title: International multicenter comparative trial of transluminal EUS-guided biliary drainage via hepatogastrostomy vs. choledochoduodenostomy approaches.
abstract: OBJECTIVE
  Endoscopic ultrasound-guided biliary drainage (EUS-BD) can be performed entirely transgastrically (hepatogastrostomy/EUS-HG) or transduodenally (choledochoduodenostomy/EUS-CDS). It is unknown how both techniques compare. The aims of this study were to compare efficacy and safety of both techniques and identify predictors of adverse events.
  
  
  METHODS
  Consecutive jaundiced patients with distal malignant biliary obstruction who underwent EUS-BD at multiple international centers were included. Technical/clinical success, adverse events, stent complications, and survival were assessed.
  
  
  RESULTS
  A total of 121 patients underwent EUS-BD (CDS 60, HG 61). Technical success was achieved in 112 (92.56 %) patients (EUS-CDS 93.3 %, EUS-HG 91.8 %, P = 0.75). Clinical success was attained in 85.5 % of patients who underwent EUS-CDS group as compared to 82.1 % of patients who underwent EUS-HG (P = 0.64). Adverse events occurred more commonly in the EUS-HG group (19.67 % vs. 13.3 %, P = 0.37). Both plastic stenting (OR 4.95, 95 %CI 1.41 - 17.38, P = 0.01) and use of non-coaxial electrocautery (OR 3.95, 95 %CI 1.16 - 13.40, P = 0.03) were independently associated with adverse events. Length of hospital stay was significantly shorter in the CDS group (5.6 days vs. 12.7 days, P < 0.001). Mean follow-up duration was 151 ± 159 days. The 1-year stent patency probability was greater in the EUS-CDS group [0.98 (95 %CI 0.76 - 0.96) vs 0.60 (95 %CI 0.35 - 0.78)] but overall patency was not significantly different. There was no difference in median survival times between the groups (P = 0.36) CONCLUSIONS: Both EUS-CDS and EUS-HG are effective and safe techniques for the treatment of distal biliary obstruction after failed ERCP. However, CDS is associated with shorter hospital stay, improved stent patency, and fewer procedure- and stent-related complications. Metallic stents should be placed whenever feasible and non-coaxial electrocautery should be avoided when possible as plastic stenting and non-coaxial electrocautery were independently associated with occurrence of adverse events.
authors.affiliation: Johns Hopkins Medical Institutions, Baltimore, MD, United States.
authors.forename: Mouen A
authors.initials: MA
authors.lastname: Khashab
authors.affiliation: Johns Hopkins Medical Institutions, Baltimore, MD, United States.
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Messallam
authors.affiliation: Hospital Universitario-Roi Hortega, Valladolid, Spain.
authors.forename: Irene
authors.initials: I
authors.lastname: Penas
authors.affiliation: University of Tokyo, Tokyo, Japan.
authors.forename: Yousuke
authors.initials: Y
authors.lastname: Nakai
authors.affiliation: Winthrop University, Mineola, NY, United States.
authors.forename: Rani J
authors.initials: RJ
authors.lastname: Modayil
authors.affiliation: Hospital Universitario-Roi Hortega, Valladolid, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: De la Serna
authors.affiliation: Aichi Cancer Center Hospital, Nagoya, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Hara
authors.affiliation: Johns Hopkins Medical Institutions, Baltimore, MD, United States.
authors.forename: Mohamad
authors.initials: M
authors.lastname: El Zein
authors.affiliation: Winthrop University, Mineola, NY, United States.
authors.forename: Stavros N
authors.initials: SN
authors.lastname: Stavropoulos
authors.affiliation: Hospital Universitario-Roi Hortega, Valladolid, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Perez-Miranda
authors.affiliation: Johns Hopkins Medical Institutions, Baltimore, MD, United States.
authors.forename: Vivek
authors.initials: V
authors.lastname: Kumbhari
authors.affiliation: Johns Hopkins Medical Institutions, Baltimore, MD, United States.
authors.forename: Saowanee
authors.initials: S
authors.lastname: Ngamruengphong
authors.affiliation: Baladota Institute of Digestive Sciences, Mumbai, India.
authors.forename: Vinay K
authors.initials: VK
authors.lastname: Dhir
authors.affiliation: Asan Medical Center, Seoul, South Korea.
authors.forename: Do Hyun
authors.initials: DH
authors.lastname: Park