Comparison of fully versus partially covered metal stents in endoscopic ultrasound-guided hepaticogastrostomy for malignant biliary obstruction (with video).

Autor: Cho SH; Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea., Kim SJ; Department of Gastroenterology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, South Korea., Song TJ; Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea., Oh D; Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea., Seo DW; Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Jazyk: angličtina
Zdroj: Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society [Dig Endosc] 2024 Nov 28. Date of Electronic Publication: 2024 Nov 28.
DOI: 10.1111/den.14952
Abstrakt: Background: Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) using a fully covered metal stent (FCMS) or partially covered metal stent (PCMS) is performed to manage unresectable malignant biliary obstruction (MBO) following unsuccessful endoscopic retrograde cholangiopancreatography. This study aimed to compare FCMS and PCMS for EUS-HGS in patients with MBO.
Methods: We reviewed the EUS database to analyze consecutive patients with MBO who underwent EUS-HGS between November 2017 and March 2023. We performed a 1:1 matching using propensity score matching based on potential confounding factors. Stent patency, technical success, clinical success, adverse events, reintervention, and overall survival were assessed.
Results: The technical success rate of EUS-HGS was 92% (123/134). A total of 80 patients with technical success (40 FCMS, 40 PCMS) were selected after propensity score matching. The two groups showed similar rates of clinical success (90% vs. 88%; P = 0.999), early adverse events (15% vs. 20%; P = 0.556), late adverse events (18% vs. 33%; P = 0.121), reintervention (20% vs. 38%; P = 0.084), and median overall survival (4.1 months [95% confidence interval (CI) 2.6-5.5] vs. 3.8 months [95% CI 1.9-5.7]; P = 0.609). During follow-up, the FCMS group showed higher patency rates (85% vs. 60% at 6 months; 76% vs. 43% at 12 months; P = 0.030).
Conclusions: FCMS and PCMS for EUS-HGS in patients with unresectable MBO showed similar rates of clinical success, as well as early and late adverse events. However, the FCMS group showed a higher cumulative stent patency rate compared to the PCMS group.
(© 2024 The Author(s). Digestive Endoscopy published by John Wiley & Sons Australia, Ltd on behalf of Japan Gastroenterological Endoscopy Society.)
Databáze: MEDLINE
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