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Pancreato-Biliary Interventional Endoscopy

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Gastroenterology & Hepatopancreatobiliary Medicine".

Deadline for manuscript submissions: closed (31 March 2021) | Viewed by 31621

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Prof. Dr. Hiroyuki Isayama

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Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan
Interests: endoscopic stenting; self-expandable metallic stent (SEMS); interventional EUS; EUS-guided biliary drainage (EUS-BD); endoscopic necrosectomy; chronic pancreatitis; pancreatic cancer; cholangiocarcinoma; obstructive jaundice; bile duct stones; primary sclerosing cholangitis (PSC)
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Dear Colleagues,

We are performing various endoscopic procedures for the patients with Pancreato-Biliary diseases. They require high skill to pull off and deep insight to recognize the patients’ condition, and require us to learn more about the problems and development of the procedures. There are two types of endoscopic intervention: ERCP-related procedures and Interventional EUS. ERCP-related procedures are considered as established, but the strategies and devices are still developing. On the contrary, the procedures of Interventional EUS are not established but are still able to treat various difficult ERCP cases. We are still trying to improve the procedures, devices, and strategies of both ERCP and EUS. In this Special Issue, we want to share the latest information by experts and rising stars. In this Special Issue, we will accept high level reviews and original articles about Interventional Endoscopy, including both ERCP and EUS-related procedures. Off course, interventional endoscopy may include both treatment and diagnosis. For articles about ERCP-related new procedures, we will favor papers presenting current strategies and technical improvement for difficult cases. On the other hand, as Interventional EUS is still a developing field, we will also welcome papers exploring new techniques, new strategies, and new trials. Systematic reviews are also welcome. I want to make this Special Issue one of the milestones of endoscopic intervention for pancreto-biliary diseases.

Prof. Dr. Isayama Hiroyuki
Guest Editor

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Keywords

Endotherapy
Pancreato-Biliary disease
Interventional EUS
ERCP
Biliary access
Biliary cannulation
Endoscopic stenting
EUS-guided biliary drainage
EUS-guided pancreatic drainage (EUS-PD)
Cholangioscopy

Related Special Issue

Pancreato-Biliary Interventional Endoscopy - Part II in Journal of Clinical Medicine (12 articles)

Published Papers (12 papers)

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Editorial

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5 pages, 209 KiB

Open AccessEditorial

Recent Advances in Pancreato-Biliary Endoscopic Intervention: How to Resolve Unmet Needs in Pancreato-Biliary Diseases Endoscopically

by Hiroyuki Isayama, Shigeto Ishii, Ko Tomishima and Toshio Fujisawa

J. Clin. Med. 2022, 11(13), 3637; https://doi.org/10.3390/jcm11133637 - 23 Jun 2022

Viewed by 926

Abstract

Various procedures are available for pancreato-biliary (PB) endoscopic interventions [...] Full article

(This article belongs to the Special Issue Pancreato-Biliary Interventional Endoscopy)

Research

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9 pages, 40169 KiB

Open AccessArticle

Risk Factors for Stent Migration into the Abdominal Cavity after Endoscopic Ultrasound-Guided Hepaticogastrostomy

by Kazushige Ochiai, Toshio Fujisawa, Shigeto Ishii, Akinori Suzuki, Hiroaki Saito, Yusuke Takasaki, Mako Ushio, Sho Takahashi, Wataru Yamagata, Ko Tomishima, Tadakazu Hisamatsu and Hiroyuki Isayama

J. Clin. Med. 2021, 10(14), 3111; https://doi.org/10.3390/jcm10143111 - 14 Jul 2021

Cited by 16 | Viewed by 2408

Abstract

Background: Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is becoming increasingly popular. However, the risk factors for stent migration into the abdominal cavity remain unknown. Methods: Forty-eight patients undergoing EUS-HGS with placement of a long, partially covered self-expandable metallic stent (LPC-SEMS) were studied retrospectively to identify risk factors of stent migration. We determined the technical and functional success rates, and recorded adverse events, including stent migration. Results: EUS-HGS was technically successful in all patients. However, stent migration was evident in five patients (one actual and four imminent, 10%). Stent migration into the abdominal cavity was observed in one patient (2%), and the other four cases required additional procedures to prevent migration (8%). Logistic regression analysis revealed that the risk of stent migration increased as the initial (pre-procedure) distance between the stomach and liver at the puncture site increased (p = 0.012). Conclusions: A longer distance between the stomach and liver at the puncture site increased the risk of stent migration. However, during EUS-HGS, it is difficult to adjust the puncture position. It is important to ensure that the proportion of the stent in the stomach is large; the use of a self-anchoring stent may be optimal. Full article

