Feasibility and efficacy of endoscopic reintervention after covered metal stent placement for EUS-guided hepaticogastrostomy: A multicenter experience

Abstract

Background and Objectives: Although the use of a long metal stent is favored for EUS-guided hepaticogastrostomy (EUS-HGS) for the relief of malignant biliary obstruction (MBO), endoscopic reintervention (E-RI) at the time of recurrent biliary obstruction (RBO) is challenging due to a long intragastric portion. This study evaluated the feasibility and safety of E-RI after a long partially covered metal stent (L-PCMS) placement during EUS-HGS. Materials and Methods: We performed a multicenter retrospective study between January 2015 and December 2019 examining patients with MBO who underwent E-RI for RBO through the EUS-HGS route after the L-PCMS placement. Technical and clinical success rates, details of E-RI, adverse events (AEs), stent patency, and survival time were evaluated. Results: Thirty-three patients at eight referral centers in Japan who underwent E-RI through the EUS-HGS route were enrolled. The location of MBO was distal in 54.5%. The median intragastric length of the L-PCMS was 5 cm. As the first E-RI attempt, E-RI via the distal end of the existing L-PCMS was successful in 60.6%. The overall technical and clinical success rates of E-RI were 100% and 81.8%, respectively. Liver abscess was noted in one patient. A proximal biliary stricture was associated with the clinical ineffectiveness of E-RI in multivariable analysis (odds ratio, 12.5, P = 0.04). The median survival and stent patency duration after E-RI were 140 and 394 days, respectively. Conclusions: Our study findings suggest that E-RI for RBO after EUS-HGS with a L-PCMS is technically feasible and clinically effective, without any severe AEs, especially for patients with distal MBO.

Salvage technique for covered metal stent migration during endoscopic reintervention after endoscopic ultrasound-guided hepaticogastrostomy

“…A partially covered self-expandable metal stent (PCSEMS) is often used for EUS-HGS, but it cannot be removed. A new metal or plastic stent is therefore placed as endoscopic reintervention following EUS-HGS 2 3 4 ; however, troubleshooting after endoscopic reintervention remains problematic because of a paucity of reported cases.…”

“…A partially covered self-expandable metal stent (PCSEMS) is often used for EUS-HGS, but it cannot be removed. A new metal or plastic stent is therefore placed as endoscopic reintervention following EUS-HGS [2][3][4]; however, troubleshooting after endoscopic reintervention remains problematic because of a paucity of reported cases. An 81-year-old woman who had previously undergone ERCP for MBO due to pancreatic cancer presented with recurrent biliary obstruction and duodenal stricture.…”

Piercing technique for mucosal hyperplasia at an uncovered part of a partially covered stent after endoscopic ultrasound-guided hepaticogastrostomy

“…1a) has been used frequently [2,3]; however, tissue hyperplasia occurs around the uncovered part, leading to recurrent biliary obstruction (RBO) [2,3]. RBO due to hyperplasia is sometimes hardened with abundant fibrosis, resulting in failed guidewire passage during endoscopic reintervention [3,4]. Here, we present a novel technique to regain biliary access after EUS-HGS with subsequent hyperplasia with the uncovered portion of the PCSEMS.…”

“…A PCSEMS with a 10-mm uncovered part on the proximal end (Modified Giobor Stent; Taewoong Medical, Seoul) (▶ Fig. 1a) has been used frequently [2,3]; however, tissue hyperplasia occurs around the uncovered part, leading to recurrent biliary obstruction (RBO) [2,3]. RBO due to hyperplasia is sometimes hardened with abundant fibrosis, resulting in failed guidewire passage during endoscopic reintervention [3,4].…”