Multicenter prospective evaluation study of endoscopic ultrasound‐guided hepaticogastrostomy combined with antegrade stenting (with video)

Ogura, Takeshi; Kitano, Masayuki; Takenaka, Mamoru; Okuda, Atsushi; Minaga, Kosuke; Yamao, Kentaro; Yamashita, Yoshihisa; Hatamaru, Keiichi; Noguchi, Chishio; Gotoh, Yasuhiko; Kuroda, Taira; Yokota, Tomoyuki; Nishikiori, Hidefumi; Sagami, Ryota; Higuchi, Kazuhide; Chiba, Yasutaka

doi:10.1111/den.12976

Cited by 64 publications

(67 citation statements)

References 30 publications

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“…Since its first report in 2001, endoscopic ultrasound‐guided biliary drainage (EUS‐BD) has emerged as a new biliary decompression procedure and has been increasingly used as an effective alternative for biliary obstruction patients with failed ERCP . In the last decade, EUS‐BD has been attracting considerable attention and various endoscopic techniques have been described for its implementation . Among these, EUS‐BD with transmural stenting can be carried out by two main access routes: choledochoduodenostomy (CDS) and hepaticogastrostomy (HGS).…”

Section: Introductionmentioning

confidence: 99%

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Comparison of the efficacy and safety of endoscopic ultrasound‐guided choledochoduodenostomy and hepaticogastrostomy for malignant distal biliary obstruction: Multicenter, randomized, clinical trial

Minaga

Ogura

Shiomi

et al. 2019

Digestive Endoscopy

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Background and Aim Endoscopic ultrasound‐guided biliary drainage (EUS‐BD) can be carried out by two different approaches: choledochoduodenostomy (CDS) and hepaticogastrostomy (HGS). We compared the efficacy and safety of these approaches in malignant distal biliary obstruction (MDBO) patients using a prospective, randomized clinical trial. Methods Patients with malignant distal biliary obstruction after failed endoscopic retrograde cholangiopancreatography were randomly selected for either CDS or HGS. The procedures were carried out at nine tertiary centers from September 2013 to March 2016. Primary endpoint was technical success rate, and the noninferiority of HGS to CDS was examined with a one‐sided significance level of 5%, where the noninferiority margin was set at 15%. Secondary endpoints were clinical success, adverse events (AE), stent patency, survival time, and overall technical success including alternative EUS‐BD procedures. Results Forty‐seven patients (HGS, 24; CDS, 23) were enrolled. Technical success rates were 87.5% and 82.6% in the HGS and CDS groups, respectively, where the lower limit of the 90% confidence interval of the risk difference was −12.2% (P = 0.0278). Clinical success rates were 100% and 94.7% in the HGS and CDS groups, respectively (P = 0.475). Overall AE rate, stent patency, and survival time did not differ between the groups. Overall technical success rates were 100% and 95.7% in the HGS and CDS groups, respectively (P = 0.983). Conclusions This study suggests that HGS is not inferior to CDS in terms of technical success. When one procedure is particularly challenging, readily switching to the other could increase technical success.

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Section: Introductionmentioning

confidence: 99%

“…4,5 In the last decade, EUS-BD has been attracting considerable attention and various endoscopic techniques have been described for its implementation. [6][7][8] Among these, EUS-BD with transmural stenting can be carried out by two main access routes: choledochoduodenostomy (CDS) and hepaticogastrostomy (HGS).…”

Section: Introductionmentioning

confidence: 99%

Comparison of the efficacy and safety of endoscopic ultrasound‐guided choledochoduodenostomy and hepaticogastrostomy for malignant distal biliary obstruction: Multicenter, randomized, clinical trial

Minaga

Ogura

Shiomi

et al. 2019

Digestive Endoscopy

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“…However, the stent in EUS-AG is placed through the tumour, and the growth of the tumour is the main cause of stent re-obstruction. Since a perforating fistula is absent, another intervention for postoperative obstruction will be more difficult in EUS-AG than in EUS-HGS [22]. EUS-HGS may result in more pneumoperitoneum and bile leaks because the fistula traverses the peritoneum [10].…”

Section: Discussionmentioning

confidence: 99%

Comparison of endoscopic ultrasound-guided hepaticogastrostomy and the antegrade technique: study protocol for a prospective, multicentre, randomised controlled trial

Liao

Xiao

Sheng

et al. 2019

Preprint

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Background: Endoscopic ultrasound-guided biliary drainage (EUS-BD) is used after failed endoscopic retrograde cholangiopancreatography. Based on existing studies, intrahepatic (IH) approaches are suggested to be preferred in patients with a dilated IH bile duct. Both ultrasound-guided hepaticogastrostomy (EUS-HGS) and ultrasound-guided antegrade treatment (EUS-AG) are available IH approaches for patients with an unreachable papilla. However, a direct comparison between these two approaches is lacking. Therefore, we aim to evaluate and compare the safety and efficiency of EUS-HGS and EUS-AG in patients with an unreachable papilla. Methods: This is a prospective, randomised, controlled, multicentre study. One-hundred forty-eight patients from three hospitals who met the inclusion criteria will be randomly assigned (1:1) to undergo either EUS-HGS or EUS-AG for relief of biliary obstruction. The final study follow-up is scheduled at 1 year postoperatively. The primary endpoint is to compare the safety and efficiency of EUS-HGS and EUS-AG in patients with an unreachable papilla. The secondary endpoint is the overall survival rate of patients undergoing EUS-HGS and EUS-AG. The chi-square test, Kaplan-Meier methods, the log-rank test, and Cox regression analysis will be used to analyse the data. Discussion: To our knowledge, this is the first study to compare these two EUS-BD approaches directly using a multicentre, randomized, controlled trial design. The clinical economic indexes will also be compared, as they may also affect the patient’s choice. The result may contribute to establishing a strategic guideline for choosing IH EUS-BD approaches. Trial registration: Chinese Clinical Trial Registry (ChiCTR), ChiCTR1900020737; registered on 15 January 2019. http://www.chictr.org.cn/showproj.aspx?proj=33672

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“…By contrast, EUS‐HGS is indicated in most cases, but the rate of adverse events associated with EUS‐HGS such as bile peritonitis or stent migration is higher than for the other procedures . Efforts to prevent adverse events and ensure durable patency have been made using EUS‐HGS with antegrade stenting (EUS‐HGAS) . Here, we present a video that shows the technique of EUS‐HGAS (Video S1).…”

Section: Brief Explanationmentioning

confidence: 99%

EUS‐guided hepaticogastrostomy

Itonaga

Hatamaru

Kitano

2018

Digestive Endoscopy

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Multicenter prospective evaluation study of endoscopic ultrasound‐guided hepaticogastrostomy combined with antegrade stenting (with video)

Abstract: The present study is the first to evaluate EUS-HGAS. EUS-HGAS has clinical benefit for obtaining long stent patency and avoiding adverse events, although the possibility of acute pancreatitis as a result of obstruction of the orifice of the pancreatic duct must be considered.

Cited by 64 publications

References 30 publications

Comparison of the efficacy and safety of endoscopic ultrasound‐guided choledochoduodenostomy and hepaticogastrostomy for malignant distal biliary obstruction: Multicenter, randomized, clinical trial

Comparison of the efficacy and safety of endoscopic ultrasound‐guided choledochoduodenostomy and hepaticogastrostomy for malignant distal biliary obstruction: Multicenter, randomized, clinical trial

Comparison of endoscopic ultrasound-guided hepaticogastrostomy and the antegrade technique: study protocol for a prospective, multicentre, randomised controlled trial

EUS‐guided hepaticogastrostomy

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