Clin Endosc.  2023 Jan;56(1):100-106. 10.5946/ce.2022.058.

Role of interventional endoscopic ultrasound in a developing country

• Maulahela H
• Annisa NG
• Fauzi A
• Renaldi K
• Abdullah M
• Simadibrata M
• Makmun D
• Syam AF

• KMID: 2538757
• DOI: http://doi.org/10.5946/ce.2022.058

Abstract

Background/Aims
Endoscopic ultrasound (EUS) has become an essential diagnostic and therapeutic tool. EUS was introduced in 2013 in Indonesia and is considered relatively new. This study aimed to describe the current role of interventional EUS at our hospital as a part of the Indonesian tertiary health center experience.
Methods
This retrospective study included all patients who underwent interventional EUS (n=94) at our center between January 2015 and December 2020. Patient characteristics, technical success, clinical success, and adverse events associated with each type of interventional EUS procedure were evaluated.
Results
Altogether, 94 interventional EUS procedures were performed at our center between 2015 and 2020 including 75 cases of EUS-guided biliary drainage (EUS-BD), 14 cases of EUS-guided pancreatic fluid drainage, and five cases of EUS-guided celiac plexus neurolysis. The technical and clinical success rates of EUS-BD were 98.6% and 52%, respectively. The technical success rate was 100% for both EUS-guided pancreatic fluid drainage and EUS-guided celiac plexus neurolysis. The adverse event rates were 10.6% and 7.1% for EUS-BD and EUS-guided pancreatic fluid drainage, respectively.
Conclusions
EUS is an effective and safe tool for the treatment of gastrointestinal and biliary diseases. It has a low rate of adverse events, even in developing countries.

Keyword

Endoscopic ultrasound-guided biliary drainage; Endoscopic ultrasound-guided celiac plexus neurolysis; Endoscopic ultrasound-guided drainage; Interventional endoscopic ultrasound

Figure

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  Fig. 1. Endoscopic ultrasound biliary drainage via the choledochoduodenostomy route in advanced pancreatic head cancer. (A) Puncture of the dilated common bile duct with a 19-gauge needle. (B) Cholangiography and wire placement. (C) Fistulization using a cystotome. (D) Placement of a plastic stent.

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  Fig. 2. Endoscopic ultrasound biliary drainage via the hepaticogastrotomy route (patient with advanced ampullary adenocarcinoma. (A) Puncture of the dilated intra-hepatic bile duct with a 19-gauge needle. (B) Cholangiography, wire placement, and fistulization. (C, D) Deployment of a fully covered self-expandable metal stent.

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  Fig. 3. Endoscopic ultrasound-guided pseudocyst drainage using a lumen-apposing metal stent. (A) Puncture of the lesion under endoscopic ultrasound guidance with a 19-gauge needle. (B) Insertion of a guidewire into the cyst. (C) Deployment of a lumen-apposing metal stent.

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  Fig. 4. Endoscopic ultrasound-guided celiac plexus neurolysis in patient with pancreatic head cancer. (A) Identification of the celiac artery. (B) Puncture with a 19-gauge needle with initial injection of 2 mL bupivacaine followed by injection of absolute alcohol solution around the celiac trunk.

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