Subscribe to RSS
DOI: 10.1055/a-2333-7898
Comparison of stent patency between EUS-guided hepaticogastrostomy with bridging and endoscopic transpapillary biliary drainage for hilar obstruction
Supported by: The National Cancer Center Research and Development Fund 2022-A-16
Abstract
Background and study aims Endoscopic ultrasound-guided hepaticogastrostomy with bridging between the left and right bile ducts is an alternative to endoscopic transpapillary drainage for malignant hilar biliary obstruction. We aimed to analyze the long-term stent patency of endoscopic ultrasound-guided hepaticogastrostomy with bridging.
Patients and methods Patients who underwent endoscopic ultrasound-guided hepaticogastrostomy with bridging between April 2018 and July 2023 were retrospectively analyzed. We retrospectively compared the stent patency of these patients with that of the individuals who underwent endoscopic transpapillary drainage-multi-stenting using unmatched (entire) and propensity score-matched cohorts.
Results Endoscopic ultrasound-guided hepaticogastrostomy with bridging had a technical success rate of 90% (18/20). Adverse events were minimal. The number of clinical success cases was 17 and 82 for endoscopic ultrasound-guided hepaticogastrostomy with bridging using metallic stent and endoscopic transpapillary drainage-multi-stenting, respectively. The recurrent biliary obstruction rate was 17.6% and 58.5% for endoscopic ultrasound-guided hepaticogastrostomy with bridging and endoscopic transpapillary drainage-multi-stenting, respectively; the median time to recurrent biliary obstruction (days) was significantly longer for endoscopic ultrasound-guided hepaticogastrostomy with bridging in the entire (not reached vs. 104, P=0.03) and propensity score-matched (183 vs. 79, P=0.05) cohorts. The non-recurrent biliary obstruction rate for endoscopic ultrasound-guided hepaticogastrostomy with bridging was 91.6% at 3 and 6 months and 57% at 12 months. Multivariate analyses revealed that endoscopic ultrasound-guided hepaticogastrostomy with bridging contributed to a lower recurrent biliary obstruction incidence (hazard ratio, 0.31, P=0.05) without significant difference.
Conclusions Stent patency was significantly better for endoscopic ultrasound-guided hepaticogastrostomy with bridging. However, future prospective studies are needed.
Keywords
Pancreatobiliary (ERCP/PTCD) - Strictures - Endoscopic ultrasonography - Biliary tract - Intervention EUSPublication History
Received: 20 February 2024
Accepted after revision: 12 April 2024
Article published online:
10 July 2024
© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 Qumseya BJ, Jamil LH, Elmunzer BJ. et al. ASGE guideline on the role of endoscopy in the management of malignant hilar obstruction. Gastrointest Endosc 2021; 94: 222-234.e222
- 2 Mukai T, Yasuda I, Nakashima M. et al. Metallic stents are more efficacious than plastic stents in unresectable malignant hilar biliary strictures: a randomized controlled trial. J Hepatobiliary Pancreat Sci 2013; 20: 214-222
- 3 Sawas T, Al Halabi S, Parsi MA. et al. Self-expandable metal stents versus plastic stents for malignant biliary obstruction: a meta-analysis. Gastrointest Endosc 2015; 82: 256-267.e257
- 4 Sangchan A, Kongkasame W, Pugkhem A. et al. Efficacy of metal and plastic stents in unresectable complex hilar cholangiocarcinoma: a randomized controlled trial. Gastrointest Endosc 2012; 76: 93-99
- 5 Lee TH, Moon JH, Choi JH. et al. Prospective comparison of endoscopic bilateral stent-in-stent versus stent-by-stent deployment for inoperable advanced malignant hilar biliary stricture. Gastrointest Endosc 2019; 90: 222-230
- 6 Maruki Y, Hijioka S, Wu SYS. et al. Novel endoscopic technique for trisegment drainage in patients with unresectable hilar malignant biliary strictures (with video). Gastrointest Endosc 2020; 92: 763-769
