A newly designed plastic stent for EUS-guided hepaticogastrostomy: a prospective preliminary feasibility study

Background: There are currently no dedicated plastic stents for EUS-guided hepaticogastrostomy (EUS-HGS). Objective: We prospectively evaluated the feasibility and the technical and functional success rates of our newly designed plastic stent for EUS-HGS. Design: Prospective preliminary feasibility study. Setting: A tertiary-care referral center. Patients: Twenty-three consecutive patients were treated. The reasons for requiring EUS-HGS were periampullary tumor invasion (n = 9), altered anatomy (n = 7), failed duodenal intubation (n = 3), and previous ERCP failure (n = 4). Interventions: An 8F single-pigtail plastic stent with 4 flanges was placed for EUS-HGS. Main Outcome Measurements: Technical success, clinical success, and adverse events according to the American Society for Gastrointestinal Endoscopy lexicon. Results: All stents were successfully deployed without procedural adverse events (100% technical success rate). Bleeding from the punctured gastric wall occurred in 1 patient 3 days postoperatively. We exchanged the plastic stent for a fully covered self-expandable metal stent. A mild adverse event of self-limited abdominal pain occurred in 3 patients. Treatment success was achieved in all patients. The occlusion rate was 13.7% (3/22) during the median follow-up period (5.0 months, range 0.5-12.5 months). The median duration of stent patency was 4.0 months (range 0.5-9.0 months). There was no stent migration or dislocation during the follow-up period. Limitations: Small number of patients and lack of a control group. Conclusions: This newly designed single-pigtail plastic stent dedicated for EUS-HGS was technically feasible and can possibly be used for highly selected patients with advanced malignancy or benign stricture.