Risk Factors For A Successful EUS-Guided Hepaticogastrostomy Using A Pre-Established Endoscopic Protocol

Aims Endoscopic ultrasound (EUS)-guided hepaticogastrostomy is a challenging alternative to endoscopic retrograde cholangiopancreatography (ERCP). However, there is no consensus on how to perform the technique to decrease morbidity and mortality. To assess the risk factors to success or complications using a pre-established protocol.

Methods This is a prospective single-center study. All patients with a malignant biliary obstruction who underwent EUS-guided hepaticogastrostomy in 2019-2020 were included. A pre-established protocol depending on anatomic/technical characteristics was used. Technical success was retained when the stent was correctly placed. Clinical success was defined as the improvement of sepsis/cholangitis in 72h. Complications were considered. Risk factors for all outcomes were assessed by multivariate analysis.

Results Twenty-six patients (mean age: 68.5±15.9yr, 65.4 % male) with a malignant duodenal stenosis (n = 17), previous ERCP failure (n = 5) or post-surgical anatomy (n = 4) were included. A hepaticogastrostomy alone (n = 21) or combined with anterograde stenting (n = 5) were performed with a median of 1.5 punctures (range: 1-4) by using a 19-gauge (n = 23, 88.5 %) or 22-gauge needles (n = 3, 11.5 %). The intrahepatic biliary duct (IHBC) measured a median of 4mm (range: 1.1-10).

Technical and clinical success were achieved in 23 (88.5 %) and 19 (73.1 %) cases. The complication rate was 23.1 % during a median follow-up of 11 weeks (1-46) as follows: peritonitis (n = 3, 11.5 %), delayed bleeding (n = 2, 7.7 %) and cholangitis (n = 1, 3.8 %). The reintervention rate was 19.2 %. Mortality was 3.8 %.

A distance >2cm between the IHBC and liver margins was associated to clinical success (p = 0.008) and lower reintervention rate (p = 0.027). The IHBC > 3mm was associated to a higher technical success (p = 0.027), clinical success (p = 0.003) and lower reintervention rate (p = 0.012). The presence of ascites was associated to peritonitis (66.7 % vs. 33.3 %, p = 0.001).

Conclusions EUS-guided gastrostomy is an effective alternative to ERCP. The understanding of risk factors to complications is essential to accurately select the patients and decrease morbidity and mortality.

Citation Perez-Cuadrado Rpbles E, Benosman H, Perrod G et al. eP429 RISK FACTORS FOR A SUCCESSFUL EUS-GUIDED HEPATICOGASTROSTOMY USING A PRE-ESTABLISHED ENDOSCOPIC PROTOCOL. Endoscopy 2021; 53: S238.

Publication History

Article published online:
19 March 2021