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Year : 2017  |  Volume : 6  |  Issue : 6  |  Page : 394-401

Interventional endoscopic ultrasound: A new promising way for intrahepatic portosystemic shunt with portal pressure gradient

1 Department of Digestive and Hepatobiliary Diseases, CHU Estaing; Auvergne University Department/CNRS 6284 Image Sciences for Innovations Techniques, France
2 Auvergne University Department/CNRS 6284 Image Sciences for Innovations Techniques; Department of Radiology, CHU Gabriel Montpied, France
3 Department of Biostatistics, DRCI, CHU Gabriel Montpied, Clermont-Ferrand, France
4 Department of Digestive and Hepatobiliary Diseases, CHU Estaing, France

Correspondence Address:
Dr. Laurent Poincloux
Department of Digestive and Hepatobiliary Diseases, CHU Estaing de Clermont-Ferrand, 1 place Lucie et Raymond Aubrac, 63003 Clermont-Ferrand
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/eus.eus_42_17

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Background and Objectives: Interventional endoscopic ultrasound (EUS) is a promising novel approach for intravascular interventions. The aim of this study was to assess the feasibility and safety of a EUS-guided intrahepatic portosystemic shunt (EGIPS) with portal pressure gradient measurement in a live porcine model. Methods: The left hepatic vein (LHV) or the inferior vena cava (IVC) was punctured with a needle that advanced into the portal vein (PV). A guidewire was then inserted into the PV, and a needle knife was used to create an intrahepatic fistula between LHV and PV. Portal pressure was recorded. The fistula was dilated with a balloon and a biliary metal stent was deployed between LHV and PV under sonographic and fluoroscopic observation. A portocavography validated the patency of the stent. Necropsies were realized after euthanasia. Results: Portosystemic stenting was achieved in 19/21 pigs. Final portocavography confirmed stent patency between PV and LHV or IVC in 17 pigs (efficacy of 81%): Four stents were dysfunctional as two were thrombosed and two were poor positioned. Portal pressure was documented before and after shunting in 20/21 pigs. Necropsies revealed that 19/21 procedures were transesophageal and two were transgastric. Hemoperitoneum and pneumothorax were found in one pig and hemothorax was found in two pigs. Morbidity was 14.2% (3/21 animals). Conclusion: EGIPS was feasible in 91% of cases, functional in 81%, with 14.2% per procedure morbidity. EGIPS still needs to be assessed in portal hypertension pig models with longer follow-up before being considered as an alternative when the transjugular intrahepatic portosystemic shunt fails.

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