1Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Chiba, Japan
2Department of Gastroenterology, Jichi Medical University Saitama Medical Center, Saitama, Japan
3Department of Gastroenterology, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
4Department of Gastroenterology, Toyooka Hospital, Hyogo, Japan
5Department of Gastroenterology, National Organization Disaster Medical Center, Tokyo, Japan
6Department of Gastroenterology, Fujigaoka Hospital, Showa University, Kanagawa, Japan
7Division of Gastroenterology, Department of Internal Medicine, University of Florida, Jacksonville, FL, USA
Copyright © 2023 Korean Society of Gastrointestinal Endoscopy
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Conflicts of Interest
The authors have no potential conflicts of interest.
Funding
None.
Author Contributions
Conceptualization: TS, YH; Data curation: KO, MS, IK, AM, YS, YT; Formal analysis: TS; Methodology: TS, YH; Supervision: YH; Visualization: TS; Writing–original draft: TS; Writing–review & editing: all authors.
Values are presented as number (%) or median (range).
PS, plastic stent; cSEMS, fully/partially covered self-expandable metallic stent; B2, segment 2 bile duct; B3, segment 3 bile duct; EUS-HGAS, combined endoscopic ultrasound-guided antegrade stenting with endoscopic ultrasound-guided hepaticogastrostomy and transmural stenting.
HR, hazard ratio; CI, confidence interval; ECOG PS, Eastern Cooperative Oncology Group performance status; EUS-HGS, endoscopic ultrasound-guided hepaticogastrostomy with transmural stenting; B2, segment 2 bile duct; B3, segment 3 bile duct; EUS-HGAS, combined endoscopic ultrasound-guided antegrade stenting with endoscopic ultrasound-guided hepaticogastrostomy and transmural stenting; PS, plastic stent; cSEMS, fully/partially covered self-expandable metallic stent.
PS | cSEMS | p-value | |
---|---|---|---|
Complications other than RBO (n=152)a) | |||
Any | 14 (12.8) | 11 (25.6) | 0.088 |
Bile leakage | 6 (5.5) | 1 (2.3) | 0.674 |
Bleeding | 1 (0.9) | 3 (7.0) | 0.069 |
Peritonitis | 3 (2.8) | 2 (4.7) | 0.622 |
Pancreatitis | 1 (0.9) | 0 (0) | 1 |
Liver abscess | 0 (0) | 2 (4.7) | 0.079 |
Mediastinal emphysema | 0 (0) | 1 (2.3) | 0.283 |
Ulcer | 0 (0) | 1 (2.3) | 0.283 |
Septic shock | 4 (3.7) | 0 (0) | 0.578 |
Stent migration | 0 (0) | 2 (4.7) | 0.079 |
RBO (n=134)b) | |||
Any | 35 (37.6) | 12 (29.3) | 0.433 |
Sludge | 27 (29.0) | 8 (19.5) | 0.471 |
Food impaction | 1 (1.1) | 1 (2.4) | 0.450 |
Hyperplasia | 0 (0) | 3 (7.3) | 0.014 |
Stent migration | 2 (2.2) | 0 (0) | 1 |
Unknown | 5 (5.4) | 0 (0) | 0.309 |
Characteristic | PS (n=109) | cSEMS (n=43) | p-value |
---|---|---|---|
Age (yr) | 70 (32–85) | 69 (32–90) | 0.278 |
Age (yr) | 0.355 | ||
<70 | 50 (45.9) | 24 (55.8) | |
≥70 | 59 (54.1) | 19 (44.2) | |
Male sex | 71 (65.1) | 31 (72.1) | 0.528 |
ECOG PS | 0.310 | ||
0, 1 | 84 (77.1) | 37 (86.0) | |
2 or more | 25 (22.9) | 6 (14.0) | |
Diagnosis | 0.170 | ||
Pancreatic cancer | 44 (40.4) | 18 (41.9) | |
Bile duct cancer | 25 (22.9) | 16 (37.2) | |
Gastric cancer | 22 (20.2) | 6 (14.0) | |
Others | 18 (16.5) | 3 (7.0) | |
Site of biliary obstruction | 0.396 | ||
Distal | 61 (56.0) | 28 (65.1) | |
Perihilar | 48 (44.0) | 15 (34.9) | |
Prior transpapillary drainage, yes | 51 (46.8) | 18 (41.9) | 0.712 |
Indication for EUS-HGS | 0.121 | ||
Inaccessible papilla | 42 (38.5) | 13 (30.2) | |
Isolated intrahepatic bile duct obstruction | 28 (25.7) | 5 (11.6) | |
Recurrent ascending cholangitis due to a transpapillary stent | 12 (11.0) | 9 (20.9) | |
Surgically altered anatomy | 14 (12.8) | 8 (18.6) | |
Failed biliary cannulation | 13 (11.9) | 8 (18.6) |
PS (n=109) | cSEMS (n=43) | p-value | |
---|---|---|---|
