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Bile aspiration during EUS-guided hepaticogastrostomy is associated with lower risk of postprocedural adverse events: a retrospective single-center study

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Abstract

Background

In endoscopic retrograde cholangiopancreatography (ERCP), reduction of pressure inside of the bile duct by bile aspiration is a well-known method to lower the rate of adverse events (AEs) including cholangitis. Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) has been introduced as an alternative to ERCP. The use of self-expandable metallic stents is recommended in EUS-HGS to reduce bile leak; however, other methods to reduce the rate of AEs including bile leak, abdominal pain, fever, and sepsis, have not been elucidated yet. This study investigated whether bile aspiration during EUS-HGS decreased the rate of postprocedural AEs.

Methods

Consecutive patients who underwent EUS-HGS between July 2016 and April 2020 were retrospectively evaluated in this study. EUS-HGS was performed at a tertiary cancer center. Patient characteristics, site of biliary obstruction, the quantity of bile aspirated during EUS-HGS, type of stent, whether or not antegrade stenting (AS) was performed, procedure time, and AEs were assessed based on a prospectively recorded institutional endoscopy database. Logistic regression analysis was performed to identify factors affecting postprocedural AEs.

Results

Ninety-six patients were included in the study. EUS-guided HGS with and without AS was performed in 45 and 51 patients, respectively. Bile was aspirated in 71 patients (74%). The quantity of bile aspirated was 0–10 mL and > 10 mL in 40 and 56 patients, respectively. AEs including fever, abdominal pain, postprocedural cholangitis, sepsis, acute pancreatitis, and bleeding occurred in 45 patients (47%). The AE rates were 65% (26/40) and 34% (19/56), for 0–10 mL and > 10 mL bile, respectively (p = 0.004). Using multivariate analysis, the only independent factor affecting the occurrence of AEs was found to be an aspirated bile amount of 0–10 mL (odds ratio: 4.16; 95% CI 1.6–10.8).

Conclusions

Bile aspiration of more than 10 mL during EUS-HGS contributes to reducing the rate of postprocedural AEs.

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Acknowledgements

We thank all members of the Division of Endoscopy, Shizuoka Cancer Center, for help rendered with this study.

Funding

The authors received no specific funding for this work.

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Authors and Affiliations

  1. Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo Nagaizumi-cho, Sunto-gun, Shizuoka, Japan

    Hirotoshi Ishiwatari, Tatsunori Satoh, Junya Sato, Junichi Kaneko, Hiroyuki Matsubayashi, Yohei Yabuuchi, Yoshihiro Kishida, Masao Yoshida, Sayo Ito, Noboru Kawata, Kenichiro Imai, Kohei Takizawa, Kinichi Hotta & Hiroyuki Ono

  2. Division of Genetic Medicine Promotion, Shizuoka Cancer Center, Shizuoka, Japan

    Hiroyuki Matsubayashi

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  1. Hirotoshi Ishiwatari
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Correspondence to Hirotoshi Ishiwatari.

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Drs. Hirotoshi Ishiwatari, Tatsunori Satoh, Junya Sato, Junichi Kaneko, Hiroyuki Matsubayashi, Yohei Yabuuchi, Yoshihiro Kishida, Masao Yoshida, Sayo Ito, Noboru Kawata, Kenichiro Imai, Kohei Takizawa, Kinichi Hotta, and Hiroyuki Ono have no conflicts of interest or financial ties to disclose.

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Ishiwatari, H., Satoh, T., Sato, J. et al. Bile aspiration during EUS-guided hepaticogastrostomy is associated with lower risk of postprocedural adverse events: a retrospective single-center study. Surg Endosc 35, 6836–6845 (2021). https://doi.org/10.1007/s00464-020-08189-w

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