Top

Published in:

01-11-2017

Rescue EUS-guided intrahepatic biliary drainage for malignant hilar biliary stricture after failed transpapillary re-intervention

Authors: Kosuke Minaga, Mamoru Takenaka, Masayuki Kitano, Yasutaka Chiba, Hajime Imai, Kentaro Yamao, Ken Kamata, Takeshi Miyata, Shunsuke Omoto, Toshiharu Sakurai, Tomohiro Watanabe, Naoshi Nishida, Masatoshi Kudo

Published in: Surgical Endoscopy | Issue 11/2017

Abstract

Background

Treatment of unresectable malignant hilar biliary stricture (UMHBS) is challenging, especially after failure of repeated transpapillary endoscopic stenting. Endoscopic ultrasonography-guided intrahepatic biliary drainage (EUS-IBD) is a recent technique for intrahepatic biliary decompression, but indications for its use for complex hilar strictures have not been well studied. The aim of this study was to assess the feasibility and safety of EUS-IBD for UMHBS after failed transpapillary re-intervention.

Methods

Retrospective analysis of all consecutive patients with UMHBS of Bismuth II grade or higher who, between December 2008 and May 2016, underwent EUS-IBD after failed repeated transpapillary interventions. The technical success, clinical success, and complication rates were evaluated. Factors associated with clinical ineffectiveness of EUS-IBD were explored.

Results

A total of 30 patients (19 women, median age 66 years [range 52–87]) underwent EUS-IBD for UMHBS during the study period. Hilar biliary stricture morphology was classified as Bismuth II, III, or IV in 5, 13, and 12 patients, respectively. The median number of preceding endoscopic interventions was 4 (range 2–14). EUS-IBD was required because the following procedures failed: duodenal scope insertion (n = 4), accessing the papilla after duodenal stent insertion (n = 5), or achieving desired intrahepatic biliary drainage (n = 21). Technical success with EUS-IBD was achieved in 29 of 30 patients (96.7%) and clinical success was attained in 22 of these 29 (75.9%). Mild peritonitis occurred in three of 30 (10%) and was managed conservatively. Stent dysfunction occurred in 23.3% (7/30). There was no procedure-related mortality. On multivariable analysis, Bismuth IV stricture predicted clinical ineffectiveness (odds ratio = 12.7, 95% CI 1.18–135.4, P = 0.035).

Conclusions

EUS-IBD may be a feasible and effective rescue alternative with few major complications after failed transpapillary endoscopic re-intervention in patients with UMHBS, particularly for Bismuth II or III strictures.

De Palma GD, Pezzullo A, Rega M, Persico M, Patrone F, Mastantuono L, Persico G (2003) Unilateral placement of metallic stents for malignant hilar obstruction: a prospective study. Gastrointest Endosc 58:50–53CrossRefPubMed

Wagner HJ, Knyrim K, Vakil N, Klose KJ (1993) Plastic endoprostheses versus metal stents in the palliative treatment of malignant hilar biliary obstruction. A prospective and randomized trial. Endoscopy 25:213–218CrossRefPubMed

Dumas R, Demuth N, Buckley M, Peten EP, Manos T, Demarquay JF, Hastier P, Caroli-Bosc FX, Rampal P, Delmont JP (2000) Endoscopic bilateral metal stent placement for malignant hilar stenoses: identification of optimal technique. Gastrointest Endosc 51:334–338CrossRefPubMed

Cheng JL, Bruno MJ, Bergman JJ, Rauws EA, Tytgat GN, Huibregtse K (2002) Endoscopic palliation of patients with biliary obstruction caused by nonresectable hilar cholangiocarcinoma: efficacy of self-expandable metallic Wallstents. Gastrointest Endosc 56:33–39CrossRefPubMed

Chen JH, Sun CK, Liao CS, Chua CS (2006) Self-expandable metallic stents for malignant biliary obstruction: efficacy on proximal and distal tumors. World J Gastroenterol 12:119–122CrossRefPubMedPubMedCentral

Mukai T, Yasuda I, Nakashima M, Doi S, Iwashita T, Iwata K, Kato T, Tomita E, Moriwaki H (2013) Metallic stents are more efficacious than plastic stents in unresectable malignant hilar biliary strictures: a randomized controlled trial. J Hepatobiliary Pancreat Sci 20:214–222CrossRefPubMed

Kato H, Tsutsumi K, Kawamoto H, Okada H (2015) Current status of endoscopic biliary drainage for unresectable malignant hilar biliary strictures. World J Gastrointest Endosc 7:1032–1038PubMedPubMedCentral

Liberato MJ, Canena JM (2012) Endoscopic stenting for hilar cholangiocarcinoma: efficacy of unilateral and bilateral placement of plastic and metal stents in a retrospective review of 480 patients. BMC Gastroenterol 12:103CrossRefPubMedPubMedCentral

Kogure H, Isayama H, Nakai Y, Tsujino T, Ito Y, Yamamoto K, Mizuno S, Yagioka H, Kawakubo K, Sasaki T, Hirano K, Sasahira N, Tada M, Omata M, Koike K (2011) Newly designed large cell Niti-S stent for malignant hilar biliary obstruction: a pilot study. Surg Endosc 25:463–467CrossRefPubMed

10.

