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01-08-2014 | Original Article

Transmural Biliary Drainage Can Be an Alternative to Transpapillary Drainage in Patients with an Indwelling Duodenal Stent

Authors: Tsuyoshi Hamada, Hiroyuki Isayama, Yousuke Nakai, Hirofumi Kogure, Natsuyo Yamamoto, Kazumichi Kawakubo, Naminatsu Takahara, Rie Uchino, Suguru Mizuno, Takashi Sasaki, Osamu Togawa, Saburo Matsubara, Yukiko Ito, Kenji Hirano, Takeshi Tsujino, Minoru Tada, Kazuhiko Koike

Published in: Digestive Diseases and Sciences | Issue 8/2014

Abstract

Background

Self-expandable metal stents (SEMS) are widely utilized to relieve symptoms of malignant gastric outlet obstruction (GOO), but GOO is frequently complicated by nonresectable distal biliary obstruction. The optimal endoscopic approach to biliary drainage in this setting remains controversial and has yet to be resolved.

Aims

To compare the safety and efficacy of endoscopic ultrasound-guided transmural biliary drainage (EUS-BD) and transpapillary drainage in patients with an indwelling duodenal SEMS.

Methods

Patients who underwent EUS-BD or transpapillary drainage for distal malignant biliary obstruction with an indwelling duodenal SEMS between June 2007 and August 2012 at three Japanese tertiary referral centers were identified retrospectively. We compared times to stent dysfunction, causes of dysfunction, and procedural related complications between these two groups.

Results

Twenty patients were included in the study (7 EUS-BD and 13 transpapillary drainage). EUS-BD was performed via hepaticogastrostomy using a SEMS in three patients and via choledochoduodenostomy using a SEMS or a plastic stent in two patients each. Transpapillary drainage was performed using a SEMS in all patients. The stent patency rate in the EUS-BD group was higher than that in the transpapillary drainage group (100 vs. 71 % at 1 month and 83 vs. 29 % at 3 months, respectively). The rate of stent dysfunction in the EUS-BD group tended to be lower than that in the transpapillary group (14 vs. 54 %; P = 0.157). Complication rates were similar between the groups (P = 1.000), with moderate bleeding in one patient in the EUS-BD group and mild pancreatitis in one patient in the transpapillary group.

Conclusion

Endoscopic ultrasound-guided transmural biliary drainage is an alternative to transpapillary drainage in patients with an indwelling duodenal SEMS.

Maire F, Hammel P, Ponsot P, et al. Long-term outcome of biliary and duodenal stents in palliative treatment of patients with unresectable adenocarcinoma of the head of pancreas. Am J Gastroenterol. 2006;101:735–742.PubMedCrossRef

Flamm CR, Mark DH, Aronson N. Evidence-based assessment of ERCP approaches to managing pancreaticobiliary malignancies. Gastrointest Endosc. 2002;56:S218–S225.PubMedCrossRef

Wong YT, Brams DM, Munson L, et al. Gastric outlet obstruction secondary to pancreatic cancer: surgical vs endoscopic palliation. Surg Endosc. 2002;16:310–312.PubMedCrossRef

Baron TH. Expandable metal stents for the treatment of cancerous obstruction of the gastrointestinal tract. N Engl J Med. 2001;344:1681–1687.PubMedCrossRef

Dormann A, Meisner S, Verin N, Wenk Lang A. Self-expanding metal stents for gastroduodenal malignancies: systematic review of their clinical effectiveness. Endoscopy. 2004;36:543–550.PubMedCrossRef

Sasaki T, Isayama H, Maetani I, et al. Japanese multicenter estimation of WallFlex duodenal stent for unresectable malignant gastric outlet obstruction. Dig Endosc. 2013;25:1–6.PubMedCrossRef

Isayama H, Sasaki T, Nakai Y, et al. Management of malignant gastric outlet obstruction with a modified triple-layer covered metal stent. Gastrointest Endosc. 2012;75:757–763.PubMedCrossRef

Kaw M, Singh S, Gagneja H. Clinical outcome of simultaneous self-expandable metal stents for palliation of malignant biliary and duodenal obstruction. Surg Endosc. 2003;17:457–461.PubMedCrossRef

Mutignani M, Tringali A, Shah SG, et al. Combined endoscopic stent insertion in malignant biliary and duodenal obstruction. Endoscopy. 2007;39:440–447.PubMedCrossRef

10.

