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| Propensity score matching analysis for clinical impact of braided-type versus laser-cut-type covered self-expandable metal stents for endoscopic ultrasound-guided hepaticogastrostomy |
| Mitsuki Tomita a ,Takeshi Ogura a , b , ∗, Akitoshi Hakoda b , Saori Ueno a , Atsushi Okuda a , Nobu Nishioka a , Yoshitaro Yamamoto a , Hiroki Nishikawa a |
a 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
b Endoscopy Center, Osaka Medical and Pharmaceutical University, Osaka, Japan
∗Corresponding author at: Endoscopy Center, Osaka Medical and Pharmaceutical University, 2-7 Daigakuchou, Takatsukishi, Osaka 569-8686, Japan.
E-mail address: takeshi.ogura@ompu.ac.jp (T. Ogura). |
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Abstract Background: To prevent stent migration during endoscopic ultrasound-guided hepaticogastrostomy (EUS- HGS), intra-scope channel release technique is important, but is unfamiliar to non-expert hands. The self expandable metal stent (SEMS) is an additional factor to prevent stent migration. However, no comparative studies of laser-cut-type and braided-type during EUS-HGS have been reported. The aim of this study was to compare the distance between the intrahepatic bile duct and stomach wall after EUS-HGS among laser-cut-type and braided-type SEMS.
Methods: To evaluate stent anchoring function, we measured the distance between the hepatic parenchyma and stomach wall before EUS-HGS, one day after EUS-HGS, and 7 days after EUS-HGS. Also, propensity score matching was performed to create a propensity score for using laser-cut-type group and braided-type group.
Results: A total of 142 patients were enrolled in this study. Among them, 24 patients underwent EUS-HGS using a laser-cut-type SEMS, and 118 patients underwent EUS-HGS using a braided-type SEMS. EUS-HGS using the laser-cut-type SEMS was mainly performed by non-expert endoscopists ( n = 21); EUS-HGS using braided-type SEMS was mainly performed by expert endoscopists ( n = 98). The distance after 1 day was significantly shorter in the laser-cut-type group than that in the braided-type group [2.00 (1.70- 3.75) vs. 6.90 (3.72-11.70) mm, P < 0.001]. In addition, this distance remained significantly shorter in the laser-cut-type group after 7 days. Although these results were similar after propensity score matching analysis, the distance between hepatic parenchyma and stomach after 7 days was increased by 4 mm compared with the distance after 1 day in the braided-type group. On the other hand, in the laser-cut-type group, the distance after 1 day and 7 days was almost the same.
Conclusions: EUS-HGS using a laser-cut-type SEMS may be safe to prevent stent migration, even in non-expert hands.
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2024, Vol. 23 
