Almadi M, Ang TL, Hara K, Hilmi I, Itoi T, Lakhtakia S, Matsuda K, Pausawasdi N, Puri R, Tang RS, Wang HP, Yang AM, Hawes R, Varadarajulu S, Yasuda K, Ho LKY (2018) Consensus guidelines on the optimal management in interventional EUS procedures: results from the Asian EUS group RAND/UCLA expert panel. Gut 67:1209–1228CrossRef

Isayama H, Nakai Y, Itoi T, Yasuda I, Kawakami H, Ryozawa S, Kitano M, Irisawa A, Katanuma A, Hara K, Iwashita T, Fujita N, Yamao K, Yoshida M, Inui K (2019) Clinical practice guidelines for safe performance of endoscopic ultrasound/ultrasonography guided biliary drainage: 2018. J Hepatobiliary Pancreat Sci 26:249–269CrossRef

Giovannini M, Dotti M, Bories E, Moutardier V, Pesenti C, Danisi C, Delpero JR (2003) Hepaticogastrostomy by echo-endoscopy as a palliative treatment in a patient with metastatic biliary obstruction. Endoscopy 35:1076–1078CrossRef

Giovannini M, Moutardier V, Pesenti C, Bories E, Lelong B, Delpero JR (2001) Endoscopic ultrasound-guided bilioduodenal anastomosis: a new technique for biliary drainage. Endoscopy 33:898–900CrossRef

Ishiwatari H, Satoh T, Sato J, Kaneko J, Ohgi K, Matsubayashi H, Uesaka K (2019) Endoscopic ultrasound-guided rendezvous for access to the right posterior bile duct in a surgical candidate. Endoscopy. https://doi.org/10.1055/a-1046-1475CrossRefPubMed

Ishiwatari H, Satoh T, Sato J, Kaneko J, Matsubayashi H, Ono H (2019) Double-guidewire technique facilitates endoscopic ultrasound-guided biliary drainage for hilar biliary obstruction. Endoscopy 51:E321–E322CrossRef

Sato J, Ishiwatari H, Satoh T, Fujie S, Kaneko J, Matsubayashi H, Ono H (2019) Two-step endoscopic ultrasound-guided drainage of an isolated posterior bile duct because of an enlarged gallbladder. Endoscopy 51:E347–E348CrossRef

10.

Ishiwatari H, Sato J, Kaneko J (2019) Hepaticojejunostomy for the right hepatic bile duct using a forward-viewing echoendoscope in a patient after pancreatoduodenectomy. Dig Endosc 31:e82–e83CrossRef

11.

Park SJ, Choi JH, Park DH, Choi JH, Lee SS, Seo DW, Lee SK, Kim MH (2013) Expanding indication: EUS-guided hepaticoduodenostomy for isolated right intrahepatic duct obstruction (with video). Gastrointest Endosc 78:374–380CrossRef

12.

Gupta K, Perez-Miranda M, Kahaleh M, Artifon EL, Itoi T, Freeman ML, de Serna C, Sauer B, Giovannini M, InEBD STUDY GROUP (2014) Endoscopic ultrasound-assisted bile duct access and drainage: Multicenter, long-term analysis of approach, outcomes, and complications of a technique in evolution. J Clin Gastroenterol 48:80–87CrossRef

13.

Hedjoudje A, Sportes A, Grabar S, Zhang A, Koch S, Vuitton L, Prat F (2019) Outcomes of endoscopic ultrasound-guided biliary drainage: a systematic review and meta-analysis. United Eur Gastroenterol J 7:60–68CrossRef

14.

Khashab MA, Messallam AA, Penas I, Nakai Y, Modayil RJ, De la Serna C, Hara K, El Zein M, Stavropoulos SN, Perez-Miranda M, Kumbhari V, Ngamruengphong S, Dhir VK, Park DH (2016) International multicentre comparative trial of transluminal EUS0guided biliary drainage via hepatogastrostomy vs. choledochoduodenostomy approaches. Endosc Int Open 4:E175–E181CrossRef

15.

