Covered self-expandable metallic stents versus plastic stents for endoscopic ultrasound-guided hepaticogastrostomy in patients with malignant biliary obstruction

Abstract

Background/Aims: Covered self-expandable metallic stents (cSEMS) have become popular for endoscopic ultrasound-guided hepaticogastrostomy with transmural stenting (EUS-HGS). We compared the time to recurrent biliary obstruction (TRBO), complications, and reintervention rates between EUS-HGS using plastic stent (PS) and cSEMS in patients with unresectable malignancies at multicenter institutions in Japan. Methods: Patients with unresectable malignant biliary obstruction who underwent EUS-HGS between April 2015 and July 2020 at any of the six participating facilities were enrolled. Primary endpoint: TRBO; secondary endpoints: rate of complications other than RBO and technical success rate of reintervention were evaluated. Results: PS and cSEMS were used for EUS-HGS in 109 and 43 patients, respectively. The TRBO was significantly longer in the cSEMS group than in the PS group (646 vs. 202 days). Multivariate analysis identified two independent factors associated with a favorable TRBO: combined EUS-guided antegrade stenting with EUS-HGS and the use of cSEMS. No significant difference was observed in the rate of complications other than RBO between the two groups. The technical success rate of reintervention was 85.7% for PS and 100% for cSEMS (p=0.309). Conclusions: cSEMS might be a better option for EUS-HGS in patients with unresectable malignancies, given the longer TRBO.

Comparison of stent patency between EUS-guided hepaticogastrostomy with bridging and endoscopic transpapillary biliary drainage for hilar obstruction

“…Furthermore, the median survival time was 60 days shorter in the EUS-HGSB group than in the ETBD-MS group. This could have contributed to the finding of longer stent patency with EUS-HGSB than with ETBD-MS. Because duration of patency for EUS-HGS and ETBD-MS with SEMS in distal obstruction has been reported to be approximately 1 year 26 27 and 6 months 5 6 , respectively, the observation period in this study appears inadequate. In addition, the stents placed via the EUS-HGS route were not standardized in this study.…”

The updated Asia-Pacific consensus statement on the role of endoscopic management in malignant hilar biliary obstruction

“…[48] Unfortunately, this stent is only available in Japan, and therefore a 7-Fr doublepigtail plastic stent may be an alternative option due to its widespread availability and affordability. [49] Shibuki et al [50] retrospectively reviewed patients who underwent EUS-HGS.…”

“…PDT is associated with an incidence of phototoxic reaction in 11.11%. [57] Kang et al [50] reported a RCT in 2022 comparing RFA plus bilateral PS and bilateral PS alone in 30 patients. The study showed that RFA significantly reduced premature PS occlusion within 3 months when compared with bilateral PS alone (30.8% vs 76.9% respectively, p = 0.018), while adverse events were not different between the 2 groups.…”

Therapeutic Endoscopic Ultrasound for Complications of Pancreatic Cancer

“…Most adverse events were mild in severity with peritonitis developing in 4.4% of cases. Another multicenter retrospective study ( n = 152, 40.8% PDAC) from Japan compared the use of SEMS with plastic stents for EUS-HG, finding that SEMS had a longer stent patency duration (646 days vs. 202 days) with no difference in clinical success rates [ 22 ]. A multicenter prospective study ( n = 49, 22.4% PDAC) found that EUS-HG combined with antegrade biliary stenting carried a technical success rate of 85.7% [ 23 ].…”