Use of endoscopic ultrasound-guided biliary drainage as a rescue of re-intervention after the placement of multiple metallic stents for malignant hilar biliary obstruction
| Autor: | Yoshikuni Nagashio, Minoru Esaki, Yasuaki Arai, Miyuki Sone, Atsushi Nakajima, Satoshi Nara, Hidetoshi Kitamura, Shunsuke Sugawara, Susumu Hijioka, Takuji Okusaka |
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| Rok vydání: | 2021 |
| Předmět: |
Endoscopic ultrasound
medicine.medical_specialty medicine.medical_treatment Endosonography medicine Humans Ultrasonography Interventional Cholangiopancreatography Endoscopic Retrograde Biliary drainage Endoscopic retrograde cholangiopancreatography Cholestasis Hepatology medicine.diagnostic_test business.industry Stent Interventional ultrasonography Odds ratio medicine.disease digestive system diseases Confidence interval Surgery Pancreatitis Acute Disease Acute pancreatitis Drainage Stents business |
| Zdroj: | Journal of hepato-biliary-pancreatic sciencesREFERENCES. 29(3) |
| ISSN: | 1868-6982 |
| Popis: | BACKGROUND/PURPOSE Endoscopic transpapillary re-intervention (ETP-RI) after multiple self-expandable metallic stent (SEMS) placement for unresectable malignant hilar biliary obstruction (MHBO) is challenging, but endoscopic ultrasound-guided biliary drainage (EUS-BD) could be an alternative following failed ETP-RI. We investigated appropriate re-intervention (RI) methods in MHBO after multiple SEMS placement and evaluated RI with EUS-BD (EUS-RI) benefits following ETP-RI failure. METHODS Patients requiring RI after multiple SEMS placement for MHBO between October 2017 and April 2021 were enrolled. Patients' characteristics, metallic-stent type, stent-placement configuration, overall survival, stent patency, re-intervention results, and re-intervention technical and clinical success rates were reviewed. RESULTS Forty-nine patients underwent ETP-RI for MHBO. ETP-RI's technical success rate was 69.4%. Of 15 failed ETP-RI cases, all underwent EUS-RI, achieving technical and clinical success rates of 86.7% and 100%, respectively. Time to recurrent biliary obstruction (TRBO) after RI was significantly different between EUS-RI and ETP-RI (212 vs 84 days; P = .01). On multivariate analysis, EUS-RI was the only factor associated with TRBO (odds ratio: 4.48; 95% confidence interval: 1.01-19.91; P = .04). Acute pancreatitis and bile peritonitis were present in 6.1% of ETP-RI and 13.3% of EUS-RI cases, respectively; both improved conservatively. CONCLUSIONS EUS-RI was effective and safe in difficult ETP-RI cases after multiple SEMS placement for MHBO. |
| Databáze: | OpenAIRE |
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