(This article belongs to the Special Issue Pancreato-Biliary Interventional Endoscopy)

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11 pages, 866 KiB

Open AccessArticle

A Prospective Multicenter Study of “Inside Stents” for Biliary Stricture: Multicenter Evolving Inside Stent Registry (MEISteR)

by Hirofumi Kogure, Hironari Kato, Kazumichi Kawakubo, Hirotoshi Ishiwatari, Akio Katanuma, Yoshinobu Okabe, Toru Ueki, Tesshin Ban, Keiji Hanada, Kazuya Sugimori, Yousuke Nakai and Hiroyuki Isayama

J. Clin. Med. 2021, 10(13), 2936; https://doi.org/10.3390/jcm10132936 - 30 Jun 2021

Cited by 15 | Viewed by 2189

Abstract

Background: Endoscopic biliary stent placement is the standard of care for biliary strictures, but stents across the papilla are prone to duodenobiliary reflux, which can cause stent occlusion. Preliminary studies of “inside stents” placed above the papilla showed encouraging outcomes, but prospective data with a large cohort were not reported. Methods: This was a prospective multicenter registry of commercially available inside stents for benign and malignant biliary strictures. Primary endpoint was recurrent biliary obstruction (RBO). Secondary endpoints were technical success of stent placement and removal, adverse events, and stricture resolution. Results: A total of 209 inside stents were placed in 132 (51 benign and 81 malignant) cases with biliary strictures in 10 Japanese centers. During the follow-up period of 8.4 months, RBO was observed in 19% of benign strictures. The RBO rate was 49% in malignant strictures, with the median time to RBO of 4.7 months. Technical success rates of stent placement and removal were both 100%. The adverse event rate was 8%. Conclusion: This prospective multicenter study demonstrated that inside stents above the papilla were feasible in malignant and benign biliary strictures, but a randomized controlled trial is warranted to confirm its superiority to conventional stents across the papilla. Full article

(This article belongs to the Special Issue Pancreato-Biliary Interventional Endoscopy)

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9 pages, 869 KiB

Open AccessArticle

Evaluation of the Feasibility and Effectiveness of Placement of Fully Covered Self-Expandable Metallic Stents via Various Insertion Routes for Benign Biliary Strictures

by Ko Tomishima, Shigeto Ishii, Toshio Fujisawa, Muneo Ikemura, Mako Ushio, Sho Takahashi, Wataru Yamagata, Yusuke Takasaki, Akinori Suzuki, Koichi Ito, Keiichi Haga, Kazushige Ochiai, Osamu Nomura, Hiroaki Saito, Tomoyoshi Shibuya, Akihito Nagahara and Hiroyuki Isayama

J. Clin. Med. 2021, 10(11), 2397; https://doi.org/10.3390/jcm10112397 - 28 May 2021

Cited by 4 | Viewed by 2165

Abstract

Background and aims: The goals of the management of benign biliary stricture (BBS) are to relieve symptoms and resolve short-/long-term stricture. We performed fully covered self-expandable metallic stent (hereafter, FCSEMS) placement for BBS using various methods and investigated the treatment outcomes and adverse events (AEs). Methods: We retrospectively studied patients who underwent FCSEMS placement for refractory BBS through various approaches between January 2017 and February 2020. FCSEMS were placed for 6 months, and an additional FCSEMS was placed if the stricture had not improved. Technical success rate, stricture resolution rate, and AE were measured. Results: A total of 26 patients with BBSs that were difficult to manage with plastic stents were included. The mean overall follow-up period was 43.3 ± 30.7 months. The cause of stricture was postoperative (46%), inflammatory (31%), and chronic pancreatitis (23%). There were four insertion methods: endoscopic with duodenoscopy, with enteroscopy, EUS-guided transmural, and percutaneous transhepatic. The technical success rate was 100%, without any AE. Stricture resolution was obtained in 19 (83%) of 23 cases, except for three cases of death due to other causes. Stent migration and cholangitis occurred in 23% and 6.3%, respectively. Stent fracture occurred in two cases in which FCSEMSs were placed for more than 6 months (7.2 and 10.3 months). Conclusion: FCSEMS placement for refractory BBS via various insertion routes was feasible and effective. FCSEMSs should be exchanged every 6 months until stricture resolution because of stent durability. Further prospective study for confirmation is required, particularly regarding EUS-guided FCSEMS placement. Full article

