Journal of Gastrointestinal Surgery

, Volume 23, Issue 1, pp 192–198 | Cite as

EUS-Guided Antegrade Biliary Stenting Using a Novel Fully Covered Metal Stent (with Video)

  • Masanori Yamada
  • Takeshi OguraEmail author
  • Rieko Kamiyama
  • Akira Miyano
  • Nobu Nishioka
  • Tadahiro Yamada
  • Kazuhide Higuchi
Multimedia Article



Recently, endoscopic ultrasound (EUS)-guided hepaticogastrostomy (HGS) combined with antegrade stenting (AS) has been reported to be associated with longer stent patency and reduced procedure-related adverse events. In EUS-AS, an uncovered metal stent is usually selected to prevent stent misplacement or dislocation. However, because patient survival has improved with advances in chemotherapy, longer stent patency may be required.


The technical feasibility and safety of EUS-guided transhepatic biliary drainage combined with EUS-AS using a novel covered metal stent were evaluated.


Patients with malignant biliary obstruction leading to obstructive jaundice, in whom standard ERCP had failed or was contraindicated, were enrolled in this study between July 2015 and October 2017. As the control group, patients undergoing EUS-AS using an uncovered metal stent were enrolled between October 2014 and June 2015.


A total of 39 patients were enrolled in this study. Among them, EUS-AS using a covered metal stent was performed in 17 patients and using an uncovered metal stent in the remaining 22 patients. Median stent patency including stent dysfunction and patient death was longer in the covered metal stent group (153 days) compared with that of the uncovered metal stent group (108 days) although there were no significant differences (P = 0.06). In only cases with stent dysfunction was median stent patency of the covered metal stent group significantly longer than that of the uncovered metal stent group (not available vs 150 days, P = 0.02).


In conclusion, EUS-guided transluminal biliary drainage combined with EUS-AS using a covered metal stent may be feasible and safe, although the indications for this procedure should be carefully considered.


EUS EUS-guided biliary drainage EUS-guided antegrade stenting ERCP 


Author Contribution

Masanori Yamada and Takeshi Ogura wrote the paper. Takeshi Ogura, Akira Miyano, Rieko Kamiyama, Nobu Nishioka, Tadahiro Yamada, and Kazuhide Higuchi interpreted the data for the work, revising it critically for important intellectual content, final approval of the version to be published, and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Compliance with Ethical Standards

This pilot study was approved by the institutional review board of Osaka Medical College. Written, informed consent was obtained from all patients.

Conflict of Interest

The authors declare that they have no conflicts of interest.

Supplementary material


The intrahepatic bile duct is punctured using 19G FNA needle, and the contrast medium is injected. Then, the 0.025-in. guidewire is inserted into the biliary tract, and also ERCP catheter is inserted. After the guidewire is advanced into the intestine across the uncovered duodenal metal stent, antegrade stent placement is performed using novel metal stent. Finally, EUS-guided hepaticogastrostomy is successfully performed. (AVI 16065 kb)


