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Initial clinical experience of a steerable access device for EUS-guided biliary drainage.
- Source :
-
Gastrointestinal endoscopy [Gastrointest Endosc] 2020 Jan; Vol. 91 (1), pp. 178-184. Date of Electronic Publication: 2019 Aug 10. - Publication Year :
- 2020
-
Abstract
- 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.<br />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.<br />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.<br />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.<br /> (Copyright © 2020 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Cholangiopancreatography, Endoscopic Retrograde
Cholestasis etiology
Cholestasis pathology
Female
Humans
Male
Middle Aged
Retrospective Studies
Treatment Outcome
Choledochostomy instrumentation
Cholestasis surgery
Drainage instrumentation
Endosonography instrumentation
Gastrostomy instrumentation
Subjects
Details
- Language :
- English
- ISSN :
- 1097-6779
- Volume :
- 91
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Gastrointestinal endoscopy
- Publication Type :
- Academic Journal
- Accession number :
- 31408653
- Full Text :
- https://doi.org/10.1016/j.gie.2019.07.035