Feasibility and efficacy of endoscopic reintervention after covered metal stent placement for EUS-guided hepaticogastrostomy: A multicenter experience

Kosuke Minaga, Masayuki Kitano, Yoshito Uenoyama, Keiichi Hatamaru, Hideyuki Shiomi, Kenji Ikezawa, Tsukasa Miyagahara, Hajime Imai, Nao Fujimori, Hisakazu Matsumoto, Yuzo Shimokawa, Atsuhiro Masuda, Mamoru Takenaka, Masatoshi Kudo, Yasutaka Chiba

Research output: Contribution to journalArticlepeer-review

Abstract

Background and Objectives: Although the use of a long metal stent is favored for EUS-guided hepaticogastrostomy (EUS-HGS) for the relief of malignant biliary obstruction (MBO), endoscopic reintervention (E-RI) at the time of recurrent biliary obstruction (RBO) is challenging due to a long intragastric portion. This study evaluated the feasibility and safety of E-RI after a long partially covered metal stent (L-PCMS) placement during EUS-HGS. Materials and Methods: We performed a multicenter retrospective study between January 2015 and December 2019 examining patients with MBO who underwent E-RI for RBO through the EUS-HGS route after the L-PCMS placement. Technical and clinical success rates, details of E-RI, adverse events (AEs), stent patency, and survival time were evaluated. Results: Thirty-three patients at eight referral centers in Japan who underwent E-RI through the EUS-HGS route were enrolled. The location of MBO was distal in 54.5%. The median intragastric length of the L-PCMS was 5 cm. As the first E-RI attempt, E-RI via the distal end of the existing L-PCMS was successful in 60.6%. The overall technical and clinical success rates of E-RI were 100% and 81.8%, respectively. Liver abscess was noted in one patient. A proximal biliary stricture was associated with the clinical ineffectiveness of E-RI in multivariable analysis (odds ratio, 12.5, P = 0.04). The median survival and stent patency duration after E-RI were 140 and 394 days, respectively. Conclusions: Our study findings suggest that E-RI for RBO after EUS-HGS with a L-PCMS is technically feasible and clinically effective, without any severe AEs, especially for patients with distal MBO.

Original languageEnglish
Pages (from-to)478-486
Number of pages9
JournalEndoscopic Ultrasound
Volume11
Issue number6
DOIs
Publication statusPublished - Nov 2022
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Hepatology
  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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