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

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

• References

• 1 Giovannini M, Moutardier V, Pesenti C. et al. Endoscopic ultrasound-guided bilioduodenal anastomosis: a new technique for biliary drainage. Endoscopy 2001; 33: 898-900
• 2 Bang JY, Navaneethan U, Hasan M. et al. Stent placement by EUS or ERCP for primary biliary decompression in pancreatic cancer: a randomized trial (with videos). Gastrointest Endosc 2018; 88: 9-17
• 3 Paik WH, Lee TH, Park DH. et al. EUS-guided biliary drainage versus ERCP for the primary palliation of malignant biliary obstruction: a multicenter randomized clinical trial. Am J Gastroenterol 2018; 113: 987-997
• 4 Minaga K, Takenaka M, Kitano M. et al. Rescue EUS-guided intrahepatic biliary drainage for malignant hilar biliary stricture after failed transpapillary re-intervention. Surg Endosc 2017; 31: 4764-4772
• 5 Kongkam P, Orprayoon T, Boonmee C. et al. ERCP plus endoscopic ultrasound-guided biliary drainage versus percutaneous transhepatic biliary drainage for malignant hilar biliary obstruction: a multicenter observational open-label study. Endoscopy 2021; 53: 55-62
• 6 Vanella G, Bronswijk M, Maleux G. et al. EUS-guided intrahepatic biliary drainage: a large retrospective series and subgroup comparison between percutaneous drainage in hilar stenoses or postsurgical anatomy. Endosc Int Open 2020; 8: E1782-E1794
• 7 Poincloux L, Rouquette O, Buc E. et al. Endoscopic ultrasound-guided biliary drainage after failed ERCP: cumulative experience of 101 procedures at a single center. Endoscopy 2015; 47: 794-801
• 8 van der Merwe SW, van Wanrooij RLJ, Bronswijk M. et al. Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2022; 54: 185-205
• 9 Tyberg A, Napoleon B, Robles-Medranda C. et al. Hepaticogastrostomy versus choledochoduodenostomy: An international multicenter study on their long-term patency. Endosc Ultrasound 2022; 11: 38-43
• 10 Ohno A, Fujimori N, Kaku T. et al. Feasibility and efficacy of endoscopic ultrasound-guided hepaticogastrostomy without dilation: a propensity score matching analysis. Dig Dis Sci 2022;
• 11 Yamamoto Y, Ogura T, Nishioka N. et al. Risk factors for adverse events associated with bile leak during EUS-guided hepaticogastrostomy. Endosc Ultrasound 2020; 9: 110-115
• 12 Nakai Y, Sato T, Hakuta R. et al. Long-term outcomes of a long, partially covered metal stent for EUS-guided hepaticogastrostomy in patients with malignant biliary obstruction (with video). Gastrointest Endosc 2020; 92: 623-631.e621
• 13 Oh D, Park DH, Song TJ. et al. Optimal biliary access point and learning curve for endoscopic ultrasound-guided hepaticogastrostomy with transmural stenting. Therap Adv Gastroenterol 2017; 10: 42-53
• 14 Fujimoto K, Fujishiro M, Kato M. et al. Guidelines for gastroenterological endoscopy in patients undergoing antithrombotic treatment. Dig Endosc 2014; 26: 1-14
• 15 Horsted F, West J, Grainge MJ. Risk of venous thromboembolism in patients with cancer: a systematic review and meta-analysis. PLoS Med 2012; 9: e1001275
• 16 Varki A. Trousseauʼs syndrome: multiple definitions and multiple mechanisms. Blood 2007; 110: 1723-1729
• 17 Takada T, Takikawa H, Sawada N. et al. Cholangio-venous reflux of biliary contents through paracellular pathways between hepatocytes in patients with acute cholangitis. J Hepatobiliary Pancreat Sci 2021; 28: 508-514
• 18 Ishiwatari H, Satoh T, Sato J. et al. Bile aspiration during EUS-guided hepaticogastrostomy is associated with lower risk of postprocedural adverse events: a retrospective single-center study. Surg Endosc 2021; 35: 6836-6845
• 19 Samanta J, Sundaram S, Dhar J. et al. EUS-guided biliary drainage in patients with moderate-severe cholangitis is safe and effective: a multi-center experience. Surg Endosc 2022;
• 20 Ogura T, Ueno S, Okuda A. et al. Technical feasibility and safety of one-step deployment of EUS-guided hepaticogastrostomy using an 8-mm diameter metal stent with a fine-gauge stent delivery system (with video). Endosc Ultrasound 2021; 10: 355-360
• 21 Park DH, Lee TH, Paik WH. et al. Feasibility and safety of a novel dedicated device for one-step EUS-guided biliary drainage: A randomized trial. J Gastroenterol Hepatol 2015; 30: 1461-1466
• 22 Kawakubo K, Isayama H, Kato H. et al. Multicenter retrospective study of endoscopic ultrasound-guided biliary drainage for malignant biliary obstruction in Japan. J Hepatobiliary Pancreat Sci 2014; 21: 328-334
• 23 Martins FP, Rossini LG, Ferrari AP. Migration of a covered metallic stent following endoscopic ultrasound-guided hepaticogastrostomy: fatal complication. Endoscopy 2010; 42: E126-E127
• 24 Minaga K, Kitano M, Yamashita Y. et al. Stent migration into the abdominal cavity after EUS-guided hepaticogastrostomy. Gastrointest Endosc 2017; 85: 263-264
• 25 Nakai Y, Isayama H, Yamamoto N. et al. Safety and effectiveness of a long, partially covered metal stent for endoscopic ultrasound-guided hepaticogastrostomy in patients with malignant biliary obstruction. Endoscopy 2016; 48: 1125-1128
• 26 Miyano A, Ogura T, Yamamoto K. et al. Clinical impact of the intra-scope channel stent release technique in preventing stent migration during EUS-guided hepaticogastrostomy. J Gastrointest Surg 2018; 22: 1312-1318
• 27 Ochiai K, Fujisawa T, Ishii S. et al. Risk factors for stent migration into the abdominal cavity after endoscopic ultrasound-guided hepaticogastrostomy. J Clin Med 2021; 10
• 28 Fujisawa T, Isayama H, Ishii S. “ClipFlap” anchoring method for endoscopic ultrasonography-guided hepaticogastrostomy with a covered self-expandable metallic stent. Dig Endosc 2020; 32: 628
• 29 Shima Y, Isayama H, Ito Y. et al. Crisscross anchor-stents to prevent metal stent migration during endoscopic ultrasound-guided hepaticogastrostomy. Endoscopy 2014; 46: E563
• 30 Yamashita Y, Itonaga M, Gon C. et al. Usefulness of a newly designed laser-cut metal stent with an anchoring hook and thin delivery system for EUS-guided hepaticogastrostomy in experimental settings (with video). Gastrointest Endosc 2021; 94: 999-1008.e1001
• 31 Cho DH, Lee SS, Oh D. et al. Long-term outcomes of a newly developed hybrid metal stent for EUS-guided biliary drainage (with videos). Gastrointest Endosc 2017; 85: 1067-1075
• 32 Harai S, Hijioka S, Nagashio Y. et al. Usefulness of the laser-cut, fully covered, self-expandable metallic stent for endoscopic ultrasound-guided hepaticogastrostomy. J Hepatobiliary Pancreat Sci 2022; 29: 1035-1043
• 33 Tyberg A, Mishra A, Cheung M. et al. Learning curve for EUS-guided biliary drainage: What have we learned?. Endosc Ultrasound 2020; 9: 392-396