Takeshi Ogura1,2, Masayuki Kitano1,3, Mamoru Takenaka1,4, Atsushi Okuda1,2, Kosuke Minaga1,4, Kentaro Yamao1,4, Yukitaka Yamashita1,5, Keiichi Hatamaru1,5, Chishio Noguchi1,6, Yasuhiko Gotoh1,6, Taira Kuroda1,7, Tomoyuki Yokota1,8, Hidefumi Nishikiori1,9, Ryota Sagami1,9, Kazuhide Higuchi1,2, Yasutaka Chiba1,10. 1. Therapeutic Endoscopic Ultrasound Group: TEUS, Takatuki, Japan. 2. 2nd Department of Internal Medicine, Osaka Medical College, Takatuki, Japan. 3. Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan. 4. Department of Gastroenterology and Hepatology, Osaka-Sayama, Japan. 5. Department of Gastroenterology and Hepatology, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan. 6. Department of Gastroenterology, Shinbeppu Hospital, Beppu, Japan. 7. Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Matsuyama, Japan. 8. Center for Liver-Biliary-Pancreatic Disease, Matsuyama Red Cross Hospital, Matsuyama, Japan. 9. Department of Gastroenterology, Oita Sanai Medical Center, Oita, Japan. 10. Clinical Research Center, Kindai University Faculty of Medicine, Osaka-Sayama, Japan.
Abstract
BACKGROUND AND AIM: Endoscopic ultrasonography-guided hepaticogastrostomy (EUS-HGS) is often indicated for advanced stage patients. Therefore it is important to prevent adverse events associated with EUS-HGS procedures and obtain long stent patency. EUS-guided antegrade stenting (AS) has been developed as an advanced technique. Thus, to prevent adverse events and achieve long stent patency, EUS-AS combined with EUS-HGS (EUS-HGAS) has been reported. The aim of the present study was to evaluate the technical feasibility and efficacy of EUS-HGAS in a multicenter, prospective study. METHODS: This prospective study was carried out at each hospital of the Therapeutic Endoscopic Ultrasound Group. Primary endpoint of this multicenter prospective study was stent patency of EUS-HGAS. RESULTS: A total of 49 patients were enrolled. Technical success rate of EUS-HGS was 95.9% (47/49). EUS-AS failed in five patients because the guidewire could not be advanced into the intestine across the bile duct obstruction site. Therefore, EUS-HGAS was successfully carried out in 40 patients (technical success rate: 85.7%). Median overall survival was 114 days. Median stent patency including stent dysfunction and patient death was 114 days. In contrast, mean stent patency was 320 days. Adverse events were seen in 10.2% (5/49) of cases. Hyperamylasemia was seen in four patients, and bleeding was seen in one patient. CONCLUSIONS: The present study is the first to evaluate EUS-HGAS. EUS-HGAS has clinical benefit for obtaining long stent patency and avoiding adverse events, although the possibility of acute pancreatitis as a result of obstruction of the orifice of the pancreatic duct must be considered.
BACKGROUND AND AIM: Endoscopic ultrasonography-guided hepaticogastrostomy (EUS-HGS) is often indicated for advanced stage patients. Therefore it is important to prevent adverse events associated with EUS-HGS procedures and obtain long stent patency. EUS-guided antegrade stenting (AS) has been developed as an advanced technique. Thus, to prevent adverse events and achieve long stent patency, EUS-AS combined with EUS-HGS (EUS-HGAS) has been reported. The aim of the present study was to evaluate the technical feasibility and efficacy of EUS-HGAS in a multicenter, prospective study. METHODS: This prospective study was carried out at each hospital of the Therapeutic Endoscopic Ultrasound Group. Primary endpoint of this multicenter prospective study was stent patency of EUS-HGAS. RESULTS: A total of 49 patients were enrolled. Technical success rate of EUS-HGS was 95.9% (47/49). EUS-AS failed in five patients because the guidewire could not be advanced into the intestine across the bile duct obstruction site. Therefore, EUS-HGAS was successfully carried out in 40 patients (technical success rate: 85.7%). Median overall survival was 114 days. Median stent patency including stent dysfunction and patient death was 114 days. In contrast, mean stent patency was 320 days. Adverse events were seen in 10.2% (5/49) of cases. Hyperamylasemia was seen in four patients, and bleeding was seen in one patient. CONCLUSIONS: The present study is the first to evaluate EUS-HGAS. EUS-HGAS has clinical benefit for obtaining long stent patency and avoiding adverse events, although the possibility of acute pancreatitis as a result of obstruction of the orifice of the pancreatic duct must be considered.
Authors: Jintao Guo; Marc Giovannini; Anand V Sahai; Adrian Saftoiu; Christoph F Dietrich; Erwin Santo; Pietro Fusaroli; Ali A Siddiqui; Manoop S Bhutani; Anthony Yuen Bun Teoh; Atsushi Irisawa; Brenda Lucia Arturo Arias; Chalapathi Rao Achanta; Christian Jenssen; Dong-Wan Seo; Douglas G Adler; Evangelos Kalaitzakis; Everson Artifon; Fumihide Itokawa; Jan Werner Poley; Girish Mishra; Khek Yu Ho; Hsiu-Po Wang; Hussein Hassan Okasha; Jesse Lachter; Juan J Vila; Julio Iglesias-Garcia; Kenji Yamao; Kenjiro Yasuda; Kensuke Kubota; Laurent Palazzo; Luis Carlos Sabbagh; Malay Sharma; Mitsuhiro Kida; Mohamed El-Nady; Nam Q Nguyen; Peter Vilmann; Pramod Kumar Garg; Praveer Rai; Shuntaro Mukai; Silvia Carrara; Sreeram Parupudi; Subbaramiah Sridhar; Sundeep Lakhtakia; Surinder S Rana; Takeshi Ogura; Todd H Baron; Vinay Dhir; Siyu Sun Journal: Endosc Ultrasound Date: 2018 Nov-Dec Impact factor: 5.628