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Endoscopic ultrasound-guided hepaticogastrostomy vs. antegrade metal stent placement kee** an access route in patients with malignant biliary obstruction

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Abstract

Background

Few studies have compared endoscopic ultrasound (EUS)-guided hepaticogastrostomy (HGS) with EUS-guided antegrade metal stent placement (AGMS). The purpose of this study was to compare times to recurrent biliary obstruction (TRBO) in patients who underwent HGS using metal stents (MS) and those who underwent AGMS kee** access routes with plastic stents (AGMS-AR).

Methods

This study retrospectively evaluated consecutive patients who underwent HGS or AGMS between September 2016 and December 2022. TRBO, overall survival (OS), and adverse event (AE) rates were compared in the two groups. The risk factors for RBO were determined using a multivariable Cox proportional hazards model.

Results

This study included 32 patients in the HGS group and 30 in the AGMS-AR group. Technical success rate was significantly higher in the HGS than in the AGMS-AR group (100 vs. 80%; P = 0.009). The technical success rate without tract dilation was significantly higher in the AGMS-AR than in the HGS group (83 vs. 38%; P < 0.001). RBO rates were significantly higher in the HGS than in the AGMS-AR group (53 vs. 17%; P = 0.024), whereas AE rates did not differ significantly. TRBO differed significantly in the HGS and AGMS-AR groups (159 days vs. not reached, P = 0.011), whereas OS did not differ significantly. Multivariable analysis revealed that HGS was an independent risk factor for RBO (hazard ratio, 6.48, P = 0.014).

Conclusion

TRBO was significantly longer in patients who underwent AGMS with PS than HGS. AGMS with PS may be effective after the failure of ERCP in patients with malignant biliary obstruction.

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Abbreviations

EUS-BD:

EUS-guided biliary drainage

AEs:

Adverse events

OS:

Overall survival

HGS:

EUS-guided hepaticogastrostomy

CDS:

EUS-guided choledochoduodenostomy

AGS:

EUS-guided antegrade stenting

RV:

EUS-guided rendezvous technique

AGMS:

EUS-guided antegrade metal stent placement

AGMS-AR:

AGMS kee** access routes with plastic stents

HGAS:

EUS-HGS with antegrade metal stent placement

RBO:

Recurrent biliary obstruction

ERCP:

Endoscopic retrograde cholangiopancreatography

MBO:

Malignant biliary obstruction

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Authors and Affiliations

  1. Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-0012, Japan

    Masahiro Itonaga, Reiko Ashida, Keiichi Hatamaru, Yasunobu Yamashita, Yuki Kawaji, Takashi Tamura, Tomoya Emori, Takahiro Shishimoto, Hiromu Koutani, Takaaki Tamura, Akiya Nakahata, Hirofumi Yamazaki & Masayuki Kitano

Authors
  1. Masahiro Itonaga
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  2. Reiko Ashida
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  3. Keiichi Hatamaru
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  4. Yasunobu Yamashita
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  5. Yuki Kawaji
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  6. Takashi Tamura
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  7. Tomoya Emori
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  8. Takahiro Shishimoto
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  9. Hiromu Koutani
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  10. Takaaki Tamura
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  11. Akiya Nakahata
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  12. Hirofumi Yamazaki
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  13. Masayuki Kitano
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Contributions

Itonaga M and Kitano M conceived the study, designed the study protocol, and drafted the manuscript. Ashida R, Emori T, Hatamaru K, Yamashita Y, Kawaji Y, Tamura T, Shishimoto T, Koutani H, Tamura T, Nakahata A, and Yamazaki H contributed to the case registration. All authors contributed to drafting the manuscript and have read and approved the final manuscript.

Corresponding author

Correspondence to Masayuki Kitano.

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Conflict of interest

Masayuki Kitano has received honoraria from Olympus Corporation for delivering lectures at conferences and grants from Boston Scientific, Zeon Medical Inc., and Medicos Hirata Inc. Masahiro Itonaga, Reiko Ashida, Tomoya Emori, Keiichi Hatamaru, Yasunobu Yamashita, Yuki Kawaji, Takashi Tamura, Takahiro Shishimoto, Hiromu Koutani, Takaaki Tamura, Akiya Nakahata, and Hirofumi Yamazaki have no conflicts of interest or financial ties to disclose.

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Itonaga, M., Ashida, R., Hatamaru, K. et al. Endoscopic ultrasound-guided hepaticogastrostomy vs. antegrade metal stent placement kee** an access route in patients with malignant biliary obstruction. Int J Clin Oncol (2024). https://doi.org/10.1007/s10147-024-02584-2

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