(This article belongs to the Special Issue Pancreato-Biliary Interventional Endoscopy)

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11 pages, 2578 KiB

Open AccessArticle

Clinical Evaluation of a Newly Developed Guidewire for Pancreatobiliary Endoscopy

by Shigeto Ishii, Toshio Fujisawa, Hiroyuki Isayama, Shingo Asahara, Shingo Ogiwara, Hironao Okubo, Hisafumi Yamagata, Mako Ushio, Sho Takahashi, Hiroki Okawa, Wataru Yamagata, Yoshihiro Okawa, Akinori Suzuki, Yusuke Takasaki, Kazushige Ochiai, Ko Tomishima, Hiroaki Saito, Shuichiro Shiina and Takaaki Ikari

J. Clin. Med. 2020, 9(12), 4059; https://doi.org/10.3390/jcm9124059 - 16 Dec 2020

Cited by 4 | Viewed by 1983

Abstract

Background: The guidewire (GW) plays an important role in pancreatobiliary endoscopy. GW quality is a critical factor in the effectiveness and efficiency of pancreatobiliary endoscopy. In this study, we evaluate a new 0.025 inch multipurpose endoscopic GW: the M-Through. Methods: Our study was a multicenter retrospective analysis. We enrolled patients who underwent endoscopic procedures using the M-Through between May 2018 and April 2020. Patients receiving the following endoscopic treatments were enrolled: common bile duct (CBD) stone extraction, endoscopic drainage for distal and hilar malignant biliary obstruction (MBO), and endoscopic drainage for acute cholecystitis. For each procedure, we examined the rate of success without GW exchange. Results: A total of 170 patients (80 with CBD stones, 60 with MBO, and 30 with cholecystitis) were enrolled. The rate of completion without GW exchange was 100% for CBD stone extraction, 83.3% for endoscopic drainage for MBO, and 43.3% for endoscopic drainage for cholecystitis. In unsuccessful cholecystitis cases with the original GW manipulator, 1 of 8 cases succeeded in the manipulator exchange. Including 6 cases who changed GW after the manipulator exchange, 11 of 16 cases succeeded in changing GW. There was significant difference in the success rate between the manipulator exchange and GW exchange (p = 0.03). The insertion of devices and stent placement after biliary cannulation (regardless of type) were almost completed with M-through. We observed no intraoperative GW-related adverse events such as perforation and bleeding due to manipulation. Conclusion: The 0.025 inch M-Through can be used for endoscopic retrograde cholangiopancreatography-related procedures efficiently and safely. Our study found high rates of success without GW exchange in all procedures except for endoscopic drainage for cholecystitis. This GW is considered (1) excellent for supportability of device insertion to remove CBD stones; (2) good for seeking the biliary malignant stricture but sometimes need the help of a hydrophilic GW; (3) suboptimal for gallbladder drainage that require a high level of seeking ability. Full article

(This article belongs to the Special Issue Pancreato-Biliary Interventional Endoscopy)

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17 pages, 6545 KiB

Open AccessArticle

A Proposed Algorithm for Endoscopic Ultrasound-Guided Rendezvous Technique in Failed Biliary Cannulation

by Saburo Matsubara, Keito Nakagawa, Kentaro Suda, Takeshi Otsuka, Hiroyuki Isayama, Yousuke Nakai, Masashi Oka and Sumiko Nagoshi

J. Clin. Med. 2020, 9(12), 3879; https://doi.org/10.3390/jcm9123879 - 29 Nov 2020

Cited by 15 | Viewed by 2554

Abstract

Background: The selection of an approach route in endoscopic ultrasound-guided rendezvous (EUS-RV) for failed biliary cannulation is complicated. We proposed an algorithm for EUS-RV. Methods: We retrospectively evaluated consecutive EUS-RV cases between April 2017 and July 2020. Puncturing the distal extrahepatic bile duct (EHBD) from the duodenal second part (D2) (DEHBD/D2 route) was attempted first. If necessary, puncturing the proximal EHBD from the duodenal bulb (D1) (PEHBD/D1 route), puncturing the left intrahepatic bile duct (IHBD) from the stomach (LIHBD/S route), or puncturing the right IHBD from the D1 (RIHBD/D1 route) were attempted in this order. Results: A total of 16 patients were included. The DEHBD/D2 route was used in 10 (62.5%) patients. The PEHBD/D1 route was attempted in five (31.3%) patients, and the biliary puncture failed in one patient in whom the RIHBD/D1 route was used because of tumor invasion to the left hepatic lobe. The LIHBD/S route was applied in one (6.3%) patient. Successful biliary cannulation was achieved in all patients eventually. The time from the puncture to the guidewire placement in the DEHBD/D2 route (3.5 min) was shorter than that in other methods (14.0 min) (p = 0.014). Adverse events occurred in one (6.3%) patient with moderate pancreatitis. Conclusions: The proposed algorithm might be useful for the selection of an appropriate approach route in EUS-RV. Full article

