Endoscopy 2014; 46(05): 416-421
DOI: 10.1055/s-0034-1365020
Innovations and brief communications
© Georg Thieme Verlag KG Stuttgart · New York

EUS-guided hepaticogastrostomy combined with fine-gauge antegrade stenting: a pilot study

Takeshi Ogura
1  Division of Gastroenterology and Hepatology, Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan
,
Daisuke Masuda
1  Division of Gastroenterology and Hepatology, Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan
,
Akira Imoto
1  Division of Gastroenterology and Hepatology, Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan
,
Toshihisa Takeushi
1  Division of Gastroenterology and Hepatology, Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan
,
Rieko Kamiyama
1  Division of Gastroenterology and Hepatology, Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan
,
Malak Mohamed
2  Gastroenterology and Hepatology Unit, Department of Internal Medicine, Sohag University Hospital, Sohag, Egypt
,
Eiji Umegaki
1  Division of Gastroenterology and Hepatology, Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan
,
Kazuhide Higuchi
1  Division of Gastroenterology and Hepatology, Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan
› Author Affiliations
Further Information

Publication History

submitted 11 September 2013

accepted after revision 09 December 2013

Publication Date:
26 February 2014 (eFirst)

Background and study aim: To minimize bile leakage and avoid possible death because of stent migration in endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS), we have recently combined EUS-HGS with EUS-guided antegrade stenting (EUS-AS) of the biliary obstruction using a novel uncovered metallic stent with a fine-gauge delivery system. In this pilot study, we evaluated the feasibility and adverse events associated with this combination therapy using the novel stent.

Patients and methods: We performed EUS-guided antegrade stenting and hepaticogastrostomy in 12 consecutive patients.

Results: The novel EUS-AS stent was placed across the ampulla of Vater in 8 patients and above the ampulla in 4. Technical and functional success rates were 100 %. In addition, the insertion of the first stent was achieved in all patients without dilation of the fistula between stomach and intrahepatic bile duct. Although 1 patient experienced mild pancreatitis, adverse events such as bile peritonitis or stent dysfunction did not occur during follow-up (mean 122 days, range 62 – 210 days).

Conclusion: This method appears to safely and effectively avoid adverse events associated with EUS-HGS.