Partially covered self-expandable metal stent with antimigratory single flange plays important role during EUS-guided hepaticogastrostomy

Abstract

Background and study aims Stent migration into the abdominal cavity, which can occur due to stent shortening or stomach mobility, is a critical adverse event (AE) in EUS-HGS. To prevent this AE due to stent shortening, a novel, partially covered self-expandable metal stent with an antimigratory single flange has recently become available in Japan. The present study evaluated the clinical feasibility and safety of EUS-HGS using this novel stent.

Patients and methods We measured stent length in the abdominal cavity and the luminal portion after EUS-HGS using computed tomography (CT) performed 1 day after EUS-HGS (early phase). To evaluate stent shortening and the influence of stomach mobility, we also measured stent length at the same sites on CT performed at least 7 days after EUS-HGS (late phase).

Results Thirty-one patients successfully underwent EUS-HGS using this stent. According to CT in the early phase, stent length in the abdominal cavity was 7.13 ± 2.11 mm and the length of the luminal portion was 53.3 ± 6.27 mm. Conversely, according to CT in the late phase, stent length in the abdominal cavity was 8.55 ± 2.36 mm and the length of the luminal portion was 50.0 ± 8.36 mm. Stent shortening in the luminal portion was significantly greater in the late phase than in the early phase (P = 0.04).

Conclusions CT showed that stent migration can occur even with successful stent deployment, due to various factors such as stent shortening. The antimigratory single flange may be helpful to prevent stent migration, but further prospective comparative studies are needed to confirm our results.

Publication History

Received: 10 September 2021

Accepted after revision: 19 October 2021

Article published online:
15 February 2022

• References

• 1 Fogel EL, Sherman S, Devereaux BM. et al. Therapeutic biliary endoscopy. Endoscopy 2001; 33: 31-38
• 2 Carrasco CH, Zornoza J, Bechtel WJ. Malignant biliary obstruction: complications of percutaneous biliary drainage. Radiology 1984; 152: 343-346
• 3 Dhindsa BS, Mashiana HS, Dhaliwal A. et al. EUS-guided biliary drainage: A systematic review and meta-analysis. Endosc Ultrasound 2020; 9: 101-109
• 4 Kakked G, Salameh H, Cheesman AR. et al. Primary EUS-guided biliary drainage versus ERCP drainage for the management of malignant biliary obstruction: A systematic review and meta-analysis. Endosc Ultrasound 2020; 9: 298-307
• 5 Miller CS, Barkun AN, Martel M. et al. Endoscopic ultrasound-guided biliary drainage for distal malignant obstruction: a systematic review and meta-analysis of randomized trials. Endosc Int Open 2019; 7: E1563-E1573
• 6 Itoi T, Isayama H, Sofuni A. et al. Stent selection and tips on placement technique of EUS-guided biliary drainage: transduodenal and transgastric stenting. J Hepatobiliary Pancreat Sci 2011; 18: 664-672
• 7 Sun B, Moon JH, Cai Q. et al. Review article: Asia-Pacific consensus recommendations on endoscopic tissue acquisition for biliary strictures. Aliment Pharmacol Ther 2018; 48: 138-151
• 8 Ogura T, Higuchi K. Endoscopic ultrasound-guided gallbladder drainage: Current status and future prospects. Dig Endosc 2019; 31 (Suppl. 01) 55-64
• 9 El Chafic AH, Shah JN. Advances in biliary access. Curr Gastroenterol Rep 2020; 22: 62
• 10 Martins FP, Rossini LG, Ferrari AP. Migration of a covered metallic stent following endoscopic ultrasound-guided hepaticogastrostomy: fatal complication. Endoscopy 2010; 42: E126-E127
• 11 Kamata K, Takenaka M, Minaga K. et al. Stent migration during EUS-guided hepaticogastrostomy in a patient with massive ascites: Troubleshooting using additional EUS-guided antegrade stenting. Arab J Gastroenterol 2017; 18: 120-121
• 12 Okuno N, Hara K, Mizuno N. et al. Stent migration into the peritoneal cavity following endoscopic ultrasound-guided hepaticogastrostomy. Endoscopy 2015; 47: E311
• 13 Yang MJ, Kim JH, Kim DJ. et al. Hepatobiliary and pancreatic: EUS-guided reintervention for extraluminal stent migration after EUS-guided hepaticogastrostomy. J Gastroenterol Hepatol 2018; 33: 772
• 14 Ogura T, Masuda D, Takeuchi T. et al. Liver impaction technique to prevent shearing of the guidewire during endoscopic ultrasound-guided hepaticogastrostomy. Endoscopy 2015; 47: E583-E584
• 15 Miyano A, Ogura T, Yamamoto K. et al. Clinical impact of the intra-scope channel stent release technique in preventing stent migration during EUS-guided hepaticogastrostomy. J Gastrointest Surg 2018; 22: 1312-1318
• 16 Ogura T, Nishioka N, Yamada MY. et al. Novel transluminal treatment protocol for hepaticojejunostomy stricture using covered self-expandable metal stent. Surg Endosc 2021; 35: 209-215
• 17 Nakai Y, Sato T, Hakuta R. et al. Long-term outcomes of a long, partially covered metal stent for EUS-guided hepaticogastrostomy in patients with malignant biliary obstruction (with video). Gastrointest Endosc 2020; 92: 623-631.e1
• 18 Cotton PB, Eisen GM, Aabakken L. et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010; 71: 446-454
• 19 Cho DH, Lee SS, Oh D. et al. Long-term outcomes of a newly developed hybrid metal stent for EUS-guided biliary drainage (with videos). Gastrointest Endosc 2017; 85: 1067-1075
• 20 Chandrasekhara V, Barthet M, Devière J. et al. Safety and efficacy of lumen-apposing metal stents versus plastic stents to treat walled-off pancreatic necrosis: systematic review and meta-analysis. Endosc Int Open 2020; 8: E1639-E1653
• 21 Teoh AYB, Kitano M, Itoi T. et al. Endosonography-guided gallbladder drainage versus percutaneous cholecystostomy in very high-risk surgical patients with acute cholecystitis: an international randomised multicentre controlled superiority trial (DRAC 1). Gut 2020; 69: 1085-1091
• 22 Okuno N, Hara K, Mizuno N. et al. Efficacy of the 6-mm fully covered self-expandable metal stent during endoscopic ultrasound-guided hepaticogastrostomy as a primary biliary drainage for the cases estimated difficult endoscopic retrograde cholangiopancreatography: A prospective clinical study. J Gastroenterol Hepatol 2018; 33: 1413-1421