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

Kimi Bessho; Takeshi Ogura; Akitoshi Hakoda; Saori Ueno; Atsushi Okuda; Nobu Nishioka; Jun Matsuno; Nobuhiro Hattori; Junichi Nakamura; Takafumi Kanadani; Nga Nguyen Trong; Hiroki Nishikawa

doi:10.1097/eus.0000000000000161

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

Endosc Ultrasound. 2026 Mar-Apr;15(2):105-109. doi: 10.1097/eus.0000000000000161. Epub 2026 May 28.

Authors

Kimi Bessho^{1

2}, Takeshi Ogura^{1

2

3}, Akitoshi Hakoda², Saori Ueno^{1

2}, Atsushi Okuda^{1

2}, Nobu Nishioka^{1

2}, Jun Matsuno^{1

2}, Nobuhiro Hattori^{1

2}, Junichi Nakamura^{1

2}, Takafumi Kanadani^{1

2}, Nga Nguyen Trong⁴, Hiroki Nishikawa²

Affiliations

¹ Pancreatobiliary Advanced Medical Center, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan.
² 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan.
³ Endoscopy Center, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan.
⁴ Gastroenterology, Trong Nam Cancer Hospital, Ha Noi, Viet Nam.

Abstract

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.

Keywords: Antegrade intervention; ERCP; ESCR; EUS-HJS; Stent removal.