Chahal P, Baron TH (2010) Expandable metal stents for endoscopic bilateral stent-within-stent placement for malignant hilar biliary obstruction. Gastrointest Endosc 71:195–199CrossRefPubMed

11.

Kim JY, Kang DH, Kim HW, Choi CW, Kim ID, Hwang JH, Kim DU, Eum JS, Bae YM (2009) Usefulness of slimmer and open-cell-design stents for endoscopic bilateral stenting and endoscopic revision in patients with hilar cholangiocarcinoma (with video). Gastrointest Endosc 70:1109–1115CrossRefPubMed

12.

Lee TH, Moon JH, Kim JH, Park DH, Lee SS, Choi HJ, Cho YD, Park SH, Kim SJ (2013) Primary and revision efficacy of cross-wired metallic stents for endoscopic bilateral stent-in-stent placement in malignant hilar biliary strictures. Endoscopy 45:106–113CrossRefPubMed

13.

Naitoh I, Hayashi K, Nakazawa T, Okumura F, Miyabe K, Shimizu S, Yoshida M, Yamashita H, Ohara H, Joh T (2012) Side-by-side versus stent-in-stent deployment in bilateral endoscopic metal stenting for malignant hilar biliary obstruction. Dig Dis Sci 57:3279–3285CrossRefPubMed

14.

Lee TH, Park DH, Lee SS, Choi HJ, Lee JK, Kim TH, Kim JH, Jeong S, Park SH, Moon JH (2013) Technical feasibility and revision efficacy of the sequential deployment of endoscopic bilateral side-by-side metal stents for malignant hilar biliary strictures: a multicenter prospective study. Dig Dis Sci 58:547–555CrossRefPubMed

15.

Law R, Baron TH (2013) Bilateral metal stents for hilar biliary obstruction using a 6Fr delivery system: outcomes following bilateral and side-by-side stent deployment. Dig Dis Sci 58:2667–2672CrossRefPubMed

16.

Ishiwatari H, Hayashi T, Ono M, Sato T, Kato J (2013) Newly designed plastic stent for endoscopic placement above the sphincter of Oddi in patients with malignant hilar biliary obstruction. Dig Endosc 25(Suppl 2):94–99CrossRefPubMed

17.

Kaneko T, Sugimori K, Shimizu Y, Miwa H, Kameta E, Koh R, Numata K, Tanaka K, Maeda S (2014) Efficacy of plastic stent placement inside bile ducts for the treatment of unresectable malignant hilar obstruction (with videos). J Hepatobiliary Pancreat Sci 21:349–355CrossRefPubMed

18.

Ridtitid W, Rerknimitr R (2012) Management of an occluded biliary metallic stent. World J Gastrointest Endosc 4:157–161CrossRefPubMedPubMedCentral

19.

Jiao D, Huang K, Zhu M, Wu G, Ren J, Wang Y, Han X (2016). Placement of a newly designed Y-configured bilateral self-expanding metallic stent for hilar biliary obstruction: a pilot study. Dig Dis Sci doi: 10.1007/s10620-016-4284-1 [Epub ahead of print]

20.

Yee AC, Ho CS (1987) Complications of percutaneous biliary drainage: benign versus malignant diseases. AJR Am J Roentgenol 148:1207–1209CrossRefPubMed

21.

Oh HC, Lee SK, Lee TY, Kwon S, Lee SS, Seo DW, Kim MH (2007) Analysis of percutaneous transhepatic cholangioscopy-related complications and the risk factors for those complications. Endoscopy 39:731–736CrossRefPubMed

22.

Garcarek J, Kurcz J, Guziński M, Janczak D, Sasiadek M (2012) Ten years single center experience in percutaneous transhepatic decompression of biliary tree in patients with malignant obstructive jaundice. Adv Clin Exp Med 21:621–632PubMed

23.

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 33:898–900CrossRefPubMed

24.

Burmester E, Niehaus J, Leineweber T, Huetteroth T (2003) EUS-cholangio-drainage of the bile duct: report of 4 cases. Gastrointest Endosc 57:246–251CrossRefPubMed

25.

Itoi T, Sofuni A, Itokawa F, Tsuchiya T, Kurihara T, Ishii K, Tsuji S, Ikeuchi N, Umeda J, Moriyasu F, Tsuchida A (2010) Endoscopic ultrasonography-guided biliary drainage. J Hepatobiliary Pancreat Sci 17:611–616CrossRefPubMed

26.

Artifon EL, Marson FP, Gaidhane M, Kahaleh M, Otoch JP (2015) Hepaticogastrostomy or choledochoduodenostomy for distal malignant biliary obstruction after failed ERCP: Is there any difference? Gastrointest Endosc 81:950–959CrossRefPubMed

27.

