BACKGROUND: Partially covered self-expandable metallic stents (PCSEMSs) used for endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) provide favorable patency and low migration risk; however, reintervention (RI) remains challenging. OBJECTIVES AND METHODS: We retrospectively evaluated the outcomes of RI after EUS-HGS with PCSEMS placement in 108 patients with malignant biliary obstruction treated between January 2016 and December 2024. Causes of recurrent biliary obstruction (RBO), RI techniques, and post-RI outcomes were analyzed. RESULTS: The median age of patients was 77 years, with pancreatic cancer being the most common (n = 62). RBO occurred in 25 (23%) patients, including those with sludge/food impaction (n = 15) and hyperplasia (n = 10). The median time to RBO (TRBO) was 196 days. RI involved PCSEMS removal and replacement (n = 11), or treatment without removal (n = 12). Post-RI RBO developed in six patients (24%), and the median post-RI TRBO was 185 days. The removal group showed a significantly longer TRBO than the nonremoval group (185 vs. 77 days; p = 0.048). Hyperplasia was an independent predictor of failed stent removal (OR, 18.7; 95% CI, 1.45-240; p = 0.02). CONCLUSIONS: Stent removal during RI is associated with longer post-RI TRBO; however, removal can be challenging, particularly in cases with hyperplasia. Careful selection of a PCSEMS for EUS-HGS is required based on the patient's life expectancy.
Iwasa et al. (Mon,) studied this question.