Abstract
Background and study aims Balloon dilation and plastic stent
deployment have been performed as hepaticojejunostomy stricture (HJS) treatment techniques
under endoscopic ultrasound guidance (EUS). Although these techniques have shown favorable
clinical results, the treatment period can be long because stent deployment is required.
In
addition, HJS may recur even after treatment because the scar tissue itself remains.
To
overcome these challenges, we developed an EUS-guided antegrade drill dilation technique
for
treating HJS. The aim of this study was to evaluate the technical feasibility and
safety of
this technique in terms of the pre- and post-cholangioscopic findings.
Patients and methods This retrospective study included
consecutive patients whose conditions were complicated with symptomatic HJS between
November
2022 and February 2023. Transluminal antegrade drill dilation (TAD) using a novel
drill
dilator was attempted within 14 days after EUS-guided hepaticogastrostomy (HGS). HJS
was
diagnosed with cholangioscopy before TAD, and resolution was evaluated after TAD using
cholangioscopy.
Results TAD was attempted at approximately 11 days after EUS-HGS.
The cholangioscope was inserted successfully in all patients after this procedure.
Cholangioscopy revealed stricture without evidence of malignancy in 19 patients. In
the
remaining three patients, stricture was not observed and these patients underwent
stent
exchange rather than TAD. Among the 19 patients, passage of the guidewire across the
HJS into
the intestine was unsuccessful in four patients, and the technical success rate for
this
procedure was 78.9%. TAD was successful in all 15 patients in whom passage of the
guidewire
was achieved.
Conclusions In conclusion, TAD appears to be technically feasible
and safe.
Keywords
Intervention EUS - Biliary tract
