Time to endosonography-created route formation after EUS–guided hepaticojejunostomy for performing antegrade procedures

Background and Objectives The antegrade procedure can be safely performed via an endosonography-created route (ESCR). Among the various types of surgically altered anatomy, antegrade procedures are frequently attempted in patients with Roux-en-Y (RY) anastomosis. For patients with RY anastomosis, EUS-guided hepaticojejunostomy (EUS-HJS) can be performed. However, evidence of the technical feasibility and safety of EUS-HJS is still limited, and there is no evidence of the time required for definitive formation of the ESCR after EUS-HJS. In the present study, we evaluated the time to formation of the ESCR after EUS-HJS for safely performing antegrade procedures. Method Patients in whom EUS-HJS was attempted were eligible for study enrollment. The primary outcome of the present study was to evaluate the time to ESCR creation after EUS-HJS. This time was measured from the day of EUS-HJS to HJS stent removal. The technical success rates of EUS-HJS, HJS stent removal, the trans-ESCR procedure, and adverse events were secondarily evaluated. Results A total of 42 patients were enrolled in the present study. The median interval prior to EUS-HJS stent removal was 10 days (range, 7–19 days). ESCR formation was confirmed in all patients who underwent EUS-HJS stent removal (100%, 42/42). The technical success rate of the subsequent trans-ESCR procedure was 95.2% (40/42). ESCR broken was not observed during procedures. Conclusions In conclusion, sufficient formation of the ESCR for performing antegrade procedures might occur within 10 days after EUS-HJS in patients with RY anastomosis.