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CC BY-NC-ND 4.0 · Endosc Int Open 2024; 12(01): E164-E175
DOI: 10.1055/a-2240-1100
Original article

Risk factors of early adverse events associated with endoscopic ultrasound-guided hepaticogastrostomy using self-expandable metal stent

So Nakaji 
1   Gastroenterology, Kameda Medical Center, Kamogawa, Japan (Ringgold ID: RIN13770)
2   Department of Metabolism and Endocrinology, Saga Medical School Faculty of Medicine, Saga University, Saga, Japan (Ringgold ID: RIN13030)
,
Hirokazu Takahashi
2   Department of Metabolism and Endocrinology, Saga Medical School Faculty of Medicine, Saga University, Saga, Japan (Ringgold ID: RIN13030)
,
Wataru Yoshioka
1   Gastroenterology, Kameda Medical Center, Kamogawa, Japan (Ringgold ID: RIN13770)
,
Toshiyasu Shiratori
1   Gastroenterology, Kameda Medical Center, Kamogawa, Japan (Ringgold ID: RIN13770)
,
Shigenobu Yoshimura
1   Gastroenterology, Kameda Medical Center, Kamogawa, Japan (Ringgold ID: RIN13770)
,
Natsuki Kawamitsu
1   Gastroenterology, Kameda Medical Center, Kamogawa, Japan (Ringgold ID: RIN13770)
,
Akiko Tomonari
3   Department of Gastroenterology, ParkwayHealth China, Shanghai, China (Ringgold ID: RIN159398)
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Abstract

Background and study aims This retrospective study aimed to investigate risk factors for early adverse events (AEs) associated with endoscopic ultrasonography-guided hepaticogastrostomy (EUS-HGS) using self-expandable metal stents (SEMS).

Patients and methods The clinical success rate, technical success rate, and early AEs were assessed at two hospitals from 2010 to 2022. The analysis focused on risk factors associated with cholangitis, peritonitis, and SEMS migration.

Results Technical success was achieved in all cases (94/94), and clinical success was 96.8% (91/94). Post-procedural acute cholangitis occurred in 12.8%of cases (12/94). However, no statistically significant risk factors were identified for cholangitis or biliary tract infection. Peritonitis occurred in only 2.1% of cases (2/94). Univariate analysis, using a 1.5 cm cut-off for the distance between the liver and gastrointestinal tract, revealed significant risk factors: braided-type SEMS, bile duct diameter (especially >4 mm), 6 mm diameter SEMS, and tract dilation (P=0.001, P=0.020, P=0.023, and P=0.046, respectively). Adjusting the cut-offs to 2 cm underscored braided-type SEMS and tract dilation as risk factors (P=0.002 and P=0.046, respectively). With 2.5-cm cut-offs, only braided-type SEMS remained significant (P=0.018). Mortality within 14 and 30 days following EUS-HGS was 5.3% (5/94) and 16.0% (15/94), respectively.

Conclusions EUS-HGS using SEMS demonstrated high technical and clinical success rates. Laser-cut SEMS may be superior in preventing early AEs.

Keywords

Biliary tract - Intervention EUS - Endoscopic ultrasonography - Pancreas


Publication History

Received: 09 October 2023

Accepted after revision: 04 January 2024

Accepted Manuscript online:
08 January 2024

Article published online:
30 January 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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