Strategic International Session2(JGES・JSGE・JSGS)
Fri. November 3rd   9:00 - 12:00   Room 11: Portopia Hotel South Wing Topaz
ST2-4_E
 Drainage stenting with a tapered sheath dilator prevents bile leakage in endoscopic ultrasound-guided biliary drainage
Akihisa Kato1, Michihiro Yoshida1, Hiromi Kataoka1
1Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences
[Background/Aims] Endoscopic ultrasound-guided biliary drainage (EUS-BD) is a promising option for patients with obstructive jaundice, cholangitis, and cholecystitis. However, bile leakage, which could cause infected biloma or severe peritonitis, may occur during EUS-BD. To address this problem, we newly developed drainage stenting using a tapered sheath dilator to prevent bile leakage.
[Patients and Methods] We retrospectively investigated 10 consecutive cases in whom the tapered sheath dilator (EndoSheather; PIOLAX) was applied during EUS-BD. In the procedure, after sufficient placement of a 0.025-inch guidewire, this tapered sheath dilator was used for mechanical dilation. Only inner-catheter was removed, and the drainage stent (metal or plastic stent up to 6Fr in diameter) was deployed through the indwelling outer-sheath.
[Results] Patients comprised 4 men and 6 women, with a median age of 76.5 years (range 52-97 years). The type of procedure was EUS-HGS (hepaticogastrostomy) in 4 patients, EUS-HGAS (HGS with antegrade stenting) in 3, EUS-GBD (gallbladder drainage) in 2, EUS-HDS (hepaticoduodenostomy) in 1. The technical success rate of dilation was 100% (10/10), and stent placement was successful in all cases (10/10). Regarding early adverse events, cholangitis occurred in 1/10 patient (10.0%), however, there was no case of bile leakage or peritonitis.
[Conclusions] This technique may have great potential to prevent bile leakage in EUS-BD, due to eliminating the need to exchange the dilation device.
Index Term 1: EUS-BD
Index Term 2: bile leakage
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