Functional success, yes | 93 (85.3) | 41 (95.3) | 0.149 |
Punctured bile duct | 0.007 | ||
B2 | 71 (65.1) | 17 (39.5) | |
B3 | 38 (34.9) | 26 (60.5) | |
Tract dilator | <0.001 | ||
Mechanical | 64 (58.7) | 12 (27.9) | |
Balloon | 19 (17.4) | 17 (39.5) | |
Electrocautery | 15 (13.8) | 14 (32.6) | |
None | 11 (10.1) | 0 (0) | |
EUS-HGAS, yes | 26 (23.9) | 5 (11.6) | 0.144 |
Procedure time (min) | 30.0 (8.0–187.0) | 41.0 (15.0–150.0) | 0.125 |
Univariate |
Multivariate |
||||
---|---|---|---|---|---|
HR (95% CI) | p-value | HR (95% CI) | p-value | ||
Age (yr) | <70 vs. ≥70 | 1.04 (0.58–1.86) | 0.907 | ||
Sex | Female vs. male | 0.79 (0.42–1.48) | 0.457 | ||
ECOG PS | 0, 1 vs. 2 or more | 0.89 (0.35–2.27) | 0.807 | ||
Diagnosis | Pancreatic cancer | Reference | Reference | ||
Bile duct cancer | 1.06 (0.55–2.05) | 0.868 | 1.03 (0.47–2.26) | 0.940 | |
Gastric cancer | 0.20 (0.06–0.66) | 0.008 | 0.27 (0.07–1.00) | 0.050 | |
Others | 0.54 (0.18–1.57) | 0.257 | 0.27 (0.07–1.10) | 0.067 | |
Site of biliary obstruction | Distal vs. perihilar | 1.31 (0.73–2.35) | 0.357 | ||
Prior transpapillary drainage | No vs. yes | 1.55 (0.86–2.79) | 0.142 | ||
Indication for EUS-HGS | Failed biliary cannulation | Reference | |||
Isolated intrahepatic bile duct obstruction | 0.96 (0.33–2.80) | 0.947 | |||
Recurrent ascending cholangitis due to a transpapillary stent | 1.44 (0.47–4.36) | 0.522 | |||
Surgically altered anatomy | 0.69 (0.21–2.24) | 0.535 | |||
Inaccessible papilla | 0.97 (0.35–2.71) | 0.953 | |||
Puncture bile duct | B2 vs. B3 | 1.05 (0.58–1.87) | 0.882 | ||
EUS-HGAS | No vs. yes | 0.15 (0.04–0.60) | 0.008 | 0.13 (0.03–0.58) | 0.002 |
Type of stent | PS vs. cSEMS | 0.50 (0.25–1.00) | 0.049 | 0.28 (0.12–0.66) | 0.003 |
PS | cSEMS | p-value | |
---|---|---|---|
Complications other than RBO (n=152) |
|||
Any | 14 (12.8) | 11 (25.6) | 0.088 |
Bile leakage | 6 (5.5) | 1 (2.3) | 0.674 |
Bleeding | 1 (0.9) | 3 (7.0) | 0.069 |
Peritonitis | 3 (2.8) | 2 (4.7) | 0.622 |
Pancreatitis | 1 (0.9) | 0 (0) | 1 |
Liver abscess | 0 (0) | 2 (4.7) | 0.079 |
Mediastinal emphysema | 0 (0) | 1 (2.3) | 0.283 |
Ulcer | 0 (0) | 1 (2.3) | 0.283 |
Septic shock | 4 (3.7) | 0 (0) | 0.578 |
Stent migration | 0 (0) | 2 (4.7) | 0.079 |
RBO (n=134) |
|||
Any | 35 (37.6) | 12 (29.3) | 0.433 |
Sludge | 27 (29.0) | 8 (19.5) | 0.471 |
Food impaction | 1 (1.1) | 1 (2.4) | 0.450 |
Hyperplasia | 0 (0) | 3 (7.3) | 0.014 |
Stent migration | 2 (2.2) | 0 (0) | 1 |
Unknown | 5 (5.4) | 0 (0) | 0.309 |
Values are presented as median (range) or number (%). PS, plastic stent; cSEMS, fully or partially covered self-expandable metallic stent; ECOG PS, Eastern Cooperative Oncology Group performance status; EUS-HGS, endoscopic ultrasound-guided hepaticogastrostomy with transmural stenting.
Values are presented as number (%) or median (range). PS, plastic stent; cSEMS, fully/partially covered self-expandable metallic stent; B2, segment 2 bile duct; B3, segment 3 bile duct; EUS-HGAS, combined endoscopic ultrasound-guided antegrade stenting with endoscopic ultrasound-guided hepaticogastrostomy and transmural stenting.
HR, hazard ratio; CI, confidence interval; ECOG PS, Eastern Cooperative Oncology Group performance status; EUS-HGS, endoscopic ultrasound-guided hepaticogastrostomy with transmural stenting; B2, segment 2 bile duct; B3, segment 3 bile duct; EUS-HGAS, combined endoscopic ultrasound-guided antegrade stenting with endoscopic ultrasound-guided hepaticogastrostomy and transmural stenting; PS, plastic stent; cSEMS, fully/partially covered self-expandable metallic stent.
Values are presented as number (%). PS, plastic stent; cSEMS, full/partially covered self-expandable metallic stent; RBO, recurrent biliary obstruction. PS ( PS (