Digestive diseases and sciences · 2025
Endoscopic Choledochoduodenostomy Versus Gallbladder Drainage for Malignant Biliary Obstruction: A Propensity Score Matched Study.
СтатьяМногоцентровое исследованиеСравнительное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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.
Siranart Noppachai, Thompson Christopher C, Ryou Marvin, Steinway Steven N
Аннотация
INTRODUCTION: Endoscopic ultrasound-guided gallbladder drainage (EUS-GB) is an emerging alternative to choledochoduodenostomy (EUS-CBD) for malignant distal biliary obstruction (MDBO), particularly when conventional access is not feasible.
METHODS: We conducted a multicenter, retrospective study of patients undergoing EUS-GB or EUS-CBD for MDBO between January 2015 and October 2024. Primary outcomes were technical and clinical success. Secondary outcomes included procedural time, 6-month reintervention, adverse events (AEs), and all-cause mortality. Propensity score matching (PSM) was used to adjust for baseline differences.
RESULTS: Eighty-two patients were included (22 EUS-GB, 60 EUS-CBD). Technical success was comparable between groups (95.5% vs. 96.7%). EUS-GB was used as salvage in 50% of cases when EUS-CBD was not feasible, with a 90.9% technical success rate. PSM yielded 21 matched pairs. After propensity score matching, clinical success was similar (95.2% EUS-GB vs. 85.7% EUS-CBD, p = 0.61). EUS-GB had significantly lower 6-month reintervention (4.8% vs. 23.8%, p = 0.004) and stent-related complications (0% vs. 18.9%). Adverse event rates and all-cause mortality were similar. Median follow-up was 116 days (IQR: 51-300). In the EUS-GB group, pre-procedural cystic duct patency predicted clinical success (94.1%).
CONCLUSION: EUS-GB is a technically effective and clinically comparable alternative to EUS-CDS for MDBO, with significantly fewer reinterventions and stent-related complications. When cystic duct patency is confirmed on imaging, EUS-GB may be considered as a primary approach or salvage strategy for biliary drainage in MDBO.
METHODS: We conducted a multicenter, retrospective study of patients undergoing EUS-GB or EUS-CBD for MDBO between January 2015 and October 2024. Primary outcomes were technical and clinical success. Secondary outcomes included procedural time, 6-month reintervention, adverse events (AEs), and all-cause mortality. Propensity score matching (PSM) was used to adjust for baseline differences.
RESULTS: Eighty-two patients were included (22 EUS-GB, 60 EUS-CBD). Technical success was comparable between groups (95.5% vs. 96.7%). EUS-GB was used as salvage in 50% of cases when EUS-CBD was not feasible, with a 90.9% technical success rate. PSM yielded 21 matched pairs. After propensity score matching, clinical success was similar (95.2% EUS-GB vs. 85.7% EUS-CBD, p = 0.61). EUS-GB had significantly lower 6-month reintervention (4.8% vs. 23.8%, p = 0.004) and stent-related complications (0% vs. 18.9%). Adverse event rates and all-cause mortality were similar. Median follow-up was 116 days (IQR: 51-300). In the EUS-GB group, pre-procedural cystic duct patency predicted clinical success (94.1%).
CONCLUSION: EUS-GB is a technically effective and clinically comparable alternative to EUS-CDS for MDBO, with significantly fewer reinterventions and stent-related complications. When cystic duct patency is confirmed on imaging, EUS-GB may be considered as a primary approach or salvage strategy for biliary drainage in MDBO.