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Article: Durability and outcome of endoscopic ultrasound‐guided hepaticoduodenostomy using a fully covered metal stent for segregated right intrahepatic duct dilatation

TitleDurability and outcome of endoscopic ultrasound‐guided hepaticoduodenostomy using a fully covered metal stent for segregated right intrahepatic duct dilatation
Authors
Keywordscholangiocarcinoma
endoscopic ultrasound
imaging and advanced technology/applied therapeutics
Issue Date2020
PublisherWiley-Blackwell Publishing Asia. The Journal's web site is located at http://www.blackwellpublishing.com/journals/JGH
Citation
Journal of Gastroenterology and Hepatology, 2020, Epub 2020-05-04 How to Cite?
AbstractBackground and Aims: Segregated right intrahepatic duct dilatation (IHD) results from complete obstruction of the biliary tract proximal to the hilar level. We aimed to evaluate long‐term efficacy and safety of endoscopic ultrasound (EUS) hepaticoduodenostomy (HDS) in segregated right IHD. Methods: Consecutive patients who had undergone EUS‐guided HDS with a fully covered self‐expandable metal stent (FCSEMS) in an academic tertiary center were recruited. All patients had segregated right hepatic duct and failed drainage by endoscopic retrograde cholangiopancreatography (ERCP). Demographic data, endoscopic findings, procedure details, and outcome data were extracted from a prospectively maintained database. Results: From 2013 to 2017, there were 35 patients who had undergone EUS‐guided HDS with a median follow‐up duration of 169 (3–2091) days. Malignancy accounted for 71.4% of the ductal segregation, followed by surgical complication (17.1%). Technical and clinical success rate was 97.1% and 80%, respectively. Early adverse event (AE) happened in seven patients (20%), two of them required endoscopic reintervention, and no percutaneous transhepatic biliary drainage (PTBD) or surgery was performed because of AE. The median stent patency duration was 331 (3–1202) days. The median duration of fistula tract keeping was 1280 (3–1280) days. There was no significant difference in terms of patency rate with respect to whether the underlying pathology was benign or malignant (P = 0.776). EUS‐guided HDS for right posterior sectional duct segregation was associated with higher 3‐month stent patency rate when compared with right anterior sectional duct (79.1% vs 38.1%, P = 0.012). Conclusion: Endoscopic ultrasound‐guided HDS with an FCSEMS appears to be a safe and effective treatment as a viable alternative option to PTBD after failed ERCP. It creates a durable and reliable fistula tract for permanent access to an isolated ductal system, and this application deserves more attention.
Persistent Identifierhttp://hdl.handle.net/10722/285455
ISSN
2019 Impact Factor: 3.437
2015 SCImago Journal Rankings: 1.190

 

DC FieldValueLanguage
dc.contributor.authorMa, KW-
dc.contributor.authorSo, H-
dc.contributor.authorCho, DH-
dc.contributor.authorOh, JS-
dc.contributor.authorCheung, TT-
dc.contributor.authorPark, DH-
dc.date.accessioned2020-08-18T03:53:35Z-
dc.date.available2020-08-18T03:53:35Z-
dc.date.issued2020-
dc.identifier.citationJournal of Gastroenterology and Hepatology, 2020, Epub 2020-05-04-
dc.identifier.issn0815-9319-
dc.identifier.urihttp://hdl.handle.net/10722/285455-
dc.description.abstractBackground and Aims: Segregated right intrahepatic duct dilatation (IHD) results from complete obstruction of the biliary tract proximal to the hilar level. We aimed to evaluate long‐term efficacy and safety of endoscopic ultrasound (EUS) hepaticoduodenostomy (HDS) in segregated right IHD. Methods: Consecutive patients who had undergone EUS‐guided HDS with a fully covered self‐expandable metal stent (FCSEMS) in an academic tertiary center were recruited. All patients had segregated right hepatic duct and failed drainage by endoscopic retrograde cholangiopancreatography (ERCP). Demographic data, endoscopic findings, procedure details, and outcome data were extracted from a prospectively maintained database. Results: From 2013 to 2017, there were 35 patients who had undergone EUS‐guided HDS with a median follow‐up duration of 169 (3–2091) days. Malignancy accounted for 71.4% of the ductal segregation, followed by surgical complication (17.1%). Technical and clinical success rate was 97.1% and 80%, respectively. Early adverse event (AE) happened in seven patients (20%), two of them required endoscopic reintervention, and no percutaneous transhepatic biliary drainage (PTBD) or surgery was performed because of AE. The median stent patency duration was 331 (3–1202) days. The median duration of fistula tract keeping was 1280 (3–1280) days. There was no significant difference in terms of patency rate with respect to whether the underlying pathology was benign or malignant (P = 0.776). EUS‐guided HDS for right posterior sectional duct segregation was associated with higher 3‐month stent patency rate when compared with right anterior sectional duct (79.1% vs 38.1%, P = 0.012). Conclusion: Endoscopic ultrasound‐guided HDS with an FCSEMS appears to be a safe and effective treatment as a viable alternative option to PTBD after failed ERCP. It creates a durable and reliable fistula tract for permanent access to an isolated ductal system, and this application deserves more attention.-
dc.languageeng-
dc.publisherWiley-Blackwell Publishing Asia. The Journal's web site is located at http://www.blackwellpublishing.com/journals/JGH-
dc.relation.ispartofJournal of Gastroenterology and Hepatology-
dc.rightsPreprint This is the pre-peer reviewed version of the following article: [FULL CITE], which has been published in final form at [Link to final article using the DOI]. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. Postprint This is the peer reviewed version of the following article: [FULL CITE], which has been published in final form at [Link to final article using the DOI]. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.-
dc.subjectcholangiocarcinoma-
dc.subjectendoscopic ultrasound-
dc.subjectimaging and advanced technology/applied therapeutics-
dc.titleDurability and outcome of endoscopic ultrasound‐guided hepaticoduodenostomy using a fully covered metal stent for segregated right intrahepatic duct dilatation-
dc.typeArticle-
dc.identifier.emailCheung, TT: cheung68@hku.hk-
dc.identifier.authorityCheung, TT=rp02129-
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1111/jgh.15089-
dc.identifier.pmid32365417-
dc.identifier.scopuseid_2-s2.0-85086043351-
dc.identifier.hkuros312945-
dc.identifier.volumeEpub 2020-05-04-
dc.publisher.placeAustralia-

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