Comparison of Two Partially Covered Metal Stents for Endoscopic Ultrasound-guided Hepaticogastrostomy: A Multi-Center Retrospective Study.

Key Takeaways for GI Nurses

• EUS-guided hepaticogastrostomy (EUS-HGS) is increasingly used as an alternative biliary drainage route when ERCP fails, and nurses supporting these procedures should be familiar with the different metal stent designs being used, as stent characteristics may influence patient outcomes.
• This study found that a high-axial-force (AF) partially covered metal stent was associated with significantly more early non-recurrent biliary obstruction adverse events (37% vs. 13%) compared to a low-AF stent, meaning patients receiving high-AF stents may need closer post-procedure monitoring in the immediate period.
• Despite the difference in early adverse events, clinical success, stent patency (time to recurrent biliary obstruction), late adverse events, and overall survival were similar between the two stent types—so this is not an argument against EUS-HGS as a technique, but a nuance in device selection.
• Nurses working in pre-procedure planning, recovery, and post-discharge follow-up should be aware that stent type may be a variable physicians consider, and that early symptom reporting (abdominal pain, fever, signs of peritonitis) is especially important after high-AF stent placement.

Clinical Relevance

EUS-HGS has become a valuable rescue technique for biliary decompression in patients with unresectable malignant biliary obstruction when conventional ERCP cannot be completed. As this procedure grows in adoption, GI and endoscopy nurses play a critical role not only in procedural support but also in recovery monitoring and patient education, since adverse events such as peritonitis and stent migration—though relatively uncommon—can have serious consequences if not recognized early. This study's finding that axial force (a stent's inherent "spring-back" or straightening force) may influence the rate of early complications adds a practical dimension nurses should understand: not all partially covered metal stents behave the same way mechanically, and this can translate into different early recovery courses for patients.

From a unit operations standpoint, this research underscores the importance of standardized post-EUS-HGS monitoring protocols, particularly in the first 24–72 hours when early non-RBO adverse events are most likely to manifest. Nurses recovering patients after high-AF stent placement should maintain heightened vigilance for signs of bile leak, peritonitis, or stent-related trauma to the gastric or hepatic tissue interface—monitoring vital signs, abdominal exam findings, and pain patterns closely. Clear communication with the endoscopy team about which stent type was used can help tailor the intensity and duration of post-procedure observation, and this information should be clearly documented and handed off to inpatient nursing staff or outpatient follow-up teams.

For professional development, this study is a useful reminder that device-level knowledge—not just procedural steps—is increasingly relevant to nursing practice in advanced endoscopy. As EUS-guided biliary drainage techniques diversify and stent technology evolves, nurses who understand basic concepts like axial force, stent covering, and migration risk will be better equipped to anticipate complications, educate patients and families, and contribute meaningfully to multidisciplinary discussions about device selection and patient-specific risk factors.

Bottom Line

When a high-axial-force partially covered metal stent is used for EUS-guided hepaticogastrostomy, patients appear more likely to experience early adverse events, so GI nurses should prioritize vigilant early post-procedure monitoring and prompt recognition of symptoms like abdominal pain or fever, while recognizing that overall stent function and long-term outcomes remain comparable between stent types.