Krishnamoorthi R, Dasari CS, Thoguluva Chandrasekar V, Priyan H, Jayaraj M, Law J, Larsen M, Kozarek R, Ross A, Irani S (2020) Effectiveness and safety of EUS-guided choledochoduodenostomy using lumen-apposing metal stents (LAMS): a systematic review and meta-analysis. Surg Endosc 34:2866–2877CrossRef

16.

Hara K, Yamao K, Mizuno N, Hijioka S, Imaoka H, Tajika M, Tanaka T, Ishihara M, Okuno N, Hieda N, Yoshida T, Niwa Y (2016) Endoscopic ultrasonography-guided biliary drainage: who, when, which, and how? World J Gastroenterol 22:1297–1303CrossRef

17.

Kumta NA, Torres-Ruiz F, Reinoso PJ, Kahaleh M (2016) Endoscopic management of hepatic abscess after EUS-guided hepaticogastrostomy. Gastrointest Endosc 84:1054–1055CrossRef

18.

Ogura T, Okuda A, Miyano A, Nishioka N, Higuchi K (2018) Successful treatment for infected biloma after endoscopic ultrasound-guided hepaticogastrostomy using double stent placement technique. Mini-invasive Surg 2:8CrossRef

19.

Navaneethan U, Lourdusamy D, Gutierrez NG, Zhu X, Vargo JJ, Parsi MA (2017) New approach to decrease post-ERCP adverse events in patients with primary sclerosing cholangitis. Endosc Int Open 5:E710–E717CrossRef

20.

Navaneethan U, Lourdusamy V, Jegadeesan R, Sanaka MR, Vargo JJ (2015) Su1626 Bile aspiration during ERCP is associated with lower risk of post-ERCP cholangitis: a single center prospective study. Gastrointest Endosc 81:357CrossRef

21.

Ishiwatari H, Satoh T, Sato J, Fujie S, Kaneko J, Matsubayashi H, Ono H (2019) Bent needle technique as a rescue for bile duct puncture in endoscopic ultrasonography-guided intrahepatic biliary drainage. Endoscopy 51:E103–E104CrossRef

22.

Cotton PB, Eisen GM, Aabakken L, Baron TH, Hutter MM, Jacobson BC, Mergener K, Nemcek A Jr, Petersen BT, Petrini JL, Pike IM, Rabeneck L, Romagnuolo J, Vargo JJ (2010) A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 71:446–454CrossRef

23.

Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, Bellomo R, Bernard GR, Chiche JD, Coopersmith CM, Hotchkiss RS, Levy MM, Marshall JC, Martin GS, Opal SM, Rubenfeld GD, van der Poll T, Vincent JL, Angus DC (2016) The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA 315:801–810CrossRef

24.

Kiriyama S, Kozaka K, Takada T, Strasberg SM, Pitt HA, Gabata T, Hata J, Liau KH, Miura F, Horiguchi A, Liu KH, Su CH, Wada K, Jagannath P, Itoi T, Gouma DJ, Mori Y, Mukai S, Giménez ME, Huang WS, Kim MH, Okamoto K, Belli G, Dervenis C, Chan ACW, Lau WY, Endo I, Gomi H, Yoshida M, Mayumi T, Baron TH, de Santibañes E, Teoh AYB, Hwang TL, Ker CG, Chen MF, Han HS, Yoon YS, Choi IS, Yoon DS, Higuchi R, Kitano S, Inomata M, Deziel DJ, Jonas E, Hirata K, Sumiyama Y, Inui K, Yamamoto M (2018) Tokyo guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos). J Hepatobiliary Pancreat Sci 25:17–30CrossRef

25.

Imai H, Takenaka M, Omoto S, Kamata K, Miyata T, Minaga K, Yamao K, Sakurai T, Nishida N, Watanabe T, Kitano M, Kudo M (2017) Utility of endoscopic ultrasound-guided hepaticogastrostomy with antegrade stenting for malignant biliary obstruction after failed endoscopic retrograde cholangiopancreatography. Oncology 93:69–75CrossRef

26.

Park DH, Lee TH, Paik WH, Choi JH, Song TJ, Lee SS, Seo DW, Lee SK, Kim MH (2015) Feasibility and safety of a novel dedicated device for one-step EUS-guided biliary drainage: a randomized trial. J Gastroenterol Hepatol 30:1461–1466CrossRef

27.

