Simplified fistula dilation technique and modified stent deployment maneuver for EUS-guided hepaticogastrostomy

AIM:To evaluate the success rates,procedural time and adverse event rates of the modified methods in endoscopic ultrasonography-guided hepaticogastrostomy(EUS-HGS).METHODS:Twenty-eight patients in a prospective case series who underwent EUS-HGS(phaseⅠ).Fortysix patients in a matched case-control study(phaseⅡ).The simplified technique for fistula dilation was the primary use of a 4 mm balloon catheter with a stainless steel stylet.The stent deployment was modified by deploying the metal stent inside a bile duct(half of the stent)under EUS and fluoroscopic guidance and gently pulling the echoendoscope after full deployment of the stent inside the echoendoscope channel(remaining portion of the stent)under fluoroscopic guidance.This cohort was compared with a matched historical cohort.RESULTS:In phaseⅠ,the technical and clinical success with the modified method was 96%(27/28)and89%(24/27 as per-protocol analysis).The overall adverse event rate was 7%.In phaseⅡ,there was no difference in technical and clinical success,stent patency and overall adverse events in each group.However,the procedural time(15.3±5.2 min vs 22.3±6.0 min,P<0.001)and early adverse events(0%vs 26%,P=0.02)were statistically improved in case cohort compared with control cohort.CONCLUSION:Compared with the conventional EUSHGS technique,the procedural time was shorter and early adverse events were less frequent with our simplified and modified technique.