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IMAGES AND VIDEOS
Year : 2018  |  Volume : 7  |  Issue : 1  |  Page : 67-68

Stent release within scope channel technique to prevent stent migration during EUS-guided hepaticogastrostomy (with video)


2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan

Date of Submission01-Mar-2017
Date of Acceptance03-Jul-2017
Date of Web Publication15-Feb-2018

Correspondence Address:
Dr. Takeshi Ogura
2nd Department of Internal Medicine, Osaka Medical College, 2-7 Daigakuchou, Takatsukishi, Osaka 569-8686
Japan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/eus.eus_57_17

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How to cite this article:
Ogura T, Okuda A, Miyano A, Nishioka N, Higuchi K. Stent release within scope channel technique to prevent stent migration during EUS-guided hepaticogastrostomy (with video). Endosc Ultrasound 2018;7:67-8

How to cite this URL:
Ogura T, Okuda A, Miyano A, Nishioka N, Higuchi K. Stent release within scope channel technique to prevent stent migration during EUS-guided hepaticogastrostomy (with video). Endosc Ultrasound [serial online] 2018 [cited 2019 Nov 17];7:67-8. Available from: http://www.eusjournal.com/text.asp?2018/7/1/67/225430



Stent migration may be sometimes fatal for EUS-guided biliary drainage such as hepaticogastrostomy (HGS) because it is not adhesions between the biliary tract and the stomach.[1],[2],[3],[4],[5] Stent migration can be occurred in two situations. First is early stent migration. In this situation, stent migration occurs due to stent deployment within abdominal cavity. Second is late stent migration due to stent shortening. If the distance between the hepatic parenchyma and the stomach wall is far, stent migration may occur due to stent shortening. In addition, in this situation, fistula may not be created. If fistula is not created, it may be led to several adverse events such as bile leak or difficult to perform reintervention through EUS-HGS stent. To prevent early and late stent migration or minimize, the stent length of abdominal cavity to create the fistula, we herein described technical tips of EUS-HGS using stent release within scope channel technique [Video 1].




The intrahepatic bile duct was punctured using a 19-gauge FNA needle. Then, the 0.025-inch guidewire (VisiGlide; Olympus Medical Systems, Tokyo, Japan) was inserted into the intrahepatic bile duct. Next, the bile duct and stomach wall were each dilated using 4 mm balloon catheter. Stent delivery system was inserted into the confluence of liver segment 2 and segment 3. Next, stent release is carefully performed from the intrahepatic bile duct to the hepatic parenchyma [Figure 1]a. After this procedure, to stabilize the EUS scope, until the stent was deployed up to 1 cm within the EUS scope [Figure 1]b. Then, EUS scope was pulled little bite after stent delivery system was pushed [Figure 1]c. Finally, stent release was performed under mainly endoscopic view guidance [Figure 1]d. In stent release within scope channel technique, stent deployment completely is performed compressing between liver parenchyma and the stomach wall. Therefore, candy sign may not be observed, and the distance between hepatic parenchyma and the stomach wall may be near [Figure 2]a and [Figure 2]b.
Figure 1: (a) Stent release is performed from the intrahepatic bile duct to hepatic parenchyma (arrow). (b) The EUS scope was stabilized until the stent is deployed up to 1 cm within the EUS scope (arrow). (c) The EUS scope is pulled little bite after stent delivery system is pushed on endoscopic view guidance. (d) Stent placement is completely performed

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Figure 2: (a) The distance between hepatic parenchyma and stomach wall is 63.6 mm on computed tomography imaging before EUS hepaticogastrostomy. (b) The distance between hepatic parenchyma and stomach wall is 5.7 mm on computed tomography imaging the day after EUS hepaticogastrostomy

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Our method has two important points. First, stent release performed within scope channel across the stomach wall; therefore, early stent migration can be prevented. Second, this technique may adhere the hepatic parenchyma and the stomach wall; therefore, late stent migration or several adverse events such as bile leakage can be prevented. The presented technique may have clinical impact during EUS-HGS.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ogura T, Yamamoto K, Sano T, et al. Stent length is impact factor associated with stent patency in endoscopic ultrasound-guided hepaticogastrostomy. J Gastroenterol Hepatol 2015;30:1748-52.  Back to cited text no. 1
[PUBMED]    
2.
Martins FP, Rossini LG, Ferrari AP. Migration of a covered metallic stent following endoscopic ultrasound-guided hepaticogastrostomy: Fatal complication. Endoscopy 2010;42 Suppl 2:E126-7.  Back to cited text no. 2
[PUBMED]    
3.
Minaga K, Kitano M, Yamashita Y, et al. Stent migration into the abdominal cavity after EUS-guided hepaticogastrostomy. Gastrointest Endosc 2017;85:263-64.  Back to cited text no. 3
[PUBMED]    
4.
Ogura T, Masuda D, Takeuchi T, et al. Fistula formation after EUS-guided hepaticogastrostomy. Gastrointest Endosc 2016;84:365.  Back to cited text no. 4
    
5.
Okuno N, Hara K, Mizuno N, et al. Stent migration into the peritoneal cavity following endoscopic ultrasound-guided hepaticogastrostomy. Endoscopy 2015;47 Suppl 1 UCTN:E311.  Back to cited text no. 5
[PUBMED]    


    Figures

  [Figure 1], [Figure 2]


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