Relationship Between the Intraperitoneal Stent Length in Endoscopic Ultrasound-Guided Hepaticogastrostomy and Surgically Altered Upper Gastrointestinal Anatomy in Patients With Malignant Biliary Obstruction

Abstract

Background: Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is associated with a relatively high proportion of adverse events, and this is attributable to the lack of standardized protocols and specialized equipment. Although the outcomes of EUS-HGS may differ between patients with and those without surgically altered upper gastrointestinal anatomy, there have been no reports on this topic. The present study aimed to evaluate the efficacy and safety of EUS-HGS using our standardized method and to compare the outcomes between patients with and those without surgically altered upper gastrointestinal anatomy.

Methods: In EUS-HGS, we used a long partially covered metal stent, and we kept the gastric wall pressed with the scope tip until the stent was deployed more than 1 cm inside the working channel of the scope to minimize free space between the liver and gastric wall (the intraperitoneal stent length). A total of 12 patients who underwent EUS-HGS using our method were retrospectively studied. Procedural success and adverse events were evaluated, and the outcomes of EUS-HGS were compared between six patients with and six without surgically altered upper gastrointestinal anatomy.

Results: The procedural success rate was 100%. Additionally, stent migration or dislocation was not noted in any of the patients. The intraperitoneal stent length was significantly greater in patients without surgically altered upper gastrointestinal anatomy than in those with surgically altered upper gastrointestinal anatomy (19.8 mm vs. 11.6 mm; 95% confidence interval, 2.185 - 14.147; P = 0.012).

Conclusions: EUS-HGS using our method was safe. Our findings suggested that special attention should be paid to stent migration or dislocation in patients without surgically altered upper gastrointestinal anatomy.




Gastroenterol Res. 2018;11(4):305-308
doi: https://doi.org/10.14740/gr1059w