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.
We designed a new plastic stent dedicated for EUS- HGS with these advantages:
- the tapered and straight distal tip can be easily advanced in the liver and bile duct via the needle tract;
- the 4 flanges and pigtail anchor of the stent can prevent proximal and distal stent migration, particularly on the gastric side;
- a 15-cm effective stent length can be used for all patients regardless of their surgically altered anatomy;
- 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;
- the absence of a hole in the middle part of the stent can prevent bile leakage into the peritoneal cavity;
- 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.
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