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Endoscopic Ultrasound-Guided Hepaticogastrostomy with Antegrade Stenting Without Dilation Device Application for Malignant Distal Biliary Obstruction in Pancreatic Cancer

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Abstract

Background

Endoscopic ultrasound-guided hepaticogastrostomy with antegrade stenting (EUS-HGAS) is a promising therapeutic option for malignant distal biliary obstruction (MDBO) in the event of transpapillary approach failure. Eliminating the fistula dilation step may further decrease the incidence of adverse events (AE) and simplify the procedure.

Aims

This study focused on MDBO associated with pancreatic cancer and aimed to examine the utility of EUS-HGAS without the use of any dilation devices.

Methods

This retrospective study investigated consecutive patients in whom the transpapillary approach had failed or was difficult, and who underwent EUS-HGAS without dilation device usage, using a tapered small-diameter catheter, ultrathin delivery system, and tapered dedicated plastic stent. The outcomes of this study included the technical success, clinical success, AE incidence, and recurrent biliary obstruction (RBO) associated with the procedure.

Results

During the study period, EUS-HGAS without dilation device usage was attempted for 57 patients with MDBO due to pancreatic cancer. The technical and clinical success rates were 91.2% (52/57) each. The median procedural time was 25 min. The rates of early and late AE besides RBO were 3.5% (2/57) and 1.9% (1/52), respectively. The incidence rate of RBO was 30.8% (16/52), and the median time to RBO was 245 days. The rate of successful endoscopic reintervention for RBO via the fistula was 100% (16/16).

Conclusions

EUS-HGAS without the use of dilation devices showed good technical feasibility with a low AE rate. It may be a useful option for MDBO associated with pancreatic cancer when the transpapillary approach is difficult.

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Acknowledgments

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Funding

This study did not receive funding from any source.

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Authors and Affiliations

  1. Department of Gastroenterology, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan

    Tadahisa Inoue, Rena Kitano, Mayu Ibusuki, Kazumasa Sakamoto, Satoshi Kimoto, Yuji Kobayashi, Yoshio Sumida, Yukiomi Nakade, Kiyoaki Ito & Masashi Yoneda

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  1. Tadahisa Inoue
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  2. Rena Kitano
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  3. Mayu Ibusuki
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  4. Kazumasa Sakamoto
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  5. Satoshi Kimoto
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  6. Yuji Kobayashi
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  7. Yoshio Sumida
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  8. Yukiomi Nakade
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  10. Masashi Yoneda
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Contributions

TI: conception and design, data acquisition, analysis and interpretation, and drafting and revision of the manuscript. RK: data acquisition and interpretation, and revision of the manuscript. MI, KS, SK, YK, YS, YN, KI, and MY: data interpretation and revision of the manuscript.

Corresponding author

Correspondence to Tadahisa Inoue.

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Conflict of interest

Tadahisa Inoue received honoraria from KANEKA, outside of the submitted work. The other authors disclose no financial relationships relevant to this publication.

Ethical approval

The institutional review board of Aichi Medical University Hospital approved this study (Approval number: 2022-002), which was conducted in accordance with the principles of the Declaration of Helsinki.

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Supplementary file1 Video 1 Endoscopic ultrasound-guided hepaticogastrostomy with antegrade stenting without the use of dilation devices for malignant distal biliary obstruction in a patient with pancreatic cancer (MPG 54100 kb)

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Inoue, T., Kitano, R., Ibusuki, M. et al. Endoscopic Ultrasound-Guided Hepaticogastrostomy with Antegrade Stenting Without Dilation Device Application for Malignant Distal Biliary Obstruction in Pancreatic Cancer. Dig Dis Sci 68, 2090–2098 (2023). https://doi.org/10.1007/s10620-022-07749-5

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