PDF herunterladen
Open Access
CC BY 4.0 · Endoscopy 2024; 56(S 01): E426-E427
DOI: 10.1055/a-2307-7866
E-Videos

Endoscopic ultrasound-guided hepaticogastrostomy stent exchange using a novel spiral plastic stent

Autoren

  • Takeshi Ogura

    1   Endoscopy Center, Osaka Medical and Pharmaceutical University Hospital, Takatsuki, Japan
    2   2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan

  • Atsushi Okuda 

    2   2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan

  • Saori Ueno

    2   2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan

  • Nobu Nishioka

    2   2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan

  • Hiroki Nishikawa

    2   2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
Weitere Informationen
Auch verfügbar auf
  Lizenzen und Reprints

Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) can be attempted for patients with failed endoscopic retrograde cholangiopancreatography [1] [2]. EUS-HGS has recently become indicated for not only malignant biliary obstruction, but also benign biliary disease [3] [4]. In benign biliary disease, a self-expandable metal stent (SEMS) might not be suitable, because stent removal may be challenging if the duration of stent deployment is prolonged. Therefore, a plastic stent is usually used. According to a previous study, regular stent exchange may have a clinical impact on prevention of benign biliary disease [4]. However, flaps are provided at the distal end in most plastic stents to prevent stent dislocation. Unlike the common bile duct, the intrahepatic bile duct has side branches; therefore, during stent removal, the flaps may become stuck in the side branches. Consequently, a plastic stent with flaps has a risk of rupture, as previously described [5].

To improve stent removability, a spiral-shaped plastic stent has been designed and is available in Japan (Gadelius Medical Co., Ltd, Tokyo, Japan) ([Fig. 1]). This stent has no side flaps; therefore, stent removal through EUS-HGS can be easily performed without the stent flaps becoming stuck in the bile duct side branches. To prevent stent dislocation, the distal end is spiral in shape, and to prevent stent migration, the proximal end is a pigtail shape. A case of successful EUS-HGS stent exchange using this novel plastic stent is reported.

Zoom
Fig. 1 A spiral-shaped plastic stent (Gadelius Medical Co., Ltd, Tokyo, Japan).

An 88-year-old woman was admitted because of obstructive jaundice caused by a hepaticojejunostomy stricture. In addition, a huge intrahepatic bile duct stone was present. She first underwent EUS-HGS using SEMS, and because of her advanced age, only stent exchange to a spiral-shaped plastic stent was performed ([Fig. 2]). After 6 months, she was admitted again for stent exchange. First, a standard duodenoscope was inserted into the stomach. Then, after a guidewire was deployed beside the stent ([Fig. 3]), stent removal using grasping forceps was attempted. As the stent had no side flaps, stent removal was easily performed without stent rupture ([Fig. 4]). After evaluation of the biliary system, a spiral-shaped plastic stent was deployed without any adverse events ([Fig. 5], [Video 1]).

Zoom
Fig. 2 The spiral-shaped plastic stent was deployed as an endoscopic ultrasound-guided hepaticogastrostomy stent.
Zoom
Fig. 3 A guidewire was deployed beside the stent.
Zoom
Fig. 4 As the stent had no side flaps, stent removal was easily performed without stent rupture.
Zoom
Fig. 5 The spiral-shaped plastic stent was deployed.
Removal of an endoscopic ultrasound-guided hepaticogastrostomy stent was attempted. As this stent had no side flaps, removal was easily performed without stent rupture.Video 1

In conclusion, a spiral-shaped plastic stent may be useful as an EUS-HGS stent for patients who undergo scheduled stent exchange because of its easy removability.

Endoscopy_UCTN_Code_TTT_1AS_2AH

Endoscopy E-Videos https://eref.thieme.de/e-videos

E-Videos is an open access online section of the journal Endoscopy, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high-quality video and are published with a Creative Commons CC-BY license. Endoscopy E-Videos qualify for HINARI discounts and waivers and eligibility is automatically checked during the submission process. We grant 100% waivers to articles whose corresponding authors are based in Group A countries and 50% waivers to those who are based in Group B countries as classified by Research4Life (see: https://www.research4life.org/access/eligibility/).

This section has its own submission website at https://mc.manuscriptcentral.com/e-videos.



Publikationsverlauf

Artikel online veröffentlicht:
17. Mai 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany