The impact of a new compatible 0.018-inch guidewire double lumen dilator for adverse events of EUS-HGS

Background: Recently, a new compatible 0.018-inch guidewire double lumen dilator (MEISSA; Japan Lifeline) allows tract dilation without switching to other devices and is expected to decrease adverse events (AE) of EUS-HGS. We aimed to clarify risk factors for AE, the efficacy and safety of MEISSA. Methods: Between September 2019 and February 2025, we included the patients who underwent EUS-HGS for malignant biliary strictures at our hospital. Results: A total of 70 patients were eligible for analysis (AE group; 14 patients, non-AE group; 56 patients). Multivariate logistic regression analysis showed tract dilation was an independent risk factor for AE (Odds ratio: 4.36; 95% confidence interval: 1.06-17.95; p = 0.041). Secondary, we investigated 36 patients who underwent tract dilation [MEISSA (M) group; 10 patients, non-M group; 26 patients]. In M group, 22-gauge needle and 0.018-inch guidewire were used in all patients. Though AE and device switching rate did not differ significantly between 2 groups (20.0% vs. 34.4%, 10.0% vs. 15.4%), total procedure time was significant shorter (median 55.5min vs. 75.5min, p = 0.028) and chatheter costs were significant lower (median 31000yen vs. 45000yen, p < 0.01) in M group. Conclusion: The risk factor for AE of EUS-HGS was tract dilation. This dilator was simple and more effective in procedure time and cost.