Long-term outcomes and predictors of adverse events of EUS-guided hepatico-gastrostomy for malignant biliary obstruction: Multicenter, retrospective study

Cho, Jae Hee; Park, Se Woo; Kim, Eui Joo; Park, Chan Hyuk; Park, Da Hae; Lee, Kyong Joo; Lee, Sang Soo

doi:10.1007/s00464-022-09346-z

Cited by 10 publications

(9 citation statements)

References 25 publications

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“…Pancreatobiliary malignancy was the strongest risk factor for recurrent biliary events; one third of patients with pancreatobiliary malignancy developed recurrent biliary events. This rate is even higher than the rate of recurrent biliary events reported after EUS‐guided choledochoduodenostomy or hepatogastrostomy 33,34 . Previous reports on EUS‐GBD do not clarify the relationship between underlying pancreatobiliary malignancy and the risk or long‐term AEs 6,31 or recurrent biliary events 22 .…”

Section: Discussionmentioning

confidence: 89%

“…This rate is even higher than the rate of recurrent biliary events reported after EUS-guided choledochoduodenostomy or hepatogastrostomy. 33,34 Previous reports on EUS-GBD do not clarify the relationship between underlying pancreatobiliary malignancy and the risk or long-term AEs 6,31 or recurrent biliary events. 22 Patients with underlying malignancy typically have previous endoscopic drainage procedures, involving the presence of indwelling transpapillary drains or stents, which may predispose to recurrent biliary events.…”

Section: Discussionmentioning

confidence: 99%

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Endoscopic ultrasound‐guided gallbladder drainage with long‐term lumen‐apposing metal stent indwell: 1‐year results from a prospective nationwide observational study

Bazaga,

García‐Alonso,

Aparicio Tormo

et al. 2023

J of Gastro and Hepatol

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Background and AimThis study aimed to determine safety and risk factors for adverse events (AEs) of endoscopic ultrasound‐guided gallbladder drainage (EUS‐GBD) with long‐term indwell of lumen‐apposing metal stents (LAMS).MethodsThis study is a multicenter prospective observational study on consecutive high surgical‐risk patients requiring gallbladder drainage who underwent EUS‐GBD with LAMS over 12 months. Centralized telephone follow‐up interviews were conducted every 3 months for 1 year. Patients were censored at LAMS removal, cholecystectomy, or death. AE‐free survival was determined using log–rank tests. Cumulative risks were estimated using life‐table analysis.ResultsEighty‐two patients were included (53.7% male, median [interquartile range] age of 84.6 [76.5–89.8] years, and 85.4% with acute cholecystitis). Technical success was achieved in 79 (96.3%), and clinical success in 73 (89%). No patient was lost to follow‐up; 45 patients (54.9%) completed 1‐year follow‐up with in situ LAMS. Median (interquartile range) LAMS indwell time was 364 (47–367) days. Overall, 12 (14.6%) patients presented 14 AEs, including 5 (6.1%) recurrent biliary events (3 acute cholangitis, 1 mild acute pancreatitis, and 1 acute cholecystitis). Patients with pancreatobiliary malignancy had an increased risk of recurrent biliary events (33% vs 1.5%, P = 0.001). The overall 1‐year cumulative risk of recurrent biliary events was 9.7% (4.1–21.8%). The 1‐year risk of AEs and of severe AEs was 18.8% (11–31.2%) and 7.9% (3.3–18.2%), respectively. Pancreatobiliary malignancy was the single risk factor for recurrent biliary events; LAMS misdeployment was the strongest risk factor for AEs.ConclusionsLong‐term LAMS indwell does not increase the risk of delayed AEs following EUS‐GBD.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Endoscopic ultrasound‐guided gallbladder drainage with long‐term lumen‐apposing metal stent indwell: 1‐year results from a prospective nationwide observational study

Bazaga,

García‐Alonso,

Aparicio Tormo

et al. 2023

J of Gastro and Hepatol

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“…As the diagnosis of distal MBO was established, treatment with appropriate antibiotics, bowel rest, and intravenous fluids was administered to all patients. 14 EUS-BD was also performed under sedation using intravenous administration of midazolam, propofol, and meperidine. 15 …”

Section: Methodsmentioning

confidence: 99%

Comparison of long-term outcomes of endoscopic ultrasound-guided hepaticogastrostomy and choledochoduodenostomy for distal malignant biliary obstruction: a multicenter retrospective study

