Combined endoscopic mAnagement of BiliaRy and gastrIc OutLET obstruction (CABRIOLET Study): A multicenter retrospective analysis
Abstract Objectives Combined biliary obstruction and gastric outlet obstruction (GOO) represent a challenging clinical scenario despite developments in therapeutic endoscopic ultrasonography (EUS) as GOO might impair EUS‐guided biliary drainage. Little is known about the effectiveness of different t...
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2023-04-01
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| Online Access: | https://doi.org/10.1002/deo2.132 |
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| author | Giuseppe Vanella Michiel Bronswijk Roy LJ van Wanrooij Giuseppe Dell'Anna Wim Laleman Hannah van Malenstein Rogier P Voermans Paul Fockens Schalk Van der Merwe Paolo Giorgio Arcidiacono |
| author_facet | Giuseppe Vanella Michiel Bronswijk Roy LJ van Wanrooij Giuseppe Dell'Anna Wim Laleman Hannah van Malenstein Rogier P Voermans Paul Fockens Schalk Van der Merwe Paolo Giorgio Arcidiacono |
| author_sort | Giuseppe Vanella |
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| description | Abstract Objectives Combined biliary obstruction and gastric outlet obstruction (GOO) represent a challenging clinical scenario despite developments in therapeutic endoscopic ultrasonography (EUS) as GOO might impair EUS‐guided biliary drainage. Little is known about the effectiveness of different therapeutic combinations used to treat double obstruction, especially regarding stent patency. Methods All consecutive patients with double obstruction treated between 2016 and 2021 in three tertiary academic centres were eligible for inclusion. Five combinations involving enteral stenting (ES), EUS‐guided gastroenterostomy (EUS‐GE), hepaticogastrostomy (EUS‐HGS), choledochoduodenostomy (EUS‐CDS), and transpapillary biliary stenting (TPS) were evaluated for dysfunction during follow‐up, either as proportions or dysfunction‐free survival (DFS) using Kaplan–Meier estimates. Results Ninety‐three patients were included (male 46%; age 67 [interquartile range 60–76] years; pancreatic cancer 73%, metastatic 57%), resulting in 103 procedure combinations. Different combinations showed significantly different overall dysfunction rates (p = 0.009), ranging from the null rate of EUS‐GE+HG to the 18% rate of EUS‐GE+TPS, 31% of EUS‐GE+EUS‐CD, 53% of ES+TPS and 83% of ES+EUS‐CDS. Sub‐analyses restricted to biliary dysfunction confirmed these trends. A multivariate Cox proportional‐hazards regression of DFS, a stenosis distal to the papilla (HR 3.2 [1.5–6.9]) and ES+EUS‐CDS (HR 5.6 [2–15.7]) independently predicted dysfunction. Conclusions Despite a lack of statistical power per combination, this study introduces new associations beyond the increased risk of GOO recurrence with ES versus EUS‐GE. EUS‐CDS showed reduced effectiveness and frequent dysfunction in the context of GOO, especially when combined with ES. EUS‐GE+HGS or EUS‐GE+TPS in this setting might result in superior patency. These results suggest that a prospective evaluation of the optimal endoscopic approach to malignant double obstruction is needed. |
| format | Article |
| id | doaj-art-8996e26412bd4351ae08ccd1da1f5aef |
| institution | OA Journals |
| issn | 2692-4609 |
| language | English |
| publishDate | 2023-04-01 |
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| series | DEN Open |
| spelling | doaj-art-8996e26412bd4351ae08ccd1da1f5aef2025-08-20T01:50:18ZengWileyDEN Open2692-46092023-04-0131n/an/a10.1002/deo2.132Combined endoscopic mAnagement of BiliaRy and gastrIc OutLET obstruction (CABRIOLET Study): A multicenter retrospective analysisGiuseppe Vanella0Michiel Bronswijk1Roy LJ van Wanrooij2Giuseppe Dell'Anna3Wim Laleman4Hannah van Malenstein5Rogier P Voermans6Paul Fockens7Schalk Van der Merwe8Paolo Giorgio Arcidiacono9Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Centre IRCCS San Raffaele Scientific Institute and University Milan ItalyDepartment of Gastroenterology and Hepatology University Hospitals Gasthuisberg University of Leuven Leuven BelgiumDepartment of Gastroenterology and Hepatology Amsterdam UMC, Vrije Universiteit, Amsterdam Gastroenterology Endocrinology and Metabolism Amsterdam the NetherlandsPancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Centre IRCCS San Raffaele Scientific Institute and University Milan ItalyDepartment of Gastroenterology and Hepatology