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Hepaticogastrostomy versus choledochoduodenostomy: An international multicenter study on their long-term patency

1 Rutgers Robert Wood Johnson Medical Hospital, New Brunswick, New Jersey, USA
2 Jean Mermoz Private hospital, Lyon, France
3 Instituto Ecuatoriano de Enfermedades Digestivas, Guayaquil, Ecuador
4 Ochsner Medical Center, New Orleans, Lousiana, USA
5 Mount Sinai Hospital, New York, New York, USA
6 Hospital Vithas Xanit Internacional, Malaga, Spain
7 Hospital Universitario Ramón y Cajal, Madrid, Spain
8 Asian Institute of Gastroenterology, Hyderabad, Telangana, India
9 Weill Cornell Medical, New York, New York, USA
10 Hospital das Clinicas da FMRPUSP, Sao Paulo, Brazil
11 Methodist Dallas Medical Center, Dallas, TX, USA
12 Department of Endoscopy, Institut Paoli-Calmettes, Marseille, France

Correspondence Address:
Michel Kahaleh,
Rutgers Robert Wood Johnson University Hospital, 1 RWJ Place, MEB 464, New Brunswick, NJ 08901
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/EUS-D-21-00006

PMID: 34494590

Background and Objectives: EUS-guided biliary drainage (EUS-BD) offers minimally invasive decompression when conventional endoscopic retrograde cholangiopancreatography fails. Stents can be placed from the intrahepatic ducts into the stomach (hepaticogastrostomy [HG]) or from the extrahepatic bile duct into the small intestine (choledochoduodenostomy [CCD]). Long-term patency of these stents is unknown. In this study, we aim to compare long-term patency of CCD versus HG. Methods: Consecutive patients from 12 centers were included in a registry over 14 years. Demographics, procedure info, adverse events, and follow-up data were collected. Student's t-test, Chi–square, and logistic regression analyses were conducted. Only patients with at least 6-month follow-up or who died within 6-month postprocedure were included. Results: One-hundred and eighty-two patients were included (93% male; mean age: 70; HG n = 95, CCD n = 87). No significant difference in indication, diagnosis, dissection instrument, or stent type was seen between the two groups. Technical success was 92% in both groups. Clinical success was achieved in 75/87 (86%) in the HG group and 80/80 (100%) in the CCD group. A trend toward higher adverse events was seen in the CCD group. A total of 25 patients out of 87 needed stent revision in the HG group (success rate 71%), while eight out of 80 were revised in the CCD group (success rate 90%). Chi square shows CCD success higher than HG (90% vs. 71%, P = 0.010). After adjusting for diagnosis, jaundice or cholangitis presentation, instrument used for dissection, and gender, CCD was 4.5 times more likely than HG to achieve longer stent patency or manage obstruction (odds ratio 4.5; 95% 1.1548–17.6500, P = 0.0302). Conclusion: CCD is associated with superior long-term patency than HG but with a trend toward higher adverse events. This is particularly important in patients with increased survival. Additional studies are required before recommending a change in practice.

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