Poincloux L, Rouquette O, Buc E, Privat J, Pezet D, Dapoigny M, Bommelaer G, Abergel A (2015) Endoscopic ultrasound-guided biliary drainage after failed ERCP: cumulative experience of 101 procedures at a single center. Endoscopy 47:794–801CrossRefPubMed

28.

Park DH (2015) Endoscopic ultrasound-guided biliary drainage of hilar biliary obstruction. J Hepatobiliary Pancreat Sci 22:664–668CrossRefPubMed

29.

Ogura T, Masuda D, Imoto A, Umegaki E, Higuchi K (2014) EUS-guided hepaticogastrtostomy for hepatic hilar obstruction. Endoscopy 46(Suppl 1):E32–E33PubMed

30.

Prachayakul V, Aswakul P (2015) Endoscopic ultrasound-guided biliary drainage: bilateral systems drainage via left duct approach. World J Gastroenterol 21:10045–10048CrossRefPubMedPubMedCentral

31.

Ogura T, Onda S, Takagi W, Sano T, Okuda A, Masuda D, Yamamoto K, Miyano A, Kitano M, Takeuchi T, Fukunishi S, Higuchi K (2016). Clinical utility of endoscopic ultrasound-guided biliary drainage as a rescue of re-intervention procedure for high-grade hilar stricture. J Gastroenterol Hepatol doi: 10.1111/jgh.13437. [Epub ahead of print]

32.

Bismuth H, Castaing D, Traynor O (1988) Resection or palliation: priority of surgery in the treatment of hilar cancer. World J Surg 12:39–47CrossRefPubMed

33.

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 71:446–454CrossRefPubMed

34.

Inoue T, Naitoh I, Okumura F, Ozeki T, Anbe K, Iwasaki H, Nishie H, Mizushima T, Sano H, Nakazawa T, Yoneda M, Joh T (2016) Reintervention for stent occlusion after bilateral self-expandable metallic stent placement for malignant hilar biliary obstruction. Dig Endosc 28:731–737CrossRefPubMed

35.

Wang K, Zhu J, Xing L, Wang Y, Jin Z, Li Z (2016) Assessment of efficacy and safety of EUS-guided biliary drainage: a systematic review. Gastrointest Endosc 83:1218–1227CrossRefPubMed

36.

Wang P, Li ZS, Liu F, Ren X, Lu NH, Fan ZN, Huang Q, Zhang X, He LP, Sun WS, Zhao Q, Shi RH, Tian ZB, Li YQ, Li W, Zhi FC (2009) Risk factors for ERCP-related complications: a prospective multicenter study. Am J Gastroenterol 104:31–40CrossRefPubMed

37.

Ogura T, Yamamoto K, Sano T, Onda S, Imoto A, Masuda D, Takagi W, Fukunishi S, Higuchi K (2015) Stent length is impact factor associated with stent patency in endoscopic ultrasound-guided hepaticogastrostomy. J Gastroenterol Hepatol 30:1748–1752CrossRefPubMed

38.

Vienne A, Hobeika E, Gouya H, Lapidus N, Fritsch J, Choury AD, Chryssostalis A, Gaudric M, Pelletier G, Buffet C, Chaussade S, Prat F (2010) Prediction of drainage effectiveness during endoscopic stenting of malignant hilar strictures: the role of liver volume assessment. Gastrointest Endosc 72:728–735CrossRefPubMed

39.

Miura S, Kanno A, Masamune A, Hamada S, Takikawa T, Nakano E, Yoshida N, Hongo S, Kikuta K, Kume K, Hirota M, Yoshida H, Katayose Y, Uuno M, Shimosegawa T (2015) Bismuth classification is associated with the requirement for multiple biliary drainage in preoperative patients with malignant perihilar biliary stricture. Surg Endosc 29:1862–1870CrossRefPubMed

Title: Rescue EUS-guided intrahepatic biliary drainage for malignant hilar biliary stricture after failed transpapillary re-intervention
Authors: Kosuke Minaga
Mamoru Takenaka
Masayuki Kitano
Yasutaka Chiba
Hajime Imai
Kentaro Yamao
Ken Kamata
Takeshi Miyata
Shunsuke Omoto
Toshiharu Sakurai
Tomohiro Watanabe
Naoshi Nishida
Masatoshi Kudo
Publication date: 01-11-2017
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 11/2017
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-017-5553-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Rescue EUS-guided intrahepatic biliary drainage for malignant hilar biliary stricture after failed transpapillary re-intervention

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 11/2017

Is old age a contraindication to elective ventral hernia repair?

Laparoscopic subtotal gastrectomy for advanced gastric cancer: technical aspects and surgical, nutritional and oncological outcomes

Anorectal complications after robotic intersphincteric resection for low rectal cancer

Primary fascial closure during laparoscopic ventral hernia repair does not reduce 30-day wound complications

Attainment and retention of force moderation following laparoscopic resection training with visual force feedback

Delayed closure of open abdomen in septic patients treated with negative pressure wound therapy and dynamic fascial suture: the long-term follow-up study