Use of partially covered and uncovered metallic prosthesis for endoscopic ultrasound-guided hepaticogastrostomy: Results of a retrospective monocentric study

Abstract

Background and Objectives:Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) represents an option to treat obstructive jaundice when endoscopic retrograde cholangiopancreatography (ERCP) fails. The success rate of this procedure has been shown to be very high. Up to now, plastic and self-expandable metallic stents (SEMSs) have been employed, each of them presenting some limitations. The aims of this study were to evaluate the technical and functional success rates of EUS-HGS using a dedicated biliary SEMS with a half-covered part (Giobor® stent).Methods:We retrospectively reviewed data of patients, who underwent EUS-HGS at our center, with at least 6 months of follow-up. Demographic, clinical, and laboratory data were extracted from the patient's charts and electronic records. Technical success rate was defined as the successful passage of the Giobor stent across the stomach, along with the flow of contrast medium and/or bile through the stent. Functional success rate was considered achieved when the decrease of bilirubin value of at least 25% within the 1st week was obtained. The rate of early and late complications was assessed.Results:A total of 41 patients were included (21F/20M, [mean age 66, range 45–85]). Technical success rate was obtained in 37 (90.2%) of patients. Functional success rate, analyzable in 29 patients, occurred in 65%. Between the 37 patients in whom HGS was technically feasible, 13 patients (31.7%) presented an early complication, mostly infective. At 6-month follow-up, 10/37 patients (27.0%) required a new biliary drainage (BD) and 11/37 (29.7%) died because of their disease.Conclusions:EUS-HGS using Giobor® stent is technically feasible, clinical effective, safe, and may be an alternative to percutaneous transhepatic BD in case of ERCP failure for biliary decompression.

Practical applications and learning curve for EUS-guided hepaticoenterostomy: results of a large single-center US retrospective analysis

“…Outside of the United States, specially designed stents for the purpose of EUS-HE are commercially available, such as Giobor stent (Taewoong Medical, Gyeonggi-do, South Korea) and Zeo Stent (ZEON Medical, Tokyo, Japan). Our study found a technical success rate for EUS-HE of 88.3 %, which is comparable to prior studies using these dedicated stents 14 15 .…”

EUS-specific stents: Available designs and probable lacunae

“…Until recently, these limitations were overcome by inserting an FCSEMS into a UCSEMS with the drawback of multiple manipulations and costs. [143334] These shortcomings led to the development of novel “hybrid” metal stents. [1434] Hybrid stents are PC SEMS, which are fully covered at the distal portion to prevent bile leakage, and UC at the proximal portion to prevent biliary side branch obstruction.…”

“…[143334] These shortcomings led to the development of novel “hybrid” metal stents. [1434] Hybrid stents are PC SEMS, which are fully covered at the distal portion to prevent bile leakage, and UC at the proximal portion to prevent biliary side branch obstruction. Furthermore, they have anti-migratory mechanisms (flaps or flares) and present sufficient stent length to prevent proximal migration into the peritoneum.…”

“…EUS-HGS dedicated hybrid stents and one-step delivery systems have helped circumvent some of the difficulties in these procedures. [34353637]…”

“…In a retrospective study by De Cassan et al ., the Giobor™ stent for EUS-HGS was evaluated in a single-center ( n = 41). [34] The technical success was 90.2%, and the functional success was 65%. About 31.7% early complications were noted, mostly infection (21.9%) followed by stent migration (4.9%), and hemorrhage (4.9%).…”