Technical feasibility and safety of one-step deployment of EUS-guided hepaticogastrostomy using an 8-mm diameter metal stent with a fine-gauge stent delivery system (with video)

• Published in: Endoscopic ultrasound 2021-09, Vol.10 (5), p.355-360
• Main Authors: Ogura, Takeshi, Ueno, Saori, Okuda, Atsushi, Nishioka, Nobu, Yamada, Masanori, Matsuno, Jun, Ueshima, Kazuya, Yamamoto, Yoshitaro, Higuchi, Kazuhide
• Format: Article
• Language: English
• Subjects: Original
• ISSN: 2303-9027; 2226-7190
• DOI: 10.4103/EUS-D-20-00206

Background and Objectives: Adverse events (AEs) such as bile peritonitis or pneumoperitoneum might occur during procedural steps for EUS-guided hepaticogastrostomy (HGS), such as during device exchange and after fistula dilation until stent deployment. Reducing the steps to the EUS-HGS procedure might therefore be ideal to prevent the occurrence of AEs. Recently, a novel, fully covered self-expandable metal stent (FCSEMS) has become available. Because of the fine-gauge stent delivery system (5.9Fr), fistula dilation might not be needed before stent deployment during EUS-HGS. The aim of this pilot study was to evaluate the technical feasibility and safety of one-step EUS-HGS using a novel 8-mm diameter FCSEMS. Patients and Methods: The primary outcome in this study was technical success, and the secondary outcomes were procedure- and stent-related AEs and clinical success. The technical success of one-step EUS-HGS was defined as successful FCSEMS deployment without any fistula dilation. Procedure time was measured from scope insertion to successful FCSEMS deployment. Results: One-step EUS-HGS using the novel FCSEMS was attempted on 14 patients. Technical success with a short procedure time (median: 7 min) and clinical success were obtained in all patients. In addition, procedure-related AEs such as bleeding, bile peritonitis, and stent migration during the procedure were not observed in any patients. Conclusions: One-step EUS-HGS using the novel FCSEMS with a fine-gauge stent delivery system is technically feasible and shortens the procedure time with no requirement for additional fistula dilation, resulting in a potential reduction in procedure-related AEs.