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Background <p>Partially covered self-expandable metallic stents (PCSEMSs) used for endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) provide favorable patency and low migration risk; however, reintervention (RI) remains challenging.</p> Objectives and Methods <p>We retrospectively evaluated the outcomes of RI after EUS-HGS with PCSEMS placement in 108 patients with malignant biliary obstruction treated between January 2016 and December 2024. Causes of recurrent biliary obstruction (RBO), RI techniques, and post-RI outcomes were analyzed.</p> Results <p>The median age of patients was 77&#xa0;years, with pancreatic cancer being the most common (<i>n</i> = 62). RBO occurred in 25 (23%) patients, including those with sludge/food impaction (<i>n</i> = 15) and hyperplasia (<i>n</i> = 10). The median time to RBO (TRBO) was 196&#xa0;days. RI involved PCSEMS removal and replacement (<i>n</i> = 11), or treatment without removal (<i>n</i> = 12). Post-RI RBO developed in six patients (24%), and the median post-RI TRBO was 185&#xa0;days. The removal group showed a significantly longer TRBO than the nonremoval group (185 vs. 77&#xa0;days; <i>p</i> = 0.048). Hyperplasia was an independent predictor of failed stent removal (OR, 18.7; 95% CI, 1.45–240; <i>p</i> = 0.02).</p> Conclusions <p>Stent removal during RI is associated with longer post-RI TRBO; however, removal can be challenging, particularly in cases with hyperplasia. Careful selection of a PCSEMS for EUS-HGS is required based on the patient’s life expectancy.</p>

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Clinical Outcomes of Reintervention After Endoscopic Ultrasound-Guided Hepaticogastrostomy Using a Partially Covered Self-Expandable Metal Stent

  • 期刊论文

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  • 发表日期：

    2026年6月1日

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  • Yuhei Iwasa,
  • Akinori Maruta,
  • Keisuke Iwata,
  • Hidetaka Kuroda,
  • Shinya Uemura,
  • Shota Iwata,
  • Yosuke Ohashi,
  • Takuya Koizumi,
  • Kensaku Yoshida,
  • Naoki Mita,
  • Hironao Ichikawa,
  • Takuji Iwashita,
  • Masahito Shimizu

摘要

Background

Partially covered self-expandable metallic stents (PCSEMSs) used for endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) provide favorable patency and low migration risk; however, reintervention (RI) remains challenging.

Objectives and Methods

We retrospectively evaluated the outcomes of RI after EUS-HGS with PCSEMS placement in 108 patients with malignant biliary obstruction treated between January 2016 and December 2024. Causes of recurrent biliary obstruction (RBO), RI techniques, and post-RI outcomes were analyzed.

Results

The median age of patients was 77 years, with pancreatic cancer being the most common (n = 62). RBO occurred in 25 (23%) patients, including those with sludge/food impaction (n = 15) and hyperplasia (n = 10). The median time to RBO (TRBO) was 196 days. RI involved PCSEMS removal and replacement (n = 11), or treatment without removal (n = 12). Post-RI RBO developed in six patients (24%), and the median post-RI TRBO was 185 days. The removal group showed a significantly longer TRBO than the nonremoval group (185 vs. 77 days; p = 0.048). Hyperplasia was an independent predictor of failed stent removal (OR, 18.7; 95% CI, 1.45–240; p = 0.02).

Conclusions

Stent removal during RI is associated with longer post-RI TRBO; however, removal can be challenging, particularly in cases with hyperplasia. Careful selection of a PCSEMS for EUS-HGS is required based on the patient’s life expectancy.