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

BackgroundEUS-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.ObjectiveTo evaluate a newly developed hybrid metal stent customized for EUS-BD.DesignA prospective, observational study.SettingA tertiary academic referral center.PatientsA total of 27 consecutive patients with malignant biliary obstruction who were candidates for alternative techniques for biliary drainage because of failed ERCP were enrolled.InterventionsEUS-BD with a newly developed hybrid metal stent.Main Outcome MeasurementsThe technical and clinical success rates and adverse events, including proximal or distal stent migration and cholangitis.ResultsEUS-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.LimitationsThis study was performed at a single center by a single experienced operator with a relatively small number of patients.ConclusionEUS-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.