Endoscopic ultrasound‐guided choledochoduodenostomy versus hepaticogastrostomy combined with gastroenterostomy in malignant double obstruction (CABRIOLET_Pro): A prospective comparative study

• DOI: 10.1002/deo2.70024
• Publication Date: 2024-10-07T05:31:42Z
• Authors: Giuseppe Vanella; Roberto Leone; Francesco Frigo; Michiel Bronswijk; Roy L. J. van Wan...; Domenico Tamburrino; Giulia Orsi; Giulio Belfiori; Marina Macchini; Michele Reni; Luca Aldrighetti; Massimo Falconi; Gabriele Capurso; Schalk van der Merwe; Paolo Giorgio Arc...
• Keywords: Gastroenterostomy; Endoscopic Ultrasound; Gastric Outlet Obstruction

Abstract Objectives Malignant double obstruction, defined as the simultaneous presence of biliary and gastric outlet represents a challenging clinical scenario. Previous retrospective experiences have demonstrated shorter dysfunction‐free survival (DyFS) endoscopic ultrasound‐guided choledochoduodenostomy (EUS‐CDS) versus EUS‐hepaticogastrostomy (EUS‐HGS) in this setting, but no prospective evidence is available. Methods Twenty consecutive patients with malignant treated EUS‐gastroenterostomy (and EUS‐guided drainage, following previously failed ERCP, were enrolled observational study (ClinicalTrials.gov NCT04813055) comparing EUS‐CDS EUS‐HGS. Efficacy safety evaluated, Biliary Dysfunctions primary outcome DyFS using Kaplan‐Meier estimates measure. Results (75% pancreatic cancer, 50% metastatic disease) included (seven 13 EUS‐HGS). No significant difference was detected at baseline. Technical success 100% both groups. compared to EUS‐HGS showed similar (100% vs. 92.3%, p = 0.5), higher rate post‐procedural adverse events (42.9% 7.7%, 0.067, mostly related severe/fatal cholangitis group) dysfunctions during follow‐up (71.4% 16.7%, 0.002). significantly group (39 [15–62] 268 [192–344] days, 0.0023), 30‐days probability 57.1% (hazard ratio 7.8 [1.4–44.2]). Conclusions In comparison obstruction undergoing EUS‐gastroenterostomy, treating jaundice resulted reduced without an increased risk (number needed harm 1.8), detection cholangitis.