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Multicenter prospective evaluation study of endoscopic ultrasound‐guided hepaticogastrostomy combined with antegrade stenting (with video)
Author(s) -
Ogura Takeshi,
Kitano Masayuki,
Takenaka Mamoru,
Okuda Atsushi,
Minaga Kosuke,
Yamao Kentaro,
Yamashita Yukitaka,
Hatamaru Keiichi,
Noguchi Chishio,
Gotoh Yasuhiko,
Kuroda Taira,
Yokota Tomoyuki,
Nishikiori Hidefumi,
Sagami Ryota,
Higuchi Kazuhide,
Chiba Yasutaka
Publication year - 2018
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/den.12976
Subject(s) - medicine , stent , clinical endpoint , endoscopic ultrasound , adverse effect , pancreatitis , prospective cohort study , acute pancreatitis , radiology , hyperamylasemia , surgery , clinical trial , biochemistry , chemistry , enzyme , amylase
Background and Aim Endoscopic ultrasonography‐guided hepaticogastrostomy ( EUS ‐ HGS ) is often indicated for advanced stage patients. Therefore it is important to prevent adverse events associated with EUS ‐ HGS procedures and obtain long stent patency. EUS ‐guided antegrade stenting ( AS ) has been developed as an advanced technique. Thus, to prevent adverse events and achieve long stent patency, EUS ‐ AS combined with EUS ‐ HGS ( EUS ‐ HGAS ) has been reported. The aim of the present study was to evaluate the technical feasibility and efficacy of EUS ‐ HGAS in a multicenter, prospective study. Methods This prospective study was carried out at each hospital of the Therapeutic Endoscopic Ultrasound Group. Primary endpoint of this multicenter prospective study was stent patency of EUS ‐ HGAS . Results A total of 49 patients were enrolled. Technical success rate of EUS ‐ HGS was 95.9% (47/49). EUS ‐ AS failed in five patients because the guidewire could not be advanced into the intestine across the bile duct obstruction site. Therefore, EUS ‐ HGAS was successfully carried out in 40 patients (technical success rate: 85.7%). Median overall survival was 114 days. Median stent patency including stent dysfunction and patient death was 114 days. In contrast, mean stent patency was 320 days. Adverse events were seen in 10.2% (5/49) of cases. Hyperamylasemia was seen in four patients, and bleeding was seen in one patient. Conclusions The present study is the first to evaluate EUS ‐ HGAS . EUS ‐ HGAS has clinical benefit for obtaining long stent patency and avoiding adverse events, although the possibility of acute pancreatitis as a result of obstruction of the orifice of the pancreatic duct must be considered.