Efficacy of Endoscopic Re-Intervention after Endoscopic Ultrasound-Guided Hepaticogastrostomy Using a New Partially Covered Self-Expandable Metal Stent with Anchoring Flange.

Background/Aims Although a long self-expandable metal stent (SEMS) with a sufficient intragastric portion is preferred for endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS), it can complicate endoscopic re-intervention for recurrent biliary obstruction (RBO). We evaluated the efficacy and safety of endoscopic re-intervention for RBO through the stent after EUS-HGS using a novel partially covered SEMS with an anchoring flange. Methods The covered SEMS featured a proximal uncovered portion measuring 1.5 cm in length and a resilient fold-back wide distal anchoring flange with a 2.0 cm diameter. Endoscopic re-interventions were performed through the stent lumen while the stent was in situ. The evaluated outcomes were the technical and clinical success of the endoscopic re-intervention, procedure time, and adverse events. Results In total, 35 re-interventions for RBO were performed in 19 patients. The overall technical and clinical success rates were 91.4% (32/35) and 85.7% (30/35). The re-intervention methods included stent cleaning (18.2%), additional HGS stent placement (33.3%), and antegrade stent placement (48.5%). Mild cholangitis occurred in 5.7% (2/35) of patients and was managed conservatively. Conclusion Various types of endoscopic re-interventions for RBO can be effectively and safely performed through the lumen of a new partially covered SEMS with an anchoring flange. [ABSTRACT FROM AUTHOR]