Published online May 7, 2014. doi: 10.3748/wjg.v20.i17.5051
Revised: January 5, 2014
Accepted: February 17, 2014
Published online: May 7, 2014
AIM: 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.
CONCLUSION: 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.
Core tip: Endoscopic ultrasonography-guided hepaticogastrostomy (EUS-HGS) with direct transluminal stenting is a complex procedure in terms of guidewire manipulation, fistula dilation and stent deployment. We prospectively evaluated our simplified and modified EUS-HGS technique; fistula dilation with a 4 mm balloon dilation catheter with a stainless steel stylet and stent deployment maneuver with an 8 mm fully covered metal stent with dual flaps. The technical and clinical success was 96% (27/28) and 89% (24/27). The overall adverse event rate was 7%. Compared with the conventional EUS-HGS technique, the procedural time was shorter and early adverse events were less frequent with our modified technique.