Clinical Endoscopy

  • 제56권6호
  • /
  • Pages.802-811
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  • 2023
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  • 2234-2400(pISSN)
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  • 2234-2443(eISSN)
대한소화기내시경학회 (The Korean Society of Gastrointestinal Endoscopy)
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Covered self-expandable metallic stents versus plastic stents for endoscopic ultrasound-guided hepaticogastrostomy in patients with malignant biliary obstruction

  • Taro Shibuki (Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East) ;
  • Kei Okumura (Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East) ;
  • Masanari Sekine (Department of Gastroenterology, Jichi Medical University Saitama Medical Center) ;
  • Ikuhiro Kobori (Department of Gastroenterology, Dokkyo Medical University Saitama Medical Center) ;
  • Aki Miyagaki (Department of Gastroenterology, Toyooka Hospital) ;
  • Yoshihiro Sasaki (Department of Gastroenterology, National Organization Disaster Medical Center) ;
  • Yuichi Takano (Department of Gastroenterology, Fujigaoka Hospital, Showa University) ;
  • Yusuke Hashimoto (Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East)
  • 투고 : 2022.08.19
  • 심사 : 2022.09.30
  • 발행 : 2023.11.30
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초록

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 recurrent biliary obstruction 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 recurrent biliary obstruction 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.

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참고문헌

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