Re-intervention utility after endoscopic ultrasound-guided hepaticogastrostomy using a partially covered stent with anchoring flange

Background and Aim: A long self-expandable metal stent (SEMS) with a sufficient intragastric portion is typically preferred for endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS). However, this type of stent 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 partially covered SEMS was designed with 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. 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 through the HGS route in 19 patients. Re-intervention was successfully conducted in 97.1% (34/35) of cases via the distal end of the stent in a retroflexed position. The overall technical and clinical success rates were 91.4% (32/35) and 85.7% (30/35), respectively. 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 successfully managed with conservative treatment. Conclusions Endoscopic re-interventions can be effectively and safely performed through the lumen of the partially covered SEMS with an anchoring flange. The HPG route with a 2–3 cm intragastric portion renders it technically simple to access the biliary tract for re-intervention procedures.