Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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Outcomes of partially covered self-expandable metal stents with different uncovered lengths in endoscopic ultrasound-guided hepaticogastrostomy: a Japanese retrospective study

  • Takeshi Okamoto (Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research) ;
  • Takashi Sasaki (Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research) ;
  • Tsuyoshi Takeda (Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research) ;
  • Tatsuki Hirai (Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research) ;
  • Takahiro Ishitsuka (Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research) ;
  • Manabu Yamada (Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research) ;
  • Hiroki Nakagawa (Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research) ;
  • Takafumi Mie (Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research) ;
  • Takaaki Furukawa (Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research) ;
  • Akiyoshi Kasuga (Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research) ;
  • Masato Ozaka (Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research) ;
  • Naoki Sasahira (Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research)
  • Received : 2023.05.24
  • Accepted : 2023.09.04
  • Published : 2024.07.30
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Abstract

Background/Aims: The optimal length of the uncovered portion of partially covered self-expandable metal stents (PCSEMSs) used in endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) remains unclear. This study investigated the safety and efficacy of PCSEMSs with different uncovered lengths, with a focus on stent migration and time to recurrent biliary obstruction (RBO). Methods: Outcomes of patients undergoing EUS-HGS using PCSEMSs with 5-mm and 20-mm uncovered portions at our institution from January 2016 to December 2021 were compared. Results: Sixty-two patients underwent EUS-HGS using PCSEMS (5/20-mm uncovered portions: 32/30). Stent migration occurred only in the 5-mm group. There were no differences in RBO rates (28.1% vs. 40.0%) or median time to RBO (6.8 vs. 7.1 months) between the two groups. Median overall survival (OS) was longer in the 20-mm group (3.1 vs. 4.9 months, p=0.037) due to the higher number of patients that resumed chemotherapy after EUS-HGS (56.7% vs. 28.1%, p=0.029). Good performance status, absence of hepatic metastases, and chemotherapy after EUS-HGS were independent predictors of longer OS. Conclusions: No migration was observed in patients treated with PCSEMS with 20-mm uncovered portions. Patients treated with PCSEMS with 20-mm uncovered portions performed at least as well as those treated with 5-mm uncovered portions in all material respects.

