Department of Gastroenterology and Hepatology, Dentistry and Pharmaceutical Science, Okayama University Graduate School of Medicine, 2-5-1, Shikata-cho, Kita-ku, Okayama-city, Okayama, 700-8558, Japan.
Surg Endosc. 2022 Dec;36(12):8981-8991. doi: 10.1007/s00464-022-09350-3. Epub 2022 Aug 4.
Endoscopic ultrasonography-guided hepaticogastrostomy (EUS-HGS) is often performed using a single guidewire (SGW), but the efficacy of the double guidewire (DGW) technique during endoscopic ultrasonography-guided biliary drainage has been reported. We evaluated the efficacy of the DGW technique for EUS-HGS, focusing on the guidewire angle at the insertion site.
This retrospective cohort study included consecutive patients who underwent EUS-HGS between April 2012 and March 2021. We measured the guidewire angle at the insertion site using still fluoroscopic imaging. We compared the clinical outcomes of EUS-HGS with the DGW and SGW techniques. The factors associated with successful cannula insertion, need for additional fistula dilation and adverse event rate were assessed by a logistic regression multivariable analysis.
The DGW group showed higher technical (p = 0.020) and clinical success rates (p = 0.016) than the SGW group, which showed more adverse events (p = 0.017) than the DGW group. Successful cannula insertion was associated with a guidewire angle > 137° and an uneven double-lumen cannula. The DGW technique made the guidewire angle obtuse at the insertion site (p < 0.0001). A guidewire angle ≤ 137° (OR, 35.6; 95% CI, 1.70-744; p = 0.0045) and intrahepatic bile duct diameter of the puncture site ≤ 3.0 mm (OR, 14.4; 95% CI, 1.37-152; p = 0.0056) were risk factors for needing additional fistula dilation in a multivariate analysis, and additional dilation was a significant predictive factor for adverse events (OR, 8.3; 95% CI, 0.9-77; p = 0.026).
The DGW technique can modify the guidewire angle at the insertion site and facilitate stent deployment with few adverse events.
内镜超声引导下肝胃吻合术（EUS-HGS）通常使用单导丝（SGW）进行，但已报道内镜超声引导下胆道引流时双导丝（DGW）技术的疗效。我们评估了 DGW 技术在 EUS-HGS 中的疗效，重点关注插入部位的导丝角度。
这是一项回顾性队列研究，纳入 2012 年 4 月至 2021 年 3 月期间接受 EUS-HGS 的连续患者。我们使用静态荧光成像测量插入部位的导丝角度。我们比较了 DGW 和 SGW 技术在 EUS-HGS 中的临床疗效。通过多变量逻辑回归分析评估与成功套管插入、需要额外的瘘管扩张和不良事件发生率相关的因素。
DGW 组的技术（p=0.020）和临床成功率（p=0.016）均高于 SGW 组，而 DGW 组的不良事件发生率（p=0.017）高于 SGW 组。成功套管插入与导丝角度>137°和不均匀的双腔套管有关。DGW 技术使插入部位的导丝角度呈钝角（p<0.0001）。导丝角度≤137°（OR，35.6；95%CI，1.70-744；p=0.0045）和穿刺部位肝内胆管直径≤3.0mm（OR，14.4；95%CI，1.37-152；p=0.0056）是多变量分析中需要额外瘘管扩张的危险因素，额外扩张是不良事件的显著预测因素（OR，8.3；95%CI，0.9-77；p=0.026）。
DGW 技术可以改变插入部位的导丝角度，并有助于支架的部署，且不良事件较少。
