Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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Puncture angle on an endoscopic ultrasound image is independently associated with unsuccessful guidewire manipulation of endoscopic ultrasound-guided hepaticogastrostomy: a retrospective study in Japan

  • Akihisa Ohno (Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University) ;
  • Nao Fujimori (Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University) ;
  • Toyoma Kaku (Department of Gastroenterology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center) ;
  • Kazuhide Matsumoto (Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University) ;
  • Masatoshi Murakami (Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University) ;
  • Katsuhito Teramatsu (Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University) ;
  • Keijiro Ueda (Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University) ;
  • Masayuki Hijioka (Department of Gastroenterology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center) ;
  • Akira Aso (Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University) ;
  • Yoshihiro Ogawa (Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University)
  • Received : 2023.09.25
  • Accepted : 2023.11.22
  • Published : 2024.09.30
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Abstract

Background/Aims: Although endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is performed globally, the procedure remains challenging. Guidewire manipulation is the most difficult step, and there are few reports on the factors associated with unsuccessful guidewire manipulation. This study aimed to assess the significance of the puncture angle on EUS images and identify the most effective guidewire rescue method for patients with unsuccessful guidewire manipulation. Methods: We retrospectively enrolled 115 patients who underwent EUS-HGS between May 2016 and April 2022 at two centers. The puncture angle between the needle and the intrahepatic bile duct was measured through EUS movie records. Results: Guidewire manipulation was unsuccessful in 28 patients. Receiver operating characteristic (ROC) curves identified an optimal puncture angle cutoff value of 85° (cutoff value, 85°; area under the ROC curve, 0.826; sensitivity, 85.7%; specificity, 81.6%). Multivariate analysis demonstrated that a puncture angle <85° was a significant risk factor for unsuccessful guidewire manipulation (odds ratio, 19.8; 95% confidence interval, 6.42-61.5; p<0.001). Among the 28 unsuccessful cases, 24 patients (85.7%) achieved successful guidewire manipulation using various rescue methods. Conclusions: The puncture angle observed on EUS is crucial for guidewire manipulation. A puncture angle of <85° was associated with unsuccessful guidewire manipulation.

Keywords

Acknowledgement

This work was supported in part by JSPS KAKENHI (grant number: JP18K09945) and the Grant of The Clinical Research Promotion Foundation (2022).

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