Post written by Masayuki Kitano, MD, PhD, from the Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan.

We developed a partially covered self-expandable metal stent with a thin delivery system (7.2 Fr) that has 2 advantages for EUS-guided hepaticogastrostomy (EUS-HGS). First, using a thin delivery system with a tapered tip, the stent can be inserted into the bile duct without fistulous tract dilation. Second, the design of these stents may prevent stent migration because these partially covered laser-cut stents have anti-migration anchoring hooks. The aim of this study was to evaluate the feasibility of these newly designed stents with anti-migration anchoring hooks for EUS-HGS in phantoms and animals.

EUS-guided biliary drainage has become the method of choice for patients with malignant biliary obstruction in whom endoscopic transpapillary drainage fails. EUS-HGS is indicated in these conditions. However, the rates of adverse events associated with EUS-HGS such as bile peritonitis and stent migration are higher. Particularly, stent migration and bile leakage are a severe adverse event of EUS-HGS. Therefore, more convenient, safer devices for EUS-HGS are also needed.

The success rate of EUS-HGS without using a fistulous tract dilation device was significantly higher with newly hook stents than with conventional stents. No adverse events occurred with either stent. The resistance forces on the distal (3.59 vs 1.73 N and 6.21 vs 1.74 N) and proximal (3.58 vs 1.5 N and 5.97 vs 1.67 N) sides in phantom and ex vivo models were significantly higher for hook stents than for conventional stents. These newly designed hook stents have 2 advantages compared with conventional stents in preventing stent migration. The anchoring hooks can catch onto tissue and create resilience to pull the stent back to the luminal side when it is pulled into the peritoneal cavity, preventing stent migration. These newly designed hook stents may prevent stent migration and peritonitis because they show strong resistance to migration and skip the dilation step. These newly designed hook stents may therefore be feasible and safe for EUS-HGS. In the future, it is necessary to assess the feasibility and safety of EUS-HGS in clinical practice.

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