title: EUS-guided hepaticogastrostomy combined with fine-gauge antegrade stenting: a pilot study.
abstract: OBJECTIVE
  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.
  
  
  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).
  
  
  CONCLUSIONS
  This method appears to safely and effectively avoid adverse events associated with EUS-HGS.
authors.affiliation: Division of Gastroenterology and Hepatology, Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Ogura
authors.affiliation: Division of Gastroenterology and Hepatology, Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Masuda
authors.affiliation: Division of Gastroenterology and Hepatology, Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Imoto
authors.affiliation: Division of Gastroenterology and Hepatology, Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan.
authors.forename: Toshihisa
authors.initials: T
authors.lastname: Takeushi
authors.affiliation: Division of Gastroenterology and Hepatology, Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan.
authors.forename: Rieko
authors.initials: R
authors.lastname: Kamiyama
authors.affiliation: Gastroenterology and Hepatology Unit, Department of Internal Medicine, Sohag University Hospital, Sohag, Egypt.
authors.forename: Malak
authors.initials: M
authors.lastname: Mohamed
authors.affiliation: Division of Gastroenterology and Hepatology, Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Umegaki
authors.affiliation: Division of Gastroenterology and Hepatology, Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan.
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Higuchi
mesh_terms: D000368:Aged; D001652:Bile Ducts / Q000601:surgery*; D019160:Endosonography / Q000379:methods*; D005260:Female; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D041781:Jaundice, Obstructive / Q000209:etiology / Q000601:surgery*; D008297:Male; D010865:Pilot Projects; D011183:Postoperative Complications; D011677:Punctures; D015607:Stents; D016896:Treatment Outcome