Comparison of Choledochoduodenostomy and Hepaticogastrostomy for EUS-Guided Biliary Drainage: A Meta-Analysis

Li, Jiasu; Tang, Jian; Liu, Feng; Fang, Jun

doi:10.3389/fsurg.2022.811005

Cited by 22 publications

(17 citation statements)

References 33 publications

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“…In our cohort, modifying stent position using accessories like snare in case of mal-deployed stent or deploying another SEMS inside the migrating one (Tandem stent placement (34)) were beneficial options. In the same to previous studies, with overall risk in the literature for HGS as 19% (ranging from 0-35%) ( 27) and 13.6-20% in CDS (26). Most AE occurred in our study were mild (8.2), but unfortunately one fatal outcome was met in our study.…”

Section: Discussionsupporting

confidence: 89%

“…Considerably, in such a developing country in the Middle East with a relatively low income, this advanced Nonetheless, the median duration of CDS was 2 minutes less than HGS. A more recent meta-analysis by Li et al, (26) has supported that CDS was slightly faster and they recommended to limit the number of accessory changes during HGS to decrease the process duration.…”

Section: Discussionmentioning

confidence: 99%

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Endoscopic ultrasound-guided biliary drainage for distal malignant biliary obstruction: a prospective 3-year multicenter Egyptian study

Ragab¹,

Abdel-Hameed²,

Gouda³

et al. 2023

AGEB

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Background/Aim: Malignant biliary obstruction (MBO) is often diagnosed at late stages with mostly unresectable lesions. Recently, EUS-guided biliary drainage (EUS-BD) has gained wide acceptance and appears to be a feasible and safe backup option after ERCP failure in such patients. Herein, we aimed to represent a 3-year multi-center Egyptian experience in the application of this challenging procedure for distal MBO as a salvage technique after failed ERCP. Patients and methods: This was a prospective multi-center study of patients underwent EUS-BD for distal MBO in the duration between December 2018 and December 2021, after ERCP failure. Results: Ninety-one patients (59 males, median age: 61 years) were included in the study. EUS-guided extrahepatic approach including choledocho-duodenostomy (CDS) was done for 48 patients (52.8%), followed by choledecho-antrostomy (CAS) in 4 patients (4.4%). The intrahepatic approach included hepaticogastrostomy (HGS) for 35 patients (38.5%) and antegrade stenting (AG) stenting in 2 patients (2.2%), while Rendezvous (RV) approach was performed in 2 patients (2.2%). Technical and Clinical success were achieved in the majority of cases; 93.4% and 94.1% respectively. Adverse events occurred in 13.2% of patients which were mostly mild (8.2%) to moderate (2.4%). Only one patient died within 48h after the procedure with progression of preceding sepsis and organ failure. Conclusion: EUS-BD is a feasible option, even in developing countries, after a failed ERCP, and it is a relatively safe option in patients with MBO once experienced team and resources were present. Majority of cases in our study have achieved technical and clinical success with relatively low incidence of adverse events

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Endoscopic ultrasound-guided biliary drainage for distal malignant biliary obstruction: a prospective 3-year multicenter Egyptian study

Ragab¹,

Abdel-Hameed²,

Gouda³

et al. 2023

AGEB

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“…Compared with EUS-HGS, the pooled OR of EUS-CDS was 0.74 (95% CI, 0.33-1.65; P = 0.46) for technical success and 0.94 (95% CI, 0.56-1.59; P = 0.83) for clinical success. 25 EUS-CDS was associated with a moderately shorter procedure time (-2.68 min) and significantly fewer early adverse events than EUS-HGS (12.2% vs 17.5%; OR, 0.58; P = 0.02).…”

Section: Eus-guided Hepaticogastrostomymentioning

confidence: 87%

Endoscopic ultrasound-guided biliary drainage in malignant distal biliary obstruction

Jang

2022

Int J Gastrointest Interv

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Endoscopic retrograde cholangiopancreatography is the standard therapeutic approach for malignant distal biliary obstruction (MDBO). However, it can be challenging in patients with surgically altered anatomy, pyloric/duodenal obstruction, or failed biliary cannulation. Since the development of endoscopic ultrasound (EUS), EUS-guided biliary drainage (EUS-BD) has been increasingly performed. The current article provides a concise review of the latest practices and techniques of EUS-BD procedures for MDBO including EUS-assisted rendezvous, EUS-guided antegrade stenting, EUSguided choledochoduodenostomy, and EUS-guided hepaticogastrostomy.

