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Takahashi K, Ohyama H, Ohno I, Kato N. Stent Deployment Without Tract Dilation in Endoscopic Ultrasound-Guided Hepaticogastrostomy Using a Novel Partially Covered Metal Stent With a Super-Slim Stent Delivery System: A Case Report. Cureus 2024; 16:e60406. [PMID: 38882994 PMCID: PMC11179154 DOI: 10.7759/cureus.60406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2024] [Indexed: 06/18/2024] Open
Abstract
Endoscopic ultrasound-guided hepaticogastrostomy is performed when transpapillary biliary drainage using endoscopic retrograde cholangiopancreatography is difficult due to surgically altered anatomy, an inaccessible papilla, or difficult biliary cannulation. This procedure consists of puncturing the intrahepatic bile duct from the stomach, inserting a guidewire into the bile duct, dilating the puncture tract, and placing a stent. Recently, a novel partially covered self-expandable metal stent with a super-slim stent delivery system of 5.9 Fr has become available. With this stent, endoscopic ultrasound-guided hepaticogastrostomy can be performed without using a dilator to expand the puncture tract. Herein, we describe a technique for dilator-free stent deployment for endoscopic ultrasound-guided hepaticogastrostomy using this novel stent. We performed an endoscopic ultrasound-guided hepaticogastrostomy with this stent in a 65-year-old patient with obstructive jaundice due to pancreatic head cancer without adverse events and with satisfactory improvement in jaundice. This procedure is expected to reduce bile leakage into the abdominal cavity and shorten the procedure time.
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Affiliation(s)
- Koji Takahashi
- Department of Gastroenterology, Chiba University, Chiba, JPN
- Department of Medical Oncology, Chiba University, Chiba, JPN
| | - Hiroshi Ohyama
- Department of Gastroenterology, Chiba University, Chiba, JPN
| | - Izumi Ohno
- Department of Gastroenterology, Chiba University, Chiba, JPN
- Department of Medical Oncology, Chiba University, Chiba, JPN
| | - Naoya Kato
- Department of Gastroenterology, Chiba University, Chiba, JPN
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Itonaga M, Kitano M, Ashida R. Development of devices for interventional endoscopic ultrasound for the management of pancreatobiliary diseases. Dig Endosc 2023; 35:302-313. [PMID: 36052861 DOI: 10.1111/den.14428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 08/30/2022] [Indexed: 02/08/2023]
Abstract
A variety of devices have been developed for interventional endoscopic ultrasound (EUS). EUS-guided drainage of the bile duct and pancreatic duct, as well as fluid collection adjacent to the gastrointestinal tract, is performed by a procedure involving puncture, guidewire manipulation, tract dilation, and stent placement. Devices specialized for interventional EUS are being developed for each step of the procedure. Mechanical dilators such as bougie, balloon, and electrocautery dilators are used for tract dilation. Various types of plastic stents, self-expandable metal stents, and lumen-apposing metal stents specifically designed for interventional EUS are now available, including one-step devices developed to improve the efficacy and safety of interventional EUS. In addition, radiofrequency ablation and the placement of fiducial markers and radioactive seeds under EUS guidance are now becoming established for pancreatic neoplasms. Such development of specialized devices has expanded the indications for interventional EUS, increased the success rate, and lowered the adverse event rate.
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Affiliation(s)
- Masahiro Itonaga
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Masayuki Kitano
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Reiko Ashida
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
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Matsubara S, Nakagawa K, Suda K, Otsuka T, Oka M, Nagoshi S. A novel tapered plastic stent with an ultrafine delivery system for one-step endoscopic ultrasound-guided hepaticogastrostomy. Endoscopy 2023; 55:E354-E355. [PMID: 36646123 PMCID: PMC9842439 DOI: 10.1055/a-1992-5535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Saburo Matsubara
- Department of Gastroenterology and Hepatology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Keito Nakagawa
- Department of Gastroenterology and Hepatology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Kentaro Suda
- Department of Gastroenterology and Hepatology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Takeshi Otsuka
- Department of Gastroenterology and Hepatology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Masashi Oka
- Department of Gastroenterology and Hepatology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Sumiko Nagoshi
- Department of Gastroenterology and Hepatology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
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Anderloni A, Fugazza A, Spadaccini M, Colombo M, Capogreco A, Carrara S, Maselli R, Ferrara EC, Galtieri PA, Pellegatta G, Repici A. Feasibility and safety of a new dedicated biliary stent for EUS-guided hepaticogastrostomy: The FIT study (with video). Endosc Ultrasound 2023; 12:59-63. [PMID: 36510880 PMCID: PMC10134938 DOI: 10.4103/eus-d-22-00023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background and Objectives EUS-guided biliary drainage (BD) through hepaticogastrostomy (HGS) is an option in case of ERCP failure. Available data suggest that this procedure may be challenging with possible severe adverse events (AEs) mainly due to stent migration. The aim of our pilot study was to prospectively assess the technical and clinical outcomes of EUS-HGS using a new dedicated partially covered self-expandable metal stent with anti-migratory systems. Methods This is a single-center prospective study enrolling patients with malignant biliary obstruction undergoing EUS-HGS after failed ERCP, between June 2020 and March 2021. The primary endpoint was the technical success rate. Evaluation of specific stent-related technical features as compared with commonly used self-expandable metal stent, clinical success rate, and procedure-related AEs was also assessed. Results Twenty-two patients (15%-68.2%, female; mean age, 66.0 ± 10.0) were enrolled in the study analysis. Different causes of ERCP failure were infiltration of papilla by neoplastic tissue (4, 18.2%), unreachable papilla for duodenal stricture (9, 40.9%), surgically altered anatomy with Roux-en-Y reconstruction (4, 18.2%), and incomplete BD after transpapillary stent placement (5, 22.7%). Technical success was achieved in all patients, in a mean procedural time of 43.3 ± 26.8 min. Technical features were graded as high or medium in all cases. The clinical success rate was 91% (20/22, mean follow-up: 10.8 ± 3.1 months). There were no cases of stent misplacement or stent migration. Three (13.6%) cases of a hepatic abscess requiring percutaneous drainage and systemic antibiotics were reported, with no impact on clinical success and following oncologic treatments. No deaths occurred. Conclusion EUS-HGS with a new dedicated stent with anti-migratory systems is feasible and effective, preventing stent migration, and misplacement. Although the persistent procedural challenges, dedicated devices may contribute to outcomes improvement and procedure diffusion.
