Comparison of long-term outcomes of endoscopic ultrasound-guided hepaticogastrostomy and choledochoduodenostomy for distal malignant biliary obstruction: a multicenter retrospective study
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...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2024-03-01
|
| Series: | Therapeutic Advances in Gastroenterology |
| Online Access: | https://doi.org/10.1177/17562848241239551 |
| _version_ | 1827313564979822592 |
|---|---|
| author | Dongwook Oh Sung Yong Han Sang Hyub Lee Seong-Hun Kim Woo Hyun Paik Hyung-Ku Chon Tae Jun Song Se Woo Park Jae Hee Cho |
| author_facet | Dongwook Oh Sung Yong Han Sang Hyub Lee Seong-Hun Kim Woo Hyun Paik Hyung-Ku Chon Tae Jun Song Se Woo Park Jae Hee Cho |
| author_sort | Dongwook Oh |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-24T22:10:55Z |
| format | Article |
| id | doaj.art-df6306fca89244b29dc2f03f00f3c531 |
| institution | Directory Open Access Journal |
| issn | 1756-2848 |
| language | English |
| last_indexed | 2024-04-24T22:10:55Z |
| publishDate | 2024-03-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Therapeutic Advances in Gastroenterology |
| spelling | doaj.art-df6306fca89244b29dc2f03f00f3c5312024-03-20T09:04:05ZengSAGE PublishingTherapeutic Advances in Gastroenterology1756-28482024-03-011710.1177/17562848241239551Comparison of long-term outcomes of endoscopic ultrasound-guided hepaticogastrostomy and choledochoduodenostomy for distal malignant biliary obstruction: a multicenter retrospective studyDongwook OhSung Yong HanSang Hyub LeeSeong-Hun KimWoo Hyun PaikHyung-Ku ChonTae Jun SongSe Woo ParkJae Hee ChoBackground: 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.https://doi.org/10.1177/17562848241239551 |
| spellingShingle | Dongwook Oh Sung Yong Han Sang Hyub Lee Seong-Hun Kim Woo Hyun Paik Hyung-Ku Chon Tae Jun Song Se Woo Park Jae Hee Cho Comparison of long-term outcomes of endoscopic ultrasound-guided hepaticogastrostomy and choledochoduodenostomy for distal malignant biliary obstruction: a multicenter retrospective study Therapeutic Advances in Gastroenterology |
| title | Comparison of long-term outcomes of endoscopic ultrasound-guided hepaticogastrostomy and choledochoduodenostomy for distal malignant biliary obstruction: a multicenter retrospective study |
| title_full | Comparison of long-term outcomes of endoscopic ultrasound-guided hepaticogastrostomy and choledochoduodenostomy for distal malignant biliary obstruction: a multicenter retrospective study |
| title_fullStr | Comparison of long-term outcomes of endoscopic ultrasound-guided hepaticogastrostomy and choledochoduodenostomy for distal malignant biliary obstruction: a multicenter retrospective study |
| title_full_unstemmed | Comparison of long-term outcomes of endoscopic ultrasound-guided hepaticogastrostomy and choledochoduodenostomy for distal malignant biliary obstruction: a multicenter retrospective study |
| title_short | Comparison of long-term outcomes of endoscopic ultrasound-guided hepaticogastrostomy and choledochoduodenostomy for distal malignant biliary obstruction: a multicenter retrospective study |
| title_sort | comparison of long term outcomes of endoscopic ultrasound guided hepaticogastrostomy and choledochoduodenostomy for distal malignant biliary obstruction a multicenter retrospective study |
| url | https://doi.org/10.1177/17562848241239551 |
| work_keys_str_mv | AT dongwookoh comparisonoflongtermoutcomesofendoscopicultrasoundguidedhepaticogastrostomyandcholedochoduodenostomyfordistalmalignantbiliaryobstructionamulticenterretrospectivestudy AT sungyonghan comparisonoflongtermoutcomesofendoscopicultrasoundguidedhepaticogastrostomyandcholedochoduodenostomyfordistalmalignantbiliaryobstructionamulticenterretrospectivestudy AT sanghyublee comparisonoflongtermoutcomesofendoscopicultrasoundguidedhepaticogastrostomyandcholedochoduodenostomyfordistalmalignantbiliaryobstructionamulticenterretrospectivestudy AT seonghunkim comparisonoflongtermoutcomesofendoscopicultrasoundguidedhepaticogastrostomyandcholedochoduodenostomyfordistalmalignantbiliaryobstructionamulticenterretrospectivestudy AT woohyunpaik comparisonoflongtermoutcomesofendoscopicultrasoundguidedhepaticogastrostomyandcholedochoduodenostomyfordistalmalignantbiliaryobstructionamulticenterretrospectivestudy AT hyungkuchon comparisonoflongtermoutcomesofendoscopicultrasoundguidedhepaticogastrostomyandcholedochoduodenostomyfordistalmalignantbiliaryobstructionamulticenterretrospectivestudy AT taejunsong comparisonoflongtermoutcomesofendoscopicultrasoundguidedhepaticogastrostomyandcholedochoduodenostomyfordistalmalignantbiliaryobstructionamulticenterretrospectivestudy AT sewoopark comparisonoflongtermoutcomesofendoscopicultrasoundguidedhepaticogastrostomyandcholedochoduodenostomyfordistalmalignantbiliaryobstructionamulticenterretrospectivestudy AT jaeheecho comparisonoflongtermoutcomesofendoscopicultrasoundguidedhepaticogastrostomyandcholedochoduodenostomyfordistalmalignantbiliaryobstructionamulticenterretrospectivestudy |