Hamada T, Nakai Y, Isayama H, et al. Duodenal metal stent placement is a risk factor for biliary metal stent dysfunction: an analysis using a time-dependent covariate. Surg Endosc. 2013;27:1243–1248.PubMedCrossRef

11.

Kahaleh M, Hernandez AJ, Tokar J, Adams RB, Shami VM, Yeaton P. Interventional EUS-guided cholangiography: evaluation of a technique in evolution. Gastrointest Endosc. 2006;64:52–59.PubMedCrossRef

12.

Horaguchi J, Fujita N, Noda Y, et al. Endosonography-guided biliary drainage in cases with difficult transpapillary endoscopic biliary drainage. Dig Endosc. 2009;21:239–244.PubMedCrossRef

13.

Park do H, Song TJ, Eum J, et al. EUS-guided hepaticogastrostomy with a fully covered metal stent as the biliary diversion technique for an occluded biliary metal stent after a failed ERCP (with videos). Gastrointest Endosc. 2010;71:413–419.PubMedCrossRef

14.

Itoi T, Isayama H, Sofuni A, et al. Stent selection and tips on placement technique of EUS-guided biliary drainage: transduodenal and transgastric stenting. J Hepatobiliary Pancreat Sci. 2011;18:664–672.PubMedCrossRef

15.

Kawakubo K, Isayama H, Nakai Y, et al. Simultaneous duodenal metal stent placement and EUS-guided choledochoduodenostomy for unresectable pancreatic cancer. Gut Liver. 2012;6:399–402.PubMedCentralPubMedCrossRef

16.

Dhir V, Artifon EL, Gupta K, et al. Multicenter study on endoscopic ultrasound-guided expandable biliary metal stent placement: Choice of access route, direction of stent insertion, and drainage route. Dig Endosc. 2014;26:430–435.

17.

Kawakubo K, Isayama H, Kato H, et al. Multicenter retrospective study of endoscopic ultrasound-guided biliary drainage for malignant biliary obstruction in Japan. J Hepatobiliary Pancreat Sci. 2014;21:328–334.

18.

Nakai Y, Isayama H, Tsujino T, et al. Impact of introduction of wire-guided cannulation in therapeutic biliary endoscopic retrograde cholangiopancreatography. J Gastroenterol Hepatol. 2011;26:1552–1558.PubMedCrossRef

19.

Cotton P, Lehman G, Vennes J, et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc. 1991;37:383–393.PubMedCrossRef

20.

Hamada T, Nakai Y, Isayama H, Koike K. Tandem stent placement as a rescue for stent misplacement in endoscopic ultrasonography-guided hepaticogastrostomy. Dig Endosc. 2013; 25:340–341.

21.

Belletrutti PJ, Gerdes H, Schattner MA. Successful endoscopic ultrasound-guided transduodenal biliary drainage through a pre-existing duodenal stent. JOP. 2010;11:234–236.PubMed

22.

Iwamuro M, Kawamoto H, Harada R, et al. Combined duodenal stent placement and endoscopic ultrasonography-guided biliary drainage for malignant duodenal obstruction with biliary stricture. Dig Endosc. 2010;22:236–240.PubMedCrossRef

23.

Khashab MA, Fujii LL, Baron TH, et al. EUS-guided biliary drainage for patients with malignant biliary obstruction with an indwelling duodenal stent (with videos). Gastrointest Endosc. 2012;76:209–213.PubMedCrossRef

24.