(This article belongs to the Special Issue Pancreato-Biliary Interventional Endoscopy)

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9 pages, 349 KiB

Open AccessArticle

Long-Term Safety of Endoscopic Biliary Stents for Cholangitis Complicating Choledocholithiasis: A Multi-Center Study

by Wisam Sbeit, Tawfik Khoury, Anas Kadah, Dan M. Livovsky, Adi Nubani, Amir Mari, Eran Goldin and Mahmud Mahamid

J. Clin. Med. 2020, 9(9), 2953; https://doi.org/10.3390/jcm9092953 - 12 Sep 2020

Cited by 5 | Viewed by 3164

Abstract

Background: Treatment of cholangitis complicating choledocholithiasis includes biliary sphincterotomy and stone extraction. In certain cases of elderly comorbid patients with high risk for definitive endoscopic treatment, biliary stenting is the only measure for relieving biliary obstruction. Aim: We aimed to report the safety of retained biliary stone. Methods: a multi-center, retrospective case-control study conducted at two Israeli medical centers from January 2013 to December 2018 including all patients 18 years of age or older who underwent ERCP and biliary stent insertion for the treatment of acute cholangitis due to choledocholithiasis. Results: Three-hundred and eight patients were identified. Eighty-three patients had retained long-term biliary stents of more than 6 months (group A) from insertion compared to 225 patients whose biliary stents were removed within a 6-month period (group B). The mean follow-up in group A was 66.1± 16.3 vs. 11.1 ± 2.7 weeks in group B. Overall complications during the follow-up were similar between groups A and B (6% vs. 4.9%, OR 1.24, Chi square 0.69). Similarly, the rate of each complication alone was not different when comparing group A to group B (3.6%, 1.2% and 1.2% vs. 2.7%, 0.44% and 1.8%) for cholangitis, stent related pancreatitis and biliary colic, respectively (Chi square 0.85). Even after 12 months, the rates of overall complications and each complication alone were not higher compared to less than 12 months (Chi square 0.72 and 0.8, respectively). Conclusion: endoscopic biliary stenting for cholangitis complicating choledocholithiasis is safe for the long-term period without increase in stent related complications. Full article

(This article belongs to the Special Issue Pancreato-Biliary Interventional Endoscopy)

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9 pages, 505 KiB

Open AccessArticle

A Novel Technique of Endoscopic Papillectomy with Hybrid Endoscopic Submucosal Dissection for Ampullary Tumors: A Proof-of-Concept Study (with Video)

by Naminatsu Takahara, Yosuke Tsuji, Yousuke Nakai, Yukari Suzuki, Akiyuki Inokuma, Sachiko Kanai, Kensaku Noguchi, Tatsuya Sato, Ryunosuke Hakuta, Kazunaga Ishigaki, Kei Saito, Yoshiki Sakaguchi, Tomotaka Saito, Tsuyoshi Hamada, Suguru Mizuno, Hirofumi Kogure and Kazuhiko Koike

