Clinical outcomes of one-step EUS-guided hepaticogastrostomy using an 8F stent introducer featuring an ultra-tapered metal tip and a preloaded partially covered metal stent (with video)

Background and Objectives: This study evaluated the clinical outcomes of a newly refined 8F stent introducer featuring an ultra-tapered metal tip and a preloaded, partially covered, self-expandable metal stent (PCSEMS) for one-step stent deployment during EUS-guided hepaticogastrostomy (EUS-HGS). Methods: A retrospective review of 34 patients who underwent EUS-HGS using the refined PCSEMS between February 2024 and February 2025 was conducted using a prospectively collected database. An expert and a novice endoscopist performed procedures. The primary outcome was technical success. Secondary outcomes included one-step deployment rate, adverse events, clinical success, recurrent biliary obstruction (RBO), and predictors of one-step stent deployment. Results: The technical success rate was 100%, with 88.2% of deployments being one-step. Adverse events occurred in 14.7%. Clinical success was 94.1%. RBO occurred in 12 patients (37.5%), with a median time to RBO of 115 days (95% confidence interval, 91 to not reached). Endoscopic reintervention was successful in 91.7% (11/12). Outcomes were comparable between the expert and novice, except for procedure time. A narrow needle–scope angle (≤138°) was associated with successful one-step deployment (86.7% vs. 25.0%, P = 0.027). On multivariable analysis, a needle–scope angle ≤138° was the only independent predictor (odds ratio 26.2; 95% confidence interval, 1.50–457.4; P = 0.025) for one-step stent deployment. Conclusion: The refined dedicated 8F stent introducer, featuring an ultra-tapered metal tip and preloaded with a PCSEMS for one-step EUS-HGS, achieved excellent technical and clinical success with an acceptable safety profile, although larger prospective studies are warranted.