Newly designed plastic stent for EUS-guided hepaticogastrostomy

Junko Umeda, MD, from the Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan discusses this New Methods article “A newly designed plastic stent for EUS-guided hepaticogastrostomy: a prospective preliminary feasibility study (with videos).”

EUS-guided hepaticogastrostomy (EUS-HGS) for the creation of a fistula between the stomach and the left intrahepatic bile duct is an EUS-guided biliary drainage technique. Although EUS-HGS has a high technical success rate of 87%, its procedure-related adverse event rate of 27% was reportedly higher than the rates of other EUS-guided biliary interventions. There are currently no dedicated plastic stents for EUS-HGS. Thus we developed a new single-pigtail plastic stent designed for EUS-HGS. In this study, we prospectively evaluated the feasibility as well as the technical and functional success rates of our newly designed plastic stent.

We used the plastic stent, which is a push-type stent and is usually not possible to retract, has a total length of 20 cm, an effective length of 15 cm, and 4 flanges (2 at the distal end and 2 at the proximal end). The proximal end has a pigtail structure and the distal end is tapered.

Twenty-three patients underwent EUS-HGS stenting. The technical success rate was 100%, and the treatment success was achieved in all patients. Bleeding from the punctured gastric wall occurred in 1 patient 3 days postoperatively. We exchanged the plastic stent for a fully covered self-expandable metal stent. Hemostasis was achieved by metal stent placement. A mild adverse event of self- limited abdominal pain occurred in 3 patients. There was no stent migration or dislocation during the follow-up period.

Figure 2. The new plastic stent designed for EUS- hepaticogastrostomy stenting. Tapered tip and 4-fold–flanged single-pigtail bile duct stent (total length: 20 cm; effective length: 15 cm; flanges: 4 with apertures, side holes, total of 12 holes, distal straight site, 4 holes and pigtail site, 8 holes [Gadelius Medical Co, Ltd, Tokyo, Japan]).
We designed a new plastic stent dedicated for EUS- HGS with these advantages:

  1. the tapered and straight distal tip can be easily advanced in the liver and bile duct via the needle tract;
  2. the 4 flanges and pigtail anchor of the stent can prevent proximal and distal stent migration, particularly on the gastric side;
  3. a 15-cm effective stent length can be used for all patients regardless of their surgically altered anatomy;
  4. relatively large apertures below the flanges and the 4 small holes in the distal end of the stent improve ductal drainage if the bile is turbid or concentrated like pus;
  5. the absence of a hole in the middle part of the stent can prevent bile leakage into the peritoneal cavity;
  6. a diameter of 8F can prevent left intrahepatic bile duct occlusion. In fact, our results showed that the stent could be easily placed in all cases (100%).

Obstructive jaundice improved in all patients. In this study, we clarified the feasibility and effectiveness of this newly developed plastic stent for EUS-HGS.

Read the abstract for this article online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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