Strategic International Session2(JGES・JSGE・JSGS)
Fri. November 3rd   9:00 - 12:00   Room 11: Portopia Hotel South Wing Topaz
ST2-10_E
 Endoscopic ultrasound-guided hepaticogastrostomy with antegrade stenting without dilation device application for malignant distal biliary obstruction in pancreatic cancer
Tadahisa Inoue1, Rena Kitano1, Kiyoaki Ito1
1Department of Gastroenterology, Aichi Medical University
Background: Endoscopic ultrasound-guided hepaticogastrostomy with antegrade stenting (EUS-HGAS) is a promising option for malignant distal biliary obstruction (MDBO) in the event of transpapillary approach failure. Eliminating the fistula dilation step may further decrease the incidence of adverse events (AE) and simplify the procedure. This study focused on MDBO associated with pancreatic cancer and aimed to examine the utility of EUS-HGAS without the use of any dilation devices.
Methods: This retrospective study investigated 58 consecutive patients who underwent EUS-HGAS without dilation device usage, using a tapered small-diameter catheter, ultrathin delivery system, and tapered dedicated plastic stent. The outcomes of this study included the technical success, clinical success, AE incidence, and recurrent biliary obstruction (RBO) associated with the procedure.
Results: The technical and clinical success rates were 91.4% (53/58) each. The median procedural time was 25 min. The rates of early and late AE besides RBO were 5.2% (3/58) and 3.8% (2/53), respectively. The incidence rate of RBO was 30.2% (16/53), and the median time to RBO was 245 days. The rate of successful endoscopic reintervention for RBO via the fistula was 100% (16/16).
Conclusions: EUS-HGAS without the use of dilation devices showed good technical feasibility with a low AE rate. It may be a useful option for MDBO associated with pancreatic cancer when the transpapillary approach is difficult.
Index Term 1: Endoscopic ultrasound-guided hepaticogastrostomy with antegrade stenting
Index Term 2: Adverse event
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