Davids P, Groen A, Rauws E, Tytgat G, Huibregtse K. Randomised trial of self-expanding metal stents versus polyethylene stents for distal malignant biliary obstruction. Lancet. 1992;340:1488–1492.PubMedCrossRef

25.

Knyrim K, Wagner H, Pausch J, Vakil N. A prospective, randomized, controlled trial of metal stents for malignant obstruction of the common bile duct. Endoscopy. 1993;25:207–212.PubMedCrossRef

26.

Isayama H, Yasuda I, Ryozawa S, et al. Results of a Japanese multicenter, randomized trial of endoscopic stenting for non-resectable pancreatic head cancer (Jm-test): covered Wallstent versus doublelayer Stent. Dig Endosc. 2011;23:310–315.PubMedCrossRef

27.

Misra S, Dwivedi M. Reflux of duodenal contents and cholangitis in patients undergoing self-expanding metal stent placement. Gastrointest Endosc. 2009;70:317–321.PubMedCrossRef

28.

Okamoto T, Fujioka S, Yanagisawa S, et al. Placement of a metallic stent across the main duodenal papilla may predispose to cholangitis. Gastrointest Endosc. 2006;63:792–796.PubMedCrossRef

29.

Hamada T, Isayama H, Nakai Y, et al. Duodenal invasion is a risk factor for the early dysfunction of biliary metal stents in unresectable pancreatic cancer. Gastrointest Endosc. 2011;74:548–555.PubMedCrossRef

30.

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

31.

Kawakubo K, Isayama H, Nakai Y, et al. Risk factors for pancreatitis following transpapillary self-expandable metal stent placement. Surg Endosc. 2012;26:771–776.PubMedCrossRef

32.

Maetani I, Isayama H, Mizumoto Y. Palliation in patients with malignant gastric outlet obstruction with a newly designed enteral stent: a multicenter study. Gastrointest Endosc. 2007;66:355–360.PubMedCrossRef

33.

Kim YW, Choi CW, Kang DH, et al. A double-layered (ComVi) self-expandable metal stent for malignant gastroduodenal obstruction: a prospective multicenter study. Dig Dis Sci. 2011;56:2030–2036.PubMedCrossRef

34.

Nakai Y, Isayama H, Komatsu Y, et al. Efficacy and safety of the covered Wallstent in patients with distal malignant biliary obstruction. Gastrointest Endosc. 2005;62:742–748.PubMedCrossRef

35.

Isayama H, Mukai T, Itoi T, et al. Comparison of partially covered nitinol stents with partially covered stainless stents as a historical control in a multicenter study of distal malignant biliary obstruction: the WATCH study. Gastrointest Endosc. 2012;76:84–92.PubMedCrossRef

36.

Isayama H, Kawabe T, Nakai Y, et al. Management of distal malignant biliary obstruction with the ComVi stent, a new covered metallic stent. Surg Endosc. 2010;24:131–137.PubMedCrossRef

Title: Transmural Biliary Drainage Can Be an Alternative to Transpapillary Drainage in Patients with an Indwelling Duodenal Stent
Authors: Tsuyoshi Hamada
Hiroyuki Isayama
Yousuke Nakai
Hirofumi Kogure
Natsuyo Yamamoto
Kazumichi Kawakubo
Naminatsu Takahara
Rie Uchino
Suguru Mizuno
Takashi Sasaki
Osamu Togawa
Saburo Matsubara
Yukiko Ito
Kenji Hirano
Takeshi Tsujino
Minoru Tada
Kazuhiko Koike
Publication date: 01-08-2014
Publisher: Springer US
Published in: Digestive Diseases and Sciences / Issue 8/2014
Print ISSN: 0163-2116
Electronic ISSN: 1573-2568
DOI: https://doi.org/10.1007/s10620-014-3062-1

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Transmural Biliary Drainage Can Be an Alternative to Transpapillary Drainage in Patients with an Indwelling Duodenal Stent

Abstract

Background

Aims

Methods

Results

Conclusion

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