New hybrid metal stent for EUS-guided biliary drainage

Drs. Song and LeeTae Jun Song, MD, PhD and Sang Soo Lee, MD, PhD from University of Ulsan in Seoul, South Korea report on their New Methods article “Preliminary report on a new hybrid metal stent for EUS-guided biliary drainage (with videos).”

We investigated the feasibility and safety of a newly developed self-expandable metal stent tailored for use with endoscopic ultrasound-guided biliary drainage (EUS-BD).

Although EUS-BD has been globally applied in recent years, concerns regarding safety issues remain to be solved. EUS-BD is an inherently complicated technique and can lead to potentially fatal adverse events, such as intraperitoneal stent migration. To avoid serious adverse events and secure safe EUS-BD procedure, it is essential to develop a new type of stent, specially designed for EUS-BD procedure.

The hybrid metal stents are partially covered metal stents that were specially designed and modified for the EUS-BD procedure. The distal portion of the stent, which is 3.5 cm long, is composed of silicone-covered nitinol wire to prevent bile leakage. The covered portion has proximal and distal anti-migrating flaps to prevent proximal and distal migration after stent placement. The proximal portion, which is 1.5-5.5 cm long, is uncovered to prevent intrahepatic bile duct obstruction.

Figure 1Figure 1. A hybrid metal stent specially designed for EUS-guided biliary drainage. A, This stent is a partially covered stent with proximal and distal antimigrating flaps at both ends of the covered portion. B, A stent with delivery system

The technical success rate of EUS-BD with the hybrid metal stent was 100%, and clinical success was achieved in 96.3% of the cases. Adverse events developed in 18.5%, including a self-limited pneumoperitoneum in three patients, minor bleeding in one patient, and abdominal pain in one patient. There was no obstructive cholangitis or bile leakage. During the follow-up period (median 134 days), proximal or distal stent migration was not observed.

Performing EUS-BD using a hybrid metal stent was technically feasible, effective, and relatively safe. The newly developed hybrid metal stent is expected to be useful in preventing stent-related adverse events and to play a major role in establishing EUS-BD as a standard alternative technique in patients for whom transpapillary drainage is unsuccessful.

Read the abstract for this article here.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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