Tae 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 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.
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