PMID- 32206005 OWN - NLM STAT- MEDLINE DCOM- 20201222 LR - 20201222 IS - 2219-2840 (Electronic) IS - 1007-9327 (Print) IS - 1007-9327 (Linking) VI - 26 IP - 9 DP - 2020 Mar 7 TI - Clinical utility of treatment method conversion during single-session endoscopic ultrasound-guided biliary drainage. PG - 947-959 LID - 10.3748/wjg.v26.i9.947 [doi] AB - BACKGROUND: Although several techniques for endoscopic ultrasound-guided biliary drainage (EUS-BD) are available at present, an optimal treatment algorithm of EUS-BD has not yet been established. AIM: To evaluate the clinical utility of treatment method conversion during single endoscopic sessions for difficult cases in initially planned EUS-BD. METHODS: This was a single-center retrospective analysis using a prospectively accumulated database. Patients with biliary obstruction undergoing EUS-BD between May 2008 and April 2016 were included. The primary outcome was to evaluate the improvement in EUS-BD success rates by converting the treatment methods during a single endoscopic session. Secondary outcomes were clarification of the factors leading to the conversion from the initial EUS-BD and the assessment of efficacy and safety of the conversion as judged by technical success, clinical success, and adverse events (AEs). RESULTS: A total of 208 patients underwent EUS-BD during the study period. For 18.8% (39/208) of the patients, the treatment methods were converted to another EUS-BD technique from the initial plan. Biliary obstruction was caused by pancreatobiliary malignancies, other malignant lesions, biliary stones, and other benign lesions in 22, 11, 4, and 2 patients, respectively. The reasons for the difficulty with the initial EUS-BD were classified into the following 3 procedures: Target puncture (n = 13), guidewire manipulation (n = 18), and puncture tract dilation (n = 8). Technical success was achieved in 97.4% (38/39) of the cases and clinical success was achieved in 89.5% of patients (34/38). AEs occurred in 10.3% of patients, including bile leakage (n = 2), bleeding (n = 1), and cholecystitis (n = 1). The puncture target and drainage technique were altered in subsequent EUS-BD procedures in 25 and 14 patients, respectively. The final technical success rate with 95%CI for all 208 cases was 97.1% (95%CI: 93.8%-98.9%), while that of the initially planned EUS-BD was 78.8% (95%CI: 72.6%-84.2%). CONCLUSION: Among multi-step procedures in EUS-BD, guidewire manipulation appeared to be the most technically challenging. When initially planned EUS-BD is technically difficult, treatment method conversion in a single endoscopic session may result in successful EUS-BD without leading to severe AEs. CI - (c)The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved. FAU - Minaga, Kosuke AU - Minaga K AD - Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama 589-8511, Japan. FAU - Takenaka, Mamoru AU - Takenaka M AD - Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama 589-8511, Japan. kousukeminaga@med.kindai.ac.jp. FAU - Yamao, Kentaro AU - Yamao K AD - Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama 589-8511, Japan. FAU - Kamata, Ken AU - Kamata K AD - Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama 589-8511, Japan. FAU - Omoto, Shunsuke AU - Omoto S AD - Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama 589-8511, Japan. FAU - Nakai, Atsushi AU - Nakai A AD - Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama 589-8511, Japan. FAU - Yamazaki, Tomohiro AU - Yamazaki T AD - Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama 589-8511, Japan. FAU - Okamoto, Ayana AU - Okamoto A AD - Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama 589-8511, Japan. FAU - Ishikawa, Rei AU - Ishikawa R AD - Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama 589-8511, Japan. FAU - Yoshikawa, Tomoe AU - Yoshikawa T AD - Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama 589-8511, Japan. FAU - Chiba, Yasutaka AU - Chiba Y AD - Clinical Research Center, Kindai University Hospital, Osaka-Sayama 589-8511, Japan. FAU - Watanabe, Tomohiro AU - Watanabe T AD - Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama 589-8511, Japan. FAU - Kudo, Masatoshi AU - Kudo M AD - Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama 589-8511, Japan. LA - eng PT - Journal Article PL - United States TA - World J Gastroenterol JT - World journal of gastroenterology JID - 100883448 SB - IM MH - Adult MH - Aged MH - Aged, 80 and over MH - Algorithms MH - Bile Duct Neoplasms/complications/diagnostic imaging/therapy MH - Bile Ducts/*pathology MH - Cholestasis/complications/*diagnostic imaging/*therapy MH - Colonic Neoplasms/complications/diagnostic imaging/therapy MH - *Drainage MH - Endoscopy MH - Endosonography MH - Female MH - Gallstones/complications/*diagnostic imaging/*therapy MH - Humans MH - Male MH - Middle Aged MH - Pancreatic Neoplasms/complications/diagnostic imaging/therapy MH - Retrospective Studies MH - Stomach Neoplasms/complications/diagnostic imaging/therapy MH - Treatment Outcome MH - Ultrasonography PMC - PMC7081009 OTO - NOTNLM OT - Biliary drainage OT - Biliary obstruction OT - Endoscopic ultrasound OT - Endoscopic ultrasound-guided biliary drainage OT - Interventional endoscopic ultrasound COIS- Conflict-of-interest statement: All authors declare no conflicts of interest related to this article. We disclose that this work was presented in part at Digestive Disease Week (DDW 2017), May 6-9, 2017, Chicago, United States (Gastrointestinal Endoscopy 2017; 85: 5 Supplement, AB493). EDAT- 2020/03/25 06:00 MHDA- 2020/12/23 06:00 PMCR- 2020/03/07 CRDT- 2020/03/25 06:00 PHST- 2019/12/06 00:00 [received] PHST- 2020/02/13 00:00 [revised] PHST- 2020/02/21 00:00 [accepted] PHST- 2020/03/25 06:00 [entrez] PHST- 2020/03/25 06:00 [pubmed] PHST- 2020/12/23 06:00 [medline] PHST- 2020/03/07 00:00 [pmc-release] AID - 10.3748/wjg.v26.i9.947 [doi] PST - ppublish SO - World J Gastroenterol. 2020 Mar 7;26(9):947-959. doi: 10.3748/wjg.v26.i9.947.