Background and study aim: To minimize bile leakage
and avoid possible death because of stent
migration in endoscopic ultrasound-guided hepaticogastrostomy
(EUS-HGS), we have recently
combined EUS-HGS with EUS-guided antegrade
stenting (EUS-AS) of the biliary obstruction using
a novel uncovered metallic stent with a finegauge
delivery system. In this pilot study,we evaluated
the feasibility and adverse events associated
with this combination therapy using the novel
stent.
Patients and methods:We performed EUS-guided
antegrade stenting and hepaticogastrostomy in
12 consecutive patients.
Results: The novel EUS-AS stent was placed across
the ampulla of Vater in 8 patients and above the
ampulla in 4. Technical and functional success
rates were 100%. In addition, the insertion of the
first stent was achieved in all patients without dilation
of the fistula between stomach and intrahepatic
bile duct. Although 1 patient experienced
mild pancreatitis, adverse events such as bile
peritonitis or stent dysfunction did not occur during
follow-up (mean 122 days, range 62–210
days).
Conclusion: This method appears to safely and effectively
avoid adverse events associated with
EUS-HGS.