Clinical evaluation of physician-controlled guidewire manipulation during endoscopic ultrasound-guided hepaticogastrostomy (with video)

Abstract

Background and study aims Endoscopic ultrasound (EUS)-guided hepaticogastrostomy (HGS) may be most complex because of the EUS-guided biliary drainage procedure and variations in the course of the intrahepatic bile duct compared with the common bile duct (CBD). Appropriate guidewire insertion is essential. Physician-controlled guidewire manipulation (PCGW) might improve technical success rates of bile duct cannulation. The present study aimed to determine the technical feasibility and safety of PCGW during EUS-HGS.

Patients and methods A total of 122 consecutive patients who were scheduled to undergo EUS-HGS between October 2017 and April 2019 were prospectively registered. The primary endpoint was the technical success rate of guidewire insertion into the CBD or hepatic hilum. Guidewire insertion was considered to have failed if the HGS assistant failed to achieve manipulation.

Results The intrahepatic bile duct was successfully punctured in 120 of 122 patients. During guidewire insertion by the HGS assistant, guidewire fracture was observed in one patient. The guidewire was successfully inserted into the biliary tract and manipulated by the HGS assistant in 96 patients. PCGW was thus attempted for the remaining 23 patients. The guidewire was inserted by PCGW in all 23 patients, improving the technical success rate for guidewire insertion from 80 % to 100 %. After tract dilation, we deployed covered metal stents and plastic stents in 117 and two patients, respectively. The overall technical success rate for EUS-HGS was 97.5 % (119/122). Adverse events comprising bile peritonitis or leakage developed in five patients.

Conclusion PCGW might contribute to improving the success rate of EUS-HGS.

Publication History

Received: 25 August 2020

Accepted: 19 October 2020

Article published online:
19 February 2021

• References

• 1 Fogel EL, Sherman S, Park SH. et al. Therapeutic biliary endoscopy. Endoscopy 2003; 35: 156-163
• 2 Fujita N. Endoscopic management of biliary malignancies. Gastrointest Endosc Clin N Am 2008; 18: 565-579
• 3 Gerges C, Schumacher B, Terheggen G. et al. Expandable metal stents for malignant biliary obstruction. Gastrointest Endosc Clin N Am 2011; 21: 481-497
• 4 Salerno R, Davies SEC, Mezzina N. et al. Comprehensive review on EUS-guided biliary drainage. World J Gastrointest Endosc 2019; 16: 354-364
• 5 Kahaleh M, Artifon ELA, Perez-Miranda M. et al. EUS-guided drainage: Summary of therapeutic EUS consortium meeting. Endosc Ultrasound 2019; 8: 151-160
• 6 Boulay BR, Lo SK. Endoscopic ultrasound-guided biliary drainage. Gastrointest Endosc Clin N Am 2018; 28: 171-185
• 7 Teoh AYB, Dhir V, Kida M. et al. Consensus guideline on the optimal management in interventional EUS procedures: results from the Asian EUS group RAND/UCLA expert panel. Gut 2018; 67: 1209-1228
• 8 Baars JE, Kaffes AJ, Saxena P. EUS-guided biliary drainage: A comprehensive review of the literature. Endosc Ultrasound 2018; 7: 4-9
• 9 Ogura T, Higuchi K. Technical tips for endoscopic ultrasound-guided hepaticogastrostomy. World J Gastroenterol 2016; 22: 3945-3951
• 10 Hedoude A, Sportes A, Grabar S. et al. Outcomes of endoscopic ultrasound-guided biliary drainage: A systematic review and meta-analysis. United European Gastroenterol J 2019; 7: 60-68
• 11 Isayama H, Nakai Y, Itoi T. et al. Clinical practice guideline for safe performance of endoscopic ultrasound/ultrasonography-guided biliary drainage: 2018. J Hepatobiliary Pancreat Sci 2019; 26: 249-269
• 12 Dhir V, Isayama H, Itoi T. et al. Endoscopic ultrasonography-guided biliary and pancreatic duct interventions. Dig Endosc 2017; 29: 472-485
• 13 Honjo M, Itoi T, Tsuchiya T. et al. Safety and efficacy of ultra-tapered mechanical dilator for EUS-guided hepaticogastrostomy and pancreatic duct drainage compared with electrocautery dilator (with video). Endosc Ultrasound 2018; 7: 376-382
• 14 Ogura T, Nakai Y, Itoi T. Novel fine gauge electrocautery dilator for endoscopic ultrasound-guided hepaticogastrostomy (with video). J Hepatobiliary Pancreat Sci 2019; 26: E3-E4
• 15 Amano M, Ogura T, Onda S. et al. Prospective clinical study of endoscopic ultrasound-guided biliary drainage using novel balloon catheter (with video). J Gastroenterol Hepatol 2017; 32: 716-720
• 16 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
• 17 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 the rate of precut sphincterotomy (with video). Gastrointest Endosc 2010; 71: 275-279
• 18 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
• 19 Cotton PB, Eisen GM, Aabakken L. et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010; 71: 446-454
• 20 Oh D, Park DH, Song TJ. et al. Optimal biliary access point and learning curve for endoscopic ultrasound-guided hepaticogastrostomy with transluminal stenting. Therap Adv Gastroenterol 2017; 10: 42-53
• 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