Thin delivery stents can obviate the need for additional fistula dilatation of large diameter in endoscopic ultrasound-guided hepaticogastrostomy

Abstract Background Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) often requires fistula dilation owing to the placement of large diameter of the delivery stent. The recently developed delivery devices as thin as 5.9/6.0 Fr may save the need for fistula dilation. Therefore, we investigated whether the large fistula dilation would be required or not in case of this newly developed thin diameter delivery stents. Methods We conducted a retrospective study involving 33 patients implemented with self-expandable metal stent (SEMS) during EUS-HGS. The patients were categorized based on the delivery device diameter into thin (n = 13; delivery device diameter: 5.9/6.0 Fr) and thick (n = 20; delivery device diameter: 8.5 Fr) groups. We compared the initial rate of success, technical success, and clinical success between the thin and thick groups. Initial rate of success was defined as successful stent placement without a balloon or large diameter mechanical dilation. Results The rate of initial stenting success was significantly higher in the thin group (100% [13/13]) compared with that in the thick group (65.0% [13/20]) (p = 0.027). In the thick group, seven cases with technical difficulty in stent placement could be successfully completed with additional fistula dilation with 9Fr bougie dilator, or 4mm balloon dilator; this resulted in a technical success of 100% in both groups ultimately. The rate of clinical success was 100% and 95.0% in the thin and thick groups, respectively (p = 1.00). Conclusions Thin-delivery stents may facilitate stent placement without the need for a balloon fistula or large-diameter mechanical dilation.