Feasibility and Efficacy of Endoscopic Ultrasound-Guided Hepaticogastrostomy Without Dilation: A Propensity Score Matching Analysis

Ohno, Akihisa; Fujimori, Nao; Kaku, Toyoma; Takamatsu, Yu; Matsumoto, K.; Murakami, Masatoshi; Teramatsu, Katsuhito; Takeno, Ayumu; Hijioka, Masayuki; Kawabe, Ken; Harada, Naohiko; Nakamuta, Makoto; Aso, Akira; Oono, Takamasa; Ogawa, Yoshihiro

doi:10.1007/s10620-022-07555-z

Cited by 13 publications

(8 citation statements)

References 21 publications

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“…Comparative analysis with existing studies involving more than 50 cases of EUS-HGS reveals varying incidence rates of AEs, including peritonitis (or abdominal pain), cholangitis (or sepsis, bacteremia, or transient fever), hemorrhage, and liver abscess, ranging from 1.1% to 24%, 2.1% to 24%, 0.9% to 6.3%, and 0.9% to 1.8%, respectively [9][10][11][12][13]. However, it is essential to approach these data with caution due to differing AE This article is protected by copyright.…”

Section: Discussionmentioning

confidence: 99%

Risk factors of early adverse events associated with endoscopic ultrasound-guided hepaticogastrostomy using self-expandable metal stent

Nakaji,

Takahashi,

Yoshioka

et al. 2024

Endosc Int Open

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Background and Study Aim: This retrospective study aimed to investigate risk factors for early adverse events (AEs) associated with endoscopic ultrasonography-guided hepaticogastrostomy (EUS-HGS) using self-expandable metal stents (SEMS). Patients and Methods: The clinical success rate, technical success rate, and early AEs were assessed at two hospitals from 2010 to 2022. The analysis focused on risk factors associated with cholangitis, peritonitis, and SEMS migration. Results: Technical success was achieved in all cases (94/94), and clinical success was 96.8% (91/94). Post-procedural acute cholangitis occurred in 12.8% (12/94) of cases. However, no statistically significant risk factors were identified for cholangitis or biliary tract infection. Peritonitis occurred in only 2.1% (2/94) of cases. Univariate analysis, using a 1.5 cm cut-off for the distance between the liver and gastrointestinal tract, revealed significant risk factors: braided-type SEMS, bile duct diameter (especially >4 mm), 6 mm diameter SEMS, and tract dilation (p=0.001, p=0.020, p=0.023, and p=0.046, respectively). Adjusting the cut-offs to 2 cm highlighted braided-type SEMS and tract dilation as risk factors (p=0.002 and p=0.046, respectively). With 2.5 cm cut-offs, only braided-type SEMS remained significant (p=0.018). Mortality within 14 and 30 days following EUS-HGS was 5.3% (5/94) and 16.0% (15/94), respectively. Conclusions: EUS-HGS using SEMS demonstrated high technical and clinical success rates. Laser-cut SEMS may be superior in preventing early AEs.

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Section: Discussionmentioning

confidence: 99%

Risk factors of early adverse events associated with endoscopic ultrasound-guided hepaticogastrostomy using self-expandable metal stent

Nakaji,

Takahashi,

Yoshioka

et al. 2024

Endosc Int Open

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“…Area under the ROC curve was 0.86 [95% confidence interval (CI) 0.00–0.76], and an angle of 135° offered 88.0% sensitivity and 82.9% specificity for predicting successful guidewire insertion. Also, several authors have described the clinical importance of various angles, such as that between the needle and the intrahepatic bile duct, 14 , 17 for inserting devices without tract dilation.…”

Section: Discussionmentioning

confidence: 99%

Liver impaction technique improves technical success rate of guidewire insertion during EUS-guided hepaticogastrostomy (with video)

