Re-intervention Utility After Endoscopic Ultrasound-Guided Hepaticogastrostomy Using a Partially Covered Stent with...

Area of Science:

• Gastroenterology
• Interventional Endoscopy
• Biliary Interventions

Background:

• Long self-expandable metal stents (SEMS) for endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) can hinder re-intervention for recurrent biliary obstruction (RBO).
• A novel stent design is needed to facilitate endoscopic re-intervention after EUS-HGS.

Purpose of the Study:

• To evaluate the efficacy and safety of endoscopic re-intervention for RBO using a novel partially covered SEMS with an anchoring flange.
• To assess the success rates, procedure time, and adverse events associated with this new stent design for re-intervention.

Main Methods:

• A partially covered SEMS with a 1.5 cm intrahepatic uncovered portion and a 2.0 cm anchoring flange was used.
• Re-interventions were performed through the in-situ stent lumen.
• Primary outcomes included technical and clinical success; secondary outcomes included procedure time, adverse events, and time to RBO.

Main Results:

• 35 re-interventions were performed in 19 patients with a 97.1% success rate for accessing the stent lumen.
• Technical and clinical success rates were 94.3% and 88.6%, respectively.
• Mild cholangitis occurred in 5.7% of cases, managed conservatively. Median time to RBO after re-intervention was 148 days.

Conclusions:

• Endoscopic re-interventions are feasible and safe through the lumen of the novel partially covered SEMS with an anchoring flange.
• This stent design simplifies re-intervention for recurrent biliary obstruction following EUS-HGS.