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“…In another meta-analysis of 12 studies with 623 patients (EUS-CDS: 303 and EUS-HGS: 320), the cumulative technical success and clinical success for EUS-CDS and EUS-HGS was 95.0 and 93.1% and 96.6 and 91.3%, respectively. 27 The cumulative early adverse events for EUS-CDS and EUS-HGS was 12.2 and 17.5%, respectively.…”

Section: Recommendation 12mentioning

confidence: 93%

“…25 In a study in patients with combined duodenal and distal biliary obstruction where both EUS-CDS and EUS-HGS can be used, it was shown that EUS-HGS has a significant risk of adverse events and it was proposed that, EUS-CDS may be the first choice in this subset of patients. 26 Li et al 27 compared EUS-HGS and EUS-CDS in a meta-analysis of 12 studies including 2 randomized controlled trials (RCTs) and showed that the cumulative technical success and clinical success for EUS-CDS and EUS-HGS was 95.0% (288/303) and 93.1% (268/288), and 96.6% (309/320) and 91.3% (282/309), respectively. Compared with EUS-HGS, the pooled odds ratio (OR) was 0.74 (95% confidence interval [CI] 0.33–1.65; p = 0.46) for EUS-CDS technical success and 0.94 (95% CI 0.56–1.59; p = 0.83) for clinical success suggesting no significant difference between CDS and HGS.…”

Section: Methodsmentioning

confidence: 99%

Society of Gastrointestinal Endoscopy of India Consensus Guidelines on Endoscopic Ultrasound-Guided Biliary Drainage: Part I (Indications, Outcomes, Comparative Evaluations, Training)

Rai

Udawat

Chowdhary

et al. 2023

Journal of Digestive Endoscopy

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Endoscopic management of bile duct obstruction is a key aspect in gastroenterology practice and has evolved since the first description of biliary cannulation by McCune et al in 1968. Over many decades, the techniques and accessories have been refined and currently, the first-line management for extrahepatic biliary obstruction is endoscopic retrograde cholangiopancreaticography (ERCP). However, even in expert hands the success rate of ERCP reaches up to 95%. In almost 4 to 16% cases, failure to cannulate the bile duct may necessitate other alternatives such as surgical bypass or more commonly percutaneous transhepatic biliary drainage (PTBD). While surgery is associated with high morbidity and mortality, PTBD has a very high reintervention and complication rate (∼80%) and poor quality of life. Almost parallelly, endoscopic ultrasound (EUS) has come a long way from a mere diagnostic tool to a substantial therapeutic option in various pancreatico-biliary diseases. Biliary drainage using EUS-guidance (EUS-BD) has gained momentum since the first report published by Giovannini et al in 2001. The concept of accessing the bile duct through a different route than the papilla, circumventing the shortcomings of PTBD and sometimes bypassing the actual obstruction have enthused a lot of interest in this novel strategy. The three key methods of EUS-BD entail transluminal, antegrade, and rendezvous approach. Over the past decade, with growing experience, EUS-BD has been found to be equivalent to ERCP or PTBD for malignant obstruction with better success rates.EUS-BD, albeit, is not devoid of adverse events and can carry fatal adverse events. However, neither the technique of EUS-BD, nor the accessories and stents for EUS-BD have been standardized.Additionally, different countries and regions have different availability of the accessories making generalizability a difficult task. Thus, technical aspects of this evolving therapy need to be outlined. For these reasons, the Society of Gastrointestinal Endoscopy India deemed it appropriate to develop technical consensus statements for performing safe and successful EUS-BD.

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Comparison of Choledochoduodenostomy and Hepaticogastrostomy for EUS-Guided Biliary Drainage: A Meta-Analysis

Cited by 22 publications

References 33 publications

Endoscopic ultrasound-guided biliary drainage for distal malignant biliary obstruction: a prospective 3-year multicenter Egyptian study

Endoscopic ultrasound-guided biliary drainage for distal malignant biliary obstruction: a prospective 3-year multicenter Egyptian study

Endoscopic ultrasound-guided biliary drainage in malignant distal biliary obstruction

Society of Gastrointestinal Endoscopy of India Consensus Guidelines on Endoscopic Ultrasound-Guided Biliary Drainage: Part I (Indications, Outcomes, Comparative Evaluations, Training)

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