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  • Title: Comparison of recurrent biliary obstruction with the use of metal and plastic stents in EUS-guided biliary drainage: A propensity score-matched analysis.
    Author: Hashimoto S, Iwashita Y, Taguchi H, Tanoue S, Ohi T, Shibata R, Haraguchi T, Kamikihara Y, Toyodome K, Kojima I, Araki N, Tsuneyoshi K, Nakamura Y, Fujita T, Hinokuchi M, Iwaya H, Arima S, Sasaki F, Kanmura S, Ido A.
    Journal: Endosc Ultrasound; 2023; 12(1):64-73. PubMed ID: 36510868.
    Abstract:
    BACKGROUND AND OBJECTIVES: In transpapillary biliary drainage, metal stents (MSs) exhibit a lower incidence of a biliary obstruction than plastic stents (PSs). However, few studies have compared recurrent biliary obstruction (RBO) when MSs and PSs are used in EUS-guided hepaticogastrostomy (EUS-HGS) and choledochoduodenostomy (EUS-CDS). We retrospectively evaluated the RBO for both stents in each procedure. PATIENTS AND METHODS: : Between November 2012 and December 2020, 85 and 53 patients who underwent EUS-HGS and EUS-CDS for unresectable malignant biliary obstruction, respectively, were enrolled. Factors associated with RBO were assessed. Clinical outcomes were compared between the MS and PS groups using propensity score matching. RESULTS: : The clinical success rate and procedure-related adverse events were similar in the MS and PS groups. Multivariate analysis identified the use of PS as a factor associated with RBO (EUS-HGS, P = 0.03; EUS-CDS, P = 0.02). After matching, the median time to RBO in EUS-HGS (MS: 313; PS: 125 days; P = 0.01) in the MS group was longer than that in the PS group. The cumulative incidence of RBO at 1, 3, and 6 months in the MS group was significantly lower than that in the PS group for EUS-HGS (MS: 4.0%, 8.2%, and 8.2%; PS: 12.4%, 24.9%, and 39.5%, respectively, P = 0.01). CONCLUSIONS: : MS exhibited a lower rate of RBO than PS for EUS-HGS and EUS-CDS.
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