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Abstract
Background and aim
In cases where tract dilation fails using the initially selected dilation device during
EUS-guided hepaticogastrostomy (HGS), dilation should be re-attempted using another
device. However, switching from one device to another during procedure is often associated
with prolonged procedure time and deviation from the correct axis. Therefore, it is
highly desired that the initial tract dilation succeeds on the first attempt. Recently,
a novel drill dilator has become available in Japan. As there have been no previous
studies comparing this novel device to others as an initial dilation device, here
we report on the technical feasibility of this novel device for use during EUS-HGS,
and compare it with a balloon catheter.
Method
This retrospective study included patients who underwent EUS-HGS using SEMS between
October 2021 and October 2022. Excluded from the study were patients who underwent
EUS-HGS using a plastic stent or stent deployment without tract dilation. The primary
outcome in this study was the technical success rate of initial tract dilation using
the drill dilator. This dilator has been available at our hospital since June 2022.
Therefore, EUS-HGS was performed using this device as the primary dilation device
from June 2022 to October 2022. As the control group, we corrected patients who underwent
EUS-HGS using 4-mm balloon catheter as the primary dilation device from October 2021
to May 2022.
Result
A total of 49 patients were included, of whom 19 underwent EUS-HGS using the drill
dilator and 30 underwent EUS-HGS using a balloon catheter. EUS-HGS using the drill
dilator initially was performed mainly by non-expert hands (n=19), whereas only some
in the balloon catheter group were performed by non-expert hands (n=2). Although the
initial tract dilation was successful in all patients in the drill dilator group (19/19,
100%) and in 29/30 (97%) in the balloon catheter group, an additional tract dilation
was needed in 73.7% (14/19) of the drill dilator group upon 8.5Fr stent delivery system
insertion. On the other hand, the stent delivery system insertion was successful without
an additional tract dilation in all patients of the balloon catheter group.
Conclusions
The novel drill dilator might be useful as a dilation device, however, the balloon
dilation technique should be selected first upon deploying a dedicated metal stent
with an 8.5Fr stent delivery system.
Key words
Abbreviations:
EUS (endoscopic ultrasound), SEMS (self-expandable metal stent), EUS-BD (endoscopic ultrasound-guided biliary drainage), EUS-HGS (endoscopic ultrasound-hepaticogastrostomy), ERCP (endoscopic retrograde cholangiopancreatography)To read this article in full you will need to make a payment
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Article info
Publication history
Accepted:
February 4,
2023
Received in revised form:
January 18,
2023
Received:
November 14,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
CONFLICT OF INTEREST: The authors declare that there are no conflicts of interest.
Authors’ contributions: Mitsuki Tomita and Takeshi Ogura wrote the paper. Takeshi Ogura, Saori Ueno, Atsushi Okuda, Nobu Nishioka, Akira Miyano, Yoshitaro Yamamoto, Kimi Bessho, Yuki Uba, Nobuhiro Hattori, Junichi Nakamura, and Hiroki Nishikawa interpreted data for the work, revised the work critically for important intellectual content, gave final approval of the version to be published, and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Identification
Copyright
© 2023 by the American Society for Gastrointestinal Endoscopy
