Cho Sung Hyun, Kim Seong Je, Song Tae Jun, Oh Dongwook, Seo Dong-Wan
Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Department of Gastroenterology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, South Korea.
Dig Endosc. 2025 May;37(5):532-540. doi: 10.1111/den.14952. Epub 2024 Nov 28.
Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) using a fully covered metal stent (FCMS) or partially covered metal stent (PCMS) is performed to manage unresectable malignant biliary obstruction (MBO) following unsuccessful endoscopic retrograde cholangiopancreatography. This study aimed to compare FCMS and PCMS for EUS-HGS in patients with MBO.
We reviewed the EUS database to analyze consecutive patients with MBO who underwent EUS-HGS between November 2017 and March 2023. We performed a 1:1 matching using propensity score matching based on potential confounding factors. Stent patency, technical success, clinical success, adverse events, reintervention, and overall survival were assessed.
The technical success rate of EUS-HGS was 92% (123/134). A total of 80 patients with technical success (40 FCMS, 40 PCMS) were selected after propensity score matching. The two groups showed similar rates of clinical success (90% vs. 88%; P = 0.999), early adverse events (15% vs. 20%; P = 0.556), late adverse events (18% vs. 33%; P = 0.121), reintervention (20% vs. 38%; P = 0.084), and median overall survival (4.1 months [95% confidence interval (CI) 2.6-5.5] vs. 3.8 months [95% CI 1.9-5.7]; P = 0.609). During follow-up, the FCMS group showed higher patency rates (85% vs. 60% at 6 months; 76% vs. 43% at 12 months; P = 0.030).
FCMS and PCMS for EUS-HGS in patients with unresectable MBO showed similar rates of clinical success, as well as early and late adverse events. However, the FCMS group showed a higher cumulative stent patency rate compared to the PCMS group.
对于内镜逆行胰胆管造影术失败后的不可切除恶性胆管梗阻（MBO）患者，采用全覆膜金属支架（FCMS）或部分覆膜金属支架（PCMS）进行内镜超声引导下肝胃吻合术（EUS-HGS）。本研究旨在比较FCMS和PCMS用于MBO患者EUS-HGS的效果。
我们回顾了EUS数据库，分析2017年11月至2023年3月期间连续接受EUS-HGS的MBO患者。我们基于潜在混杂因素使用倾向评分匹配进行1:1匹配。评估支架通畅性、技术成功率、临床成功率、不良事件、再次干预和总生存期。
EUS-HGS的技术成功率为92%（123/134）。倾向评分匹配后共选择了80例技术成功的患者（40例FCMS，40例PCMS）。两组的临床成功率（90%对88%；P = 0.999）、早期不良事件（15%对20%；P = 0.556）、晚期不良事件（18%对33%；P = 0.121）、再次干预（20%对38%；P = 0.084）和中位总生存期（4.1个月[95%置信区间（CI）2.6 - 5.5]对3.8个月[95%CI 1.9 - 5.7]；P = 0.609）相似。随访期间，FCMS组的通畅率更高（6个月时85%对60%；12个月时76%对43%；P = 0.030）。
对于不可切除MBO患者的EUS-HGS，FCMS和PCMS的临床成功率以及早期和晚期不良事件发生率相似。然而，FCMS组的累积支架通畅率高于PCMS组。