Nakamura,

Ogura,

Ueno

et al. 2023

Therap Adv Gastroenterol

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Background: If the guidewire becomes kinked by the needle, guidewire manipulation may be difficult, and can cause complications such as guidewire shearing or injury during endoscopic ultrasound (EUS)-guided hepaticogastrostomy (HGS). To overcome this matter, we have previously described a technical tip for preventing guidewire injury, termed ‘liver impaction technique’. However, its technical feasibility has been not reported in the setting of a large patient cohort. Objectives: The aim of study was to evaluate the clinical usefulness of the liver impaction technique during EUS-HGS. Design: Retrospective, single-center study. Methods: This retrospective study included consecutive patients who underwent EUS-HGS between April 2018 and September 2022. The primary outcome of this study was the technical success rate of guidewire insertion using the liver impaction technique. Results: A total of 166 patients were enrolled in this study. Initial successful guidewire insertion without using liver impaction technique was obtained in 108 patients (65.1%). Among 58 patients in whom guidewire insertion failed initially, guidewire advancement into the periphery of the bile duct was observed in 32 patients (55.2%) and into a non-interest bile duct branch was observed in 26 patients (44.8%). Liver impaction technique contributed to increasing the technical success rate of guidewire insertion from 65.1% to 95.8%. Overall, adverse events were observed in 12 patients (7.2%; bile peritonitis n = 9, cholangitis n = 3), and these adverse events were Grade I. Among patients who underwent liver impaction technique ( n = 58), adverse events were observed in two patients (3.4%; bile peritonitis). Also, guidewire sharing was not observed in any patients during liver impaction technique. Conclusions: In conclusion, the liver impaction technique may be helpful during EUS-HGS to obtain successful guidewire insertion into the biliary tract of interest.

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“…Several efforts have been reported in this regard, including some that have evaluated the angle between the guidewire or the needle and the biliary tract during EUS-HGS. 20,21 Ohno et al. reported the feasibility and efficacy of EUS-HGS without dilation using a propensity score matching analysis.…”

Section: Discussionmentioning

confidence: 99%

Moving scope technique improves technical success rate of device insertion during EUS-guided hepaticogastrostomy (with video)

Bessho,

Ogura,

Ueno

et al. 2023

Therap Adv Gastroenterol

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Background: Technical tips for device insertion during endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) have not been reported. To improve the technical success rate of device insertion without unnecessary tract dilation, the pushing force should be transmitted directly from the channel of the echoendoscope to the intrahepatic bile duct. Objectives: We developed a novel technique, termed the ‘moving scope technique’, the feasibility of which during EUS-HGS is described. Design: Retrospective study. Methods: The primary outcome of this study was the technical success rate of dilation device insertion without electrocautery dilation after the moving scope technique. The initial technical success rate of dilation device insertion was defined as successful insertion into the biliary tract. If dilation device insertion failed, the moving scope technique was attempted. Results: A total of 143 patients were enrolled in this study. The initial technical success rate for device insertion was 80.4% (115/143). The moving scope technique was therefore attempted in 28 patients. The mean angle between the intrahepatic bile duct and the guidewire was improved to 141.0° and resulted in a technical success rate of 100% (28/28). The area under the ROC curve (AUC) was 0.88, and 120° predicted successful dilation device insertion with sensitivity of 88.0% and specificity of 78.8%. Bile peritonitis ( n = 8) and cholangitis ( n = 2) were observed as adverse events, but were not severe. Conclusion: In conclusion, the moving scope technique may be helpful during EUS-HGS to achieve successful insertion of the dilation device into the biliary tract. These results should be evaluated in a prospective randomized controlled trial.

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Feasibility and Efficacy of Endoscopic Ultrasound-Guided Hepaticogastrostomy Without Dilation: A Propensity Score Matching Analysis

Cited by 13 publications

References 21 publications

Risk factors of early adverse events associated with endoscopic ultrasound-guided hepaticogastrostomy using self-expandable metal stent

Risk factors of early adverse events associated with endoscopic ultrasound-guided hepaticogastrostomy using self-expandable metal stent

Liver impaction technique improves technical success rate of guidewire insertion during EUS-guided hepaticogastrostomy (with video)

Moving scope technique improves technical success rate of device insertion during EUS-guided hepaticogastrostomy (with video)

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