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

• DOI: 10.1007/s00464-020-08189-w
• Publication Date: 2021-01-04T20:03:55Z
• Authors: Hirotoshi Ishiwatari; Tatsunori Satoh; Junya Sato; Junichi Kaneko; Hiroyuki Matsubay...; Yohei Yabuuchi; Yoshihiro Kishida; Masao Yoshida; Sayo Ito; Noboru Kawata; Kenichiro Imai; Kohei Takizawa; Kinichi Hotta; Hiroyuki Ono
• Keywords: Cholangiopancreatography, Endoscopic Retrograde; Cholestasis; Endosonography; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Pancreatitis; Acute Disease; Bile; Drainage; Humans; Stents; Retrospective Studies

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