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Endoscopy
DOI: 10.1055/a-2282-3350
Systematic review

Efficacy and safety of endoscopic ultrasound-guided hepatico-gastrostomy: a meta-regression analysis.

Cecilia Binda 
1   Unit of Gastroenterology and Digestive Endoscopy, Morgagni-Pierantoni Hospital, Forli, Italy (Ringgold ID: RIN18568)
2   Unit of Gastroenterology and Digestive Endoscopy, Maurizio Bufalini Hospital, Cesena, Italy (Ringgold ID: RIN161128)
,
Elton Dajti 
3   Department of Medical and Surgical Sciences - DIMEC; Alma Mater Studiorum - University of Bologna, Italy., University of Bologna, Bologna, Italy (Ringgold ID: RIN9296)
4   Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena, Italy, AUSL della Romagna, Forlì-Cesena, Italy (Ringgold ID: RIN390233)
,
Paolo Giuffrida 
4   Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena, Italy, AUSL della Romagna, Forlì-Cesena, Italy (Ringgold ID: RIN390233)
5   Section 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
4   Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena, Italy, AUSL della Romagna, Forlì-Cesena, Italy (Ringgold ID: RIN390233)
,
Chiara Coluccio
6   Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena, Italy., AUSL della Romagna, Forlì-Cesena, Italy (Ringgold ID: RIN390233)
,
Alessandro Cucchetti
7   Department of Medical and Surgical Sciences - DIMEC; Alma Mater Studiorum - University of Bologna, Italy, Alma Mater Studiorum University of Bologna, Bologna, Italy (Ringgold ID: RIN9296)
,
Alessandro Fugazza 
8   Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, Humanitas Research Hospital - IRCCS, Rozzano 20089, Milan, Italy, Humanitas Research Hospital, Rozzano, Italy
,
Barbara Perini
9   Gastroenterology Unit, Azienda Ospedale-Università di Padova (AOUP), Padua, Italy., University of Padua, Padova, Italy (Ringgold ID: RIN9308)
10   Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena, Italy. Forlì-Cesena, Emilia-Romagna, IT, AUSL della Romagna, Forlì-Cesena, Italy (Ringgold ID: RIN390233)
,
Giulia Gibiino 
11   Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena, Italy. Forlì-Cesena, Emilia-Romagna, IT, Morgagni-Pierantoni Hospital, Forli, Italy (Ringgold ID: RIN18568)
,
Andrea Anderloni
12   Gastroenterology and Digestive Endoscopy Unit, Fondazione I.R.C.C.S. Policlinico San Matteo Viale Camillo Golgi 19, 27100 Pavia (PV)., Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (Ringgold ID: RIN18631)
,
Alessandro Repici
13   Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy, Humanitas University, Pieve Emanuele, Milan, Italy (Ringgold ID: RIN437807)
14   Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, Humanitas Research Hospital - IRCCS, Rozzano 20089, Milan, Italy, IRCCS Humanitas Research Hospital, Rozzano, Italy (Ringgold ID: RIN9268)
,
Carlo Fabbri
10   Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena, Italy. Forlì-Cesena, Emilia-Romagna, IT, AUSL della Romagna, Forlì-Cesena, Italy (Ringgold ID: RIN390233)
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Background and study aim: EUS-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 the study were to provide a systematic review with meta-analysis and meta-regression of features and outcomes of this procedure. Methods: MEDLINE, Scopus, Web-of-Science, and Cochrane databases were searched for literature pertinent to EUS-HGS. Meta-analysis of 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: Thirty-three studies including 1644 patients were included in the meta-analysis. Malignant biliary obstruction was the underlying cause in almost all (99.6%) cases; the main indications for EUS-HGS were duodenal/papillary invasion (34.8%), surgical altered anatomy (18.4%) and hilar stenosis (16%). Pooled technical success of EUS-HGS was 97.7% (95%-CI: 96.1-99%, I2=0%), the intention to treat (ITT) clinical success was 88.1% (95%-CI: 84.7-91.2%, I2=33.9%) and procedure-related AEs occurred in 12% (95%-CI: 9.8-14.5%, I2=20.4%), being cholangitis/sepsis (2.8%) and bleeding (2.3%) the most frequent. The rate of procedure related AEs was reduced with the use of dedicated stents at the univariable meta regression analysis. Meta-regression showed that technical success and clinical success rates were modified by centers’ experience (>4/year). Conclusions: EUS-HGS represents an effective and safe procedure for EUS-guided biliary drainage in patients with malignant biliary obstruction. Future studies should address the impact of center experience, patient selection, and use of dedicated stents to improve this technique’s performance.



Publication History

Received: 16 October 2023

Accepted after revision: 06 March 2024

Accepted Manuscript online:
06 March 2024

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