Efficacy and safety of endoscopic ultrasound-guided hepaticogastrostomy: a meta-regression analysis

Cecilia Binda; Elton Dajti; Paolo Giuffrida; Margherita Trebbi; Chiara Coluccio; Alessandro Cucchetti; Alessandro Fugazza; Barbara Perini; Giulia Gibiino; Andrea Anderloni; Alessandro Repici; Carlo Fabbri

doi:10.1055/a-2282-3350

Endoscopy, Table of Contents

Endoscopy 2024; 56(09): 694-705
DOI: 10.1055/a-2282-3350

Systematic review

Efficacy and safety of endoscopic ultrasound-guided hepaticogastrostomy: a meta-regression analysis

Authors

Cecilia Binda

¹Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL della Romagna, Forlì-Cesena, Italy (Ringgold ID: RIN390233)
Elton Dajti

²European Reference Network on Hepatological Diseases, IRCSS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy

³Department of Medical and Surgical Sciences - DIMEC, Alma Mater Studiorum University of Bologna, Bologna, Italy (Ringgold ID: RIN9296)
Paolo Giuffrida

¹Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL della Romagna, Forlì-Cesena, Italy (Ringgold ID: RIN390233)

⁴Section of Gastroenterology & Hepatology, Department of Health Promotion Sciences Maternal and Infant Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, Palermo, Italy (Ringgold ID: RIN18998)
Margherita Trebbi

¹Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL della Romagna, Forlì-Cesena, Italy (Ringgold ID: RIN390233)
Chiara Coluccio

¹Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL della Romagna, Forlì-Cesena, Italy (Ringgold ID: RIN390233)
Alessandro Cucchetti

³Department of Medical and Surgical Sciences - DIMEC, Alma Mater Studiorum University of Bologna, Bologna, Italy (Ringgold ID: RIN9296)
Alessandro Fugazza

⁵Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Italy (Ringgold ID: RIN9268)
Barbara Perini

¹Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL della Romagna, Forlì-Cesena, Italy (Ringgold ID: RIN390233)

⁶Gastroenterology Unit, Azienda Ospedale Universita Padova, Padova, Italy (Ringgold ID: RIN18624)
Giulia Gibiino

¹Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL della Romagna, Forlì-Cesena, Italy (Ringgold ID: RIN390233)
Andrea Anderloni

⁷Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (Ringgold ID: RIN18631)
Alessandro Repici

⁵Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Italy (Ringgold ID: RIN9268)

⁸Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (Ringgold ID: RIN437807)
Carlo Fabbri

¹Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL della Romagna, Forlì-Cesena, Italy (Ringgold ID: RIN390233)

Abstract

Background Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is a valid option for EUS-guided biliary drainage that has been increasingly used in the last decade. The aims of this study were to provide a systematic review with meta-analysis and meta-regression of the features and outcomes of this procedure.

Methods The MEDLINE, Scopus, Web of Science, and Cochrane databases were searched for literature pertinent to EUS-HGS. Meta-analysis of the proportions and meta-regression of potential modifiers of the main outcome measures were applied. The main outcome was technical success; secondary outcomes were clinical success and procedure-related adverse events (AEs).

Results 33 studies, including 1644 patients, were included in the meta-analysis. Malignant biliary obstruction (MBO) was the underlying cause in almost all cases (99.6%); the main indications for EUS-HGS were duodenal/papillary invasion (34.8%), surgically altered anatomy (18.4%), and hilar stenosis (16.0%). The pooled technical success of EUS-HGS was 97.7% (95%CI 96.1%–99.0%; I ² = 0%), the intention-to-treat clinical success rate was 88.1% (95%CI 84.7%–91.2%; I ²= 33.9%), and procedure-related AEs occurred in 12.0% (95%CI 9.8%–14.5%; I ²= 20.4%), with cholangitis/sepsis (2.8%) and bleeding (2.3%) the most frequent. The rate of procedure-related AEs was lower with the use of dedicated stents on univariable meta-regression analysis. Meta-regression showed that technical success and clinical success rates were modified by the centers’ experience (>4/year).

Conclusions EUS-HGS represents an effective and safe procedure for EUS-guided biliary drainage in patients with MBO. Future studies should address the impact of center experience, patient selection, and the use of dedicated stents to improve performance of this technique.

Full Text

References

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