J. Clin. Med. 2020, 9(8), 2671; https://doi.org/10.3390/jcm9082671 - 18 Aug 2020

Cited by 8 | Viewed by 2551

Abstract

Background: Endoscopic papillectomy (EP) carries a potential risk of procedure-related adverse events and incomplete resection. Since hybrid endoscopic submucosal dissection (ESD) had been established as an alternative option for relatively large and difficult gastrointestinal tumors, we evaluated a novel EP with hybrid ESD (hybrid ESD-EP) for curative safe margin in this proof-of-concept study. Methods: A total of eight cases who underwent hybrid ESD-EP between 2018 and 2020 were identified from our prospectively maintained database. Hybrid ESD-EP involved a (sub)circumferential incision with partial submucosal dissection, and subsequent snare resection of ampullary tumors, which was performed by two endoscopists with expertise in ESD or endoscopic retrograde cholangiopancreatography. Demographic data and clinicopathological outcomes were retrospectively evaluated. Results: En bloc resection was achieved by hybrid ESD-EP in all eight cases, with the median procedure time of 112 (range: 65–170) minutes. The median diameters of the resected specimens and tumors were 18 and 12 mm, respectively. All lateral margins were clear, whereas vertical margin was uncertain in three (38%), resulting in the complete resection rate of 63%. Postoperative bleeding and pancreatitis developed in each one (13%). No tumor recurrence was observed even in those cases with uncertain vertical margin, after a median follow-up of 244 (range, 97–678) days. Conclusions: Hybrid ESD-EP seems to be feasible and promising in ensuring the lateral resection margin. However, further investigations, especially to secure the vertical margin and to shorten the procedure time, should be required. Full article

(This article belongs to the Special Issue Pancreato-Biliary Interventional Endoscopy)

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Review

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When Should We Perform Endoscopic Drainage and Necrosectomy for Walled-Off Necrosis?

by Tanyaporn Chantarojanasiri, Thawee Ratanachu-Ek and Hiroyuki Isayama

J. Clin. Med. 2020, 9(12), 4072; https://doi.org/10.3390/jcm9124072 - 17 Dec 2020

Cited by 12 | Viewed by 4217

Abstract

Endoscopic drainage and necrosectomy are now accepted treatment approaches for patients with symptomatic walled-off pancreatic necrosis (WON). The current recommendations advocate step-up approaches for the treatment of symptomatic WON. Previous recommendations stipulated that endoscopic intervention should be delayed until more than four weeks after the onset. Recent data on early drainage have been increasing and this option might be considered in well-encapsulated cases, but the percutaneous route is preferred if the drainage is performed within two weeks after onset or in nonencapsulated cases. Recently, additional drainage methods, such as the multiple gateway technique and multiple stent placement, have been developed to open up multiple dead spaces in the WON cavity. Endoscopic necrosectomy could be performed via the transluminal route or percutaneous route after failed initial and additional drainage procedures. The use of novel lumen-apposing stents is a promising treatment option that could reduce the number of steps, the procedure time, and the overall number of necrosectomies. Full article

(This article belongs to the Special Issue Pancreato-Biliary Interventional Endoscopy)

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21 pages, 1541 KiB

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Best Procedure for the Management of Common Bile Duct Stones via the Papilla: Literature Review and Analysis of Procedural Efficacy and Safety

by Shigeto Ishii, Hiroyuki Isayama, Mako Ushio, Sho Takahashi, Wataru Yamagata, Yusuke Takasaki, Akinori Suzuki, Kazushige Ochiai, Ko Tomishima, Ryo Kanazawa, Hiroaki Saito, Toshio Fujisawa and Shuichiro Shiina

J. Clin. Med. 2020, 9(12), 3808; https://doi.org/10.3390/jcm9123808 - 25 Nov 2020

Cited by 8 | Viewed by 2087

Abstract

Background: Endoscopic management of common bile duct stones (CBDS) is standard; however, various techniques are performed via the papilla, and the best procedure in terms of both efficacy and safety has not been determined. Methods: Endoscopic procedures were classified into five categories according to endoscopic sphincterotomy (EST) and balloon dilation (BD): (1) EST, (2) endoscopic papillary BD (≤10 mm) (EPBD), (3) EST followed by BD (≤10 mm) (ESBD), (4) endoscopic papillary large BD (≥12 mm) (EPLBD), and (5) EST followed by large BD (≥12 mm) (ESLBD). We performed a literature review of prospective and retrospective studies to compare efficacy and adverse events (AEs). Each procedure was associated with different efficacy and AE profiles. Results: In total, 19 prospective and seven retrospective studies with a total of 3930 patients were included in this study. For EST, the complete stone removal rate at the first session, rate of mechanical lithotripsy (ML), and rate of overall AEs in EST were superior to EPBD, but a higher rate of bleeding was found for EST. Based on one retrospective study, complete stone removal rate at the first session, rate of ML, and rate of overall AEs were superior for ESBD vs. EST, and the rate of bleeding for the former was also lower. Complete stone removal rate at the first session and rate of ML for ESLBD were superior to those for EST, with no significant difference in rate of AEs. For EST vs. EPLBD, complete stone removal rate at the first session and rate of ML were superior for the latter. For EPLBD vs. ESLBD, the efficacy and safety were similar. Conclusions: ESBD is considered the best procedure for the management of small CBDS, but strong evidence is lacking. For large CBDS, both ESLBD and EPLBD are similar. Full article

