Evaluation of time to endosonographic creation route after endoscopic ultrasound-guided hepaticogastrostomy.

Abstract

<h4>Background and study aims</h4>Recently, antegrade procedures via the endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) have been developed as an alternative technique for failed endoscopic retrograde cholangiopancreatography However, time required for formation of endosonography-created route (ESCR) after EUS-HGS is still unknown. To prevent adverse events (AEs) after stent removal, stent removal using the through mesh technique might be useful. The aim of this study was to evaluate time to ESCR formation.<h4>Patients and methods</h4>Consecutive patients who underwent EUS-HGS using self-expandable metal stents (SEMSs) and EUS-HGS stent removal for performing antegrade procedures were retrospectively enrolled. The primary endpoint was evaluation of the rate of ESCR formation. In the present study, EUS-HGS stent removal was attempted at approximately 14 days.<h4>Results</h4>A total of 104 patients were enrolled in this study. EUS-HGS was performed using by partially covered SEMSs (n = 82) or fully covered SEMSs (n = 22). EUS-HGS stent removal was successfully performed in 102 patients (98.1%). Median interval prior to EUS-HGS stent removal in the study subjects was 13 days (range 12-14 days). Among patients who underwent EUS-HGS stent removal, ESCR formation was confirmed in all cases. Mean procedure time was 24.0 minutes. The rate of AEs was 2.9% (3/104)and all AEs were successfully treated conservatively.<h4>Conclusions</h4>In conclusion, ESCR may have been established by a median of 13 days following EUS-HGS using SEMS; however, time to ESCR formation should be evaluated in a future study.