PMID- 37473968 OWN - NLM STAT- Publisher LR - 20231020 IS - 1097-6779 (Electronic) IS - 0016-5107 (Linking) VI - 98 IP - 5 DP - 2023 Nov TI - Preliminary feasibility study of a new partially covered self-expandable metal stent with an anchoring flange for EUS-guided hepaticogastrostomy (with videos). PG - 848-856 LID - S0016-5107(23)02751-7 [pii] LID - 10.1016/j.gie.2023.07.020 [doi] AB - BACKGROUND AND AIMS: EUS-guided hepaticogastrostomy (EUS-HPG) has a risk of serious procedural adverse events (AEs), but few dedicated devices for EUS-HPG are available. We evaluated the feasibility of a new partially covered self-expandable metal stent (PCSEMS) with an anchoring flange for EUS-HPG. METHODS: The feasibility of a stent featuring a proximal radiopaque uncovered portion 1.5 cm in length and a distal anchoring flange 20 mm in diameter was evaluated in consecutive patients undergoing EUS-HPG for unresectable malignant biliary obstruction. Primary outcomes were the technical and clinical success of EUS-HPG, and secondary outcomes were AEs, recurrent biliary obstruction (RBO), reintervention for RBO, and the technical feasibility of peroral cholangioscopy (POC) through the stent in situ. RESULTS: EUS-HPG was performed in 24 patients with unresectable malignant biliary obstruction. The technical and clinical success rates of EUS-HPG were 100% (24/24) and 91.7% (22/24), respectively. AEs developed after EUS-HPG in 8.3% of patients (2/24, cholangitis). RBO developed in 29.2% of patients (7/24), with a median cumulative time to RBO of 6.7 months. The causes of RBO were sludge formation (n = 4), hyperplasia at an uncovered portion (n = 2), and nonocclusive cholangitis (n = 1). Reintervention for RBO had a 100% success rate (7/7), and POC through the stent in situ was technically feasible in 7 of 8 patients with a stent diameter of 10 mm. CONCLUSIONS: EUS-HPG with a new PCSEMS can alleviate malignant biliary obstruction after failed ERCP. The novel stent evaluated in this study may prevent stent-related AEs, including stent migration, and allow advanced endoscopic interventions through the HPG route. CI - Copyright (c) 2023 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved. FAU - Shin, Il Sang AU - Shin IS AD - Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon, South Korea. FAU - Moon, Jong Ho AU - Moon JH AD - Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon, South Korea. FAU - Lee, Yun Nah AU - Lee YN AD - Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon, South Korea. FAU - Myeong, Jun Ho AU - Myeong JH AD - Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon, South Korea. FAU - Lee, Tae Hoon AU - Lee TH AD - Cheonan, South Korea. FAU - Yang, Jae Kook AU - Yang JK AD - Cheonan, South Korea. FAU - Cho, Young Deok AU - Cho YD AD - Seoul, South Korea. FAU - Park, Sang-Heum AU - Park SH AD - Cheonan, South Korea. FAU - Giovannini, Marc AU - Giovannini M AD - Endoscopy Unit, Paoli Calmettes Institute, Marseille, France. LA - eng PT - Journal Article DEP - 20230718 PL - United States TA - Gastrointest Endosc JT - Gastrointestinal endoscopy JID - 0010505 SB - IM COIS- Disclosure The following author received research support for this study in part from the SoonChunHyang University Research Fund: J. H. Moon. In addition, the following author disclosed financial relationships: J. H. Moon: Inventor of the Niti-S Spaxus-MG stent. All other authors disclosed no financial relationships. EDAT- 2023/07/21 01:11 MHDA- 2023/07/21 01:11 CRDT- 2023/07/20 19:26 PHST- 2023/04/24 00:00 [received] PHST- 2023/06/13 00:00 [revised] PHST- 2023/07/13 00:00 [accepted] PHST- 2023/07/21 01:11 [pubmed] PHST- 2023/07/21 01:11 [medline] PHST- 2023/07/20 19:26 [entrez] AID - S0016-5107(23)02751-7 [pii] AID - 10.1016/j.gie.2023.07.020 [doi] PST - ppublish SO - Gastrointest Endosc. 2023 Nov;98(5):848-856. doi: 10.1016/j.gie.2023.07.020. Epub 2023 Jul 18.