Chandra S, Klair JS, Soota K, Livorsi DJ, Johlin FC (2019) Endoscopic retrograde cholangio-pancreatography-obtained bile culture can guide antibiotic therapy in acute cholangitis. Dig Dis 37:155–160CrossRef

28.

Gomi H, Solomkin JS, Schlossberg D, Okamoto K, Takada T, Strasberg SM, Ukai T, Endo I, Iwashita Y, Hibi T, Pitt HA, Matsunaga N, Takamori Y, Umezawa A, Asai K, Suzuki K, Han HS, Hwang TL, Mori Y, Yoon YS, Huang WS, Belli G, Dervenis C, Yokoe M, Kiriyama S, Itoi T, Jagannath P, Garden OJ, Miura F, de Santibañes E, Shikata S, Noguchi Y, Wada K, Honda G, Supe AN, Yoshida M, Mayumi T, Gouma DJ, Deziel DJ, Liau KH, Chen MF, Liu KH, Su CH, Chan ACW, Yoon DS, Choi IS, Jonas E, Chen XP, Fan ST, Ker CG, Giménez ME, Kitano S, Inomata M, Mukai S, Higuchi R, Hirata K, Inui K, Sumiyama Y, Yamamoto M (2018) Tokyo Guidelines 2018: antimicrobial therapy for acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci 25:3–16CrossRef

29.

Yamamoto Y, Ogura T, Nishioka N, Yamada T, Yamada M, Ueno S, Higuchi K (2020) Risks factors for adverse events associated with bile leak during EUS-guided hepaticogastrostomy. Endosc Ultrasound 9:110–115CrossRef

30.

Davidson B, Varsamidakis N, Dooley J, Deery A, Dick R, Kurzawinski T, Hobbs K (1992) Value of exfoliative cytology for investigating bile duct strictures. Gut 33:1408–1411CrossRef

31.

Sugiyama M, Atomi Y, Wada N, Kuroda A, Muto T (1996) Endoscopic transpapillary bile duct biopsy without sphincterotomy for diagnosing biliary strictures: a prospective comparative study with bile and brush cytology. Am J Gastroenterol 91:465–467PubMed

32.

Iwashita T, Doi S, Yasuda I (2014) Endoscopic ultrasound-guided biliary drainage: a review. Am J Gastroenterol 7:94–102

Title: Bile aspiration during EUS-guided hepaticogastrostomy is associated with lower risk of postprocedural adverse events: a retrospective single-center study
Authors: Hirotoshi Ishiwatari
Tatsunori Satoh
Junya Sato
Junichi Kaneko
Hiroyuki Matsubayashi
Yohei Yabuuchi
Yoshihiro Kishida
Masao Yoshida
Sayo Ito
Noboru Kawata
Kenichiro Imai
Kohei Takizawa
Kinichi Hotta
Hiroyuki Ono
Publication date: 01-12-2021
Publisher: Springer US
Keywords: Ultrasound
Septicemia
Septicemia
Foreign Body Aspiration
Foreign Body Aspiration
Aspiration
Ultrasound
Cholangitis
Endoscopic Retrograde Cholangiopancreatography
Key Symptom
Abdominal Pain
Published in: Surgical Endoscopy / Issue 12/2021
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-020-08189-w

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Bile aspiration during EUS-guided hepaticogastrostomy is associated with lower risk of postprocedural adverse events: a retrospective single-center study

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 12/2021

Learning curve of robotic-assisted transabdominal preperitoneal repair (rTAPP) for inguinal hernias

Understanding intraoperative fluorescent cholangiography: ten steps for an effective and successful procedure

The significance of the time to arterial perfusion in intraoperative ICG angiography during colorectal surgery

Impact of accommodation, convergence and stereoacuity on perceived symptoms and surgical performance among surgeons

Comparison of laparoscopic transabdominal preperitoneal hernioplasty and laparoscopic iliopubic tract repair for Nyhus type II hernia in women

Anti-reflux mucosectomy (ARMS) results in improved recovery and similar reflux quality of life outcomes compared to laparoscopic Nissen fundoplication