IS Eus-Guided Hepaticogastrostomy Efficient In Hilar Biliary Stricture Induced By Bile Duct Cancer?

Aims To evaluate the clinical outcomes of patients affected by bile duct cancers (BDC) involving the liver hilum treated with EUS-guided hepaticogastrostomy (EUS-HGS).

Methods A retrospective analysis of a prospectively-collected database was performed, retrieving all patients with BDC involving the liver hilum who underwent EUS-HGS from July 2010 to January 2020. Primary outcome of the study was clinical success rate; secondary outcomes were technical success rate, adverse events and the oncological outcomes. Survival was expressed as median [95 % C.I.]. Kaplan-Meier curve and Cox proportional-hazards regression were analysed to identify variables related to survival.

Results Thirty-four patients (50 % males, 75-year-old) were included; 24 (70.6 %) presented with distant metastasis. Indications for EUS-HGS were ERCP failure (64.7 %), duodenal stricture (23.5 %), post-surgical modified anatomy (5.9 %) and dilation limited to left intrahepatic duct (5.9 %). Technical success rate was 97.1 %. Clinical success rate was 64.7 %. Four (11.8 %) patients underwent percutaneous drainage because of technical failure (no.1) or persistent cholangitis (no.3). Nine (26.5 %) patients presented adverse events, that in 2 cases led to death (bleeding and bile leakage).

Stent dysfunction was reported in 6 (17.6 %) cases (patency: 235 [202-425] days). Median overall survival was 91 [40-263] days. In case of EUS-HGS clinical success, a significantly longer survival (178 [61-393] vs 15 [7-324] days; P < 0.001) was obtained. Before enrolment, 25 patients (73.5 %) were fit for chemotherapy; of them, 17 (68.0 %) had access to a systemic treatment, leading to a significantly longer survival (324 [178-439] vs 40 [9-61]; P < 0.001).

On multivariate analysis, EUS-HGS clinical success (Exp(b) 0.23[0.09-0.60]; P = 0.003) and chemotherapy [Exp(b) 0.07[0.02-0.23]; P < 0.001) were independently related to prolonged survival.

Conclusions EUS-HGS is technically and clinically effective in patients with hilar cholangiocarcinoma despite a not negligible rate of adverse event. The achievement of clinical success, potentially leading to jaundice resolution and access to chemotherapy, significantly impacts patients’ survival.

Citation Schoch A, Lisotti A, Fumex F et al. eP428 IS EUS-GUIDED HEPATICOGASTROSTOMY EFFICIENT IN HILAR BILIARY STRICTURE INDUCED BY BILE DUCT CANCER? Endoscopy 2021; 53: S237.

Publication History

Article published online:
19 March 2021