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EUS-guided gastrojejunostomy and hepaticogastrostomy for malignant duodenal and biliary obstruction.

ABSTRACT:

SUBMITTER: Platt KD

PROVIDER: S-EPMC7859654 | biostudies-literature | 2021 Feb

REPOSITORIES: biostudies-literature

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EUS-guided gastrojejunostomy and hepaticogastrostomy for malignant duodenal and biliary obstruction.

Platt Kevin D KD Bhalla Sean S Sondhi Arjun R AR Millet John D JD Law Ryan J RJ

VideoGIE : an official video journal of the American Society for Gastrointestinal Endoscopy 20201207 2

PMID: 33884339

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Project description:BackgroundHepaticogastrostomy drainage through endoscopic ultrasound (EUS-HGS) has emerged in the 2010s as a new technique for biliary decompression in cases of endoscopic retrograde cholangiopancreatography (ERCP) failure for malignant biliary obstruction (MBO). Substantial technical and procedural progress in performing EUS-HGS has been achieved, allowing high technical and clinical success and an acceptable risk of adverse events in studies mainly focusing on short-term outcomes. However, the long-term effects of EUS-HGS and the risk of recurrent biliary obstruction (RBO) have not been fully evaluated.ObjectivesTo evaluate the long-term effects of EUS-HGS and the risk of RBO.MethodsData from 211 patients undergoing technically successful EUS-HGS in three academic centers were retrospectively collected. Clinical success, adverse events, RBO, and reinterventions were evaluated.ResultsIn total, 198 patients underwent technically successful EUS-HGS for MBO. The median overall survival was 144 days [108, 2011] after the procedure. Mean patient age was 69.39 (12.91) years. The cause of MBO was pancreatic cancer (n = 98, 49.5%) followed by cholangiocarcinoma (n = 29, 14.6%). The location of MBO was distal in 27.6% of cases and proximal in 68.4%. Adverse events were observed during the follow-up in 65 patients (33%). On multivariate analysis, the use of partially covered self-expandable metal stents (PCSEMS) was associated with a lower risk of RBO (HR = 0.47 [0.24-0.95], p = 0.034). Additionally, patients with distal stenoses had a trend toward better stent patency (HR = 0.06[0-0.77], p = 0.031). RBO developed in 38 cases (19.1%) mainly due tumor ingrowth (36.8%) with a high success rate of endoscopic management.ConclusionsWhile RBO occurred in a notable proportion of patients, the primary cause of mortality was progression of the underlying malignancy rather than stent dysfunction. The efficiency of stents, particularly PCSEMS, and the high success rate of endoscopic management for RBO underscore the effectiveness and reliability of these treatments in managing biliary complications.

Dataset Information

EUS-guided gastrojejunostomy and hepaticogastrostomy for malignant duodenal and biliary obstruction.

Publications

EUS-guided gastrojejunostomy and hepaticogastrostomy for malignant duodenal and biliary obstruction.

Similar Datasets

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