B2 puncture with forward-viewing EUS simplifies EUS-guided hepaticogastrostomy (with video)

Area of Science:

• Gastroenterology
• Endoscopic Ultrasound

Background:

• EUS-guided hepaticogastrostomy (EUS-HGS) is a common procedure.
• Conventional oblique-viewing (OV) EUS for the B2 route carries risks of transesophageal puncture and adverse events.
• There is a need for safer dedicated devices for EUS-HGS.

Purpose of the Study:

• To assess the safety and efficacy of a newly developed forward-viewing (FV) EUS system for B2 puncture in EUS-HGS.
• To evaluate the reduction in adverse events associated with the FV EUS approach.

Main Methods:

• A single-center retrospective study of 61 consecutive patients undergoing B2-EUS-HGS with FV EUS.
• Prospective patient enrollment with retrospective data collection.
• Analysis of technical success rates, adverse events, and procedure times.

Main Results:

• Overall technical success rate for EUS-HGS was 98.3%.
• B2-EUS-HGS with FV achieved an 88.5% success rate.
• The early adverse event rate was 6.5%, with no transesophageal punctures observed.

Conclusions:

• Forward-viewing EUS enables safe performance of B2-EUS-HGS, eliminating transesophageal punctures.
• The FV system improves device supportability due to coaxial alignment with the guidewire.
• FV EUS is efficacious for B2-EUS-HGS, indicating potential for future clinical adoption.