Saint Peter's University Hospital / Robert Wood Johnson Medical School New Brunswick, NJ
Award: Outstanding Research Award in the Interventional Endoscopy Category
Award: Presidential Poster Award
Vishali Moond, MD1, Priyadarshini Loganathan, MD2, Bhargav Koyani, MBBS3, Parth Patel, MD4, Shahab R. Khan, MBBS5, Lena L. Kassab, MBA6, Saurabh Chandan, MD7, Babu Mohan, MD, MS8, Arkady Broder, MD1, Douglas G. Adler, MD9 1Saint Peter's University Hospital / Robert Wood Johnson Medical School, New Brunswick, NJ; 2University of Texas Health Science Center, San Antonio, TX; 3Ascension Saint Francis Hospital, Evanston, IL; 4Ascension Saint Joseph Hospital, Chicago, IL; 5Brigham and Women's Hospital, Harvard Medical School, Boston, MA; 6Mayo Clinic, Rochester, MN; 7Creighton University School of Medicine, Omaha, NE; 8University of Utah Health School of Medicine, Salt Lake City, UT; 9Center for Advanced Therapeutic (CATE), Centura Health, Porter Adventist Hospital, Peak Gastroenterology, Denver, CO
Introduction: US-guided hepaticogastrostomy (EUS-HGS) is one of the preferred methods in biliary drainage where endoscopic retrograde cholangiopancreatography (ERCP) fails or is contraindicated. EUS-HGS in particular is gathering a lot of interest due to its ease, and high rates of success. The reported adverse events with this procedure have been inconsistent among studies.
Methods: We conducted a search of multiple electronic databases and conference proceedings from inception through Jan 2023. The primary outcome was to estimate the risk of adverse events, and the commonly reported subtype of adverse events in EUS-HGS. The secondary outcome was to estimate the pooled technical and clinical success rates.
Results: We analyzed 42 studies which included 18 prospective and 24 retrospective studies. The pooled technical success rate of EUS-HGS was 93.8 %( CI 92.2-95.1; I2 =0%) and the pooled clinical success rate was 86.8% (CI 79.1-91.1; I2 = 0%). The mild adverse event rate associated with HGS was 6.5% (3.7-10.9; I2 =0%), moderate adverse event rate was 11.7% (8.3-16.1; I2 =16%, ), severe adverse event rate was 3.4% (2.1-5.5; I2 = 61% ) whereas fatal adverse event rate was 3.2% (1.9-5.4; I2 =62% ).
On subgroup analysis, the pooled rate of adverse events of EUS-guided hepaticogastrostomy with anterograde stenting (EUS-HGAS) was 13.3% (95% CI,8.2-21.0). The pooled technical success with EUS-HGAS was 97.7% (95% CI, 72.3-99.9), and clinical success was 92.5% (95% CI, 77.9-97.7).
Discussion: On the basis of our analysis of EUS-HGS, the overall technical success was 93.8% and the clinical success rate was 87.2% remains to be high and the severe as well as fatal adverse events associated with the procedure remain to be the lowest reported in the literature so far. This data can also help improve the clinical benefits of EUS-HGS in the selected patients in whom it is performed.
Cumulative outcomes
Pooled rates (95% confidence interval), I2, number of studies
EUS-HGS
EUS-HGAS
Technical success
93.8 %(92.2-95.1); 0%; 42
97.7%(72.3-99.9); 29.6%, 3
Clinical success
86.8% (79.1-91.1); 0%; 41
92.5% (77.9-97.7); 0%, 6
ASGE Lexicon
20.3% (17.3-23.8)
13.3% (8.2-21.0)
Mild
6.5% (3.7-10.9); 0%; 37
2.1% (5.9 - 23.0); 51.65%, 6
Moderate
11.7% (8.3-16.1); 16%; 36
5.2% (2.6-1.01); 0%, 6
Severe
3.4% (2.1-5.5); 61%; 36
1.9% (0.6-5.8); 0%, 6
Fatal
3.2% (1.9-5.4); 62%; 38
1.9% (0.6-5.8); 0%, 6
Disclosures:
Vishali Moond indicated no relevant financial relationships.
Priyadarshini Loganathan indicated no relevant financial relationships.
Bhargav Koyani indicated no relevant financial relationships.
Parth Patel indicated no relevant financial relationships.
Shahab Khan indicated no relevant financial relationships.
Lena L. Kassab indicated no relevant financial relationships.
Saurabh Chandan indicated no relevant financial relationships.
Babu Mohan indicated no relevant financial relationships.
Arkady Broder indicated no relevant financial relationships.
Douglas Adler indicated no relevant financial relationships.
Vishali Moond, MD1, Priyadarshini Loganathan, MD2, Bhargav Koyani, MBBS3, Parth Patel, MD4, Shahab R. Khan, MBBS5, Lena L. Kassab, MBA6, Saurabh Chandan, MD7, Babu Mohan, MD, MS8, Arkady Broder, MD1, Douglas G. Adler, MD9. P3701 - Efficacy and Safety of EUS-Guided Hepatogastrostomy: A Systematic Review and Meta-analysis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.
