Skip to main content

Advertisement

SpringerLink
Log in

Double guidewire technique stabilization procedure for endoscopic ultrasound-guided hepaticogastrostomy involving modifying the guidewire angle at the insertion site

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background and aims

Endoscopic ultrasonography-guided hepaticogastrostomy (EUS-HGS) is often performed using a single guidewire (SGW), but the efficacy of the double guidewire (DGW) technique during endoscopic ultrasonography-guided biliary drainage has been reported. We evaluated the efficacy of the DGW technique for EUS-HGS, focusing on the guidewire angle at the insertion site.

Methods

This retrospective cohort study included consecutive patients who underwent EUS-HGS between April 2012 and March 2021. We measured the guidewire angle at the insertion site using still fluoroscopic imaging. We compared the clinical outcomes of EUS-HGS with the DGW and SGW techniques. The factors associated with successful cannula insertion, need for additional fistula dilation and adverse event rate were assessed by a logistic regression multivariable analysis.

Results

The DGW group showed higher technical (p = 0.020) and clinical success rates (p = 0.016) than the SGW group, which showed more adverse events (p = 0.017) than the DGW group. Successful cannula insertion was associated with a guidewire angle > 137° and an uneven double-lumen cannula. The DGW technique made the guidewire angle obtuse at the insertion site (p < 0.0001). A guidewire angle ≤ 137° (OR, 35.6; 95% CI, 1.70–744; p = 0.0045) and intrahepatic bile duct diameter of the puncture site ≤ 3.0 mm (OR, 14.4; 95% CI, 1.37–152; p = 0.0056) were risk factors for needing additional fistula dilation in a multivariate analysis, and additional dilation was a significant predictive factor for adverse events (OR, 8.3; 95% CI, 0.9–77; p = 0.026).

Conclusions

The DGW technique can modify the guidewire angle at the insertion site and facilitate stent deployment with few adverse events.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Fogel E, Sherman S, Devereaux B et al (2001) Therapeutic biliary endoscopy. Endoscopy 33:31–38

    Article  CAS  PubMed  Google Scholar 

  2. Freeman M, Guda N (2005) ERCP cannulation: a review of reported techniques. Gastrointest Endosc 61:112–125

    Article  PubMed  Google Scholar 

  3. Van Delden O, Lameris J (2008) Percutaneous drainage and stenting for palliation of malignant bile duct obstruction. Eur Radiol 18:448–456

    Article  PubMed  Google Scholar 

  4. Giovannini M, Moutardier V, Pesenti C et al (2001) Endoscopic ultrasound-guided bilioduodenal anastomosis: a new technique for biliary drainage. Endoscopy 33:898–900

    Article  CAS  PubMed  Google Scholar 

  5. Lee T, Choi J, Park Do H et al (2016) Similar efficacies of endoscopic ultrasound-guided transmural and percutaneous drainage for malignant distal biliary obstruction. Clin Gastroenterol Hepatol 14:1011–1019

    Article  PubMed  Google Scholar 

  6. Hedjoudje A, Sportes A, Grabar S et al (2019) Outcomes of endoscopic ultrasound-guided biliary drainage: a systematic review and meta-analysis. United European Gstroenterol J 7:E52-59

    Google Scholar 

  7. Miller CS, Barkun A, Martel M et al (2019) Endoscopic ultrasound-guided biliary drainage for distal malignant obstruction: a systematic review and meta-analysis of randomized trials. Endosc Int Open 7:E1563–E1573

    Article  PubMed  PubMed Central  Google Scholar 

  8. Isayama H, Nakai Y, Itoi T et al (2019) Clinical practice guidelines for safe performance of endoscopic ultrasound/ultrasonography-guided biliary drainage: 2018. J Hepatobiliary Pancreat sci 26:249–269

    Article  PubMed  PubMed Central  Google Scholar 

  9. Van Geenen EJM, Siersema PD (2018) Stent migration into the abdominal cavity after EUS-guided hepaticogastrostomy. Gastrointest Endosc 87:617–618

    Article  PubMed  Google Scholar 

  10. Prachayakul V, Aswakul P (2012) Successful endoscopic treatment of iatrogenic biloma as a complication of endosonography-guided hepaticogastrostomy: the first case report. J interv Gastroenterol 2:202–204

    Article  PubMed  PubMed Central  Google Scholar 

  11. Nakai Y, Oyama H, Koike K et al (2021) Double guidewire technique using an uneven double lumen catheter for endoscopic ultrasound-guided interventions. Dig Dis Sci 66:1540–1547

    Article  PubMed  Google Scholar 

  12. Ishiwatari H, Satoh T, Sato J et al (2019) Double-guidewire technique facilitates endoscopic ultrasound- guided biliary drainage for hilar biliary obstruction. Endoscopy 11:E321–E322

    Google Scholar 

  13. Shiomi H, Masuda A, Kodama Y (2019) Novel approach for successful endoscopic ultrasound-guided hepaticogastrostomy using a double-guidewire technique. Dig Endosc 31:e50–e51

