The 4th Joint Session between JDDW-KDDW-TDDW3(JDDW)
Thu. November 5th   9:00 - 11:15   Room 10: Portopia Hotel Waraku
JKT3-RS1
 Novel EUS-guided therapeutic approach for postoperative bile duct stricture
Takeshi Ogura
2nd Department of Internal Medicine, Osaka Medical College
[Background and aim]
A hepaticojejunostomy anastomotic stricture (HJS) is a rare complication after pancreatoduodenectomy (PD). However, the rate of HJS may may increase as operative indications expand to include more conditions such as intraductal papillary mucinous neoplasm. HJS is commonly treated under percutaneous transhepatic or enteroscopic guidance. However, there are several disadvantages in these procedures such as prolong procedure time, low technical success rate, or self-tube removal. Recently, EUS-guided biliary drainage (EUS-BD) is indicated for malignant biliary obstruction. EUS-BD for benign biliary stricture has been reported, however, the evidence of EUS-BD for HJS is not sufficient. The aim of this study is to evaluate the feasibility and efficacy of interventional endoscopy under EUS guidance for HJS.
[Patients and Method]
Between January 2017 and May 2019, a total 38 HJS patients were enrolled. First, EUS-BD was performed using covered metal stent. After 1 week, cholangioscope inserted into the biliary tract through the HGS stent. Then, HJS was evaluated, and dilated using balloon catheter. Finally, HGS was performed using plastic stent. After 3 months, if HJS was still presence, antegrade metal stent deployment (M-Intraductal stent) was attempted.
The primary endpoint in this study is to evaluate the technical success rate, and adverse events were secondary evaluated.
[Results]
The 38 patients underwent EUS-BD. Indications for EUS-BD comprised obstructive jaundice (n = 12) and frequent cholangitis (n = 26). Among them, intrahepatic bile duct stones were complicated in 14 patients. Technical success of EUS-BD was obtained in 36 patients (94.7%). HJS dilation was attempted in 35 patients except one patient who was diagnosed as recurrence of cholangiocarcinoma at HJS site. HJS was resolved in 22 patients (median follow-up period 188 days). Antegrade metal stent deployment were attempted in 16 patients, and stent deployment was successfully performed in all patients. In addition, after 1 month, stent removal via HGS route could be successfully performed in all patients. During clinical follow up (median 132 days), recurrence of HJS were seen in three patients (recurrence rate, 18.8%). These patients continuously underwent scheduled EUS-HGS stent exchange. Finally, severe adverse events were not seen in any patients.
[Conclusion]
Transluminal treatment including antegrade stent deployment for HJS under EUS-guidance appears feasible and safe, although further study with a larger sample size and longer follow-up is warranted.
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