Journal of Medical Ultrasonics

, Volume 45, Issue 3, pp 399–403 | Cite as

The intra-conduit release method is useful for avoiding migration of metallic stents during EUS-guided hepaticogastrostomy (with video)

  • Daisuke Uchida
  • Hirofumi KawamotoEmail author
  • Hironari Kato
  • Daisuke Goto
  • Takeshi Tomoda
  • Kazuyuki Matsumoto
  • Naoki Yamamoto
  • Shigeru Horiguchi
  • Koichiro Tsutsumi
  • Hiroyuki Okada
Original Article



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.


Biliary 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.

Ethical statements

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

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)


  1. 1.
    Park DH, Song TJ, Eum J, et al. EUS-guided hepaticogastrostomy with a fully covered metal stent as the biliary diversion technique for an occluded biliary metal stent after a failed ERCP. Gastrointest Endosc. 2010;71:413–9.CrossRefPubMedGoogle Scholar
  2. 2.
    Poincloux L, Rouquette O, Buc E, et al. Endoscopic ultrasound-guided biliary drainage after failed ERCP: cumulative experience of 101 procedures at a single center. Endoscopy. 2015;47:794–801.CrossRefPubMedGoogle Scholar
  3. 3.
    Park DH, Jeong SU, Lee BU, et al. Prospective evaluation of a treatment algorithm with enhanced guidewire manipulation protocol for EUS-guided biliary drainage after failed ERCP. Gastrointest Endosc. 2013;78:91–101.CrossRefPubMedGoogle Scholar
  4. 4.
    Cho DH, Lee SS, Oh D, et al. Long-term outcomes of a newly developed hybrid metal stent for EUS-guided biliary drainage (with videos). Gastrointest Endosc. 2016;. Scholar
  5. 5.
    Ogura T, Kurisu Y, Masuda D, et al. Novel method of endoscopic ultrasound-guided hepaticogastrostomy to prevent stent dysfunction. J Gastroenterol Hepatol. 2014;29:1815–21.CrossRefPubMedGoogle Scholar
  6. 6.
    Deviere J, Baize M, de Toeuf J, et al. Long-term follow-up of patients with hilar malignant stricture treated by endoscopic internal biliary drainage. Gastrointest Endosc. 1988;34:95–101.CrossRefPubMedGoogle Scholar
  7. 7.
    Davids PH, Groen AK, Rauws EA, et al. Randomised trial of self-expanding metal stents versus polyethylene stents for distal malignant biliary obstruction. Lancet. 1992;340:1488–92.CrossRefPubMedGoogle Scholar
  8. 8.
    Knyrim K, Wagner HJ, Pausch J, et al. A prospective, randomized, controlled trial of metal stents for malignant obstruction of the common bile duct. Endoscopy. 1993;25:207–12.CrossRefPubMedGoogle Scholar
  9. 9.
    Smith AC, Dowsett JF, Russell RC, et al. Randomised trial of endoscopic stenting versus surgical bypass in malignant low bileduct obstruction. Lancet. 1994;344:1655–60.CrossRefPubMedGoogle Scholar
  10. 10.
    Chandrashekhara SH, Gamanagatti S, Singh A, et al. Current status of percutaneous transhepatic biliary drainage in palliation of malignant obstructive jaundice: a review. Indian J Palliat Care. 2016;22:378–87.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Giovannini M, Moutardier V, Pesenti C, et al. Endoscopic ultrasound-guided bilioduodenal anastomosis: a new technique for biliary drainage. Endoscopy. 2001;33:898–900.CrossRefPubMedGoogle Scholar
  12. 12.