    Article  PubMed  Google Scholar 

  14. Cotton PB, Eisen GM, Aabakken L et al (2010) A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 71:446–454

    Article  PubMed  Google Scholar 

  15. Hathom KE, Bazarbashi AN, Sack JS et al (2019) EUS-guided biliary drainage is equivalent to ERCP for primary treatment of malignant distal biliary obstruction: a systematic review and meta-analysis. Endosc Int Open 7:E1432–E1441

    Article  Google Scholar 

  16. Wang K, Zhu J, Xing L et al (2016) Assessment of efficacy and safety of EUS-guided biliary drainage: a systematic review. Gastrointest Endosc 83:1218–1227

    Article  PubMed  Google Scholar 

  17. Kawakubo K, Isayama H, Kato H et al (2014) Multicenter retrospective study of endoscopic ultrasound-guided biliary drainage for malignant biliary obstruction in Japan. J Hepatobiliary Pancreat Sci 21:328–334

    Article  PubMed  Google Scholar 

  18. Oh D, Park DH, Song TJ et al (2017) Optimal biliary access point and learning curve for endoscopic ultrasound-guided hepaticogastrostomy with transmural stenting. Therap Adv Gastroenterol 10:42–53

    Article  PubMed  Google Scholar 

  19. Yamamoto Y, Ogura T, Nishioka N et al (2020) Risk factors for adverse events associated with bile leak during EUS-guided hepaticogastrostomy. Endosc Ultrasound 9:110–115

    Article  PubMed  PubMed Central  Google Scholar 

  20. Ogura T, Nishioka N, Higuchi K et al (2021) Effect of echoendoscope angle on success of guidewire manipulation during endoscopic ultrasound- guided hepaticogastrostomy. Endoscopy 53:369–375

    Article  PubMed  Google Scholar 

  21. Ang TL, Teo EK, Fock KM et al (2008) EUS-guided drainage of infected pancreatic pseudocyst: use of a 10F Soehendra dilator to facilitate a double-wire technique for initial transgastric access (with videos). Gastrointest Endosc 68:192–194

    Article  PubMed  Google Scholar 

  22. Itoi T, Itokawa F, Tsuchiya T et al (2009) EUS-guided pancreatic pseudocyst drainage: simultaneous placement of stents and nasocystic catheter using double-guidewire technique. Dig Endosc 21:S53–S56

    Article  PubMed  Google Scholar 

  23. Vila JJ, Perez-Miranda M, Vazquez-Sequeiros E et al (2012) Initial experience with EUS-guided cholangiopancreatography for biliary and pancreatic duct drainage: a Spanish national survey. Gastrointest Endosc 76:1133–1141

    Article  PubMed  Google Scholar 

  24. Poincloux L, Rouquette O, Buc E et al (2015) Endoscopic ultrasound-guided biliary drainage after failed ERCP: cumulative experience of 101 procedures at a single center. Endoscopy 47:794–801

    Article  PubMed  Google Scholar 

  25. Manta R, Mutignani M, Galloro G et al (2018) Endoscopic ultrasound-guided gallbladder drainage for acute cholecystitis with a lumen-apposing metal stent: a systematic review of case series. Eur J Gastroenterol Hepatol 30:695–698

    Article  PubMed  Google Scholar 

  26. Chandrasekhara V, Barthet M, Deviere J et al (2020) Safety and efficacy of lumen-apposing metal stents versus plastic stents to treat walled-off pancreatic necrosis: systematic review and meta-analysis. Endosc Int Open 8:E1639–E1653

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

None.

Author information

Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Dentistry and Pharmaceutical Science, Okayama University Graduate School of Medicine, 2-5-1, Shikata-cho, Kita-ku, Okayama-city, Okayama, 700-8558, Japan

    Yuki Fujii, Hironari Kato, Hitomi Himei, Eijiro Ueta, Taiji Ogawa, Hiroyuki Terasawa, Tatsuhiro Yamazaki, Kazuyuki Matsumoto, Shigeru Horiguchi, Koichiro Tsutsumi & Hiroyuki Okada

Authors
  1. Yuki Fujii
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hironari Kato
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hitomi Himei
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eijiro Ueta
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Taiji Ogawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hiroyuki Terasawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Tatsuhiro Yamazaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kazuyuki Matsumoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Shigeru Horiguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Koichiro Tsutsumi
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Hiroyuki Okada
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yuki Fujii.

Ethics declarations

Disclosures

Drs. Yuki Fujii, Hironari Kato, Hitomi Himei, Eijiro Ueta, Taiji Ogawa, Hiroyuki Terasawa, Tatsuhiro Yamazaki, Kazuyuki Matsumoto, Shigeru Horiguchi, Koichiro Tsutsumi, and Hiroyuki Okada have no conflicts of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fujii, Y., Kato, H., Himei, H. et al. Double guidewire technique stabilization procedure for endoscopic ultrasound-guided hepaticogastrostomy involving modifying the guidewire angle at the insertion site. Surg Endosc 36, 8981–8991 (2022). https://doi.org/10.1007/s00464-022-09350-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-022-09350-3

Keywords

Search

Navigation