Endoscopy 2022; 54(S 01): S73
DOI: 10.1055/s-0042-1744732
Abstracts | ESGE Days 2022
ESGE Days 2022 Oral presentations
15:30–16:30 Friday, 29 April 2022 Club A. Gastroparesis and outlet obstruction

OUTCOMES OF COMBINED MANAGEMENT BILIARY AND GASTRIC OUTLET OBSTRUCTION (CABRIOLET STUDY): A MULTICENTRE RETROSPECTIVE ANALYSIS

G. Vanella
1   IRCCS San Raffaele Scientific Institute, Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, Milan, Italy
,
M. Bronswijk
2   University Hospitals Gasthuisberg, University of Leuven, Department of Gastroenterology and Hepatology, Leuven, Belgium
3   Imelda General Hospital, Department of Gastroenterology and Hepatology, Bonheiden, Belgium
,
R.L. van Wanrooij
4   Vrije Universiteit, Gastroenterology Endocrinology & Metabolism, Department of Gastroenterology and Hepatology, Amsterdam, Netherlands
,
G. Dell'Anna
1   IRCCS San Raffaele Scientific Institute, Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, Milan, Italy
,
W. Laleman
2   University Hospitals Gasthuisberg, University of Leuven, Department of Gastroenterology and Hepatology, Leuven, Belgium
,
H. van Malenstein
2   University Hospitals Gasthuisberg, University of Leuven, Department of Gastroenterology and Hepatology, Leuven, Belgium
,
R.P Voermans
5   University of Amsterdam, Gastroenterology Endocrinology & Metabolism, Department of Gastroenterology and Hepatology, Amsterdam, Netherlands
,
P. Fockens
4   Vrije Universiteit, Gastroenterology Endocrinology & Metabolism, Department of Gastroenterology and Hepatology, Amsterdam, Netherlands
5   University of Amsterdam, Gastroenterology Endocrinology & Metabolism, Department of Gastroenterology and Hepatology, Amsterdam, Netherlands
,
S. van der Merwe
2   University Hospitals Gasthuisberg, University of Leuven, Department of Gastroenterology and Hepatology, Leuven, Belgium
,
P.G. Arcidiacono
1   IRCCS San Raffaele Scientific Institute, Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, Milan, Italy
› Author Affiliations
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    Aims Combined Biliary (BO) and Gastric Outlet Obstruction (GOO) is a challenging scenario, even in the era of therapeutic EUS, as GOO might reduce the clinical success of EUS-guided biliary drainage. Little is known on post-procedural dysfunction-free survival (DFS) of different combinations used to treat double obstruction (DO).

    Methods All consecutive patients with DO treated between 2016-2021 in 3 tertiary academic centres were eligible if between-procedures interval < 180days and post-procedural follow-up (FU) > 30 days. Multiple combinations were allowed involving duodenal stenting [DS], EUS-guided gastroenterostomy [EUS-GE], hepaticogastrostomy [EUS-HGS], choledochoduodenostomy [EUS-CDS], transpapillary stenting [TPS]. Primary outcome was any recurrent BO/DO needing reintervention. DFS probability was estimated by Kaplan-Meier analysis.

    Results Ninety-three patients with DO were eligible (male 46%; median age 67 [60-76]; pancreatic cancer 73%), resulting in 103 procedure combinations. Combinations with DS experienced more primary failure than those using EUS-GE (OR=3.2 [0.94-11.1]). Different combinations showed significantly different risk of recurrence during FU (p=0.009). EUS-GE+HG combination showed the longest estimated DFS, while DS+EUS-CD and DS overlying TPS the shortest, with a recurrence HR of 5.1 [1.9-14.1] and 2.6 [1.2-5.9] respectively.

    Conclusions Despite the limitations of an underpowered inclusion per each combination, this study suggests that combinations including DS versus EUS-GE are more prone to dysfunction, while introducing new to-be-proven trends. EUS-CD might have reduced efficacy and patency in the context of GOO, either above a DS or with GE in place. GE+HG in this setting seems promising. Combined obstruction deserves specific prospective evaluation beyond the expected results of single procedures.


     

    Publication History

    Article published online:
    14 April 2022

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