Oh,

Han,

Lee

et al. 2024

Therap Adv Gastroenterol

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Background: Endoscopic ultrasound-guided biliary drainage (EUS-BD), classified as choledochoduodenostomy (CDS) and hepaticogastrostomy (HGS), is a feasible and effective alternative for distal malignant biliary obstruction (MBO) in failed endoscopic retrograde cholangiopancreatography. However, the preferred technique for better outcomes has not yet been evaluated. Objectives: We compared the long-term outcomes between the techniques. Design: Retrospective comparative study. Methods: We reviewed consecutive patients who underwent EUS-CDS or EUS-HGS with transmural stent placement for distal MBO between 2009 and 2022. The primary outcome was the stent patency. The secondary outcomes were technical and clinical success, adverse events (AEs) of each technique, and independent risk factors for stent dysfunction. Results: In all, 115 patients were divided into EUS-CDS ( n = 56) and EUS-HGS ( n = 59) groups. Among them, technical success was achieved in 98.2% of EUS-CDS and 96.6% of EUS-HGS groups. Furthermore, clinical success was 96.4% in EUS-CDS and 88.1% in EUS-HGS groups, without significant difference ( p = 0.200). The mean duration of stent patency for EUS-CDS was 770.3 days while that for EUS-HGS was 164.9 days ( p = 0.010). In addition, the only independent risk factor for stent dysfunction was systematic treatment after EUS-BD [hazard ratio and 95% confidence interval 0.238 (0.066–0.863), p = 0.029]. The incidence of stent dysfunction of EUS-HGS was higher than EUS-CDS (35.1% versus 18.2%, 0.071), despite no significant differences even in late AEs. Conclusion: In distal MBO, EUS-CDS may be better than EUS-HGS with longer stent patency and fewer AEs. Furthermore, systematic treatment after EUS-BD is recommended for the improvement of stent patency.

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“…MHBO is an independent net risk factor for stent occlusion, as reported in a study that evaluated 120 patients who underwent EUS-HGS. 43 …”

Section: Complicationsmentioning

confidence: 99%

Endoscopic ultrasound-guided intervention for inaccessible papilla in advanced malignant hilar biliary obstruction

Pal

Lakhtakia²

2023

Clin Endosc

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Advanced malignant hilar biliary obstruction (MHBO) with inaccessible papilla poses a significant challenge to endoscopists, as drainage of multiple liver segments may be warranted. Transpapillary drainage may not be feasible in patients with surgically altered anatomy, duodenal stenosis, prior duodenal self-expanding metal stent, and after initial transpapillary drainage, but require re-intervention for draining separated liver segments. Endoscopic ultrasound-guided biliary drainage (EUS-BD) and percutaneous trans-hepatic biliary drainage are the feasible options in this scenario. The major advantages of EUS-BD over percutaneous trans-hepatic biliary drainage include a reduction in patient discomfort and internal drainage away from the tumor, thus reducing the possibility of tissue or tumor ingrowth. With innovations, EUS-BD is helpful not only for bilateral communicating MHBO but also for non-communicating systems with bridging hilar stents or isolated right intra-hepatic duct drainage by hepatico-duodenostomy. EUS-guided multi-stent drainage with specially designed cannulas and guidewires has become a reality. A combined approach with endoscopic retrograde cholangiopancreatography for re-intervention, interventional radiology, and intraductal tumor ablative therapies has been reported. Stent migration and bile leakage can be minimized with proper stent selection and technique, and stent blocks can be managed with EUS-guided interventions in a majority of cases. Future comparative studies are required to establish the role of EUS-guided interventions in MHBO as rescue or primary therapy.

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Long-term outcomes and predictors of adverse events of EUS-guided hepatico-gastrostomy for malignant biliary obstruction: Multicenter, retrospective study

Cited by 10 publications

References 25 publications

Endoscopic ultrasound‐guided gallbladder drainage with long‐term lumen‐apposing metal stent indwell: 1‐year results from a prospective nationwide observational study

Endoscopic ultrasound‐guided gallbladder drainage with long‐term lumen‐apposing metal stent indwell: 1‐year results from a prospective nationwide observational study

Comparison of long-term outcomes of endoscopic ultrasound-guided hepaticogastrostomy and choledochoduodenostomy for distal malignant biliary obstruction: a multicenter retrospective study

Endoscopic ultrasound-guided intervention for inaccessible papilla in advanced malignant hilar biliary obstruction

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