Strategic International Session2(JGES・JSGE・JSGS)
Fri. November 3rd   9:00 - 12:00   Room 11: Portopia Hotel South Wing Topaz
Troubleshooting to improve safety and success rate of EUS-guided antegrade treatment for bile duct stones in patients with surgically altered anatomy
Takuji Iwashita1, Keisuke Iwata2, Masahito Shimizu1
1First Department of Internal Medicine, Gifu University Hospital, 2Department of Gastroenterology, Gifu Municipal Hospital
EUS-guided antegrade treatment (AG) has emerged as one of the endoscopic treatment options for bile duct stone (BDS).
Aims: To evaluate troubleshooting to improve the safety and efficacy of EUS-AG in management of BDS in patients with surgically altered anatomy (SAA).
Methods: 27 Patients with SAA who underwent EUS-AG for BDS at 2 care centers were retrospectively evaluated. The original EUS-AG was performed as followings: 1) biliary puncture using 19g needle and guidewire insertion, 2) tract dilation, 3) papillary balloon dilation, 4) stone extraction using a retrieval balloon, and 5) biliary drainage (BD). Possible troubleshooting was evaluated, if the technique used was different from the original.
Results: The overall success and adverse event (AE) rates in EUS-AG for BDS were 74.1% (20/27) and 14.8% (4/27: bile peritonitis, mild in 2, severe in 1; CRP elevation, mild in 1) respectively. Possible troubleshooting was application of 22g FNA needle for the difficult biliary puncture in 7 and the multi-stage approach for large BDS in 3. Also, severe AE was observed in no BD which may indicate essential BD is required to prevent deterioration of bile peritonitis.
Conclusion: The application of 22g needle, multi-stage approach, and essential BD might be useful to improve the safety and success rate of EUS-AG for BDS in patients with SAA.
Index Term 1: EUS-guided antegrade management
Index Term 2: Bile duct stones
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