Clinical outcomes of endoscopic ultrasound-guided hepaticogastrostomy-based internal drainage for unresectable malignant hilar biliary obstruction: a comprehensive evaluation with malignant distal biliary obstruction.

IF 3.9 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Therapeutic Advances in Gastroenterology Pub Date : 2025-07-13 eCollection Date: 2025-01-01 DOI:10.1177/17562848251356099

Daiki Yamashige, Susumu Hijioka, Yoshikuni Nagashio, Shota Harai, Yasuhiro Komori, Aoi Kita, Masaru Kuwada, Soma Fukuda, Shin Yagi, Kohei Okamoto, Daiki Agarie, Shunsuke Sugawara, Miyuki Sone, Yutaka Saito, Takuji Okusaka

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引用次数: 0

Abstract

Background: Endoscopic retrograde cholangiopancreatography (ERCP) may not provide adequate drainage for patients with malignant hilar biliary obstruction (MHBO). Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is a salvage method for malignant distal biliary obstruction (MDBO); however, its effectiveness for MHBO remains unclear.

Objectives: We aimed to evaluate the short- and long-term outcomes of EUS-HGS for MHBO.

Design: This was a single-center retrospective cohort study.

Methods: Unresectable patients who underwent initial EUS-HGS because of ERCP failure were recruited. Distal biliary stenosis or Bismuth types I and II-IV were defined as MDBO and MHBO, respectively. We defined EUS-HGS for MDBO as the control and analyzed the outcomes for MHBO.

Results: The MDBO group (n = 208) was treated using EUS-HGS alone. In the MHBO group (n = 63), EUS-HGS alone (unilateral drainage, n = 26), EUS-HGS with bridging (EUS-HGSB, bilateral drainage, n = 21), and ERCP + EUS-HGS (bilateral drainage, n = 16) were performed. In EUS-HGS (MDBO), EUS-HGS (MHBO), EUS-HGSB, and ERCP + EUS-HGS, the technical success rates were 98.6%, 96.3%, 95.5%, and 94.1%; clinical success rates were 88.5%, 76.9%, 85.7%, and 75.0%; adverse event rates were 19.7%, 15.4%, 9.5%, and 25.0%; and non-recurrent biliary obstruction (RBO) rates at 180 days were 45.5%, 19.8%, 61.9%, and 68.4%, respectively. In multivariate analysis of the MHBO group, EUS-HGSB tended to have a lower risk of RBO (adjusted hazard ratio (aHR), 0.39; p = 0.09), and ERCP + EUS-HGS showed a significantly lower risk (aHR, 0.25; p = 0.03) compared to EUS-HGS alone (unilateral drainage).

Conclusion: ERCP + EUS-HGS followed by EUS-HGSB, providing bilateral drainage, can offer preferred palliation for MHBO. These drainages may serve as potential salvage options in the management of MHBO.

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超声内镜引导下肝胃造口内引流治疗不可切除的恶性肝门胆道梗阻的临床效果：恶性胆道远端梗阻的综合评价。

背景：内镜逆行胆管造影（ERCP）可能不能为恶性肝门胆道梗阻（MHBO）患者提供足够的引流。超声内镜引导下肝胃造口术（EUS-HGS）是恶性胆道远端梗阻（MDBO）的一种抢救方法；然而，其对MHBO的有效性尚不清楚。目的：我们旨在评估EUS-HGS治疗MHBO的短期和长期结果。设计：这是一项单中心回顾性队列研究。方法：招募因ERCP失败而行EUS-HGS的不可切除患者。远端胆道狭窄或Bismuth I型和II-IV型分别定义为MDBO和MHBO。我们将EUS-HGS定义为MDBO的对照，并分析MHBO的结果。结果：MDBO组（n = 208）采用EUS-HGS治疗。MHBO组（n = 63）分别行单纯EUS-HGS（单侧引流，n = 26）、EUS-HGS联合桥接（EUS-HGSB，双侧引流，n = 21）、ERCP + EUS-HGS（双侧引流，n = 16）。EUS-HGS （MDBO）、EUS-HGS （MHBO）、EUS-HGSB和ERCP + EUS-HGS的技术成功率分别为98.6%、96.3%、95.5%和94.1%；临床成功率分别为88.5%、76.9%、85.7%、75.0%；不良事件发生率分别为19.7%、15.4%、9.5%、25.0%；180天非复发性胆道梗阻（RBO）发生率分别为45.5%、19.8%、61.9%和68.4%。在MHBO组的多因素分析中，EUS-HGSB倾向于具有较低的RBO风险(校正危险比（aHR）， 0.39；p = 0.09)， ERCP + EUS-HGS的风险显著降低(aHR, 0.25；p = 0.03)与单独EUS-HGS（单侧引流）相比。结论：ERCP + EUS-HGS加EUS-HGSB，提供双侧引流，是缓解MHBO的首选方法。这些流失可以作为MHBO管理的潜在补救方案。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Therapeutic Advances in Gastroenterology GASTROENTEROLOGY & HEPATOLOGY-

CiteScore

6.70

自引率

2.40%

发文量

103

审稿时长

15 weeks

期刊介绍： Therapeutic Advances in Gastroenterology is an open access journal which delivers the highest quality peer-reviewed original research articles, reviews, and scholarly comment on pioneering efforts and innovative studies in the medical treatment of gastrointestinal and hepatic disorders. The journal has a strong clinical and pharmacological focus and is aimed at an international audience of clinicians and researchers in gastroenterology and related disciplines, providing an online forum for rapid dissemination of recent research and perspectives in this area. The editors welcome original research articles across all areas of gastroenterology and hepatology. The journal publishes original research articles and review articles primarily. Original research manuscripts may include laboratory, animal or human/clinical studies – all phases. Letters to the Editor and Case Reports will also be considered.