Brief Article
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World J Gastroenterol. May 28, 2012; 18(20): 2526-2532
Published online May 28, 2012. doi: 10.3748/wjg.v18.i20.2526
Endoscopic ultrasound-guided biliary drainage with placement of a fully covered metal stent for malignant biliary obstruction
Tae Hyeon Kim, Seong Hun Kim, Hyo Jeong Oh, Young Woo Sohn, Seung Ok Lee
Tae Hyeon Kim, Department of Internal Medicine, School of Medicine, Wonkwang University, Iksan, Chonbuk 570-749, South Korea
Seong Hun Kim, Seung Ok Lee, Department of Internal Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Chonbuk 561-712, South Korea
Hyo Jeong Oh, Young Woo Sohn, Department of Internal Medicine, School of Medicine, Wonkwang University, Sanbon, Gyounggi 570-749, South Korea
Author contributions: Kim TH and Kim SH made substantial contributions to conception and design, drafting the article revising it critically for important intellectual content; these authors contributed equally to this paper; Oh HJ and Sohn YW made the analysis of data; Kim TH, Kim SH and Lee SO contributed to collect patients, endoscopic procedures; and all authors approved the version to be published.
Supported by Institute of Wonkwang Medical Science in 2011
Correspondence to: Tae Hyeon Kim, MD, Associate Professor, Department of Internal Medicine, School of Medicine, Wonkwang University, Iksan, Chonbuk 570-749, South Korea. kth@wonkwang.ac.kr
Telephone: +82-63-8592564 Fax: +82-63-8502205
Received: September 27, 2011
Revised: February 6, 2012
Accepted: February 16, 2012
Published online: May 28, 2012
Abstract

AIM: To determine the utility of endoscopic ultrasound-guided biliary drainage (EUS-BD) with a fully covered self-expandable metal stent for managing malignant biliary stricture.

METHODS: We collected data from 13 patients who presented with malignant biliary obstruction and underwent EUS-BD with a nitinol fully covered self-expandable metal stent when endoscopic retrograde cholangiopancreatography (ERCP) fails. EUS-guided choledochoduodenostomy (EUS-CD) and EUS-guided hepaticogastrostomy (EUS-HG) was performed in 9 patients and 4 patients, respectively.

RESULTS: The technical and functional success rate was 92.3% (12/13) and 91.7% (11/12), respectively. Using an intrahepatic approach (EUS-HG, n = 4), there was mild peritonitis (n = 1) and migration of the metal stent to the stomach (n = 1). With an extrahepatic approach (EUS-CD, n = 10), there was pneumoperitoneum (n = 2), migration (n = 2), and mild peritonitis (n = 1). All patients were managed conservatively with antibiotics. During follow-up (range, 1-12 mo), there was re-intervention (4/13 cases, 30.7%) necessitated by stent migration (n = 2) and stent occlusion (n = 2).

CONCLUSION: EUS-BD with a nitinol fully covered self-expandable metal stent may be a feasible and effective treatment option in patients with malignant biliary obstruction when ERCP fails.

Keywords: Endoscopic ultrasound-guided, Biliary drainage, Metal stent, Biliary obstruction