- 7 de Souza GMV, Ribeiro IB, Funari MP. et al. Endoscopic retrograde cholangiopancreatography drainage for palliation of malignant hilar biliary obstruction - stent-in-stent or side-by-side? A systematic review and meta-analysis. World J Hepatol 2021; 13: 595-610
- 8 Ogura T, Masuda D, Imoto A. et al. EUS-guided hepaticogastrostomy for hepatic hilar obstruction. Endoscopy 2014; 46: E32-E33
- 9 Prachayakul V, Aswakul P. Endoscopic ultrasound-guided biliary drainage: Bilateral systems drainage via left duct approach. World J Gastroenterol 2015; 21: 10045-10048
- 10 Ogura T, Sano T, Onda S. et al. Endoscopic ultrasound-guided biliary drainage for right hepatic bile duct obstruction: novel technical tips. Endoscopy 2015; 47: 72-75
- 11 Moryoussef F, Sportes A, Leblanc S. et al. Is EUS-guided drainage a suitable alternative technique in case of proximal biliary obstruction?. Therap Adv Gastroenterol 2017; 10: 537-544
- 12 Caillol F, Bosshardt C, Reimao S. et al. Drainage of the right liver under EUS guidance: a bridge technique allowing drainage of the right liver through the left liver into the stomach or jejunum. Endosc Ultrasound 2019; 8: 199-203
- 13 Nakai Y, Kogure H, Isayama H. et al. Endoscopic ultrasound-guided biliary drainage for unresectable hilar malignant biliary obstruction. Clin Endosc 2019; 52: 220-225
- 14 Maehara K, Hijioka S, Nagashio Y. et al. Simultaneous endoscopic ultrasound-guided hepaticogastrostomy and bridging stenting with partial stent-in-stent method. Endoscopy 2020; 52: E381-E382
- 15 Winkler J, Caillol F, Ratone JP. et al. Feasibility of EUS-guided hepaticogastrostomy for inoperable malignant hilar biliary strictures. Endosc Ultrasound 2021; 10: 51-56
- 16 Sundaram S, Dhir V. EUS-guided biliary drainage for malignant hilar biliary obstruction: A concise review. Endosc Ultrasound 2021; 10: 154-160
- 17 Kato H, Matsumoto K, Okada H. Recent advances regarding endoscopic biliary drainage for unresectable malignant hilar biliary obstruction. DEN Open 2022; 2: e33
- 18 Dhar J, Gupta P, Samanta J. The role of endoscopy in malignant hilar obstruction. Ann Gastroenterol 2023; 36: 347-359
- 19 Pal P, Lakhtakia S. Endoscopic ultrasound-guided intervention for inaccessible papilla in advanced malignant hilar biliary obstruction. Clin Endosc 2023; 56: 143-154
- 20 Nakahara K, Morita R, Itoh F. Endoscopic ultrasound-guided bilateral biliary drainage through the mesh of the metal stents using a balloon occlusion method. Dig Endosc 2020; 32: e104-e105
- 21 Nakai Y, Oyama H, Kanai S. et al. Double guidewire technique using an uneven double lumen catheter for endoscopic ultrasound-guided interventions. Dig Dis Sci 2021; 66: 1540-1547
- 22 Isayama H, Hamada T, Yasuda I. et al. TOKYO criteria 2014 for transpapillary biliary stenting. Dig Endosc 2015; 27: 259-264
- 23 Sherman S, Lehman GA. ERCP- and endoscopic sphincterotomy-induced pancreatitis. Pancreas 1991; 6: 350-367
- 24 Vienne A, Hobeika E, Gouya H. et al. Prediction of drainage effectiveness during endoscopic stenting of malignant hilar strictures: the role of liver volume assessment. Gastrointest Endosc 2010; 72: 728-735
- 25 Schoch A, Lisotti A, Walter T. et al. Efficacy of EUS-guided hepaticogastrostomy in prolonging survival of patients with perihilar cholangiocarcinoma. Endosc Ultrasound 2022; 11: 487-494
- 26 Minaga K, Ogura T, Shiomi H. et al. Comparison of the efficacy and safety of endoscopic ultrasound-guided choledochoduodenostomy and hepaticogastrostomy for malignant distal biliary obstruction: Multicenter, randomized, clinical trial. Dig Endosc 2019; 31: 575-582
- 27 Shibuki T, Okumura K, Sekine M. et al. Covered self-expandable metallic stents versus plastic stents for endoscopic ultrasound-guided hepaticogastrostomy in patients with malignant biliary obstruction. Clin Endosc 2023; 56: 802-811