Effect of echoendoscope angle on success of guidewire manipulation during endoscopic ultrasound-guided hepaticogastrostomy
Background With endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS), guidewire manipulation might be a critically limiting step for nonexperts. However, the causes of difficult guidewire manipulation remain unclear. The aim of this study was to evaluate factors associated with successful guidewire manipulation.
Methods This retrospective cohort study included consecutive patients who underwent EUS-HGS between October 2018 and October 2019. We measured scope angle between the long and needle axes of the echoendoscope using still fluoroscopic imaging immediately after puncturing the intrahepatic bile duct. Factors associated with successful guidewire insertion were assessed by multivariable analysis using logistic regression.
Result The influence of the angle between the fine-needle aspiration (FNA) needle and echoendoscope on failed guidewire insertion was assessed using receiver operating characteristic (ROC) curves. Area under the ROC curve was 0.86 (95 % confidence interval [CI] 0.00 – 0.76), and an angle of 135° offered 88.0 % sensitivity and 82.9 % specificity for predicting successful guidewire insertion. According to multivariable analysis, only angle between the FNA needle and echoendoscope > 135° was independently associated with successful guidewire insertion (odd ratio 0.03, 95 %CI 0.01 – 0.14; P < 0.05), whereas sex, puncture site, and diameter of puncture site were not significant factors. After multivariable analysis, all variables were adjusted using age ≥ 70 or < 70 years, yielding the same results.
Conclusion The angle between the FNA needle and echoendoscope might be associated with successful guidewire manipulation during EUS-HGS. Adjusting this angle to 135° before puncturing the intrahepatic bile duct might be helpful in achieving successful guidewire manipulation during EUS-HGS.
Received: 25 February 2020
Accepted: 15 June 2020
15 June 2020 (online)
© 2020. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
- 1 Coté GA, Ansstas M, Pawa R. et al. Difficult biliary cannulation: use of physician-controlled wire-guided cannulation over a pancreatic duct stent to reduce of precut sphincterotomy (with video). Gastrointest Endosc 2010; 71: 275-279
- 2 Takenaka M, Minaga K, Kamata K. et al. Efficacy of a modified double-guidewire technique using an uneven double lumen cannula (uneven method) in patients with surgically altered gastrointestinal anatomy (with video). Surg Endosc 2020; 34: 1432-1441
- 3 Tonozuka R, Itoi T, Tsuchiya T. et al. EUS-guided biliary drainage is infrequency used even in high-volume centers of interventional EUS. Gastrointest Endosc 2016; 84: 206-207
- 4 Sano I, Katanuma A, Kuwatanb M. et al. Long-term outcomes after therapeutic endoscopic retrograde cholangiopancreatography using balloon-assisted enteroscopy for anastomotic stenosis of choledochojejunostomy/ pancreaticojejunostomy. J Gastroenterol Hepatol 2019; 34: 612-619
- 5 Miller CS, Barkun A, Martel M. et al. Endoscopic ultrasound-guided biliary drainage for distal malignant obstruction: a systematic review and meta-analysis of randomized trials. Endosc Int Open 2019; 7: E1563-E1573
- 6 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
- 7 Hedjoudje A, Sportes A, Grabar S. et al. Outcomes of endoscopic ultrasound-guided biliary drainage: a systematic review and meta-analysis. United European Gstroenterol J 2019; 7: 52-59
- 8 Guo J, Giovannini M, Sahai AV. et al. A multi-institution consensus on how to perform EUS-guided biliary drainage for malignant biliary obstruction. Endosc Ultrasound 2018; 7: 356-365
- 9 Teoh AYB, Dhir V, Kida M. et al. Consensus guidelines on the optimal management in interventional EUS procedures: result from the Asian EUS group RAND/UCLA expert panel. Gut 2018; 67: 1209-1228
- 10 Boulay BR, Lo SK. Endoscopic ultrasound-guided biliary drainage. Gastrointest Endosc Clin N Am 2018; 28: 171-185
- 11 Nakai Y, Kogure H, Isayama H. et al. Endoscopic ultrasound-guided biliary drainage for benign biliary disease. Clin Endosc 2019; 52: 212-219
- 12 Mukai S, Itoi T, Sofuni A. et al. EUS-guided antegrade intervention for benign diseases in patients with surgically altered anatomy (with videos). Gastrointest Endosc 2019; 89: 399-407
- 13 Ogura T, Takenaka M, Shiomi H. et al. Long-term outcomes of EUS-guided transluminal stent deployment for benign biliary disease: multicenter clinical experience (with videos). Endosc Ultrasound 2019; 8: 398-403
- 14 Ogura T, Nishioka N, Yamada M. et al. Novel transluminal treatment protocol for hepaticojejunostomy stricture using covered self-expandable metal stent. Surg Endosc 2020; DOI: 10.1007/s00464-020-07381-2.
- 15 Ogura T, Nishioka N, Higuchi K. Transluminal intrahepatic bile duct stone removal using coaxial basket catheter via the previously created EUS-guided hepaticogastrostomy tract (with videos). Endosc Ultrasound 2019; 8: 133-135
- 16 Eum J, Park DH, Ryu CH. et al. EUS-guided biliary drainage with a fully covered metal stent as a novel route for natural orifice transluminal endoscopic biliary interventions: a pilot study (with videos). Gastrointest Endosc 2010; 72: 1279-1284
- 17 Ogura T, Takagi W, Kurisu Y. et al. Technical tips for peroral transluminal cholangioscopy using novel single-operator cholangioscope (with videos). J Hepatobiliary Pancreat Sci 2016; 23: E25-E29
- 18 Kamiyama R, Ogura T, Okuda A. et al. Electrohydraulic lithotripsy for difficult bile duct stones under endoscopic retrograde cholangiopancreatography and peroral transluminal cholangioscopy guidance. Gut Liver 2018; 15: 457-462
- 19 van Geenen EJM, Siersema PD. Stent migration into the abdominal cavity after EUS-guided hepaticogastrostomy. Gastrointest Endosc 2018; 87: 617-618
- 20 Prachayakul V, Aswakul P. Successful endoscopic treatment of iatrogenic biloma as a complication of endosonography-guided hepaticogastrostomy: the first case report. J Interv Gastroenterol 2012; 2: 202-204
- 21 Vila JJ, Pérez-Miranda M, Vazquez-Sequeiros E. et al. Initial experience with EUS-guided cholangiopancreatography for biliary and pancreatic duct drainage: a Spanish national survey. Gastrointest Endosc 2012; 76: 1133-1141
- 22 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
- 23 Cotton PB, Eisen GM, Aabakken L. et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010; 71: 746-754
- 24 Paik WH, Lee TH, Park DH. et al. EUS-guided biliary drainage versus ERCP for the primary palliation of malignant biliary obstruction: a multicenter randomized clinical trial. Am J Gastroenterol 2018; 113: 987-997
- 25 Hathom KE, Bazarbashi AN, Sack JS. et al. EUS-guided biliary drainage is equivalent to ERCP for primary treatment of malignant distal biliary obstruction: a systematic review and meta-analysis. Endosc Int Open 2019; 7: E1432-E1441
- 26 Ogura T, Masuda D, Takeuchi T. et al. Liver impaction technique to prevent shearing of the guidewire during endoscopic ultrasound-guided hepaticogastrostomy. Endoscopy 2015; 47: E583-E584
- 27 Oh D, Park DH, Song TJ. et al. Optimal biliary access point and learning curve for endoscopic ultrasound-guided hepaticogastrostomy with transmural stenting. Therap Adv Gastroenterol 2017; 10: 42-53