Drainage of the right liver using EUS guidance

Caillol, Fabrice; Rouy, Mathieu; Pesenti, Christian; Ratone, Jean‐Philippe; Giovannini, Marc

doi:10.4103/eus.eus_52_19

Cited by 8 publications

(6 citation statements)

References 22 publications

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“…The proportion of patients with duodenal/papillary invasion and surgically altered anatomy ranged from 0% to 91% [20,24] and 0% [20,25,26,27] to 70% [28], respectively. The rate of patients with hilar stenosis was highly variable (0% [27,29,30,31,32,33,34] to 100% [20,25,26,35,36]). The transgastric approach was used exclusively in 24 studies, whereas the use of this approach ranged from 80% [21] to 97% [37] in the other studies; one study used only the transduodenal approach [38].…”

Section: Characteristics Of Included Patientsmentioning

confidence: 99%

Efficacy and safety of endoscopic ultrasound-guided hepaticogastrostomy: a meta-regression analysis

Binda,

Dajti,

Giuffrida

et al. 2024

Endoscopy

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Background and study aim: EUS-guided hepaticogastrostomy (EUS-HGS) is a valid option for EUS-guided biliary drainage that has been increasingly used in the last decade. The aims of the study were to provide a systematic review with meta-analysis and meta-regression of features and outcomes of this procedure. Methods: MEDLINE, Scopus, Web-of-Science, and Cochrane databases were searched for literature pertinent to EUS-HGS. Meta-analysis of proportions and meta-regression of potential modifiers of the main outcome measures were applied. The main outcome was technical success. Secondary outcomes were clinical success and procedure-related adverse events (AEs). Results: Thirty-three studies including 1644 patients were included in the meta-analysis. Malignant biliary obstruction was the underlying cause in almost all (99.6%) cases; the main indications for EUS-HGS were duodenal/papillary invasion (34.8%), surgical altered anatomy (18.4%) and hilar stenosis (16%). Pooled technical success of EUS-HGS was 97.7% (95%-CI: 96.1-99%, I2=0%), the intention to treat (ITT) clinical success was 88.1% (95%-CI: 84.7-91.2%, I2=33.9%) and procedure-related AEs occurred in 12% (95%-CI: 9.8-14.5%, I2=20.4%), being cholangitis/sepsis (2.8%) and bleeding (2.3%) the most frequent. The rate of procedure related AEs was reduced with the use of dedicated stents at the univariable meta regression analysis. Meta-regression showed that technical success and clinical success rates were modified by centers’ experience (>4/year). Conclusions: EUS-HGS represents an effective and safe procedure for EUS-guided biliary drainage in patients with malignant biliary obstruction. Future studies should address the impact of center experience, patient selection, and use of dedicated stents to improve this technique’s performance.

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Section: Characteristics Of Included Patientsmentioning

confidence: 99%

Efficacy and safety of endoscopic ultrasound-guided hepaticogastrostomy: a meta-regression analysis

Binda,

Dajti,

Giuffrida

et al. 2024

Endoscopy

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“…Ogura et al [ 75 ] reported success using a novel “bridge” technique which involves placement of a stent across the HBO, thus connecting the right and left intrahepatic, followed by EUS-HGS[ 75 ]. Both techniques are challenging and only a small number of cases performed in referral centers have been reported to date[ 76 ]. In addition, EUS-HGS may be contraindicated in patients with large abdominal ascites (preventing fistula formation with increased risk of stent migration) and unresectable gastric cancer.…”

Section: Eus-guided Hepaticogastrostomymentioning

confidence: 99%

Endoscopic ultrasound-guided biliary drainage: Are we there yet?

Pawa¹,

Pleasant²,

Tom³

et al. 2021

WJGE

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Endoscopic retrograde cholangiopancreatography (ERCP) is the mainstay procedure of choice for management of obstructive biliary disease. While ERCP is widely performed with high success rates, the procedure is not feasible in every patient such as cases of non-accessible papilla. In the setting of unsuccessful ERCP, endoscopic ultrasound-guided biliary drainage (EUS-BD) has become a promising alternative to surgical bypass and percutaneous biliary drainage (PTBD). A variety of different forms of EUS-BD have been described, allowing for both intrahepatic and extrahepatic approaches. Recent studies have reported high success rates utilizing EUS-BD for both transpapillary and transluminal drainage, with fewer adverse events when compared to PTBD. Advancements in novel technologies designed specifically for EUS-BD have led to increased success rates as well as improved safety profile for the procedure. The techniques of EUS-BD are yet to be fully standardized and are currently performed by highly trained advanced endoscopists. The aim of our review is to highlight the different EUS-guided interventions for achieving biliary drainage and to both assess the progress that has been made in the field as well as consider what the future may hold.

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“…For EUS-BD of the right-side of the liver, two main techniques have been described: direct puncture of the rightside of the liver from the bulbus (EUS-HDS), as first reported by Park et al in 2013 [3], and a bridge technique that allows drainage of the right-side of the liver from the left via hepaticogastrostomy (the bridge technique) [4]. In this case, the latter technique could not be applied because of the left-sided liver metastasis; the former was feasible, but only 13 further cases of the technique have been reported [5]. In cases such as this, where we were unable to obtain a cholangiogram using a contrast agent, EUS-BD might be preferable because of its rapidity and cost-effectiveness.…”

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confidence: 94%