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CC BY 4.0 · Journal of Digestive Endoscopy 2025; 16(01): 029-036
DOI: 10.1055/s-0045-1806742
Research Article

Outcomes of Endoscopic Ultrasound-Guided Hepaticogastrostomy Using a 22G Needle Combined with a Double-Guidewire Technique

Autoren

  • Toru Kaneko

    1   Department of Gastroenterology, Kitasato University Medical Center, Saitama, Japan

  • Mitsuhiro Kida

    1   Department of Gastroenterology, Kitasato University Medical Center, Saitama, Japan

  • Takahiro Kurosu

    1   Department of Gastroenterology, Kitasato University Medical Center, Saitama, Japan

  • Gen Kitahara

    1   Department of Gastroenterology, Kitasato University Medical Center, Saitama, Japan

  • Shiori Koyama

    1   Department of Gastroenterology, Kitasato University Medical Center, Saitama, Japan

  • Tomohiro Betto

    1   Department of Gastroenterology, Kitasato University Medical Center, Saitama, Japan

  • Chika Kusano

    2   Department of Gastroenterology, Kitasato University, Kanagawa, Japan

Funding None declared.
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Abstract

Objectives Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is an increasingly used alternative treatment for malignant biliary obstructions. However, improvements to this approach are warranted. Recently, the use of a 22G puncture needle and a 0.018-inch guidewire (GW), as well as the double-GW technique (DGT), have been introduced and adopted by our institution. We retrospectively evaluated the outcomes of EUS-HGS, combined with DGT, using a 22G needle.

Patients and Methods This study included 34 of 54 patients who underwent EUS-HGS, which was performed using a 22G puncture needle combined with DGT at Kitasato University Medical Center Hospital from October 2021 to March 2024. We retrospectively examined patients' backgrounds, the technical success rate (defined as the successful insertion of a stent from the stomach into the intended bile duct), clinical success rate (defined as a decrease in total bilirubin levels to either the normal range or to at least 50% of the prior value within 2 weeks), procedure time (defined as the time from endoscope insertion to stent deployment), incidence of complications, and changes in the angle between the puncture axis and bile duct axis resulting from the use of DGT.

Endpoints and Data Analysis The primary endpoint was the technical success rate of EUS-HGS using a 22G needle combined with a DGT. Secondary endpoints included the clinical success rate, procedure time, GW angle at the puncture site before and after DGT, and incidence of complications. Descriptive statistics were performed.

Results The technical and clinical success rates were 100 and 97.1%, respectively. The average procedure time was 16 minutes. The angle between the puncture and bile duct axis was 145.6 degrees before the DGT, which only involved a 0.018-inch GW; the angle increased to 161.1 degrees after the DGT, bringing the puncture and bile duct axis closer to alignment. The incidence of complications was 2.9%.

Conclusion EUS-HGS with a 22G needle in conjunction with the DGT has a high procedural success rate and low incidence of complications. These two components complement each other and contribute to the overall efficiency and effectiveness of the procedure, even in challenging situations.

Keywords

endoscopic ultrasound-guided hepaticogastrostomy - obstructive jaundice - punctures

Ethical Approval

The study was performed in accordance with the Declaration of Helsinki and was approved by the Institutional Review Board of Kitasato University Medical Centre (IRB approval number: 2024006). All participants provided written informed consent before the procedure.


Data Availability

The data presented in this study are available upon reasonable request from the corresponding author.


Authors' Contributions

M.K.: Supervision, writing–review, and editing; T.K.: Resources; G.K.: Resources; S.K.: Resources; T.B.: Resources; C.K.: Supervision; T.K.: Conceptualization, data curation, investigation, formal analysis, project administration, validation, visualization, and writing–original draft.


Supplementary Material



Publikationsverlauf

Artikel online veröffentlicht:
28. März 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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