Endoscopic ultrasound‐guided hepaticogastrostomy versus hepaticogastrostomy with antegrade stenting for malignant distal biliary obstruction

Abstract

Background: Recurrent biliary obstruction (RBO) is a possible complication of endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) in patients with malignant distal biliary obstruction (MDBO). Therefore, adding antegrade stenting across MDBO, followed by EUS-HGS (EUS-HGAS), may prolong the time to RBO (TRBO). We aimed to compare the outcomes of EUS-HGS and HGAS. Methods:We retrospectively evaluated consecutive patients who underwent EUS-HGS or HGAS between July 2016 and November 2020. The TRBO, overall survival (OS), and adverse event (AE) rate were compared between the groups.The risk factors for RBO were determined using a multivariable Cox proportional hazards model. Results: This study included 96 patients (EUS-HGS, n = 58; HGAS, n = 38).There was a significant difference in the cause of endoscopic retrograde cholangiopancreatography failure and the HGS stent type between the groups. A significant difference was found in TRBO (234 days vs not reached, P = .036), whereas no significant difference was found in the OS (123 vs 126 days, P = .76). The AE rate was not significantly different. Multivariable analysis revealed that EUS-HGS was an independent risk factor for RBO (hazard ratio: 4.01, 95% confidence interval: 1.16-13.9).Conclusions: Endoscopic ultrasound-guided hepaticogastrostomy prolonged the TRBO compared with EUS-HGS for biliary drainage in patients with MDBO.

Bile aspiration technique for successful guidewire manipulation in endoscopic ultrasound-guided hepaticogastrostomy with antegrade stenting

“…The greatest technical challenge in endoscopic ultrasound (EUS)-guided hepaticogastrostomy with antegrade stenting is breaching the bile duct stricture with guidewire 1 2 . Herein, we report a case in which a novel bile aspiration technique achieved smooth guidewire breaching of the biliary stricture.…”

Development of devices for interventional endoscopic ultrasound for the management of pancreatobiliary diseases

“…Available SEMS include the Zilver stent (Cook Medical), BileRush selective (Piolax Medical Devices), and YABUSAME (Kaneka Medix). These SEMS have a thin delivery system (6F or less), allowing direct insertion without tract dilation 53,54 …”

“…These SEMS have a thin delivery system (6F or less), allowing direct insertion without tract dilation. 53,54…”

Endoscopic ultrasound-guided biliary drainage and gastrointestinal anastomoses: the journey from promising innovations to standard of care

“…In these cases, a new stent can be placed through the open fistula [ 34 , 56 ]. An interesting recent retrospective series by Ishiwatari et al , comparing EUS-HGS with or without additional antegrade stenting in patients with dMBO, suggested that associating antegrade stenting with EUS-HGS might prolong the time to biliary recurrence (P=0.036 on log-rank test) and independently predict a reduced recurrent biliary obstruction (hazard ratio 0.2, 95%CI 0.1-0.9); despite the non-different risk of AEs, fewer cases of peritonitis and cholangitis (but more frequent pancreatitis) were observed in the double procedure than in EUS-HGS alone [ 57 ].…”