Journal of hepato-biliary-pancreatic sciences · 2025
Adverse Events of EUS-Guided Biliary Drainage for Malignant Biliary Obstruction: A Large Multicenter Study.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Itonaga Masahiro, Ogura Takeshi, Takenaka Mamoru, Matsumoto Kazuyuki, Shiomi Hideyuki, Shintani Shuhei, Kamada Hideki, Yamashita Taro, Mandai Koichiro, Asada Masanori, Imai Hajime, Takeshita Kotaro, Ikeura Tsukasa, Fujimori Nao, Kinoshita Makiko, Ikezawa Kenji, Sugimori Satoshi, Kitagawa Koh, Sagami Ryota, Kokubu Masahito, Kuroda Taira, Nishioka Nobu, Hatamaru Keiichi, Minaga Kosuke, Wan Ke, Shimokawa Toshio, Kitano Masayuki
Аннотация
BACKGROUND AND AIMS: This study aimed to evaluate adverse events (AEs) for endoscopic ultrasound-guided biliary drainage (EUS-BD) and identify risk factors for early AEs and recurrent biliary obstruction (RBO).
METHODS: A multicenter retrospective study was conducted using a common database of 21 Japanese referral centers.
RESULTS: A total of 616 patients who underwent EUS-BD, including endoscopic ultrasound-guided choledochoduodenostomy (n = 107), hepaticogastrostomy (n = 487), and hepaticojejunostomy (n = 22), for malignant biliary obstruction were analyzed. Early AEs occurred in 13.6% of patients. Independent risk factors for all AEs included procedure time ≥ 32 min (odds ratio [OR] 1.82) and antiplatelet/anticoagulant use (OR 2.15). A risk factor for peritonitis included electrocautery use (OR 3.87), while bleeding risk was increased with antiplatelet/anticoagulant use (OR 7.19) and performance status > 2 (OR 5.26). The use of plastic stents was associated with a higher risk of a shorter time to RBO. AE and RBO rates did not significantly differ among the three EUS-BD approaches.
CONCLUSIONS: Patients on antiplatelet and/or anticoagulation therapy should be aware of the increased risk of AEs of EUS-BD. In addition, it is important to minimize procedure time, avoid the use of electrocautery, and use a metal stent to prevent early AEs and RBO.
METHODS: A multicenter retrospective study was conducted using a common database of 21 Japanese referral centers.
RESULTS: A total of 616 patients who underwent EUS-BD, including endoscopic ultrasound-guided choledochoduodenostomy (n = 107), hepaticogastrostomy (n = 487), and hepaticojejunostomy (n = 22), for malignant biliary obstruction were analyzed. Early AEs occurred in 13.6% of patients. Independent risk factors for all AEs included procedure time ≥ 32 min (odds ratio [OR] 1.82) and antiplatelet/anticoagulant use (OR 2.15). A risk factor for peritonitis included electrocautery use (OR 3.87), while bleeding risk was increased with antiplatelet/anticoagulant use (OR 7.19) and performance status > 2 (OR 5.26). The use of plastic stents was associated with a higher risk of a shorter time to RBO. AE and RBO rates did not significantly differ among the three EUS-BD approaches.
CONCLUSIONS: Patients on antiplatelet and/or anticoagulation therapy should be aware of the increased risk of AEs of EUS-BD. In addition, it is important to minimize procedure time, avoid the use of electrocautery, and use a metal stent to prevent early AEs and RBO.