BMC gastroenterology · 2026
EUS-guided hepaticogastrostomy versus EUS-guided hepaticogastrostomy with antegrade stent placement in patients with unresectable malignant distal biliary obstruction: a meta-analysis of individual patient data.
СтатьяМетаанализСравнительное исследованиеСистематический обзорНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Shaaban Abdelgalil Mahmoud, Abdelrazek Ahmad, Mohamed Mahmoud Samir, Hassan Amro, Mabrouk Manar Alaa, Nasser Mohamed, Alhmeid Eyad Khalil, Nizar Abdullah, Wazir Abid, Ali Noha, Hraybi Adam, Iqbal Ryad, Paracha Sadia, Amin Shray
Аннотация
BACKGROUND: In patients with malignant biliary obstruction (MBO) where endoscopic retrograde cholangiopancreatography (ERCP) fails, endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is an important rescue option. This study compared the safety and efficacy of EUS-HGS alone versus EUS-HGS with antegrade stenting (EUS-HGAS).
METHODS: PubMed, Scopus, and Web of Science were searched for studies comparing EUS-HGS and EUS-HGAS in MBO. Primary outcomes included reintervention rates, and time to recurrent biliary obstruction (TRBO). Secondary outcomes were technical success, clinical success, procedure duration, and adverse events. Individual patient data for TRBO were reconstructed from Kaplan Meier curves and analyzed using restricted mean survival time.
RESULTS: Five observational studies including 451 patients were analyzed (250 EUS-HGS, 201 EUS-HGAS). Reintervention rates were significantly higher in the EUS-HGS group compared with the EUS-HGAS group (RR = 3.00; 95% CI: 1.69-5.34; P = 0.0002). No significant differences were observed between the two groups in terms of technical success, clinical success, procedure duration, overall adverse events, cholangitis, or bleeding. TRBO was significantly longer with EUS-HGAS (mean 651 vs. 227 days; HR = 0.15; 95% CI: 0.03,0.83; P = 0.03), indicating improved stent patency. EUS-HGS was associated with a lower risk of pancreatitis (RR 0.14; 95% CI 0.03-0.60; P=0.008) but a higher risk of bile leakage (RR 5.58; 95% CI 1.03-30.09; P=0.05).
CONCLUSION: This meta-analysis suggests that EUS-HGAS may provide longer time to recurrent biliary obstruction and lower reintervention rates compared with EUS-HGS, while maintaining similar technical and clinical success and procedure time. Overall adverse events were comparable, although bile leakage was more frequent with EUS-HGS and acute pancreatitis with EUS-HGAS. These findings may indicate a potential advantage of EUS-HGAS in terms of stent durability, warranting further studies for confirmation.
METHODS: PubMed, Scopus, and Web of Science were searched for studies comparing EUS-HGS and EUS-HGAS in MBO. Primary outcomes included reintervention rates, and time to recurrent biliary obstruction (TRBO). Secondary outcomes were technical success, clinical success, procedure duration, and adverse events. Individual patient data for TRBO were reconstructed from Kaplan Meier curves and analyzed using restricted mean survival time.
RESULTS: Five observational studies including 451 patients were analyzed (250 EUS-HGS, 201 EUS-HGAS). Reintervention rates were significantly higher in the EUS-HGS group compared with the EUS-HGAS group (RR = 3.00; 95% CI: 1.69-5.34; P = 0.0002). No significant differences were observed between the two groups in terms of technical success, clinical success, procedure duration, overall adverse events, cholangitis, or bleeding. TRBO was significantly longer with EUS-HGAS (mean 651 vs. 227 days; HR = 0.15; 95% CI: 0.03,0.83; P = 0.03), indicating improved stent patency. EUS-HGS was associated with a lower risk of pancreatitis (RR 0.14; 95% CI 0.03-0.60; P=0.008) but a higher risk of bile leakage (RR 5.58; 95% CI 1.03-30.09; P=0.05).
CONCLUSION: This meta-analysis suggests that EUS-HGAS may provide longer time to recurrent biliary obstruction and lower reintervention rates compared with EUS-HGS, while maintaining similar technical and clinical success and procedure time. Overall adverse events were comparable, although bile leakage was more frequent with EUS-HGS and acute pancreatitis with EUS-HGAS. These findings may indicate a potential advantage of EUS-HGAS in terms of stent durability, warranting further studies for confirmation.