TY - JOUR
T1 - 切除不能遠位悪性胆道閉塞に対する超音波内視鏡下胆道ドレナージにおける choledochoduodenostomy およびhepaticogastrostomy のアプローチルートの有効性と安全性を比較検討する多施設共同前向き無作為化試験
AU - Minaga, Kosuke
AU - Ogura, Takeshi
AU - Shiomi, Hideyuki
AU - Imai, Hajime
AU - Hoki, Noriyuki
AU - Takenaka, Mamoru
AU - Nishikiori, Hidefumi
AU - Yamashita, Yukitaka
AU - Hisa, Takeshi
AU - Kato, Hironari
AU - Kamada, Hideki
AU - Okuda, Atsushi
AU - Sagami, Ryota
AU - Hashimoto, Hiroaki
AU - Higuchi, Kazuhide
AU - Chiba, Yasutaka
AU - Kudo, Masatoshi
AU - Kitano, Masayuki
N1 - Publisher Copyright:
© 2020 Japan Gastroenterological Endoscopy Society. All rights reserved.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/7
Y1 - 2020/7
N2 - Background and Aim: Endoscopic ultrasound-guided biliary drainage (EUS-BD) can be carried out by two different approaches: choledochoduodenostomy (CDS) and hepaticogastrostomy (HGS). We compared the efficacy and safety of these approaches in malignant distal biliary obstruction (MDBO) patients using a prospective, randomized clinical trial. Methods: Patients with malignant distal biliary obstruction after failed endoscopic retrograde cholangiopancreatography were randomly selected for either CDS or HGS. The procedures were carried out at nine tertiary centers from September 2013 to March 2016. Primary endpoint was technical success rate, and the noninferiority of HGS to CDS was examined with a onesided significance level of 5%, where the noninferiority margin was set at 15%. Secondary endpoints were clinical success, adverse events (AE), stent patency, survival time, and overall technical success including alternative EUS-BD procedures. Results: Forty-seven patients (HGS, 24; CDS, 23) were enrolled. Technical success rates were 87.5% and 82.6% in the HGS and CDS groups, respectively, where the lower limit of the 90% confidence interval of the risk difference was - 12.2% (P=0.0278). Clinical success rates were 100% and 94.7% in the HGS and CDS groups, respectively (P=0.475). Overall AE rate, stent patency, and survival time did not differ between the groups. Overall technical success rates were 100% and 95.7% in the HGS and CDS groups, respectively (P=0.983). Conclusions: This study suggests that HGS is not inferior to CDS in terms of technical success. When one procedure is particularly challenging, readily switching to the other could increase technical success.
AB - Background and Aim: Endoscopic ultrasound-guided biliary drainage (EUS-BD) can be carried out by two different approaches: choledochoduodenostomy (CDS) and hepaticogastrostomy (HGS). We compared the efficacy and safety of these approaches in malignant distal biliary obstruction (MDBO) patients using a prospective, randomized clinical trial. Methods: Patients with malignant distal biliary obstruction after failed endoscopic retrograde cholangiopancreatography were randomly selected for either CDS or HGS. The procedures were carried out at nine tertiary centers from September 2013 to March 2016. Primary endpoint was technical success rate, and the noninferiority of HGS to CDS was examined with a onesided significance level of 5%, where the noninferiority margin was set at 15%. Secondary endpoints were clinical success, adverse events (AE), stent patency, survival time, and overall technical success including alternative EUS-BD procedures. Results: Forty-seven patients (HGS, 24; CDS, 23) were enrolled. Technical success rates were 87.5% and 82.6% in the HGS and CDS groups, respectively, where the lower limit of the 90% confidence interval of the risk difference was - 12.2% (P=0.0278). Clinical success rates were 100% and 94.7% in the HGS and CDS groups, respectively (P=0.475). Overall AE rate, stent patency, and survival time did not differ between the groups. Overall technical success rates were 100% and 95.7% in the HGS and CDS groups, respectively (P=0.983). Conclusions: This study suggests that HGS is not inferior to CDS in terms of technical success. When one procedure is particularly challenging, readily switching to the other could increase technical success.
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U2 - 10.11280/gee.62.817
DO - 10.11280/gee.62.817
M3 - Article
AN - SCOPUS:85090561913
VL - 62
SP - 817
EP - 826
JO - Gastroenterological Endoscopy
JF - Gastroenterological Endoscopy
SN - 0387-1207
IS - 7
ER -