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EUS-guided antegrade metal stent deployment using a novel fully covered metal stent with a fine gauge stent delivery system (with video)


 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan

Date of Submission09-Dec-2020
Date of Acceptance23-Mar-2021
Date of Web Publication02-Jul-2021

Correspondence Address:
Takeshi Ogura,
2nd Department of Internal Medicine, Osaka Medical College, 2-7 Daigakuchou, Takatsukishi, Osaka 569-8686
Japan
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/EUS-D-20-00257

PMID: 34259216



How to cite this URL:
Ogura T, Ueno S, Okuda A, Nishioka N, Higuchi K. EUS-guided antegrade metal stent deployment using a novel fully covered metal stent with a fine gauge stent delivery system (with video). Endosc Ultrasound [Epub ahead of print] [cited 2021 Oct 24]. Available from: http://www.eusjournal.com/preprintarticle.asp?id=320555

EUS-guided antegrade stent deployment (EUS-AG) is an alternative technique for patients with the complication of an inaccessible papilla.[1],[2],[3],[4] One of the advantages of EUS-AG is decreased bile leak before stent deployment from the intrahepatic bile duct to the stomach; therefore, it is ideal that EUS-AG can be performed without additional fistula dilation such as with a balloon dilator or electrocautery dilator. To prevent stent dislocation, an uncovered metal stent is mainly selected as the EUS-AG stent according to previous reports. However, compared with a fully covered self-expandable metal stent (FCSEMS), stent patency of uncovered metal stents is shorter. Recently, a novel FCSEMS has become available in Japan (BileRush Advance, Piolax, Kanagawa, Japan) [Figure 1]. The stent delivery system is only 7 Fr in size, and the stent has a laser cut construction and both ends are flared. Therefore, this system might allow stent insertion by fistula dilation up to 7 Fr, and stent dislocation might also be prevented. We herein describe the technical procedure of EUS-AG using this novel FCSEMS.
Figure 1: BileRush Advance (Piolax, Kanagawa, Japan). The size of the stent delivery system is only 7 Fr, and the stent has a laser cut construction and both ends are flared

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The intrahepatic bile duct is punctured using a 19G needle, and contrast medium is injected [Figure 2]. A 0.025-inch guidewire is deployed into the biliary tree. The Endoscopic retrograde cholangiopancreatography catheter is then inserted, and guidewire insertion into the intestine across the stricture site is successfully performed [Figure 3]. Next, the novel FCSEMS (10 mm × 6 cm) is inserted antegradely without additional fistula dilation, and stent release is carefully performed across the stricture site [Figure 4]. Finally, EUS-HGS was performed using plastic stent [Figure 5] and Video 1] [Additional file 1]. To prevent bile leak, this novel stent can be inserted across a fistula that has been dilated up to 7 Fr. Therefore, the presented technique might successfully decrease the incidence of adverse events such as bile peritonitis, although this technique needs further evaluation in clinical trials.
Figure 2: The intrahepatic bile duct is punctured using a 19G needle, and the contrast medium is injected

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Figure 3: The 0.025-inch guidewire is successfully inserted into the intestine across the stricture site

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Figure 4: Antegrade stent deployment is successfully performed

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Figure 5: Plastic stent deployment is performed from the intrahepatic bile duct to the intestine

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Financial support and sponsorship

Nil.

Conflicts of interest

Takeshi Ogura is an Editorial Board Member of Endoscopic Ultrasound. The article was subject to the journal's standard procedures, with peer review handled independently of this Member and his research groups. There are no other conflicts of interest.



 
  References Top

1.
Iwashita T, Uemura S, Mita N, et al. Endoscopic ultrasound guided-antegrade biliary stenting vs percutaneous transhepatic biliary stenting for unresectable distal malignant biliary obstruction in patients with surgically altered anatomy. J Hepatobiliary Pancreat Sci 2020;27:968-76.  Back to cited text no. 1
    
2.
Yamamoto K, Itoi T, Tsuchiya T, et al. EUS-guided antegrade metal stenting with hepaticoenterostomy using a dedicated plastic stent with a review of the literature (with video). Endosc Ultrasound 2018;7:404-12.  Back to cited text no. 2
    
3.
Ogura T, Kitano M, Takenaka M, et al. Multicenter prospective evaluation study of endoscopic ultrasound-guided hepaticogastrostomy combined with antegrade stenting (with video). Dig Endosc 2018;30:252-9.  Back to cited text no. 3
    
4.
Ogura T, Masuda D, Imoto A, et al. EUS-guided hepaticogastrostomy combined with fine-gauge antegrade stenting: A pilot study. Endoscopy 2014;46:416-21.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

 
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