  1. 1.
    Dhir V, Isayama H, Itoi T, et al. Endoscopic ultrasonography-guided biliary and pancreatic duct interventions. Dig Endosc 2017;29:472–485CrossRefGoogle Scholar
  2. 2.
    Itoi T, Dhir V, Moon JH. EUS-guided biliary drainage: moving into a new era of biliary drainage. Gastrointest Endosc 2017;85:915–917CrossRefGoogle Scholar
  3. 3.
    Sharaiha RZ, Khan MA, Kamal F, et al. Efficacy and safety of EUS-guided biliary drainage in comparison with percutaneous biliary drainage when ERCP fails: a systematic review and meta-analysis. Gastrointest Endosc 2017;85:904–914CrossRefGoogle Scholar
  4. 4.
    Ogura T, Higuchi K. Technical tips of endoscopic ultrasound-guided choledochoduodenostomy. World J Gastroenterol 2015;21:820–828CrossRefGoogle Scholar
  5. 5.
    Ogura T, Higuchi K. Technicap tips for endoscopic ultrasound-guided hepaticogastrostomy. World J Gastroenterol 2016;22:3945–3951CrossRefGoogle Scholar
  6. 6.
    Hara K, Yamao K, Mizuno N, et al. Endoscopic ultrasonography-guided biliary drainage: who, when, which, and how? World J Gastroenterol 2016;22:1297–1303CrossRefGoogle Scholar
  7. 7.
    Sharaiha RZ, Kumta NA, Desai AP, et al. Endoscopic ultrasound-guided biliary drainage versus percutaneous transhepatic biliary drainage: predictors of successful outcome in patients who failed endoscopic retrograde cholangiopancreatography. Surg Endosc 2016;30:5500–5505CrossRefGoogle Scholar
  8. 8.
    Law R, Baron TH. Endoscopic ultrasound-guided biliary interventions: an update on recent developments. Curr Opin Gastroenterol 2016;32:232–237CrossRefGoogle Scholar
  9. 9.
    Khashab MA, Valeshabad AK, Afghani E, et al. A comparative evaluation of EUS-guided biliary drainage and percutaneous drainage in patients with distal malignant biliary obstruction and failed ERCP. Dig Dis Sci 2015;60:557–565CrossRefGoogle Scholar
  10. 10.
    Lee TH, Choi JH, Park do H, et al. Similar efficacies of endoscopic ultrasound-guided transmural and percutaneous drainage for malignant distal biliary obstruction. Clin Gastroenterol Hepatol 2016;14:1011–1019CrossRefGoogle Scholar
  11. 11.
    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;30:252–259Google Scholar
  12. 12.
    Imai H, Takenaka M, Omoto S, et al. Utility of endoscopic ultrasound-guided hepaticogastrostomy with antegrade stenting for malignant biliary obstruction after failed endoscopic retrograde cholangiopancreatography. Oncology 2017;93:69–75CrossRefGoogle Scholar
  13. 13.
    Kumbhari V, Tleu AH, Khashab MA. EUS-guided biliary drainage made safer by a combination of hepaticogastrostomy and antegrade transpapillary stenting. Gastrointest Endosc 2015;81:1015–1016CrossRefGoogle Scholar
  14. 14.
    Ogura T, Edogawa S, Imoto A, et al. EUS-guided hepaticojejunostomy combined with antegrade stent placement. Gastrointest Endosc 2015;81:462–463CrossRefGoogle Scholar
  15. 15.
    Ogura T, Masuda D, Imoto A, et al. EUS-guided hepaticogastrostomy combined with fine-gauge antegrade stenting: a pilot study. Endoscopy 2014;46:416–421CrossRefGoogle Scholar
  16. 16.
    Cotton PB, Eisen GM, Abakken L, et al. A lexicon for endoscopic adverse events: report of an ASGE work shop. Gastrointest Endosc 2010;71:446–454CrossRefGoogle Scholar
  17. 17.
    Iwashita T, Yasuda I, Mukai T, et al. Endoscopic ultrasound-guided antegrade biliary stenting for unresectable malignant biliary obstruction in patients with surgically altered anatomy: single-center prospective pilot study. Dig Endosc 2017;29:362–368CrossRefGoogle Scholar
  18. 18.
    Almadi MA, Eltayeb M, Thaniash S. Endscopic ultrasound-guided antegrade stenting in an occluded biliary self-expandable metal stent. Saudi J Gastroenterol 2016;22:337–340CrossRefGoogle Scholar
  19. 19.
    Iwashita T, Nakai Y, Hara K, et al. Endoscopic ultrasound-guided antegrade treatment of bile duct stone in patients with surgically altered anatomy: a multicenter retrospective cohort study. J Hepatobiliary Pancreat Sci 2016;23:227–233CrossRefGoogle Scholar
  20. 20.
    Itoi T, Sofuni A, Tsuchiya T, et al. Endoscopic ultrasonography-guided transhepatic antegrade stone removal in patients with surgically altered anatomy: case series and technical review (with videos). J Hepatobiliary Pancreat Sci 2014;21:E86-E93CrossRefGoogle Scholar
  21. 21.
    Weilert F, Binmoeller KF, Marson F, et al. Endoscopic ultrasound-guided anterograde treatment of biliary stones following gastric bypass. Endoscopy 2011;43:1105–1108CrossRefGoogle Scholar
  22. 22.
    Godat S, Bories E, Caillol F, et al. Efficacy and safety in case of technical success of endoscopic ultrasound-guided transhepatic antegrade biliary drainage: a report of a monocentric study. Endosc Ultrasound 2017;6:181–186CrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2018

Authors and Affiliations

  • Masanori Yamada
    • 1
  • Takeshi Ogura
    • 1
    Email author
  • Rieko Kamiyama
    • 1
  • Akira Miyano
    • 1
  • Nobu Nishioka
    • 1
  • Tadahiro Yamada
    • 1
  • Kazuhide Higuchi
    • 1
  1. 1.2nd Department of Internal MedicineOsaka Medical CollegeOsakaJapan

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