University Hospitals Gasthuisberg University of Leuven Leuven BelgiumDepartment of Gastroenterology and Hepatology University Hospitals Gasthuisberg University of Leuven Leuven BelgiumDepartment of Gastroenterology and Hepatology Amsterdam UMC, University of Amsterdam, Amsterdam Gastroenterology Endocrinology and Metabolism Amsterdam the NetherlandsDepartment of Gastroenterology and Hepatology Amsterdam UMC, Vrije Universiteit, Amsterdam Gastroenterology Endocrinology and Metabolism Amsterdam the NetherlandsDepartment of Gastroenterology and Hepatology University Hospitals Gasthuisberg University of Leuven Leuven BelgiumPancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Centre IRCCS San Raffaele Scientific Institute and University Milan ItalyAbstract Objectives Combined biliary obstruction and gastric outlet obstruction (GOO) represent a challenging clinical scenario despite developments in therapeutic endoscopic ultrasonography (EUS) as GOO might impair EUS‐guided biliary drainage. Little is known about the effectiveness of different therapeutic combinations used to treat double obstruction, especially regarding stent patency. Methods All consecutive patients with double obstruction treated between 2016 and 2021 in three tertiary academic centres were eligible for inclusion. Five combinations involving enteral stenting (ES), EUS‐guided gastroenterostomy (EUS‐GE), hepaticogastrostomy (EUS‐HGS), choledochoduodenostomy (EUS‐CDS), and transpapillary biliary stenting (TPS) were evaluated for dysfunction during follow‐up, either as proportions or dysfunction‐free survival (DFS) using Kaplan–Meier estimates. Results Ninety‐three patients were included (male 46%; age 67 [interquartile range 60–76] years; pancreatic cancer 73%, metastatic 57%), resulting in 103 procedure combinations. Different combinations showed significantly different overall dysfunction rates (p = 0.009), ranging from the null rate of EUS‐GE+HG to the 18% rate of EUS‐GE+TPS, 31% of EUS‐GE+EUS‐CD, 53% of ES+TPS and 83% of ES+EUS‐CDS. Sub‐analyses restricted to biliary dysfunction confirmed these trends. A multivariate Cox proportional‐hazards regression of DFS, a stenosis distal to the papilla (HR 3.2 [1.5–6.9]) and ES+EUS‐CDS (HR 5.6 [2–15.7]) independently predicted dysfunction. Conclusions Despite a lack of statistical power per combination, this study introduces new associations beyond the increased risk of GOO recurrence with ES versus EUS‐GE. EUS‐CDS showed reduced effectiveness and frequent dysfunction in the context of GOO, especially when combined with ES. EUS‐GE+HGS or EUS‐GE+TPS in this setting might result in superior patency. These results suggest that a prospective evaluation of the optimal endoscopic approach to malignant double obstruction is needed.https://doi.org/10.1002/deo2.132biliary obstructionendosonographygastric outlet obstructionstentstherapeutic endoscopic ultrasonography |
| spellingShingle | Giuseppe Vanella Michiel Bronswijk Roy LJ van Wanrooij Giuseppe Dell'Anna Wim Laleman Hannah van Malenstein Rogier P Voermans Paul Fockens Schalk Van der Merwe Paolo Giorgio Arcidiacono Combined endoscopic mAnagement of BiliaRy and gastrIc OutLET obstruction (CABRIOLET Study): A multicenter retrospective analysis DEN Open biliary obstruction endosonography gastric outlet obstruction stents therapeutic endoscopic ultrasonography |
| title | Combined endoscopic mAnagement of BiliaRy and gastrIc OutLET obstruction (CABRIOLET Study): A multicenter retrospective analysis |
| title_full | Combined endoscopic mAnagement of BiliaRy and gastrIc OutLET obstruction (CABRIOLET Study): A multicenter retrospective analysis |
| title_fullStr | Combined endoscopic mAnagement of BiliaRy and gastrIc OutLET obstruction (CABRIOLET Study): A multicenter retrospective analysis |
| title_full_unstemmed | Combined endoscopic mAnagement of BiliaRy and gastrIc OutLET obstruction (CABRIOLET Study): A multicenter retrospective analysis |
| title_short | Combined endoscopic mAnagement of BiliaRy and gastrIc OutLET obstruction (CABRIOLET Study): A multicenter retrospective analysis |
| title_sort | combined endoscopic management of biliary and gastric outlet obstruction cabriolet study a multicenter retrospective analysis |
| topic | biliary obstruction endosonography gastric outlet obstruction stents therapeutic endoscopic ultrasonography |
| url | https://doi.org/10.1002/deo2.132 |
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