Novel method of endoscopic ultrasound-guided hepaticogastrostomy to prevent stent dysfunction.
OBJECTIVE
The present study assesses the feasibility as well as the technical and functional success rates of a novel endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) technique called the locking stent method that uses end-bare covered metallic stents (EBCMS).


METHODS
Twenty consecutive patients who were histologically diagnosed with unresectable cancer complicated with obstructive jaundice underwent EUS-HGS due to failed endoscopic biliary drainage or inaccessible papilla. We retrospectively collected clinical data for these patients including technical and functional success rates and complications.


RESULTS
Seven were treated by EUS-HGS (EUS-HGS group), and 13 were treated using the locking stent EUS-HGS method (LS group). Technical and functional success rates were 100% in both groups. Procedural duration did not significantly differ between the EUS-HGS and LS groups (26.9 ± 9.0 versus 32.3 ± 11.1 min, P = 0.30). Two patients developed complications related to stent migration in the EUS-HGS group. In contrast, although mild post-procedural bile peritonitis required conservative treatment for a few days, none of the stents malfunctioned in the LS group.


CONCLUSIONS
Our method can safely and effectively prevent stent dysfunction, but validation in a prospective clinical trial is required.
2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan.
Takeshi
T
Ogura
Yoshitaka
Y
Kurisu
Daisuke
D
Masuda
Akira
A
Imoto
Michihiro
M
Hayashi
Mohamed
M
Malak
Eiji
E
Umegaki
Kazuhisa
K
Uchiyama
Kazuhide
K
Higuchi
D000368:Aged; D004067:Digestive System Neoplasms / Q000150:complications / Q000601:surgery*; D016145:Endoscopy, Digestive System / Q000379:methods*; D019160:Endosonography / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005548:Foreign-Body Migration / Q000209:etiology* / Q000517:prevention & control*; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D041781:Jaundice, Obstructive / Q000150:complications; D008099:Liver / Q000601:surgery*; D008297:Male; D008670:Metals; D008875:Middle Aged; D010538:Peritonitis / Q000209:etiology / Q000517:prevention & control; D011475:Prosthesis Failure / Q000009:adverse effects*; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects*; D025321:Surgery, Computer-Assisted / Q000379:methods*
D008670:Metals
EUS; EUS-BD; EUS-FNA; EUS-HGS