Paraskevopoulos Panagiotis, Obeidat Mahmoud, Bednárik Dániel, Martinekova Petrana, Veres Dániel Sándor, Faluhelyi Nándor, Mikó Alexandra, Mátrai Péter, Hegyi Péter, Erőss Bálint
Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.
Heim Pál National Pediatric Institute, Budapest, Hungary.
Therap Adv Gastroenterol. 2024 Oct 8;17:17562848241273085. doi: 10.1177/17562848241273085. eCollection 2024.
Combining antegrade stenting (AGS) and hepaticogastrostomy (HGS) is an increasingly used endoscopic ultrasound-guided intervention when stenting by endoscopic retrograde cholangiopancreatography is impossible.
We comprehensively assessed the benefits and downsides of combined AGS and HGS (HGS procedure with AGS, HGAS).
From 788 HGS and 295 HGAS cases, a random-effects meta-analysis was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. Five electronic databases were searched for studies on HGS with or without AGS from inception until May 2024. The odds ratio (OR) and pooled rates were used for single and two-arm comparisons with 95% confidence intervals (CI).
From 26 eligible studies. The pooled technical and clinical success was 94% (CI: 92%-96%) and 88% (CI: 84%-91%) for HGS and 89% (CI: 83%-93%) and 94% (CI: 89%-97%) for HGAS, respectively. Pooled OR of HGAS and HGS showed an OR = 0.38 (CI: 0.07-2.00) for technical success and an OR = 1.02 (CI: 0.50-2.06) for clinical success. The pooled adverse event rates were 20% (CI: 16%-25%) for HGS and 14% (CI: 9%-20%) for HGAS, whereas pooled OR showed an OR = 1.09 (CI: 0.30-3.94). For re-intervention, an OR = 0.37 (CI: 0.27-0.52) was found. Time to stent dysfunction increased, HGAS 333 (CI: 280-Not reached) and HGS 209 (CI: 120-325) with no change in overall survival HGS 117 (CI: 94-147) and 140 (CI: 105-170).
The use of HGAS appears to increase clinical success and reduce the need for re-intervention. Overall adverse event rates were similar but bile leakage prevalence was decreased. Time to stent dysfunction seems to increase with no change in overall survival.
Our protocol was prospectively registered with PROSPERO (CRD42024509412).
当无法通过内镜逆行胰胆管造影进行支架置入时，顺行支架置入术（AGS）联合肝胃吻合术（HGS）是一种越来越常用的内镜超声引导下的干预措施。
我们全面评估了AGS联合HGS（HGS联合AGS手术，HGAS）的益处和缺点。
从788例HGS和295例HGAS病例中，按照系统评价和Meta分析的首选报告项目规范进行随机效应Meta分析。检索了五个电子数据库，以查找从数据库建立至2024年5月有关有或无AGS的HGS研究。优势比（OR）和合并率用于单臂和双臂比较，并给出95%置信区间（CI）。
来自26项符合条件的研究。HGS的技术成功率和临床成功率合并值分别为94%（CI：92%-96%）和88%（CI：84%-91%），HGAS的技术成功率和临床成功率合并值分别为89%（CI：83%-93%）和94%（CI：89%-97%）。HGAS和HGS的合并OR显示，技术成功的OR = 0.38（CI：0.07-2.00），临床成功的OR = 1.02（CI：0.50-2.06）。HGS的合并不良事件发生率为20%（CI：16%-25%），HGAS为14%（CI：9%-20%），而合并OR显示OR = 1.09（CI：0.30-3.94）。对于再次干预，OR = 0.37（CI：0.27-0.52）。支架功能障碍出现时间增加，HGAS为333（CI：280-未达到），HGS为209（CI：120-325），总体生存率无变化，HGS为117（CI：94-147），HGAS为140（CI：105-170）。
使用HGAS似乎可提高临床成功率并减少再次干预的需求。总体不良事件发生率相似，但胆汁漏发生率降低。支架功能障碍出现时间似乎增加，总体生存率无变化。
我们的方案已在国际前瞻性系统评价注册库（PROSPERO，CRD42024509412）进行前瞻性注册。
