International multicenter comparative trial of transluminal EUS-guided biliary drainage via hepatogastrostomy vs. choledochoduodenostomy approaches

摘要

Background and study aims: Endoscopic ultrasound-guided biliary drainage (EUS-BD) can be performed entirely transgastrically (hepatogastrostomy/EUS-HG) or transduodenally (choledochoduodenostomy/EUS-CDS). It is unknown how both techniques compare. The aims of this study were to compare efficacy and safety of both techniques and identify predictors of adverse events. Patients and methods: Consecutive jaundiced patients with distal malignant biliary obstruction who underwent EUS-BD at multiple international centers were included. Technical/clinical success, adverse events, stent complications, and survival were assessed. Results: A total of 121 patients underwent EUS-BD (CDS 60, HG 61). Technical success was achieved in 112 (92.56?%) patients (EUS-CDS 93.3?%, EUS-HG 91.8?%, P?=?0.75). Clinical success was attained in 85.5?% of patients who underwent EUS-CDS group as compared to 82.1?% of patients who underwent EUS-HG (P?=?0.64). Adverse events occurred more commonly in the EUS-HG group (19.67?% vs. 13.3?%, P?=?0.37). Both plastic stenting (OR 4.95, 95?%CI 1.41?–?17.38, P?=?0.01) and use of non-coaxial electrocautery (OR 3.95, 95?%CI 1.16?–?13.40, P?=?0.03) were independently associated with adverse events. Length of hospital stay was significantly shorter in the CDS group (5.6 days vs. 12.7 days, P?