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References

  1. Isayama H, Nakai Y, Itoi T, et al. Clinical practice guidelines for safe performance of endoscopic ultrasound/ultrasonography-guided biliary drainage: 2018. J Hepatobiliary Pancreat Sci 2019;26:249-269. https://doi.org/10.1002/jhbp.631
  2. van der Merwe SW, van Wanrooij RL, Bronswijk M, et al. Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2022;54:185-205. https://doi.org/10.1055/a-1717-1391
  3. Khashab MA, Messallam AA, Penas I, et al. International multicenter comparative trial of transluminal EUS-guided biliary drainage via hepatogastrostomy vs. choledochoduodenostomy approaches. Endosc Int Open 2016;4:E175-E181. https://doi.org/10.1055/s-0041-109083
  4. Ochiai K, Fujisawa T, Ishii S, et al. Risk factors for stent migration into the abdominal cavity after endoscopic ultrasound-guided heapticogastrostomy. J Clin Med 2021;10:3111.
  5. 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-E127. https://doi.org/10.1055/s-0029-1243911
  6. Okuno N, Hara K, Mizuno N, et al. Stent migration into the peritoneal cavity following endoscopic ultrasound-guided hepaticogastrostomy. Endoscopy 2015;47 Suppl 1 UCTN:E311.
  7. 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;48:1125-1128. https://doi.org/10.1055/s-0042-116595
  8. Nakai Y, Sato T, Hakuta R, et al. Long-term outcomes of a long, partially covered metal stent for EUS-guided hepaticogastrostomy in patients with malignant biliary obstruction (with video). Gastrointest Endosc 2020;92:623-631. https://doi.org/10.1016/j.gie.2020.03.3856
  9. Cotton PB, Eisen GM, Aabakken L, et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010;71:446-454. https://doi.org/10.1016/j.gie.2009.10.027
  10. Isayama H, Hamada T, Yasuda I, et al. TOKYO criteria 2014 for transpapillary biliary stenting. Dig Endosc 2015;27:259-264. https://doi.org/10.1111/den.12379
  11. Asai S, Takeshita K, Ichinona T, et al. A novel partially covered metallic stent with a 20-mm long distal bare portion for EUS-guided hepaticogastrostomy. VideoGIE 2021;6:322-324. https://doi.org/10.1016/j.vgie.2021.03.007
  12. Ishii S, Isayama H, Sasahira N, et al. A pilot study of Spring Stopper Stents: novel partially covered self-expandable metallic stents with anti-migration properties for EUS-guided hepaticogastrostomy. Endosc Ultrasound 2023;12:266-272.
  13. Eisenhauer EA, Therasse P, Bogaerts J, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 2009;45:228-247. https://doi.org/10.1016/j.ejca.2008.10.026
  14. Artifon EL, Marson FP, Gaidhane M, et al. Hepaticogastrostomy or choledochoduodenostomy for distal malignant biliary obstruction after failed ERCP: is there any difference? Gastrointest Endosc 2015;81:950-959. https://doi.org/10.1016/j.gie.2014.09.047
  15. 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 2017;85:1067-1075. https://doi.org/10.1016/j.gie.2016.09.010
  16. De Cassan C, Bories E, Pesenti C, et al. Use of partially covered and uncovered metallic prosthesis for endoscopic ultrasound-guided hepaticogastrostomy: results of a retrospective monocentric study. Endosc Ultrasound 2017;6:329-335. https://doi.org/10.4103/2303-9027.209869
  17. Miyano A, Ogura T, Yamamoto K, et al. Clinical impact of the intra-scope channel stent release technique in preventing stent migration during EUS-guided hepaticogastrostomy. J Gastrointest Surg 2018;22:1312-1318. https://doi.org/10.1007/s11605-018-3758-1
  18. Emmanuel J, Omar H, See LT. Endoscopic ultrasound-guided hepaticogastrostomy using a partially covered metal stent in patients with malignant biliary obstruction after failed endoscopic retrograde cholangiopancreatography. JGH Open 2020;4:1059-1064. https://doi.org/10.1002/jgh3.12386
  19. Yamamura M, Ogura T, Ueno S, et al. Partially covered self-expandable metal stent with antimigratory single flange plays important role during EUS-guided hepaticogastrostomy. Endosc Int Open 2022;10:E209-E214. https://doi.org/10.1055/a-1729-0048
  20. Paik WH, Park DH. Outcomes and limitations: EUS-guided hepaticogastrostomy. Endosc Ultrasound 2019;8(Suppl 1):S44-S49. https://doi.org/10.4103/eus.eus_51_19
  21. 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;30:1748-1752. https://doi.org/10.1111/jgh.13021
  22. Wang K, Zhu J, Xing L, et al. Assessment of efficacy and safety of EUS-guided biliary drainage: a systematic review. Gastrointest Endosc 2016;83:1218-1227. https://doi.org/10.1016/j.gie.2015.10.033
  23. Bories E, Pesenti C, Caillol F, et al. Transgastric endoscopic ultrasonography-guided biliary drainage: results of a pilot study. Endoscopy 2007;39:287-291. https://doi.org/10.1055/s-2007-966212
  24. Paik WH, Park DH, Choi JH, et al. Simplified fistula dilation technique and modified stent deployment maneuver for EUS-guided hepaticogastrostomy. World J Gastroenterol 2014;20:5051-5059. https://doi.org/10.3748/wjg.v20.i17.5051
  25. Ogura T, Kurisu Y, Masuda D, et al. Novel method of endoscopic ultrasound-guided hepaticogastrostomy to prevent stent dysfunction. J Gastroenterol Hepatol 2014;29:1815-1821. https://doi.org/10.1111/jgh.12598
  26. Panpimanmas S, Ratanachu-ek T. Endoscopic ultrasound-guided hepaticogastrostomy for advanced cholangiocarcinoma after failed stenting by endoscopic retrograde cholangiopancreatography. Asian J Surg 2013;36:154-158. https://doi.org/10.1016/j.asjsur.2013.04.007
  27. Attasaranya S, Netinasunton N, Jongboonyanuparp T, et al. The spectrum of endoscopic ultrasound intervention in biliary diseases: a single center's experience in 31 cases. Gastroenterol Res Pract 2012;2012:680753.
  28. Kim TH, Kim SH, Oh HJ, et al. Endoscopic ultrasound-guided biliary drainage with placement of a fully covered metal stent for malignant biliary obstruction. World J Gastroenterol 2012;18:2526-2532. https://doi.org/10.3748/wjg.v18.i20.2526
  29. Ramirez-Luna MA, Tellez-Avila FI, Giovannini M, et al. Endoscopic ultrasound-guided biliodigestive drainage is a good alternative in patients with unresectable cancer. Endoscopy 2011;43:826-830. https://doi.org/10.1055/s-0030-1256406