PDF(Pubmed)
Abstract：
UNASSIGNED: Endoscopic ultrasound-guided biliary drainage (EUS-BD), classified as choledochoduodenostomy (CDS) and hepaticogastrostomy (HGS), is a feasible and effective alternative for distal malignant biliary obstruction (MBO) in failed endoscopic retrograde cholangiopancreatography. However, the preferred technique for better outcomes has not yet been evaluated.
UNASSIGNED: We compared the long-term outcomes between the techniques.
UNASSIGNED: Retrospective comparative study.
UNASSIGNED: We reviewed consecutive patients who underwent EUS-CDS or EUS-HGS with transmural stent placement for distal MBO between 2009 and 2022. The primary outcome was the stent patency. The secondary outcomes were technical and clinical success, adverse events (AEs) of each technique, and independent risk factors for stent dysfunction.
UNASSIGNED: In all, 115 patients were divided into EUS-CDS (n = 56) and EUS-HGS (n = 59) groups. Among them, technical success was achieved in 98.2% of EUS-CDS and 96.6% of EUS-HGS groups. Furthermore, clinical success was 96.4% in EUS-CDS and 88.1% in EUS-HGS groups, without significant difference (p = 0.200). The mean duration of stent patency for EUS-CDS was 770.3 days while that for EUS-HGS was 164.9 days (p = 0.010). In addition, the only independent risk factor for stent dysfunction was systematic treatment after EUS-BD [hazard ratio and 95% confidence interval 0.238 (0.066-0.863), p = 0.029]. The incidence of stent dysfunction of EUS-HGS was higher than EUS-CDS (35.1% versus 18.2%, 0.071), despite no significant differences even in late AEs.
UNASSIGNED: In distal MBO, EUS-CDS may be better than EUS-HGS with longer stent patency and fewer AEs. Furthermore, systematic treatment after EUS-BD is recommended for the improvement of stent patency.
UNASSIGNED: We compared the long-term outcomes between the techniques.
UNASSIGNED: Retrospective comparative study.
UNASSIGNED: We reviewed consecutive patients who underwent EUS-CDS or EUS-HGS with transmural stent placement for distal MBO between 2009 and 2022. The primary outcome was the stent patency. The secondary outcomes were technical and clinical success, adverse events (AEs) of each technique, and independent risk factors for stent dysfunction.
UNASSIGNED: In all, 115 patients were divided into EUS-CDS (n = 56) and EUS-HGS (n = 59) groups. Among them, technical success was achieved in 98.2% of EUS-CDS and 96.6% of EUS-HGS groups. Furthermore, clinical success was 96.4% in EUS-CDS and 88.1% in EUS-HGS groups, without significant difference (p = 0.200). The mean duration of stent patency for EUS-CDS was 770.3 days while that for EUS-HGS was 164.9 days (p = 0.010). In addition, the only independent risk factor for stent dysfunction was systematic treatment after EUS-BD [hazard ratio and 95% confidence interval 0.238 (0.066-0.863), p = 0.029]. The incidence of stent dysfunction of EUS-HGS was higher than EUS-CDS (35.1% versus 18.2%, 0.071), despite no significant differences even in late AEs.
UNASSIGNED: In distal MBO, EUS-CDS may be better than EUS-HGS with longer stent patency and fewer AEs. Furthermore, systematic treatment after EUS-BD is recommended for the improvement of stent patency.
摘要：
■内镜超声引导胆道引流（EUS-BD），分为胆总管十二指肠吻合术（CDS）和肝胃吻合术（HGS），是内镜逆行胰胆管造影术失败的远端恶性胆道梗阻（MBO）的可行且有效的替代方法。然而,更好结局的首选技术尚未评估.
■我们比较了两种技术之间的长期结果。
■回顾性比较研究。
■我们回顾了2009年至2022年期间接受EUS-CDS或EUS-HGS并进行透壁支架置入远端MBO的连续患者。主要结果是支架通畅。次要结果是技术和临床成功，每种技术的不良事件（AE），和支架功能障碍的独立危险因素。
■总之，115例患者分为EUS-CDS组(n=56)和EUS-HGS组(n=59)。其中,在98.2%的EUS-CDS和96.6%的EUS-HGS组中取得了技术成功.此外，EUS-CDS和EUS-HGS组的临床成功率分别为96.4%和88.1%,无显著性差异(p=0.200)。EUS-CDS的平均支架通畅时间为770.3天，而EUS-HGS的平均支架通畅时间为164.9天（p=0.010）。此外,支架功能障碍的唯一独立危险因素是EUS-BD后的系统治疗[风险比和95％置信区间0.238（0.066-0.863），p=0.029]。EUS-HGS的支架功能障碍发生率高于EUS-CDS（35.1%对18.2%，0.071),尽管即使在晚期AE中也没有显着差异。
■在远端MBO中，EUS-CDS可能优于EUS-HGS，具有更长的支架通畅性和更少的AE。此外，建议在EUS-BD后进行系统治疗以改善支架的通畅性。
■我们比较了两种技术之间的长期结果。
■回顾性比较研究。
■我们回顾了2009年至2022年期间接受EUS-CDS或EUS-HGS并进行透壁支架置入远端MBO的连续患者。主要结果是支架通畅。次要结果是技术和临床成功，每种技术的不良事件（AE），和支架功能障碍的独立危险因素。
■总之，115例患者分为EUS-CDS组(n=56)和EUS-HGS组(n=59)。其中,在98.2%的EUS-CDS和96.6%的EUS-HGS组中取得了技术成功.此外，EUS-CDS和EUS-HGS组的临床成功率分别为96.4%和88.1%,无显著性差异(p=0.200)。EUS-CDS的平均支架通畅时间为770.3天，而EUS-HGS的平均支架通畅时间为164.9天（p=0.010）。此外,支架功能障碍的唯一独立危险因素是EUS-BD后的系统治疗[风险比和95％置信区间0.238（0.066-0.863），p=0.029]。EUS-HGS的支架功能障碍发生率高于EUS-CDS（35.1%对18.2%，0.071),尽管即使在晚期AE中也没有显着差异。
■在远端MBO中，EUS-CDS可能优于EUS-HGS，具有更长的支架通畅性和更少的AE。此外，建议在EUS-BD后进行系统治疗以改善支架的通畅性。
