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Long-term outcomes and predictors of adverse events of EUS-guided hepatico-gastrostomy for malignant biliary obstruction: Multicenter, retrospective study

Authors
 Jae Hee Cho  ;  Se Woo Park  ;  Eui Joo Kim  ;  Chan Hyuk Park  ;  Da Hae Park  ;  Kyong Joo Lee  ;  Sang Soo Lee 
Citation
 SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, Vol.36(12) : 8950-8958, 2022-12 
Journal Title
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES
ISSN
 0930-2794 
Issue Date
2022-12
MeSH
Biliary Tract Surgical Procedures* / adverse effects ; Cholangiopancreatography, Endoscopic Retrograde / adverse effects ; Cholestasis* / etiology ; Cholestasis* / surgery ; Drainage / adverse effects ; Endosonography / adverse effects ; Gastrostomy / adverse effects ; Humans ; Retrospective Studies ; Stents / adverse effects
Keywords
Biliary obstruction ; Endoscopic ultrasound ; Hepaticogastrostomy ; Risk factor ; Stent
Abstract
Background and aims: Endoscopic ultrasound (EUS)-guided hepaticogastrostomy (HGS) may be a feasible and useful alternative in patients with malignant biliary obstruction (MBO) after failed endoscopic retrograde cholangiopancreatography (ERCP). To date, the risk factors for adverse events (AEs) and long-term outcomes of EUS-HGS have not been fully explored according to stent type. Therefore, we evaluated potential risk factors for AEs and long-term outcomes of EUS-HGS.

Methods: In total, 120 patients who underwent EUS-HGS were retrospectively reviewed. A multivariate analysis through Cox proportional hazard and logistic regression model was used to identify the risk factors for stent dysfunction and AEs, respectively. Stent patency and patient survival were evaluated using Kaplan-Meier plots with a log-rank test for each stent.

Results: The technical and clinical success rates were 96.2% (102/106) and 83.0% (88/106). The median duration of stent patency was longer in self-expandable metal stents (SEMS) compared to plastic stents (PS) (158 vs. 108 days). Kaplan-Meier analysis indicated that the type of stent was not associated with stent patency (Hazard ratios [HR] 0.997, 95% confidence interval [CI] [0.525-1.896]) or overall survival. In addition, multivariate analysis indicated that hilar MBO significantly associated with stent dysfunction (HR, 2.340; 95% CI, 1.028-5.326, p = 0.043) and late AEs.

Conclusions: Given the lower incidence of AEs and better long-term outcomes of EUS-HGS, it can be considered a safe alternative to ERCP or percutaneous approaches regardless of which stent is used. Furthermore, hilar MBO was established as a potential risk factor for stent dysfunction and late AEs.
Full Text
https://link.springer.com/article/10.1007/s00464-022-09346-z
DOI
10.1007/s00464-022-09346-z
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Cho, Jae Hee(조재희) ORCID logo https://orcid.org/0000-0003-4174-0091
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/192791
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