One-step stent deployment of EUS-guided hepaticogastrostomy using a novel covered metal stent with a fine-gauge stent delivery system (with video)

摘要

EUS-guided hepaticogastrostomy (EUS-HGS) is indicated for patients with surgically altered anatomy or an inaccessible papilla.[1,2] The rate of adverse events is also not infrequent. Various kinds of adverse events have been reported, such as bleeding, bile peritonitis, or stent migration.[3,4] During EUS-HGS, bile leakage into the abdominal cavity from the bile duct might occur after fistula dilation. If this step could be omitted, procedure time might be shortened. In addition, risk of bleeding due to dilation devices might also be reduced. Recently, a novel fully covered self-expandable metal stent with a fine-gauge stent delivery system (8 mm × 12 cm, HANAROSTENT® Biliary Full Cover Benefit™; M.I. Tech, Seoul, Korea) has become available in Japan [Figure 1]. This stent delivery system is only 5.9 Fr. In addition, the tip of this stent is extremely tapered and stiff. Herein, we describe a one-step stent deployment technique for EUS-HGS using this novel stent.