Usefulness of the laser‐cut, fully covered, self‐expandable metallic stent for endoscopic ultrasound‐guided hepaticogastrostomy. (25th May 2022) - Harai, Shota
Abstract: Background/Purpose: Endoscopic ultrasound‐guided hepaticogastrostomy (EUS‐HGS) has many associated adverse events. We evaluated the clinical efficacy and safety of the laser‐cut, fully covered, self‐expandable metallic stent (FCSEMS) for this procedure. Methods: This single‐center, retrospective study included cases where EUS‐HGS with a laser‐cut FCSEMS was performed for malignant biliary obstruction. Technical and clinical success, time to recurrent biliary obstruction (TRBO), procedure time, adverse events, and re‐interventions were evaluated. Results: There were 95 eligible cases. Technical and clinical success rates were 100.0% and 95.8%, respectively. Median TRBO was 398 days. RBO causes were hyperplasia (7.4%), debris (3.2%), and migration (4.2%). Adverse events occurred in nine cases (9.5%). Non‐occlusion and focal cholangitis occurred in four cases (4.2%) each. Nineteen patients (20%) underwent combined EUS‐HGS (CH) procedures: antegrade stenting, bridging methods, plastic stent anchoring in SEMS, and EUS‐hepaticoduodenostomy. The solely EUS‐HGS (SH) group had significantly longer median TRBO than the CH group (398 vs 246 days, P = .04). There were no significant differences in adverse events between the two groups. Re‐intervention was performed in 29 cases (technical success rate: 100.0%). Conclusions: Laser‐cut FCSEMS can be safely placed in the bile duct and easily applied during re‐intervention, making it useful in EUS‐HGS. Abstract : Harai and colleagues evaluated the safety and usefulness of the laser‐cut fully covered self‐expandable metallic stent in endoscopic ultrasound‐guided hepaticogastrostomy. The stent placement method that took maximum advantage of its characteristics facilitated stenting and re‐intervention, and was associated with lower adverse event rates and longer time to recurrent biliary obstruction.