title: Simplified fistula dilation technique and modified stent deployment maneuver for EUS-guided hepaticogastrostomy.
abstract: OBJECTIVE
  To evaluate the success rates, procedural time and adverse event rates of the modified methods in endoscopic ultrasonography-guided hepaticogastrostomy (EUS-HGS).
  
  
  METHODS
  Twenty-eight patients in a prospective case series who underwent EUS-HGS (phase I). Forty-six patients in a matched case-control study (phase II). The simplified technique for fistula dilation was the primary use of a 4 mm balloon catheter with a stainless steel stylet. The stent deployment was modified by deploying the metal stent inside a bile duct (half of the stent) under EUS and fluoroscopic guidance and gently pulling the echoendoscope after full deployment of the stent inside the echoendoscope channel (remaining portion of the stent) under fluoroscopic guidance. This cohort was compared with a matched historical cohort.
  
  
  RESULTS
  In phase I, the technical and clinical success with the modified method was 96% (27/28) and 89% (24/27 as per-protocol analysis). The overall adverse event rate was 7%. In phase II, there was no difference in technical and clinical success, stent patency and overall adverse events in each group. However, the procedural time (15.3 ± 5.2 min vs 22.3 ± 6.0 min, P < 0.001) and early adverse events (0% vs 26%, P = 0.02) were statistically improved in case cohort compared with control cohort.
  
  
  CONCLUSIONS
  Compared with the conventional EUS-HGS technique, the procedural time was shorter and early adverse events were less frequent with our simplified and modified technique.
authors.affiliation: Woo Hyun Paik, Do Hyun Park, Jun-Ho Choi, Joon Hyuk Choi, Sang Soo Lee, Dong Wan Seo, Sung Koo Lee, Myung-Hwan Kim, Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul 138-736, South Korea.
authors.forename: Woo Hyun
authors.initials: WH
authors.lastname: Paik
authors.affiliation: Woo Hyun Paik, Do Hyun Park, Jun-Ho Choi, Joon Hyuk Choi, Sang Soo Lee, Dong Wan Seo, Sung Koo Lee, Myung-Hwan Kim, Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul 138-736, South Korea.
authors.forename: Do Hyun
authors.initials: DH
authors.lastname: Park
authors.affiliation: Woo Hyun Paik, Do Hyun Park, Jun-Ho Choi, Joon Hyuk Choi, Sang Soo Lee, Dong Wan Seo, Sung Koo Lee, Myung-Hwan Kim, Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul 138-736, South Korea.
authors.forename: Jun-Ho
authors.initials: JH
authors.lastname: Choi
authors.affiliation: Woo Hyun Paik, Do Hyun Park, Jun-Ho Choi, Joon Hyuk Choi, Sang Soo Lee, Dong Wan Seo, Sung Koo Lee, Myung-Hwan Kim, Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul 138-736, South Korea.
authors.forename: Joon Hyuk
authors.initials: JH
authors.lastname: Choi
authors.affiliation: Woo Hyun Paik, Do Hyun Park, Jun-Ho Choi, Joon Hyuk Choi, Sang Soo Lee, Dong Wan Seo, Sung Koo Lee, Myung-Hwan Kim, Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul 138-736, South Korea.
authors.forename: Sang Soo
authors.initials: SS
authors.lastname: Lee
authors.affiliation: Woo Hyun Paik, Do Hyun Park, Jun-Ho Choi, Joon Hyuk Choi, Sang Soo Lee, Dong Wan Seo, Sung Koo Lee, Myung-Hwan Kim, Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul 138-736, South Korea.
authors.forename: Dong Wan
authors.initials: DW
authors.lastname: Seo
authors.affiliation: Woo Hyun Paik, Do Hyun Park, Jun-Ho Choi, Joon Hyuk Choi, Sang Soo Lee, Dong Wan Seo, Sung Koo Lee, Myung-Hwan Kim, Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul 138-736, South Korea.
authors.forename: Sung Koo
authors.initials: SK
authors.lastname: Lee
authors.affiliation: Woo Hyun Paik, Do Hyun Park, Jun-Ho Choi, Joon Hyuk Choi, Sang Soo Lee, Dong Wan Seo, Sung Koo Lee, Myung-Hwan Kim, Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul 138-736, South Korea.
authors.forename: Myung-Hwan
authors.initials: MH
authors.lastname: Kim
authors.affiliation: Woo Hyun Paik, Do Hyun Park, Jun-Ho Choi, Joon Hyuk Choi, Sang Soo Lee, Dong Wan Seo, Sung Koo Lee, Myung-Hwan Kim, Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul 138-736, South Korea.
authors.forename: Jung Bok
authors.initials: JB
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001658:Biliary Fistula / Q000000981:diagnostic imaging / Q000628:therapy*; D016022:Case-Control Studies; D057785:Catheters; D002780:Cholestasis, Intrahepatic / Q000000981:diagnostic imaging / Q000628:therapy*; D003664:Decompression / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D004106:Dilatation; D004322:Drainage / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D019160:Endosonography; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011474:Prosthesis Design; D011677:Punctures; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
keywords: Adverse event; Biliary drainage; Endoscopic ultrasonography; Hepaticogastrostomy; Treatment outcome