A multicenter prospective evaluation study of endoscopic ultrasound-guided hepaticogastrostomy combined with antegrade stenting (with video)

Abstract

Objective

EUS-guided hepaticogastrostomy (EUS-HGS) is often indicated for advanced stage patients because it prevents the adverse events associated with EUS-HGS procedures, and provides long stent patency.

EUS-guided antegrade stenting (AS) has been developed as an advanced technique. Thus, to prevent adverse events and achieve, long stent patency, EUS-AS combined with EUS-HGS (EUS-HGAS) has been reported. The aim of this study was to evaluate the technical feasibility and efficacy of EUS-HGAS in a multicenter, prospective study.

Methods

This prospective study was carried out at each hospital of the Therapeutic endoscopic ultrasound group. The primary endpoint of this multicenter prospective study was the stent patency of EUS-HGAS.

Results

A total of 49 patients were enrolled. The technical success rate of EUS-HGS was 95.8% (47/49). EUS-AS failed in 5 patients because the guidewire could not be advanced into the intestine across the bile duct obstruction site. Therefore, EUS-HGAS was successfully performed in 40 patients (technical success rate: 85.7%). Median overall survival was 114days. Median stent patency including stent dysfunction and patient's death was 114days. On the other hand, mean stent patency was 320 days. Adverse events were seen in 10.2% (5/49) of cases. Hyperamylasemia was seen in 4patients, and bleeding was seen in 1 patient.

Conclusions

In conclusions, the present study is the first to evaluate EUS-HGAS. EUS-HGAS has clinical benefit for obtaining long stent patency, and avoiding adverse events, although the possibility of acute pancreatitis due to obstruction of the orifice of the pancreatic duct must be considered.

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