    Iwashita T, Doi S, Yasuda I. Endoscopic ultrasound-guided biliary drainage: a review. Clin J Gastroenterol. 2014;7:94–102.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Giovannini M, Dotti M, Bories E, et al. Hepaticogastrostomy by echo-endoscopy as a palliative treatment in a patient with metastatic biliary obstruction. Endoscopy. 2003;35:1076–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Tarantino I, Barresi L, Repici A, et al. EUS-guided biliary drainage: a case series. Endoscopy. 2008;40:336–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Nguyen-Tang T, Binmoeller KF, Sanchez-Yague A, et al. Endoscopic ultrasound (EUS)-guided transhepatic anterograde self-expandable metal stent (SEMS) placement across malignant biliary obstruction. Endoscopy. 2010;42:232–6.CrossRefPubMedGoogle Scholar
  16. 16.
    Kim YS, Gupta K, Mallery S, et al. Endoscopic ultrasound rendezvous for bile duct access using a transduodenal approach: cumulative experience at a single center. A case series. Endoscopy. 2010;42:496–502.CrossRefPubMedGoogle Scholar
  17. 17.
    Ogura T, Chiba Y, Masuda D, et al. Comparison of the clinical impact of endoscopic ultrasound-guided choledochoduodenostomy and hepaticogastrostomy for bile duct obstruction with duodenal obstruction. Endoscopy. 2016;48:156–63.CrossRefPubMedGoogle Scholar
  18. 18.
    Martins FP, Rossini LG, Ferrari AP. Migration of a covered metallic stent following endoscopic ultrasound-guided hepaticogastrostomy: fatal complication. Endoscopy. 2010;42(Suppl 2):E126–7.CrossRefPubMedGoogle Scholar
  19. 19.
    Park DH, Koo JE, Oh J, et al. EUS-guided biliary drainage with one-step placement of a fully covered metal stent for malignant biliary obstruction: a prospective feasibility study. Am J Gastroenterol. 2009;104:2168–74.CrossRefPubMedGoogle Scholar
  20. 20.
    Vila JJ, Perez-Miranda M, Vazquez-Sequeiros E, et al. Initial experience with EUS-guided cholangiopancreatography for biliary and pancreatic duct drainage: a Spanish national survey. Gastrointest Endosc. 2012;76:1133–41.CrossRefPubMedGoogle Scholar
  21. 21.
    Park DH, Jang JW, Lee SS, et al. EUS-guided biliary drainage with transluminal stenting after failed ERCP: predictors of adverse events and long-term results. Gastrointest Endosc. 2011;74:1276–84.CrossRefPubMedGoogle Scholar
  22. 22.
    Ogura T, Yamamoto K, Sano T, et al. Stent length is impact factor associated with stent patency in endoscopic ultrasound-guided hepaticogastrostomy. J Gastroenterol Hepatol. 2015;30:1748–52.CrossRefPubMedGoogle Scholar
  23. 23.
    Nakai Y, Isayama H, Yamamoto N, et al. Safety and effectiveness of a long, partially covered metal stent for endoscopic ultrasound-guided hepaticogastrostomy in patients with malignant biliary obstruction. Endoscopy. 2016;. Scholar

Copyright information

© The Japan Society of Ultrasonics in Medicine 2017

Authors and Affiliations

  • Daisuke Uchida
    • 1
  • Hirofumi Kawamoto
    • 2
    Email author
  • Hironari Kato
    • 1
  • Daisuke Goto
    • 3
  • Takeshi Tomoda
    • 1
  • Kazuyuki Matsumoto
    • 1
  • Naoki Yamamoto
    • 4
  • Shigeru Horiguchi
    • 1
  • Koichiro Tsutsumi
    • 1
  • Hiroyuki Okada
    • 1
  1. 1.Department of GastroenterologyOkayama University HospitalOkayamaJapan
  2. 2.Department of General Internal Medicine 2Kawasaki Hospital, Kawasaki Medical SchoolOkayamaJapan
  3. 3.Department of Internal MedicineTottori Red Cross HospitalTottoriJapan
  4. 4.Department of GastroenterologyShigei Medical Research HospitalOkayamaJapan

Personalised recommendations