Feasibility and Efficacy of Endoscopic Ultrasound-Guided Hepaticogastrostomy Without Dilation: A Propensity Score Matching Analysis

Background Recently, endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) procedures have been gradually established; nonetheless, some adverse events (AEs) have been reported. Dilation procedures using a non-cautery or cautery device increase the incidence of AEs in EUS-HGS. Aims We evaluated EUS-HGS procedures without dilation and the factors associated with dilation. Methods We enrolled 79 patients who underwent EUS-HGS between July 2015 and March 2021 at two centers, 72 of whom had technical success (72/79, 91%). During the EUS-HGS procedures, we defined patients without dilation procedures as the dilation (−) group. We divided the patients into two groups: the dilation (+) (35 patients) and dilation (−) (37 patients) groups. We performed a propensity score matching analysis to adjust for confounding bias between the two groups. Multivariable logistic regression analysis was conducted to identify factors associated with dilation. Results There was no difference in clinical success rate between the dilation (+) and dilation (−) groups (91% vs. 95%, P = 0.545). The AE rate ( P = 0.013) and long procedure time ( P = 0.017) were significantly higher in the dilation (+) group than in the dilation (−) group before and after propensity score matching. Factors associated with dilation were plastic stent placement (odds ratio [OR], 6.96; 95% confidence interval [CI], 1.68–28.7; P = 0.007) and puncture angle of ≤ 90° (OR, 44.6; 95% CI, 5.1–390; P