(This article belongs to the Special Issue Pancreato-Biliary Interventional Endoscopy)

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25 pages, 6292 KiB

Open AccessReview

Systematic Review with Meta-Analysis: Endoscopic and Surgical Resection for Ampullary Lesions

by Christian Heise, Einas Abou Ali, Dirk Hasenclever, Francesco Auriemma, Aiste Gulla, Sara Regner, Sébastien Gaujoux and Marcus Hollenbach

J. Clin. Med. 2020, 9(11), 3622; https://doi.org/10.3390/jcm9113622 - 10 Nov 2020

Cited by 21 | Viewed by 2596

Abstract

Ampullary lesions (ALs) can be treated by endoscopic (EA) or surgical ampullectomy (SA) or pancreaticoduodenectomy (PD). However, EA carries significant risk of incomplete resection while surgical interventions can lead to substantial morbidity. We performed a systematic review and meta-analysis for R0, adverse-events (AEs) and recurrence between EA, SA and PD. Electronic databases were searched from 1990 to 2018. Outcomes were calculated as pooled means using fixed and random-effects models and the Freeman-Tukey-Double-Arcsine-Proportion-model. We identified 59 independent studies. The pooled R0 rate was 76.6% (71.8–81.4%, I² = 91.38%) for EA, 96.4% (93.6–99.2%, I² = 37.8%) for SA and 98.9% (98.0–99.7%, I² = 0%) for PD. AEs were 24.7% (19.8–29.6%, I² = 86.4%), 28.3% (19.0–37.7%, I² = 76.8%) and 44.7% (37.9–51.4%, I² = 0%), respectively. Recurrences were registered in 13.0% (10.2–15.6%, I² = 91.3%), 9.4% (4.8–14%, I² = 57.3%) and 14.2% (9.5–18.9%, I² = 0%). Differences between proportions were significant in R0 for EA compared to SA (p = 0.007) and PD (p = 0.022). AEs were statistically different only between EA and PD (p = 0.049) and recurrence showed no significance for EA/SA or EA/PD. Our data indicate an increased rate of complete resection in surgical interventions accompanied with a higher risk of complications. However, studies showed various sources of bias, limited quality of data and a significant heterogeneity, particularly in EA studies. Full article

(This article belongs to the Special Issue Pancreato-Biliary Interventional Endoscopy)

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23 pages, 22650 KiB

Open AccessReview

Which Are the Most Suitable Stents for Interventional Endoscopic Ultrasound?

by Se Woo Park and Sang Soo Lee

J. Clin. Med. 2020, 9(11), 3595; https://doi.org/10.3390/jcm9113595 - 8 Nov 2020

Cited by 10 | Viewed by 3817

Abstract

Endoscopic ultrasound (EUS)-guided interventions provide easy access to structures adjacent to the gastrointestinal tract, effectively targeting them for therapeutic purposes. They play an important role in the management of pancreatic fluid collections (PFC) and bile duct (BD) and pancreatic duct (PD) drainage in cases of failed endoscopic retrograde cholangiopancreatography (ERCP) or gallbladder (GB) drainage. Specially designed stents and delivery systems for EUS-guided transluminal interventions allow various new applications and improve the efficacy and safety of these procedures. In fact, EUS-guided drainage has emerged as the treatment of choice for the management of PFC, and recent innovations such as fully covered metal stents (including lumen-apposing metal stents) have improved outcomes in patients with walled-off necrosis. Similarly, EUS-guided BD and PD drainage with specially designed stents can be beneficial for patients with failed ERCP due to an inaccessible papilla, gastric outlet obstruction, or surgically altered anatomy. EUS-guided GB drainage is also performed using dedicated stents in patients with acute cholecystitis who are not fit for surgery. Although the field of dedicated stents for interventional EUS is rapidly advancing with increasing innovations, the debate on the most appropriate stent for EUS-guided drainage has resurfaced. Furthermore, some important questions remain unaddressed, such as which stent improves clinical outcomes and safety in EUS-guided drainage. Herein, the current status and problems of the available stents are reviewed, including the applicable indications, long-term clinical outcomes, comparison between each stent, and their future prospects. Full article

(This article belongs to the Special Issue Pancreato-Biliary Interventional Endoscopy)

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