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Affiliation(s)
- Andrea Anderloni
- Department of Gastroenterology, Humanitas Clinical and Research Center, Digestive Endoscopy Unit, IRCCS, Rozzano, Milan, Italy
| | - Alessandro Fugazza
- Department of Gastroenterology, Humanitas Clinical and Research Center, Digestive Endoscopy Unit, IRCCS, Rozzano, Milan, Italy
| | - Marco Spadaccini
- Department of Gastroenterology, Humanitas Clinical and Research Center, Digestive Endoscopy Unit, IRCCS, Rozzano; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Matteo Colombo
- Department of Gastroenterology, Humanitas Clinical and Research Center, Digestive Endoscopy Unit, IRCCS, Rozzano; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Antonio Capogreco
- Department of Gastroenterology, Humanitas Clinical and Research Center, Digestive Endoscopy Unit, IRCCS, Rozzano; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Silvia Carrara
- Department of Gastroenterology, Humanitas Clinical and Research Center, Digestive Endoscopy Unit, IRCCS, Rozzano, Milan, Italy
| | - Roberta Maselli
- Department of Gastroenterology, Humanitas Clinical and Research Center, Digestive Endoscopy Unit, IRCCS, Rozzano, Milan, Italy
| | - Elisa Chiara Ferrara
- Department of Gastroenterology, Humanitas Clinical and Research Center, Digestive Endoscopy Unit, IRCCS, Rozzano, Milan, Italy
| | - Piera Alessia Galtieri
- Department of Gastroenterology, Humanitas Clinical and Research Center, Digestive Endoscopy Unit, IRCCS, Rozzano, Milan, Italy
| | - Gaia Pellegatta
- Department of Gastroenterology, Humanitas Clinical and Research Center, Digestive Endoscopy Unit, IRCCS, Rozzano, Milan, Italy
| | - Alessandro Repici
- Department of Gastroenterology, Humanitas Clinical and Research Center, Digestive Endoscopy Unit, IRCCS, Rozzano; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
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Matsubara S, Nakagawa K, Suda K, Otsuka T, Oka M, Nagoshi S. Practical Tips for Safe and Successful Endoscopic Ultrasound-Guided Hepaticogastrostomy: A State-of-the-Art Technical Review. J Clin Med 2022; 11:jcm11061591. [PMID: 35329917 PMCID: PMC8949311 DOI: 10.3390/jcm11061591] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 03/09/2022] [Indexed: 02/04/2023] Open
Abstract
Currently, endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is widely performed worldwide for various benign and malignant biliary diseases in cases of difficult or unsuccessful endoscopic transpapillary cholangiopancreatography (ERCP). Furthermore, its applicability as primary drainage has also been reported. Although recent advances in EUS systems and equipment have made EUS-HGS easier and safer, the risk of serious adverse events such as bile leak and stent migration still exists. Physicians and assistants need not only sufficient skills and experience in ERCP-related procedures and basic EUS-related procedures such as fine needle aspiration and pancreatic fluid collection drainage, but also knowledge and techniques specific to EUS-HGS. This technical review mainly focuses on EUS-HGS with self-expandable metal stents for unresectable malignant biliary obstruction and presents the latest and detailed tips for safe and successful performance of the technique.
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Affiliation(s)
- Saburo Matsubara
- Correspondence: ; Tel.: +81-49-228-3400 (ext. 7839); Fax: +81-49-226-5284
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Ogura T, Higuchi K. Technical Review of Developments in Endoscopic Ultrasound-Guided Hepaticogastrostomy. Clin Endosc 2021; 54:651-659. [PMID: 33896154 PMCID: PMC8505184 DOI: 10.5946/ce.2021.020-kddw] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 01/06/2021] [Indexed: 12/16/2022] Open
Abstract
Endoscopic ultrasound-guided biliary drainage has been developed as an alternative method for biliary drainage. EUS-guided hepaticogastrostomy (EUS-HGS) can be attempted via the trans-gastric route. These procedures are technically complex for two reasons. First, puncture of the intrahepatic bile duct via the trans-gastric route can be more difficult than that by other approaches because of the small diameter of the target site, and guidewire insertion or manipulation is challenging during EUS-HGS. Second, critical adverse events, such as stent migration into the abdominal cavity, could occur because of the greater mobility of the stomach compared to the duodenum. Therefore, endoscopists should be cautious when performing EUS-HGS. An advantage of EUS-HGS is that it can be performed in patients with complications such as duodenal bulb obstruction or surgically altered anatomy. Recent advances in technique and improvements in devices and stents for EUS-HGS have shown promise for improving the technical success rate of EUS-HGS and reducing the rate of adverse events. However, endoscopists should remain aware of the possibility of critical adverse events such as stent migration.
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Affiliation(s)
- Takeshi Ogura
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Kazuhide Higuchi
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
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Kunda R. Recent development of endoscopic ultrasound-guided biliary drainage. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2020. [DOI: 10.18528/ijgii200047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Rastislav Kunda
- Department of Surgery, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Gastroenterology-Hepatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Advanced Interventional Endoscopy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
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