Preliminary report on a new hybrid metal stent for EUS-guided biliary drainage (with videos)

Abstract

Background: EUS-guided biliary drainage (EUS-BD) may be a feasible and useful alternative in patients with malignant biliary obstruction after failed ERCP. One of the main limitations of EUS-BD is the lack of devices specifically tailored to this technique.

Objective: To evaluate a newly developed hybrid metal stent customized for EUS-BD.

Design: A prospective, observational study.

Setting: A tertiary academic referral center.

Patients: A total of 27 consecutive patients with malignant biliary obstruction who were candidates for alternative techniques for biliary drainage because of failed ERCP were enrolled.

Interventions: EUS-BD with a newly developed hybrid metal stent.

Main outcome measurements: The technical and clinical success rates and adverse events, including proximal or distal stent migration and cholangitis.

Results: EUS-guided hepaticogastrostomy was performed in 10 patients, and EUS-guided choledochoduodenostomy was performed in 17 patients. The technical success rate of EUS-BD with the hybrid metal stent was 100% (27/27), and clinical success was achieved in 96.3% (26/27) of the cases. Adverse events developed in 5 patients (5/27, 18.5%), including a self-limited pneumoperitoneum in 3 patients, minor bleeding in 1 patient, and abdominal pain in 1 patient. During the follow-up period (median 134 days), proximal or distal stent migration was not observed.

Limitations: This study was performed at a single center by a single experienced operator with a relatively small number of patients.

Conclusion: EUS-BD with a hybrid metal stent is technically feasible and can be an effective treatment for malignant biliary obstruction after failed ERCP. Hybrid metal stents may be used safely in EUS-BD, and they can prevent stent-related adverse events.