PMID- 38488871
OWN - NLM
STAT- MEDLINE
DCOM- 20240401
LR  - 20240401
IS  - 1432-2218 (Electronic)
IS  - 0930-2794 (Linking)
VI  - 38
IP  - 4
DP  - 2024 Apr
TI  - Safety of skipping the tract dilation step for EUS-guided biliary drainage in 
      patients with unresectable malignant biliary obstruction (with video).
PG  - 2288-2296
LID - 10.1007/s00464-024-10731-z [doi]
AB  - BACKGROUND: Thin delivery system stents can be inserted directly without the need 
      for a tract dilation step and are expected to reduce bile leakage during 
      endoscopic ultrasound-guided biliary drainage (EUS-BD). The present study 
      retrospectively compared the safety and efficacy of EUS-BD using a thin metal 
      stent (< 7.5 Fr) with those of EUS-BD using a conventional stent (>/= 7.5 Fr). 
      METHODS: The present study enrolled 112 patients who underwent EUS-BD using metal 
      stents for unresectable malignant biliary obstruction between April 2016 and July 
      2022. The primary endpoint was the rate of adverse events (AEs). The secondary 
      endpoints were clinical success rate, procedure time, procedure success rate in 
      the absence of the tract dilation step, recurrent biliary obstruction rate, time 
      to biliary obstruction, and overall survival. Risk factors associated with early 
      AEs were also evaluated. RESULTS: The rate of early AEs was significantly lower 
      (12% vs. 35%, P = 0.013) and the procedure success without the tract dilation 
      step was significantly higher (82% vs. 33%, P < 0.001) in the thin than in the 
      conventional delivery system stent group. None of the other secondary endpoints 
      differed significantly between the two groups. Multivariate analysis showed that 
      employing the tract dilation step during EUS-BD was a significant independent 
      risk factor for early AEs (skipping vs. employing; HR, 9.66; 95% CI, 1.13-83.0, 
      P = 0.028). CONCLUSION: Employing the tract dilation step during EUS-BD was a 
      significant risk factor for early AEs. Metal stents with a delivery 
      diameter < 7.5 Fr can be inserted directly without the tract dilation step, 
      resulting in lower early AE rates.
CI  - (c) 2024. The Author(s), under exclusive licence to Springer Science+Business 
      Media, LLC, part of Springer Nature.
FAU - Itonaga, Masahiro
AU  - Itonaga M
AD  - Second Department of Internal Medicine, Wakayama Medical University, 811-1 
      Kimiidera, Wakayama City, Wakayama, 641-0012, Japan.
FAU - Ashida, Reiko
AU  - Ashida R
AD  - Second Department of Internal Medicine, Wakayama Medical University, 811-1 
      Kimiidera, Wakayama City, Wakayama, 641-0012, Japan.
FAU - Emori, Tomoya
AU  - Emori T
AD  - Second Department of Internal Medicine, Wakayama Medical University, 811-1 
      Kimiidera, Wakayama City, Wakayama, 641-0012, Japan.
FAU - Hatamaru, Keiichi
AU  - Hatamaru K
AD  - Second Department of Internal Medicine, Wakayama Medical University, 811-1 
      Kimiidera, Wakayama City, Wakayama, 641-0012, Japan.
FAU - Yamashita, Yasunobu
AU  - Yamashita Y
AD  - Second Department of Internal Medicine, Wakayama Medical University, 811-1 
      Kimiidera, Wakayama City, Wakayama, 641-0012, Japan.
FAU - Kawaji, Yuki
AU  - Kawaji Y
AD  - Second Department of Internal Medicine, Wakayama Medical University, 811-1 
      Kimiidera, Wakayama City, Wakayama, 641-0012, Japan.
FAU - Tamura, Takashi
AU  - Tamura T
AD  - Second Department of Internal Medicine, Wakayama Medical University, 811-1 
      Kimiidera, Wakayama City, Wakayama, 641-0012, Japan.
FAU - Tuda, Ikuhisa
AU  - Tuda I
AD  - Second Department of Internal Medicine, Wakayama Medical University, 811-1 
      Kimiidera, Wakayama City, Wakayama, 641-0012, Japan.
FAU - Tamura, Takaaki
AU  - Tamura T
AD  - Second Department of Internal Medicine, Wakayama Medical University, 811-1 
      Kimiidera, Wakayama City, Wakayama, 641-0012, Japan.
FAU - Koutani, Hiromu
AU  - Koutani H
AD  - Second Department of Internal Medicine, Wakayama Medical University, 811-1 
      Kimiidera, Wakayama City, Wakayama, 641-0012, Japan.
FAU - Yamazaki, Hirofumi
AU  - Yamazaki H
AD  - Second Department of Internal Medicine, Wakayama Medical University, 811-1 
      Kimiidera, Wakayama City, Wakayama, 641-0012, Japan.
FAU - Shimokawa, Toshio
AU  - Shimokawa T
AD  - Clinical Study Support Center, Wakayama Medical University, Wakayama, Japan.
FAU - Kitano, Masayuki
AU  - Kitano M
AUID- ORCID: 0000-0001-6885-9223
AD  - Second Department of Internal Medicine, Wakayama Medical University, 811-1 
      Kimiidera, Wakayama City, Wakayama, 641-0012, Japan. kitano@wakayama-med.ac.jp.
LA  - eng
PT  - Journal Article
PT  - Video-Audio Media
DEP - 20240315
PL  - Germany
TA  - Surg Endosc
JT  - Surgical endoscopy
JID - 8806653
SB  - IM
MH  - Humans
MH  - Retrospective Studies
MH  - *Cholangiopancreatography, Endoscopic Retrograde/adverse effects
MH  - Dilatation/adverse effects
MH  - *Cholestasis/etiology/surgery
MH  - Endosonography/methods
MH  - Stents/adverse effects
MH  - Drainage/adverse effects/methods
MH  - Ultrasonography, Interventional/adverse effects
OTO - NOTNLM
OT  - EUS-BD
OT  - EUS-CDS
OT  - EUS-HGS
OT  - Interventional EUS
EDAT- 2024/03/15 18:42
MHDA- 2024/04/01 06:42
CRDT- 2024/03/15 12:03
PHST- 2023/08/31 00:00 [received]
PHST- 2024/01/28 00:00 [accepted]
PHST- 2024/04/01 06:42 [medline]
PHST- 2024/03/15 18:42 [pubmed]
PHST- 2024/03/15 12:03 [entrez]
AID - 10.1007/s00464-024-10731-z [pii]
AID - 10.1007/s00464-024-10731-z [doi]
PST - ppublish
SO  - Surg Endosc. 2024 Apr;38(4):2288-2296. doi: 10.1007/s00464-024-10731-z. Epub 2024 
      Mar 15.