Background With endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS), guidewire manipulation might be a critically limiting step for non-experts. However, the causative factors for difficulties with guidewire manipulation remain unclear. The aim of this study was to evaluate factors associated with successful guidewire manipulation. Method This retrospective cohort study included consecutive patients who underwent EUS-HGS between October 2018 and October 2019. We measured scope angle between the long and angle axes of the echoendoscope using still fluoroscopic imaging immediately after puncturing the intrahepatic bile duct. Factors associated with successful guidewire insertion were assessed by multivariable analysis using logistic regression. Result The influence of the angle between the FNA needle and echoendoscope on failed guidewire insertion was assessed using ROC curves. 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. According to multivariable analysis, only angle between the FNA needle and echoendoscope >135° was independently associated with successful guidewire insertion (odd ratio, 0.034; 95%CI, 0.008–0.144; P<0.05), although sex, puncture site, and diameter of puncture site were not significant factors. After multivariable analysis, all variables were adjusted using age 70 or <70 years, yielding the same results. Conclusion In conclusion, angle between FNA needle and echoendoscope might be associated with successful guidewire manipulation during EUS-HGS. Adjusting between FNA needle and echoendoscope to 135° before puncturing the intrahepatic bile duct might be helpful to obtain successful guidewire manipulation during EUS-HGS.

BackgroundLaparoscopic and endoscopic cooperative surgery (LECS) was performed for the local resection of gastrointestinal stromal tumors (GIST). LECS enables less resection of the lesion area and preserves function. Furthermore, LECS can be safely performed and independent of tumor location. However, LECS is not usually used for cases involving gastric carcinoma because it may seed tumor cells into the peritoneal cavity when the gastric wall is perforated. Here, we report seven cases of LECS for intra-mucosal gastric carcinoma, which were difficult to carry out by endoscopic submucosal dissection (ESD) because of ulcer scars.MethodsWe performed LECS (classical LECS and inverted LECS) in seven cases of intra-mucosal gastric carcinoma. All cases had ulcer scars beside the tumor. LECS was chosen because ESD was thought to be difficult because of the ulcer scars. We only selected cases in which the patients did not prefer gastrectomy and endoscopic examination was indicative of intra-mucosal gastric carcinoma.ResultsIn all cases, LECS was performed without severe complications including postoperative stenosis. Histopathology findings proved that the tumors were intra-mucosal carcinoma and had been resected completely. Furthermore, there were ulcer scars (Ul IIIs-IVs) beside the tumor. Currently, dissemination and recurrence have not been apparent.ConclusionsLECS for intra-mucosal gastric carcinoma is an efficient procedure, but strict observation is necessary because of the possibility of peritoneal dissemination. Results suggest that LECS is likely to be effective for cases involving intra-mucosal gastric carcinoma that are difficult to treat by ESD due to ulcer scars.

Background and Aim Bilateral stent deployment for malignant biliary obstruction (MHBO) can be achieved using side‐by‐side (SBS) or stent‐in‐stent (SIS) procedures. Compared with SBS techniques, the procedural steps of SIS are technically complex due to the necessity of introducing the delivery system into a contralateral biliary tract through the mesh of the SEMS. To overcome this issue, a novel uncovered SEMS, the HILZO Moving Cell Stent (MCS) has been released. The present study examined the technical feasibility of treating MHBO using bilateral deployment of this novel stent without dilating the mesh of the first stent to achieve insertion of the second stent within a single session, using a prospective, multicenter setting. Method The primary outcome in the present study was the technical success rate. Technical success was defined as deployment of bilateral MCSs into two or more biliary tracts using SIS without a dilation device in a single‐session. Results A total of 27 patients with complications of MHBO were enrolled in this study. Bilateral SIS using two MCS was successfully performed in 23 patients without using dilation devices among 27 patients (initial technical success rate; 85.2%). Median time to recurrent biliary obstruction (TRBO) was 271 days. Stent dysfunction was observed in 12 patients (44.4%), and re‐intervention was successfully performed in all patients without one patient who instead received best supportive care. Conclusions The SIS technique using MCS without dilation of the mesh may be technically feasible and safe. In addition, this may be useful for re‐intervention. Further comparative randomized trials are needed.

No abstract