Pain scores were assessed using visual analogue scale while QoL was assessed using the EORTC-QLQ-30 instrument, Global health status/Quality of life score. Adverse events Paclitaxel were graded according to the ASGE lexicon’s severity grading system. Results: A total of 45 patients (age 63 ± 17 yr, female 35%, pancreatic cancer 78% underwent EUS-BD [REN 12, AG 7, TL 26 (Choledochoduodenostomy 18, Hepatogastrostomy 5, Hepatoduodenostomy 3)]. Reason for EUS-BD was obscured ampulla by invasive cancer or enteral stent
(65%), altered anatomy (11%), failed deep biliary cannulation (22%), and gastric outlet obstruction (2%). Electrocautery was used during 32% of procedures. EUS-guided cholangiography was successful in all patients (100%). Mean intra- or extra- hepatic bile duct diameter was 13.1 mm (range 1–25 mm). Stent placement Bioactive Compound Library in desired location (technical success) was achieved in 44 (97.8%) patients (metallic stent 40, plastic stent 5). Mean procedure time was 42.8 ± 33 mins. Clinical success was attained in 41/45 (91%) patients of who achieved technical success. There
was significant decrease in bilirubin at 4 weeks (246.2 ± 164.2 vs. 37.6 ± 27.3 μmol/L, p < 0.001). Mean length of hospital stay was 2.9 days. A total of 5 (11.1%) adverse events occurred (2 moderate: bile leak, sheared wire and 3 mild: 1 pancreatitis, 2 pain managed conservatively). During long-term follow-up of 113.4 ± 109.3 days, 10 patients died because of disease progression with patent stents in place at a mean of 80.4 ± 77.8 days after EUS-BD. One patient had stent occlusion (metal stent) treated with endoscopic cleansing
and placement of plastic stent. Three patients had stent migration (metal stents). QoL score improved 4 weeks after medchemexpress EGBD (39.3 ± 20.0 vs. 50.0 ± 22.2, P = 0.33). Conclusions: Excellent efficacy and safety of EUS-BD in the management of distal malignant biliary obstruction after failed ERCP is demonstrated in a rigorous ongoing prospective international study. P SAXENA,1 V KUMBHARI,1 M EL ZEIN,1 A ABDELGELIL,1 S BESHARATI,1 A MESALLAM,1 T STEVENS,2 EJ SHIN,1 VK SINGH,1 AM LENNON,1 MI CANTO,1 MA KHASHAB1 1Division of Medicine, Department of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, MD, USA, 2Division of Medicine, Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA Background: Emerging data suggests that needle aspiration techniques have direct effect on yield of EUS-FNA. Standard FNA procedures involve use of “no-suction” or “suction” aspiration techniques. However, recent data suggests that using minimal negative pressure provided by pulling the needle stylet slowly and continuously (capillary suction technique) is associated with improved diagnostic yield.