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EUS-guided hepaticogastrostomy for patients with afferent loop syndrome: a comparison with EUS-guided gastroenterostomy or percutaneous drainage

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Abstract

Objectives

Where palliative surgery or percutaneous drainage used to be the only option in patients with afferent loop syndrome, endoscopic management by EUS-guided gastroenterostomy has been gaining ground. However, EUS-guided hepaticogastrostomy might also provide sufficient biliary drainage. Our aim was to evaluate the feasibility of EUS-guided hepaticogastrostomy for the management of afferent loop syndrome and provide comparative data on the different approaches.

Methods

The institutional databases were queried for all consecutive minimally invasive procedures for afferent loop syndrome. A retrospective, dual-centre analysis was performed, separately analysing EUS-guided hepaticogastrostomy, EUS-guided gastroenterostomy and percutaneous drainage. Efficacy, safety, need for re-intervention, hospital stay and overall survival were compared.

Results

In total, 17 patients were included (mean age 59 years (± SD 10.5), 23.5% female). Six patients, which were ineligible for EUS-guided gastroenterostomy, were treated with EUS-guided hepaticogastrostomy. EUS-guided gastroenterostomy and percutaneous drainage were performed in 6 and 5 patients respectively. Clinical success was achieved in all EUS-treated patients, versus 80% in the percutaneous drainage group (p = 0.455). Furthermore, higher rates of bilirubin decrease were seen among patients undergoing EUS: > 25% bilirubin decrease in 10 vs. 1 patient(s) in the percutaneously drained group (p = 0.028), with > 50% and > 75% decrease identified only in the EUS group. Using the ASGE lexicon for adverse event grading, adverse events occurred only in patients treated with percutaneous drainage (60%, p = 0.015). And last, the median number of re-interventions was significantly lower in patients undergoing EUS (0 (IQR 0.0–1.0) vs. 1 (0.5–2.5), p = 0.045) when compared to percutaneous drainage.

Conclusions

In the management of afferent loop syndrome, EUS seems to outperform percutaneous drainage. Moreover, in our cohort, EUS-guided gastroenterostomy and hepaticogastrostomy provided similar outcomes, suggesting EUS-guided hepaticogastrostomy as the salvage procedure in situations where EUS-guided gastroenterostomy is not feasible or has failed.

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Abbreviations

EUS:

Endoscopic ultrasound

PTD:

Percutaneous drainage

SEMS:

Self-expandable metal stents

EUS-GE:

EUS-guided gastroenterostomy

EUS-HG:

EUS-guided hepaticogastrostomy

ASGE:

American society gastrointestinal endoscopy

LAMS:

Lumen-apposing metal stent

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Author notes

  1. Michiel Bronswijk and Charlotte De Bie have contributed equally to the writing of this manuscript.

Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, University Hospitals Gasthuisberg, University of Leuven, Herestraat 49, 3000, Leuven, Belgium

    Charlotte De Bie, Michiel Bronswijk, Giuseppe Vanella, Hannah van Malenstein, Wim Laleman & Schalk Van der Merwe

  2. Department of Gastroenterology and Hepatology, Imelda Hospital, Bonheiden, Belgium

    Michiel Bronswijk

  3. Pancreatobiliary Endoscopy and EUS Division, IRCSS San Raffaele Scientific Institute, Milan, Italy

    Giuseppe Vanella

  4. Gastroenterology and Digestive Endoscopy Department, Georges Pompidou European Hospital, Paris, France

    Enrique Pérez-Cuadrado-Robles

Authors
  1. Charlotte De Bie
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  2. Michiel Bronswijk
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  3. Giuseppe Vanella
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  4. Enrique Pérez-Cuadrado-Robles
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  5. Hannah van Malenstein
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  6. Wim Laleman
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  7. Schalk Van der Merwe
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Contributions

CDB was responsible for initial drafts of the manuscript. MB was responsible for study design, data collection, statistical analysis and drafting of the manuscript. GV collected data, aided in statistical analysis and revised the final version. EPCR was responsible for data collection, the endoscopic procedures and revised the final version. HvM, WL and SVDM performed the procedures and critically revised the final version of the manuscript.

Corresponding author

Correspondence to Michiel Bronswijk.

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Disclosure

Charlotte De Bie received travel grants from Abbvie. Michiel Bronswijk received travel grants from Takeda, Taewoong and Prion medical. Giuseppe Vanella received travel grants from Alfasigma and Mylan. Enrique Pérez-Cuadrado-Robles declares no conflicts of interest. Schalk van der Merwe holds the Cook chair in Interventional endoscopy and holds consultancy agreements with Cook, Pentax and Olympus. Wim Laleman co-chairs the Boston Scientific Chair in Therapeutic Biliopancreatic Endoscopy with Schalk Van der Merwe and has consultancy agreements with Boston Scientific and Cook. Hannah van Malenstein holds a consultancy agreement with Boston Scientific

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De Bie, C., Bronswijk, M., Vanella, G. et al. EUS-guided hepaticogastrostomy for patients with afferent loop syndrome: a comparison with EUS-guided gastroenterostomy or percutaneous drainage. Surg Endosc 36, 2393–2400 (2022). https://doi.org/10.1007/s00464-021-08520-z

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  • DOI: https://doi.org/10.1007/s00464-021-08520-z

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