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Application of endoscopic ultrasound-guided hepaticogastrostomy combined with antegrade stenting in patients with malignant biliary obstruction after failed ERCP

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Abstract

Background

This study was aimed at comparing the safety and effectiveness of endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) and EUS-HGS combined with antegrade stenting (EUS-HGAS) in patients with malignant biliary obstruction (MBO) after failed endoscopic retrograde cholangiopancreatography (ERCP).

Methods

Patients diagnosed with MBO and receiving EUS-HGS or EUS-HGAS from September 2015 to October 2020 were enrolled in this study. Clinical success, complications, reintervention rate, post-operative hospital stay, time to stent dysfunction, and patient death were compared.

Results

A total of 45 patients (21 in the EUS-HGAS group and 24 in the EUS-HGS group) were enrolled in this study. In the EUS-HGAS group, 21 patients all achieved clinical success (100%); in the EUS-HGS group, 24 patients also achieved technical success (100%) (P > 0.05). The differences between pre- and post-operative TB and ALT and AST levels were greater in the single-step EUS-HGAS group (P < 0.05). The incidence of complications was 2 of 21 (9.5%) in the EUS-HGAS group and 5 of 24 (20.8%) in the EUS-HGS group (P > 0.05). The reintervention rate was 0 in the EUS-HGAS group and 1 (4.2%) in the EUS-HGS group (P > 0.05). Time to stent dysfunction or patient death was longer in the EUS-HGAS group (P < 0.05). The post-operative hospital stay was longer and the total cost was higher in the EUS-HGAS group.

Conclusion

EUS-HGAS was superior to EUS-HGS in terms of biliary drainage effectiveness and time to stent dysfunction or patient death in patients with MBO after failed ERCP. Furthermore, two-step EUS-HGAS may be safer in some patients.

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Funding

The study was partially funded by the National Natural Science Foundation of China (Grant No. 81700575), the Young Talent Development Plan of Changzhou Health Commission (Grant No. CZQM2020017).

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Author notes

  1. Yin Zhang and ** Chen, Bingfang Chen & Yanbo Ding

  2. Department of Gastroenterology, The Second Affiliated Hospital of Xuzhou Medical University, General Hospital of XuZhou Mining Group, Xuzhou, China

    **aohong Wang

  3. Department of Hepatopancreatobiliary Surgery, The First People’s Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou, China

    Yue Zhang & Longqing Shi

  4. Digestive Endoscopy Department, Jiangsu Provincial People’s Hospital, The First Affiliated Hospital of Nan**g Medical University, Nan**g, China

    Zhining Fan & Li Liu

Authors
  1. Yin Zhang
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  2. **aohong Wang
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Correspondence to Yanbo Ding.

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Disclosures

Drs. Yin Zhang, ** Chen, Yue Zhang, Longqing Shi, Zhining Fan, Li Liu, Bingfang Chen, and Yanbo Ding have no conflicts of interest or financial ties to disclose.

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Zhang, Y., Wang, X., Sun, K. et al. Application of endoscopic ultrasound-guided hepaticogastrostomy combined with antegrade stenting in patients with malignant biliary obstruction after failed ERCP. Surg Endosc 36, 5930–5937 (2022). https://doi.org/10.1007/s00464-022-09117-w

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