Endoscopic ultrasound-guided hepaticogastrostomy and endoscopic retrograde cholangiopancreatography-guided biliary drainage for distal malignant biliary obstruction due to pancreatic cancer with asymptomatic duodenal invasion: a retrospective, single-center study in Japan
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Background/Aims: Duodenal invasion (DI) is a risk factor for early recurrent biliary obstruction (RBO) in endoscopic retrogradecholangiopancreatography-guided biliary drainage (ERCP-BD). Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) mayreduce early RBO in cases of asymptomatic DI, even when ERCP is possible. Methods: We enrolled 56 patients with pancreatic cancer and asymptomatic DI who underwent EUS-HGS (n=25) or ERCP-BD (n=31). Technical and clinical success, early (<3 months) and overall RBO rates, time to RBO (TRBO), and adverse events were compared betweenthe EUS-HGS and ERCP-BD groups. Risk factors for early RBO were also evaluated. Results: Baseline characteristics were similar between the groups. Both procedures demonstrated 100% technical and clinical successrates, with a similar incidence of adverse events (48% vs. 39%, p=0.59). While the median TRBO was comparable (5.7 vs. 8.8 months,p=0.60), EUS-HGS was associated with a lower incidence of early RBO compared to ERCP-BD (8% vs. 29%, p=0.09). The major causesof early RBO in ERCP-BD were sludge and food impaction, rarely occurring in EUS-HGS. EUS-HGS was potentially reduced earlyRBO (odds ratio, 0.32; p=0.07). Conclusions: EUS-HGS can be a viable option for treating pancreatic cancer with asymptomatic DI.
Abstract
Background/Aims: Duodenal invasion (DI) is a risk factor for early recurrent biliary obstruction (RBO) in endoscopic retrogradecholangiopancreatography-guided biliary drainage (ERCP-BD). Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) mayreduce early RBO in cases of asymptomatic DI, even when ERCP is possible. Methods: We enrolled 56 patients with pancreatic cancer and asymptomatic DI who underwent EUS-HGS (n=25) or ERCP-BD (n=31). Technical and clinical success, early (<3 months) and overall RBO rates, time to RBO (TRBO), and adverse events were compared betweenthe EUS-HGS and ERCP-BD groups. Risk factors for early RBO were also evaluated. Results: Baseline characteristics were similar between the groups. Both procedures demonstrated 100% technical and clinical successrates, with a similar incidence of adverse events (48% vs. 39%, p=0.59). While the median TRBO was comparable (5.7 vs. 8.8 months,p=0.60), EUS-HGS was associated with a lower incidence of early RBO compared to ERCP-BD (8% vs. 29%, p=0.09). The major causesof early RBO in ERCP-BD were sludge and food impaction, rarely occurring in EUS-HGS. EUS-HGS was potentially reduced earlyRBO (odds ratio, 0.32; p=0.07). Conclusions: EUS-HGS can be a viable option for treating pancreatic cancer with asymptomatic DI.