Clin Endosc.  2024 Jul;57(4):515-526. 10.5946/ce.2023.142.

Outcomes of partially covered self-expandable metal stents with different uncovered lengths in endoscopic ultrasound-guided hepaticogastrostomy: a Japanese retrospective study

• Okamoto T
• Sasaki T
• Takeda T
• Hirai T
• Ishitsuka T
• Yamada M
• Nakagawa H
• Mie T
• Furukawa T
• Kasuga A
• Ozaka M
• Sasahira N

• KMID: 2558109
• DOI: http://doi.org/10.5946/ce.2023.142

Abstract

Background/Aims
The optimal length of the uncovered portion of partially covered self-expandable metal stents (PCSEMSs) used in endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) remains unclear. This study investigated the safety and efficacy of PCSEMSs with different uncovered lengths, with a focus on stent migration and time to recurrent biliary obstruction (RBO).
Methods
Outcomes of patients undergoing EUS-HGS using PCSEMSs with 5-mm and 20-mm uncovered portions at our institution from January 2016 to December 2021 were compared.
Results
Sixty-two patients underwent EUS-HGS using PCSEMS (5/20-mm uncovered portions: 32/30). Stent migration occurred only in the 5-mm group. There were no differences in RBO rates (28.1% vs. 40.0%) or median time to RBO (6.8 vs. 7.1 months) between the two groups. Median overall survival (OS) was longer in the 20-mm group (3.1 vs. 4.9 months, p=0.037) due to the higher number of patients that resumed chemotherapy after EUS-HGS (56.7% vs. 28.1%, p=0.029). Good performance status, absence of hepatic metastases, and chemotherapy after EUS-HGS were independent predictors of longer OS.
Conclusions
No migration was observed in patients treated with PCSEMS with 20-mm uncovered portions. Patients treated with PCSEMS with 20-mm uncovered portions performed at least as well as those treated with 5-mm uncovered portions in all material respects.

Keyword

Biliary tract; Bile duct obstruction; Endosonography; Pancreatic neoplasms; Self expandable metallic stents

Figure

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  Fig. 1. (A) Niti-S Biliary S-type Stent, a partially covered self-expandable metal stent (PCSEMS) with a 5-mm uncovered portion on the liver side (right) and a short, 2-mm flare on the stomach side (left). (B) Modified EGIS Biliary Stent, Double Covered, a PCSEMS modified to extend the short uncovered portion on the liver side (right) to 20 mm. (C) Niti-S S-type Spring Stopper Stent, a PCSEMS with a 20-mm uncovered portion on the liver side (right) and a flange on the stomach side (left).

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  Fig. 2. Kaplan-Meier curve for time to recurrent biliary obstruction (RBO), stratified by length of the uncovered portion.

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