The intra-conduit release method is useful for avoiding migration of metallic stents during EUS-guided hepaticogastrostomy (with video)
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Although EUS-guided hepaticogastrostomy (EUS-HGS) with a covered self-expandable metal stent (SEMS) is a useful procedure, it is associated with severe adverse events, including stent migration. We, therefore, developed an intra-conduit release method, and investigated whether the technique yields a safer and more stable procedure.
The intra-conduit release method is a procedure to release the SEMS in the working channel conduit of the scope for anchoring between the liver and stomach to avoid stent migration. Forty-three patients who underwent EUS-HGS at two high-volume centers in Japan were enrolled in this retrospective study, and the safety and usefulness of this method were evaluated retrospectively.
The intra-conduit release method was applied in 36 cases. The technical success rate of EUS-HGS with the intra-conduit release method was significantly higher in comparison with the conventional method. Additionally, the rate of early adverse events was significantly lower than that for the conventional method.
The intra-conduit release method during EUS-HGS is useful for a stable procedure that avoids early adverse events.
KeywordsBiliary drainage Interventional EUS EUS-guided hepaticogastrostomy Stent migration
Compliance with ethical standards
Conflict of interest
Drs. Daisuke Uchida, Hirofumi Kawamoto, Hironari Kato, Daisuke Goto, Takeshi Tomoda, Kazuyuki Matsumoto, Naoki Yamamoto, Shigeru Horiguchi, Koichiro Tsutsumi, and Hiroyuki Okada have no conflicts of interest or financial ties to disclose.
The study protocol conformed to the ethical guidelines of the 1975 Declaration of Helsinki, as reflected in its approval by the ethics committee at Okayama University Hospital and Kawasaki Hospital.
Supplementary material 1 Video 1 An animation demonstrating the mechanism of SEMS migration (MP4 27390 kb)
Supplementary material 2 Video 2 An animation demonstrating the intra-conduit release method (MP4 17500 kb)
Supplementary material 3 Video 3 A video demonstrating the intra-conduit release method (MP4 43559 kb)