Feasibility and Efficacy of Endoscopic Ultrasound-Guided Hepaticogastrostomy Without Dilation: A Propensity Score Matching Analysis

Akihisa Ohno, Nao Fujimori, Toyoma Kaku, Yu Takamatsu, Kazuhide Matsumoto, Masatoshi Murakami, Katsuhito Teramatsu, Ayumu Takeno, Masayuki Hijioka, Ken Kawabe, Naohiko Harada, Makoto Nakamuta, Akira Aso, Takamasa Oono, Yoshihiro Ogawa

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)


Background: Recently, endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) procedures have been gradually established; nonetheless, some adverse events (AEs) have been reported. Dilation procedures using a non-cautery or cautery device increase the incidence of AEs in EUS-HGS. Aims: We evaluated EUS-HGS procedures without dilation and the factors associated with dilation. Methods: We enrolled 79 patients who underwent EUS-HGS between July 2015 and March 2021 at two centers, 72 of whom had technical success (72/79, 91%). During the EUS-HGS procedures, we defined patients without dilation procedures as the dilation (−) group. We divided the patients into two groups: the dilation (+) (35 patients) and dilation (−) (37 patients) groups. We performed a propensity score matching analysis to adjust for confounding bias between the two groups. Multivariable logistic regression analysis was conducted to identify factors associated with dilation. Results: There was no difference in clinical success rate between the dilation (+) and dilation (−) groups (91% vs. 95%, P = 0.545). The AE rate (P = 0.013) and long procedure time (P = 0.017) were significantly higher in the dilation (+) group than in the dilation (−) group before and after propensity score matching. Factors associated with dilation were plastic stent placement (odds ratio [OR], 6.96; 95% confidence interval [CI], 1.68–28.7; P = 0.007) and puncture angle of ≤ 90° (OR, 44.6; 95% CI, 5.1–390; P < 0.001). Conclusions: A dilation procedure in EUS-HGS may not always be necessary. However, patients with an angle of ≤ 90° between the needle and intrahepatic biliary tract or plastic stent deployment require dilation procedures.

Original languageEnglish
Pages (from-to)5676-5684
Number of pages9
JournalDigestive Diseases and Sciences
Issue number12
Publication statusPublished - Dec 2022

All Science Journal Classification (ASJC) codes

  • Physiology
  • Gastroenterology


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