PMID- 38447958 OWN - NLM STAT- Publisher LR - 20240306 IS - 1438-8812 (Electronic) IS - 0013-726X (Linking) DP - 2024 Mar 6 TI - Efficacy and safety of endoscopic ultrasound-guided hepatico-gastrostomy: a meta-regression analysis. LID - 10.1055/a-2282-3350 [doi] AB - 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. CI - Thieme. All rights reserved. FAU - Binda, Cecilia AU - Binda C AUID- ORCID: 0000-0003-1148-9684 AD - Unit of Gastroenterology and Digestive Endoscopy, Morgagni-Pierantoni Hospital, Forli, Italy. AD - Unit of Gastroenterology and Digestive Endoscopy, Maurizio Bufalini Hospital, Cesena, Italy. FAU - Dajti, Elton AU - Dajti E AUID- ORCID: 0000-0003-2905-1146 AD - Department of Medical and Surgical Sciences - DIMEC; Alma Mater Studiorum - University of Bologna, Italy., University of Bologna, Bologna, Italy. AD - Gastroenterology and Digestive Endoscopy Unit, Forli-Cesena Hospitals, AUSL Romagna, Forli-Cesena, Italy, AUSL della Romagna, Forli-Cesena, Italy. FAU - Giuffrida, Paolo AU - Giuffrida P AUID- ORCID: 0000-0002-4628-1130 AD - Gastroenterology and Digestive Endoscopy Unit, Forli-Cesena Hospitals, AUSL Romagna, Forli-Cesena, Italy, AUSL della Romagna, Forli-Cesena, Italy. AD - Section of Gastroenterology & Hepatology, Department of Health Promotion Sciences Maternal and Infant Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, Palermo, Italy. FAU - Trebbi, Margherita AU - Trebbi M AD - Gastroenterology and Digestive Endoscopy Unit, Forli-Cesena Hospitals, AUSL Romagna, Forli-Cesena, Italy, AUSL della Romagna, Forli-Cesena, Italy. FAU - Coluccio, Chiara AU - Coluccio C AD - Gastroenterology and Digestive Endoscopy Unit, Forli-Cesena Hospitals, AUSL Romagna, Forli-Cesena, Italy., AUSL della Romagna, Forli-Cesena, Italy. FAU - Cucchetti, Alessandro AU - Cucchetti A AD - Department of Medical and Surgical Sciences - DIMEC; Alma Mater Studiorum - University of Bologna, Italy, Alma Mater Studiorum University of Bologna, Bologna, Italy. FAU - Fugazza, Alessandro AU - Fugazza A AUID- ORCID: 0000-0003-0485-4903 AD - Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, Humanitas Research Hospital - IRCCS, Rozzano 20089, Milan, Italy, Humanitas Research Hospital, Rozzano, Italy. FAU - Perini, Barbara AU - Perini B AD - Gastroenterology Unit, Azienda Ospedale-Universita di Padova (AOUP), Padua, Italy., University of Padua, Padova, Italy. AD - Gastroenterology and Digestive Endoscopy Unit, Forli-Cesena Hospitals, AUSL Romagna, Forli-Cesena, Italy. Forli-Cesena, Emilia-Romagna, IT, AUSL della Romagna, Forli-Cesena, Italy. FAU - Gibiino, Giulia AU - Gibiino G AUID- ORCID: 0000-0003-2211-6322 AD - Gastroenterology and Digestive Endoscopy Unit, Forli-Cesena Hospitals, AUSL Romagna, Forli-Cesena, Italy. Forli-Cesena, Emilia-Romagna, IT, Morgagni-Pierantoni Hospital, Forli, Italy. FAU - Anderloni, Andrea AU - Anderloni A AD - 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. FAU - Repici, Alessandro AU - Repici A AD - Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy, Humanitas University, Pieve Emanuele, Milan, Italy. AD - Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, Humanitas Research Hospital - IRCCS, Rozzano 20089, Milan, Italy, IRCCS Humanitas Research Hospital, Rozzano, Italy. FAU - Fabbri, Carlo AU - Fabbri C AD - Gastroenterology and Digestive Endoscopy Unit, Forli-Cesena Hospitals, AUSL Romagna, Forli-Cesena, Italy. Forli-Cesena, Emilia-Romagna, IT, AUSL della Romagna, Forli-Cesena, Italy. LA - eng PT - Journal Article DEP - 20240306 PL - Germany TA - Endoscopy JT - Endoscopy JID - 0215166 SB - IM COIS- The authors declare that they have no conflict of interest. EDAT- 2024/03/07 00:43 MHDA- 2024/03/07 00:43 CRDT- 2024/03/06 19:52 PHST- 2024/03/07 00:43 [medline] PHST- 2024/03/07 00:43 [pubmed] PHST- 2024/03/06 19:52 [entrez] AID - 10.1055/a-2282-3350 [doi] PST - aheadofprint SO - Endoscopy. 2024 Mar 6. doi: 10.1055/a-2282-3350.