B2 puncture with forward-viewing EUS simplifies EUS-guided hepaticogastrostomy (with video)
Nozomi Okuno1, Kazuo Hara1, Nobumasa Mizuno1, Shin Haba1, Takamichi Kuwahara1, Yasuhiro Kuraishi1, Masahiro Tajika2, Tsutomu Tanaka2, Sachiyo Onishi2, Keisaku Yamada2, Daiki Fumihara1, Takafumi Yanaidani1, Sho Ishikawa1, Masanori Yamada1, Tsukasa Yasuda1, Moaz Elshair1
1 Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
2 Department of Endoscopy, Aichi Cancer Center Hospital, Nagoya, Japan
Department of Gastroenterology, Aichi Cancer Center Hospital 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi 464-8681
Source of Support: None, Conflict of Interest: None
Background and Objectives: EUS-guided hepaticogastrostomy (EUS-HGS) is in widespread use; however, there are few dedicated devices. The B2 route is technically easier than the B3 route for guidewire insertion, dilation, and stenting but if performed with conventional oblique-viewing (OV) EUS, B2 puncture can cause transesophageal puncture and severe adverse events. The aim of this study was to assess the efficacy of forward-viewing (FV) EUS, which we have developed to improve safety for B2 puncture in EUS-HGS (B2-EUS-HGS). Patients and Methods: This single-center retrospective study included 61 consecutive patients who underwent B2-EUS-HGS with FV between February 2020 and March 2021 at Aichi Cancer Center, Japan. The patients were prospectively enrolled, and clinical data were retrospectively collected for these 61 cases. Results: The overall technical success rate of EUS-HGS was 98.3% (60/61). The rate of EUS-HGS with FV was 95.0% (58/61) after three cases converted to OV, and that of B2-EUS-HGS with FV was 88.5% (54/61). The early adverse event rate was 6.5% (4/61). There were no instances of transesophageal puncture. Median procedure time was 24 min (range, 8–70), and no patient required cautery dilation. Conclusions: B2-EUS-HGS can be performed safely using FV, without transesophageal puncture, and supportability of the device is improved as FV is coaxial with the guidewire. FV was efficacious in B2-EUS-HGS, which shows promise for clinical application in the future.