Novel Devices Facilitate EUS-Guided Hepaticoenterostomy Without Tract Dilation

Background: EUS-guided hepaticoenterostomy (EUS-HES) is widely performed; however, a standard technique has not been established due to continuous device development. This study evaluated the outcomes of EUS-HES without tract dilation using novel devices.
Methods: 151 patients who underwent EUS-HES from January 2015 to February 2025 were retrospectively analyzed. As a novel non-dilation technique (Group N), a dedicated plastic stent (Type IT) combined with a novel 0.035-inch guidewire (CAPELLA) and a partially covered SEMS with a 7-Fr slim-delivery system for a 0.025-inch guidewire (7Fr Niti-S End Bare Single Flare) were compared with the conventional technique (Group C).
Results: Overall technical success rate of EUS-HES was 97.4%. Among 147 successful cases (141 hepaticogastrostomy and 6 hepaticojejunostomy), 17 were in Group N and 130 were in Group C. Group N had a technical success rate of 88.2%, with 2 cases requiring additional dilation. Plastic stent placement was more frequent in Group N (65% vs. 34%), and median procedure time was significantly shorter in Group N (19 min vs. 24 min, p < 0.05). Clinical success rates were 94% in Group N and 91% in Group C, respectively. Early adverse event rates were lower in Group N (12% vs. 25%), with no peritonitis observed (compared to 13% in Group C), though differences were not statistically significant.
Conclusion: EUS-HES without tract dilation using novel devices shortens procedure time and may potentially reduce adverse events.