Feasibility of an Endoscopic Nasobiliary Drainage Tube-Derived Modified Single-Pigtail Plastic Stent for Endoscopic Ultrasound-Guided Transmural Drainage: A Single-Center Retrospective Study

Although endoscopic ultrasound-guided transmural drainage (EUS-TD) is widely used, procedural success depends on reliable sequential device delivery into the target organ/cavity. We aimed to evaluate the feasibility and clinical outcomes of an endoscopic nasobiliary drainage (ENBD) tube-derived modified single-pigtail plastic stent (mSPPS) for EUS-TD. This retrospective single-center study included 13 patients who underwent EUS-TD with attempted mSPPS placement between November 2017 and April 2022. Procedures comprised EUS-guided gallbladder drainage (n = 7), hepaticogastrostomy (n = 1), hepaticojejunostomy (n = 1), choledochoduodenostomy (n = 1), pancreatic duct drainage (n = 1), cyst drainage (n = 1), and pelvic abscess drainage (n = 1). Clinical success of the drainage procedure was defined as an acceptable clinical response without evidence of stent-related problems. Data were summarized using descriptive statistics. Technical success of mSPPS placement was achieved in 12 of 13 cases (92.3%). The only technical failure occurred during EUS-guided pancreatic duct drainage in a patient with chronic pancreatitis. Among the 12 technically successful cases, clinical success of the drainage procedure was achieved in 11 cases (91.7%); the remaining case failed to achieve clinical success because of an uncontrolled abscess associated with end-stage malignancy, without evidence of stent-related problems. Among the 11 clinically successful cases, 6 underwent permanent stent placement, whereas 5 underwent scheduled stent exchange or removal during follow-up. In the permanent-placement group, follow-up ranged from 21 to 889 days, and spontaneous stent dislodgement occurred in 2 of 6 cases (33.3%). No clinically evident stent-related adverse events were observed after spontaneous dislodgement. One patient with clinically successful drainage died during hospitalization because of progression of the underlying disease, without stent-related complications. After excluding this patient, the remaining 10 patients were discharged and transitioned to outpatient follow-up within a mean of 17.4 days (range, 6–29 days) after the index EUS-TD procedure. EUS-TD using an ENBD-derived mSPPS was technically feasible in selected cases. The mSPPS may serve as a practical alternative or salvage option when standard plastic stent advancement is difficult. Further studies are needed to define optimal indications, safety, and comparative effectiveness of ENBD-derived mSPPS.