On the way to standardisation of EUS-guided hepaticogastrostomy

Aims Fistula dilation is one of the key steps when performing EUS-guided hepaticogastrostomy (EUS-HG). Knowing whether there are differences between the existing tools used in EUS-HG dilation may reduce the complexity and adverse events (AEs) associated with this technique.

Methods Retrospective study of all HG-EUS performed in a tertiary centre between 2017 and 2023. The procedure time, technical success clinical success and adverse events associated with different dilatation methods during EUS-HG were evaluated. Dilation methods used were: 4mm balloon dilator, 6F cystotome, filiform catheter (4/7F) or a combination of the previous.

Results Thirty-four patients were included with a technical success rate of 31/34 (91.2%). Clinical success was 100% when technical success was achieved. Table 1 shows the methods used for fistula dilatation. There were 7 AE (20.6%), all early AE and none intra-procedurally. The duration of the procedure was 37.5 (±15.7) minutes.

A filiform catheter was used in 18 cases and fistula creation was possible in 17 cases (94.4%). The use of a single method for fistula creation reduced procedure time: 44.24 (±17) vs 31.8 (±13.7) min, p=0.018, but not AE. The use of a filiform catheter alone or in combination with dilatation was associated with a significant reduction in the procedure time: 33.7±(15.3) vs 44.6 (±16.5) min, p=0.033, as was the rate of AE: 5. 9% vs 35.7%, p=0.036. However, the use of balloon dilatation was associated with a significantly longer duration:42.7 (16.4) vs 31.3 (14.9), and AE: 25% vs 9.1%, the latter without statistical significance.

Conclusions The use of a filiform catheter reduces the time and AE associated with EUS-HG. Its use can be recommended over other methods of fistula dilatation in EUS-HG. Standardisation of complex procedures increases safety and allows their use to be extended to other centres.

Conflicts of interest

Authors do not have any conflict of interest to disclose.

Publication History

Article published online:
15 April 2024