Efficacy and Safety of Double Pigtail Stents in the Context of Hepaticogastrostomy Dysfunction and Repeated Intrahepatic Access

Aims EUS-guided hepaticogastrostomy (EUS-HG) may provide an important therapeutic option in the context of failed ERCP, inaccessible papilla or post-surgical anatomy. However, hepaticogastrostomy dysfunction or the nature of the underlying disease may necessitate reinterventions over time. Our aim was to evaluate the efficacy and safety of double pigtail stents for the treatment of hepaticogastrostomy dysfunction and in the context of repeated intrahepatic biliary access.

Methods A tertiary single center retrospective analysis of all consecutive EUS-HG procedures was performed at the University Hospitals Leuven, Belgium. All cases undergoing subsequent treatment in the context of EUS-HG dysfunction or repeated intrahepatic access by means of double pigtails were included. Baseline characteristics, underlying disease characteristics, as well as technical procedural details and outcomes were collected.

Results Fifteen patients were identified (mean age 69 (SD ±10.5) years, female 46.7 %, 53.3 % benign disease), which underwent a total of 32 individual procedures using double pigtails. In all but one procedure technical success was attained (96.9 %), whereas clinical success, defined by successful treatment of cholangitis or bilirubin decrease >25 % in cases with EUS-HG dysfunction, was achieved in 12 out of 15 patients (80.0 %). In the 3 patients with clinical failure, successful percutaneous transhepatic drainage was performed. Using the ASGE lexicon for adverse events (AE), two AE (6.3 %) were identified (one mild and one moderate), both consisting of post-interventional cholangitis, for which antibiotics were administered successfully. No severe or fatal adverse occurred. Stent dysfunction was detected following 6 procedures (18.8 %) after a median of 46 days (IQR 23-62). No episodes of stent migration occurred, provided that successful simultaneous intraduodenal and intragastric placement was achieved.

Conclusions Our data show that double pigtail stents facilitate safe and effective treatment of EUS-hepaticogastrostomy dysfunction and provided long term intrahepatic access, paving the way towards definitive treatment in challenging situations and both benign or malignant disease.

Citation: Bronswijk M, Vanella G, van Malenstein H et al. OP164 EFFICACY AND SAFETY OF DOUBLE PIGTAIL STENTS IN THE CONTEXT OF HEPATICOGASTROSTOMY DYSFUNCTION AND REPEATED INTRAHEPATIC ACCESS. Endoscopy 2021; 53: S67.

Publication History

Article published online:
19 March 2021