Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan.
Endoscopy Center, Osaka Medical and Pharmaceutical University, Osaka, Japan.
Gastrointest Endosc. 2024 Jul;100(1):66-75. doi: 10.1016/j.gie.2024.02.012. Epub 2024 Feb 19.
EUS-guided hepaticogastrostomy (EUS-HGS) is a rescue procedure when ERCP fails. Peritonitis and recurrent biliary obstruction (RBO) are adverse events (AEs) associated with EUS-HGS. Antegrade stent placement across a malignant distal biliary obstruction (DBO) followed by EUS-HGS (EUS-HGAS) creates 2 biliary drainage routes, potentially reducing peritonitis and prolonging time to RBO (TRBO). We compared the outcomes of the 2 techniques.
Data of consecutive patients with malignant DBO who underwent attempted EUS-HGS or EUS-HGAS across 5 institutions from January 2014 to December 2020 were retrospectively analyzed. A matched cohort of patients was obtained using 1-to-1 propensity score matching. The primary outcome was TRBO, and secondary outcomes were AEs except for RBO and overall survival.
Among 360 patients, 283 (176 and 107 in the HGS and HGAS groups, respectively) were eligible. The matched cohorts included 81 patients in each group. AEs developed in 10 (12.3%) and 15 (18.5%) patients (P = .38) in the HGS and HGAS groups, respectively. RBO occurred in 18 and 2 patients in the HGS and HGAS groups, respectively (P < .001). TRBO was significantly longer in the HGAS group (median, 194 days vs 716 days; hazard ratio, .050; 95% confidence interval, .0066-.37; P < .01). However, no significant differences occurred in overall survival between the groups (median, 97 days vs 112 days; hazard ratio, .97; 95% confidence interval, .66-1.4; P = .88).
EUS-HGAS extended TRBO compared with EUS-HGS, whereas AEs, except for RBO and overall survival, did not differ. The longer TRBO of EUS-HGAS could benefit patients with longer life expectancy.
EUS 引导下的经肝胃吻合术（EUS-HGS）是 ERCP 失败时的抢救程序。腹膜炎和复发性胆道梗阻（RBO）是与 EUS-HGS 相关的不良事件（AE）。经恶性远端胆道梗阻（DBO）前向支架置入后再行 EUS-HGS（EUS-HGAS）可建立 2 条胆道引流途径，可能降低腹膜炎发生率并延长 RBO 时间（TRBO）。我们比较了这两种技术的结果。
回顾性分析了 2014 年 1 月至 2020 年 12 月期间，在 5 家机构连续接受 EUS-HGS 或 EUS-HGAS 尝试的恶性 DBO 患者的数据。采用 1:1 倾向评分匹配获得匹配队列。主要结局是 TRBO，次要结局是除 RBO 和总生存以外的 AE。
在 360 例患者中，283 例（HGS 组 176 例，HGAS 组 107 例）符合条件。匹配队列每组包括 81 例患者。HGS 和 HGAS 组分别有 10 例（12.3%）和 15 例（18.5%）患者发生 AE（P=0.38）。HGS 和 HGAS 组的 RBO 发生率分别为 18 例和 2 例（P<0.001）。HGAS 组的 TRBO 明显更长（中位数，194 天比 716 天；风险比，0.050；95%置信区间，0.0066-0.37；P<0.01）。然而，两组之间的总生存率没有显著差异（中位数，97 天比 112 天；风险比，0.97；95%置信区间，0.66-1.4；P=0.88）。
EUS-HGAS 延长了 TRBO，与 EUS-HGS 相比，除 RBO 和总生存率外，AE 没有差异。EUS-HGAS 更长的 TRBO 可能使预期寿命更长的患者受益。
