Dilation Device Use and Concomitant Antegrade Stenting are Associated With Procedure‐related Early Adverse Events After Endoscopic Ultrasound‐guided Hepaticogastrostomy: A Retrospective Multicenter Study

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Abstract
Objectives: Endoscopic ultrasound‐guided hepaticogastrostomy (EUS‐HGS) is useful in cases of endoscopic retrograde cholangiopancreatography failure. However, the procedure has a high incidence of procedure‐related early adverse events (PRAEs). This study retrospectively evaluated risk factors for such events post‐EUS‐HGS. Methods: This multicenter study included 222 patients (120 males and 102 females; median age = 73 years) who underwent initial EUS‐HGS. The clinical success rate and PRAE incidence, and risk factors were analyzed. PRAEs were defined as AEs occurring within 2 weeks. Results: The median procedure time was 41 min. Metal or plastic stents were used for EUS‐HGS in 107 and 115 patients, respectively. Fistula dilation and concomitant antegrade stenting (AGS) were performed in 166 and 45 patients, respectively. The clinical success rate and PRAE incidence were 85.1% and 22.1%, respectively. Identified PRAEs included acute peritonitis (9.5%), fever (6.8%), abdominal pain (2.3%), and acute pancreatitis (1.4%). Multivariate analysis identified dilation device use ( p = 0.01) and AGS ( p = 0.03) as PRAE risk factors. AGS in patients who underwent fistula dilation ( p = 0.02) and procedure time ≥41 min in those who underwent EUS‐HGS with AGS ( p = 0.01) were PRAE risk factors. Conclusions: Fistula dilation and AGS are associated with an increased risk of PRAEs post‐EUS‐HGS. Careful postoperative follow‐up for such events is required in patients undergoing fistula dilation for EUS‐HGS with AGS and prolonged procedure time.

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