Outcomes of Partially Covered Self-expandable Metal Stents with Different Uncovered Lengths in Endoscopic Ultrasound-guided Hepaticogastrostomy: a Japanese Retrospective Study

Overview

Journal Clin Endosc

Date 2024 May 10

PMID 38725401

Authors

Takeshi Okamoto

Takashi Sasaki

Tsuyoshi Takeda

Tatsuki Hirai

Takahiro Ishitsuka

Manabu Yamada

Hiroki Nakagawa

Takafumi Mie

Takaaki Furukawa

Akiyoshi Kasuga

Masato Ozaka

Naoki Sasahira

Affiliations

Soon will be listed here.

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.

Citing Articles

Migration of covered expandable metal stents after endoscopic ultrasound-guided hepaticogastrostomy: stent covering versus stent design?.

Baron T Clin Endosc. 2024; 57(4):471-472.

PMID: 39075974 PMC: 11294865. DOI: 10.5946/ce.2024.158.

References

Eisenhauer E, Therasse P, Bogaerts J, Schwartz L, Sargent D, Ford R . New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2008; 45(2):228-47. DOI: 10.1016/j.ejca.2008.10.026. View

Wang K, Zhu J, Xing L, Wang Y, Jin Z, Li Z . Assessment of efficacy and safety of EUS-guided biliary drainage: a systematic review. Gastrointest Endosc. 2015; 83(6):1218-27. DOI: 10.1016/j.gie.2015.10.033. View

Cho D, Lee S, Oh D, Song T, Park D, Seo D . Long-term outcomes of a newly developed hybrid metal stent for EUS-guided biliary drainage (with videos). Gastrointest Endosc. 2016; 85(5):1067-1075. DOI: 10.1016/j.gie.2016.09.010. View

Attasaranya S, Netinasunton N, Jongboonyanuparp T, Sottisuporn J, Witeerungrot T, Pirathvisuth T . The Spectrum of Endoscopic Ultrasound Intervention in Biliary Diseases: A Single Center's Experience in 31 Cases. Gastroenterol Res Pract. 2012; 2012:680753. PMC: 3357930. DOI: 10.1155/2012/680753. View

Bories E, Pesenti C, Caillol F, Lopes C, Giovannini M . Transgastric endoscopic ultrasonography-guided biliary drainage: results of a pilot study. Endoscopy. 2007; 39(4):287-91. DOI: 10.1055/s-2007-966212. View

Nakai Y, Isayama H, Yamamoto N, Matsubara S, Ito Y, Sasahira N . Safety and effectiveness of a long, partially covered metal stent for endoscopic ultrasound-guided hepaticogastrostomy in patients with malignant biliary obstruction. Endoscopy. 2016; 48(12):1125-1128. DOI: 10.1055/s-0042-116595. View

Cassan C, Bories E, Pesenti C, Caillol F, Godat S, Ratone J . Use of partially covered and uncovered metallic prosthesis for endoscopic ultrasound-guided hepaticogastrostomy: Results of a retrospective monocentric study. Endosc Ultrasound. 2017; 6(5):329-335. PMC: 5664854. DOI: 10.4103/2303-9027.209869. View

Ogura T, Yamamoto K, Sano T, Onda S, Imoto A, Masuda D . Stent length is impact factor associated with stent patency in endoscopic ultrasound-guided hepaticogastrostomy. J Gastroenterol Hepatol. 2015; 30(12):1748-52. DOI: 10.1111/jgh.13021. View

Emmanuel J, Omar H, See L . 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(6):1059-1064. PMC: 7731807. DOI: 10.1002/jgh3.12386. View

10.

Miyano A, Ogura T, Yamamoto K, Okuda A, Nishioka N, Higuchi K . Clinical Impact of the Intra-scope Channel Stent Release Technique in Preventing Stent Migration During EUS-Guided Hepaticogastrostomy. J Gastrointest Surg. 2018; 22(7):1312-1318. DOI: 10.1007/s11605-018-3758-1. View

11.

Martins F, Rossini L, Ferrari A . Migration of a covered metallic stent following endoscopic ultrasound-guided hepaticogastrostomy: fatal complication. Endoscopy. 2010; 42 Suppl 2:E126-7. DOI: 10.1055/s-0029-1243911. View

12.

Ramirez-Luna M, Tellez-Avila F, Giovannini M, Valdovinos-Andraca F, Guerrero-Hernandez I, Herrera-Esquivel J . Endoscopic ultrasound-guided biliodigestive drainage is a good alternative in patients with unresectable cancer. Endoscopy. 2011; 43(9):826-30. DOI: 10.1055/s-0030-1256406. View

13.

Isayama H, Nakai Y, Itoi T, Yasuda I, Kawakami H, Ryozawa S . Clinical practice guidelines for safe performance of endoscopic ultrasound/ultrasonography-guided biliary drainage: 2018. J Hepatobiliary Pancreat Sci. 2019; 26(7):249-269. PMC: 7064894. DOI: 10.1002/jhbp.631. View

14.

Paik W, Park D, Choi J, Choi J, Lee S, Seo D . Simplified fistula dilation technique and modified stent deployment maneuver for EUS-guided hepaticogastrostomy. World J Gastroenterol. 2014; 20(17):5051-9. PMC: 4009540. DOI: 10.3748/wjg.v20.i17.5051. View

15.

Yamamura M, Ogura T, Ueno S, Okuda A, Nishioka N, Yamada M . Partially covered self-expandable metal stent with antimigratory single flange plays important role during EUS-guided hepaticogastrostomy. Endosc Int Open. 2022; 10(2):E209-E214. PMC: 8847065. DOI: 10.1055/a-1729-0048. View

16.

Isayama H, Hamada T, Yasuda I, Itoi T, Ryozawa S, Nakai Y . TOKYO criteria 2014 for transpapillary biliary stenting. Dig Endosc. 2014; 27(2):259-64. DOI: 10.1111/den.12379. View

17.

Okuno N, Hara K, Mizuno N, Hijioka S, Imaoka H, Yamao K . Stent migration into the peritoneal cavity following endoscopic ultrasound-guided hepaticogastrostomy. Endoscopy. 2015; 47 Suppl 1 UCTN:E311. DOI: 10.1055/s-0034-1392314. View

18.

Asai S, Takeshita K, Ichinona T, Akamine E, Fujimoto N . A novel partially covered metallic stent with a 20-mm long distal bare portion for EUS-guided hepaticogastrostomy. VideoGIE. 2021; 6(7):322-324. PMC: 8270758. DOI: 10.1016/j.vgie.2021.03.007. View

19.

Nakai Y, Sato T, Hakuta R, Ishigaki K, Saito K, Saito T . 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(3):623-631.e1. DOI: 10.1016/j.gie.2020.03.3856. View

20.

Cotton P, Eisen G, Aabakken L, Baron T, Hutter M, Jacobson B . A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc. 2010; 71(3):446-54. DOI: 10.1016/j.gie.2009.10.027. View