Shota Harai1,2, Susumu Hijioka1, Yoshikuni Nagashio1, Akihiro Ohba1, Yuta Maruki1, Miyuki Sone3, Yutaka Saito4, Takuji Okusaka1, Mitsuharu Fukasawa2, Nobuyuki Enomoto2. 1. Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Japan, Chuo-ku, Japan. 2. First Department of Internal medicine, Faculty of Medicine Graduate School of Medicine, University of Yamanashi, Chuo-shi, Japan. 3. Department of Diagnostic Radiology, National Cancer Center Japan, Chuo-ku, Japan. 4. Department of Endoscopy, National Cancer Center Japan, Chuo-ku, Japan.
Abstract
BACKGROUND/ PURPOSE: Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) has many associated adverse events. We evaluated the clinical efficacy and safety of the laser-cut, fully covered, self-expandable metallic stent (FCSEMS) for this procedure. METHODS: This single-center, retrospective study included cases where EUS-HGS with a laser-cut FCSEMS was performed for malignant biliary obstruction. Technical and clinical success, time to recurrent biliary obstruction (TRBO), procedure time, adverse events, and re-interventions were evaluated. RESULTS: There were 95 eligible cases. Technical and clinical success rates were 100.0% and 95.8%, respectively. Median TRBO was 398 days. RBO causes were hyperplasia (7.4%), debris (3.2%), and migration (4.2%). Adverse events occurred in nine cases (9.5%). Non-occlusion and focal cholangitis occurred in four cases (4.2%) each. Nineteen patients (20%) underwent combined EUS-HGS (CH) procedures: antegrade stenting, bridging methods, plastic stent anchoring in SEMS, and EUS-hepaticoduodenostomy. The solely EUS-HGS (SH) group had significantly longer median TRBO than the CH group (398 vs 246 days, P = .04). There were no significant differences in adverse events between the two groups. Re-intervention was performed in 29 cases (technical success rate: 100.0%). CONCLUSIONS: Laser-cut FCSEMS can be safely placed in the bile duct and easily applied during re-intervention, making it useful in EUS-HGS.
BACKGROUND/ PURPOSE: Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) has many associated adverse events. We evaluated the clinical efficacy and safety of the laser-cut, fully covered, self-expandable metallic stent (FCSEMS) for this procedure. METHODS: This single-center, retrospective study included cases where EUS-HGS with a laser-cut FCSEMS was performed for malignant biliary obstruction. Technical and clinical success, time to recurrent biliary obstruction (TRBO), procedure time, adverse events, and re-interventions were evaluated. RESULTS: There were 95 eligible cases. Technical and clinical success rates were 100.0% and 95.8%, respectively. Median TRBO was 398 days. RBO causes were hyperplasia (7.4%), debris (3.2%), and migration (4.2%). Adverse events occurred in nine cases (9.5%). Non-occlusion and focal cholangitis occurred in four cases (4.2%) each. Nineteen patients (20%) underwent combined EUS-HGS (CH) procedures: antegrade stenting, bridging methods, plastic stent anchoring in SEMS, and EUS-hepaticoduodenostomy. The solely EUS-HGS (SH) group had significantly longer median TRBO than the CH group (398 vs 246 days, P = .04). There were no significant differences in adverse events between the two groups. Re-intervention was performed in 29 cases (technical success rate: 100.0%). CONCLUSIONS: Laser-cut FCSEMS can be safely placed in the bile duct and easily applied during re-intervention, making it useful in EUS-HGS.