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

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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.

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Author notes

  1. Se Woo Park and Sang Soo Lee both have equally contributed to this work as corresponding author.

Authors and Affiliations

  1. Division of Gastroenterology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea

    Jae Hee Cho

  2. Division of Gastroenterology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, 7, Keunjaebong-gil, Hwaseong-si, Gyeonggi-do, 18450, South Korea

    Se Woo Park, Da Hae Park & Kyong Joo Lee

  3. Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea

    Eui Joo Kim

  4. Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, South Korea

    Chan Hyuk Park

  5. Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil Songpa-gu, Seoul, 05505, South Korea

    Sang Soo Lee

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  1. Jae Hee Cho
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Contributions

Conception and design: JHC, SSL, and SWP; Data analysis and interpretation: JHC, SSL, EJK, SWP, DHP, KJL, and CHP; Article drafting: JHC, SSL, and SWP; Critical revision of the article for important intellectual content: JHC, SSL, and SWP; Final approval of the article: JHC, SSL, and SWP.

Corresponding authors

Correspondence to Se Woo Park or Sang Soo Lee.

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Disclosures

Jae Hee Cho, Sang Soo Lee, Eui Joo Kim, Da Hae Park, Chan Hyuk Park, Kyong Joo Lee, and Se Woo Park have no conflicts of interest to disclose.

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Cho, J.H., Park, S.W., Kim, E.J. et al. Long-term outcomes and predictors of adverse events of EUS-guided hepatico-gastrostomy for malignant biliary obstruction: Multicenter, retrospective study. Surg Endosc 36, 8950–8958 (2022). https://doi.org/10.1007/s00464-022-09346-z

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