Brief Article
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World J Gastroenterol. May 7, 2014; 20(17): 5051-5059
Published online May 7, 2014. doi: 10.3748/wjg.v20.i17.5051
Simplified fistula dilation technique and modified stent deployment maneuver for EUS-guided hepaticogastrostomy
Woo Hyun Paik, Do Hyun Park, Jun-Ho Choi, Joon Hyuk Choi, Sang Soo Lee, Dong Wan Seo, Sung Koo Lee, Myung-Hwan Kim, Jung Bok Lee
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
Woo Hyun Paik, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Koyang 411-706, South Korea
Jung Bok Lee, Department of Clinical Epidemiology and Biostatics, University of Ulsan College of Medicine, Asan Medical Center, Seoul 138-736, South Korea
Author contributions: Paik WH performed the research, analyzed the data and wrote the manuscript; Park DH designed the research, analyzed the data and contributed to the preparation, editing, and final approval of the manuscript; Choi JH and Choi JH wrote the manuscript; Lee SS, Seo DW, Lee SK and Kim MH contributed to the preparation, recruitment of patients and final approval of the manuscript; Lee JB was involved in the statistical analysis of the study.
Correspondence to: Do Hyun Park, MD, PhD, Associate Professor, Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-Ro 43-Gil, Songpa-gu, Seoul 138-736, South Korea. dhpark@amc.seoul.kr
Telephone: +82-2-30103194 Fax: +82-2-30108043
Received: November 21, 2013
Revised: January 5, 2014
Accepted: February 17, 2014
Published online: May 7, 2014
Abstract

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.

Keywords: Endoscopic ultrasonography, Biliary drainage, Hepaticogastrostomy, Treatment outcome, Adverse event

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.