Curved puncture technique using a flexible stainless-steel needle in endoscopic ultrasound-guided hepaticogastrostomy

Various efforts to improve technical success rates and decrease adverse event rates have also been described in endoscopic ultrasound (EUS)‐guided choledochoduodenostomy (CDS). In particular, lumen‐apposing metal stents (LAMS) may open novel opportunities in EUS‐biliary drainage (BD). To date, various studies have been reported with EUS‐CDS using LAMS, so we should clarify the benefits and limitations of recent EUS‐CDS based on developments in both techniques and devices. In this review, we provide technical tips and describe recent developments in EUS‐CDS, along with a review of the recent literature (between 2015 and 2020). The overall technical success rate is 95.0% (939/988), and the overall clinical success rate is 97.0% (820/845). The most frequent adverse event is cholangitis or cholecystitis (24.5%, 27/110). According to previous review, pneumoperitoneum (28%, 9/34) or peritonitis associated with bile leak (23.5%, 8/34) was most commonly observed. This difference might be based on improvements in dilation devices or the use of covered metal stents. Several randomized controlled trials comparing EUS‐CDS and endoscopic retrograde cholangiopancreatography (ERCP) for malignant biliary obstruction have recently been reported. To summarize, overall technical success rates for ERCP and EUS‐CDS were 92.7% (101/109) and 91.1% (72/79), respectively ( p  = 0.788). Overall clinical success rates for ERCP and EUS‐CDS were 94.1% (96/102) and 93.6% (72/78), respectively ( p  = 0.765). Further high‐quality evidence is needed to establish EUS‐CDS as a primary drainage technique.

Background/Aims Endoscopic ultrasound-guided tissue acquisition (EUS-TA) using Franseen needles is reportedly useful for its high diagnostic yield. This study compared the diagnostic yield and puncturing ability of EUS-TA using 22-gauge cobalt-chromium (CO-Cr) needles with those of stainless-steel Franseen needles in patients with solid pancreatic lesions. Methods Outcomes were compared between the 22-gauge Co-Cr Franseen needle (December 2019 to November 2020; group C) and stainless-steel needle (November 2020 to May 2022; group S). Results A total of 155 patients (group C, 75; group S, 80) were eligible. The diagnostic accuracy was 92.0% in group C and 96.3% in group S with no significant intergroup differences ( p =0.32). The rate of change in the operator (from training fellows to experts) was 20.0% (15/75) in group C and 7.5% (6/80) in group S. Stainless-steel Franseen needles showed less inter-operator difference than Co-Cr needles ( p =0.03). Conclusions Both Co-Cr and stainless-steel Franseen needles showed high diagnostic ability. Stainless-steel Franseen needles are soft and flexible; therefore, the range of puncture angles can be widely adjusted, making them suitable for training fellows to complete the procedure.