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

• Published in: Surgical endoscopy Vol. 36; no. 12; pp. 8981 - 8991
• Main Authors: Fujii, Yuki, Kato, Hironari, Himei, Hitomi, Ueta, Eijiro, Ogawa, Taiji, Terasawa, Hiroyuki, Yamazaki, Tatsuhiro, Matsumoto, Kazuyuki, Horiguchi, Shigeru, Tsutsumi, Koichiro, Okada, Hiroyuki
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.12.2022; Springer Nature B.V
• Subjects: Abdomen; Abdominal Surgery; Bile ducts; Cholangiopancreatography, Endoscopic Retrograde - methods; Cholangitis; Cholestasis - etiology; Drainage - methods; Endoscopy; Endosonography - methods; Fistula; Gastroenterology; Gynecology; Hepatology; Hospitals; Humans; Medicine; Medicine & Public Health; Ostomy; Peritonitis; Proctology; Retrospective Studies; Stents; Stents - adverse effects; Surgery; Surgical techniques; Treatment Outcome; Ultrasonic imaging; Ultrasonography, Interventional - adverse effects; Endoscopic ultrasound-guided hepaticogastrostomy; Biliary drainage; Interventions; Double guidewire; Endoscopic ultrasound
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-022-09350-3

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.