EUS-GUIDED HEPATICOGASTROSTOMY (HGS) AND ANTEGRADE TREATMENT WITH KAFFES ANASTOMOTIC STENT (KAS) OF BILIO-ENTERIC ANASTOMOTIC STRICTURES (BEAS) IN PATIENTS WITH SURGICALLY ALTERED ANATOMY (SAA)

Introduction BEAS can be treated endoscopically in SAA antegradely via HGS. We adapted KAS, originally designed for choledocho-choledochostomy strictures, to treat BEAS.

Procedure Two stages: INDEX=a+b; a)Creation of HGS using transgastric cholangiography (segment-II), serial dilation, 8x80mm SEMS with antimigration flaps placement, stent dilation and fixation/clipping; b)Antegrade intervention attempting transanastomotic guidewire passage through catheters introduced via HGS, antegrade BEAS dilation, and transanastomotic KAS placement. REVISION=KAS&HGS removal. 5 BEAS were treated with 100% short-term success (1-cholangitis). At 21[3-33]-months follow-up, 4 patients finished treatment (3-asymptomatic/1-relapse, re-treated with KAS), and 1 await stent removal.

Conclusions The design of KAS may enhance BEAS treatment via HGS.