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Background: Endoscopic ultrasound-guided biliary drainage (EUS-BD), classified as choledochoduodenostomy (CDS) and hepaticogastrostomy (HGS), is a feasible and effective alternative for distal malignant biliary obstruction (MBO) in failed endoscopic retrograde cholangiopancreatography. However, the preferred technique for better outcomes has not yet been evaluated. Objectives: We compared the long-term outcomes between the techniques. Design: Retrospective comparative study. Methods: We reviewed consecutive patients who underwent EUS-CDS or EUS-HGS with transmural stent placement for distal MBO between 2009 and 2022. The primary outcome was the stent patency. The secondary outcomes were technical and clinical success, adverse events (AEs) of each technique, and independent risk factors for stent dysfunction. Results: In all, 115 patients were divided into EUS-CDS ( n = 56) and EUS-HGS ( n = 59) groups. Among them, technical success was achieved in 98.2% of EUS-CDS and 96.6% of EUS-HGS groups. Furthermore, clinical success was 96.4% in EUS-CDS and 88.1% in EUS-HGS groups, without significant difference ( p = 0.200). The mean duration of stent patency for EUS-CDS was 770.3 days while that for EUS-HGS was 164.9 days ( p = 0.010). In addition, the only independent risk factor for stent dysfunction was systematic treatment after EUS-BD [hazard ratio and 95% confidence interval 0.238 (0.066–0.863), p = 0.029]. The incidence of stent dysfunction of EUS-HGS was higher than EUS-CDS (35.1% versus 18.2%, 0.071), despite no significant differences even in late AEs. Conclusion: In distal MBO, EUS-CDS may be better than EUS-HGS with longer stent patency and fewer AEs. Furthermore, systematic treatment after EUS-BD is recommended for the improvement of stent patency.

Background: Gallstones are a well-known risk factor for acute cholecystitis. However, their role as a risk factor for gallbladder perforation (GBP) remains unclear. Therefore, this study aimed to determine the effect of gallstones on the development of GBP. Materials and methods: This large-scale retrospective cohort study enroled consecutive patients who underwent cholecystectomy for acute cholecystitis. The primary endpoint was the role of gallstones as a risk factor for developing GBP. Secondary endpoints included the clinical characteristics of GBP, other risk factors for GBP, differences in clinical outcomes between patients with acalculous cholecystitis (AC) and calculous cholecystitis (CC), and the influence of cholecystectomy timing. Results: A total of 4497 patients were included in this study. The incidence of GBP was significantly higher in the AC group compared to the CC group (5.6% vs. 1.0%, P< 0.001). However, there were no differences in ICU admission and hospital stay durations. The incidence of overall complications was significantly higher in the AC group than in the CC group (2.2% vs. 1.0%, P <0.001). Patients with AC had a higher risk of developing GBP than those with CC (odds ratio, 5.00; 95% CI, 2.94-8.33). In addition, older age (≥ 60 years), male sex, comorbidities, poor performance status, and concomitant acute cholangitis were associated with the development of GBP. Furthermore, the incidence of GBP was significantly higher in the delayed cholecystectomy group than in the early cholecystectomy group (2.0% vs. 0.9%, P <0.001). Conclusions: AC is a significant risk factor for GBP. Furthermore, early cholecystectomy can significantly reduce GBP-related morbidity and mortality. [ABSTRACT FROM AUTHOR]

Background/Aims This multicenter randomized prospective study aimed to compare the efficacy and safety of heparin wet-suction technique (HWST) versus conventional suction technique (CSWT) for endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) of solid pancreatic masses. Methods A total of 170 patients were enrolled in this cross over trial and randomly assigned to two groups: Group A (n=84), which underwent EUS-FNB with HWST first, and Group B (n=86), which began with CSWT. The primary outcomes measured were diagnostic accuracy, sensitivity, and specificity. Secondary outcomes included specimen quality, procedural success, and the incidence of complications. Results The overall diagnostic accuracy was similar between HWST (77.65%) and CSWT (78.24%) with no significant difference (p=0.908). Both techniques showed comparable sensitivity (HWST: 76.54%, CSWT: 71.95%) and 100% specificity. The positive predictive value was 100% for both techniques, while the negative predictive value was similar between CSWT (17.78%) and HWST (17.39%). No significant differences were observed in the presence of macroscopic visible core tissue, immunohistochemistry availability, or pathologic classification between the two groups. Procedure-related complications were minimal, with only one case of bleeding reported in the CSWT group, which was successfully managed with endoscopic treatment. Conclusion Both HWST and CSWT are effective and safe techniques for EUS-FNB of solid pancreatic masses, with comparable diagnostic accuracy, sensitivity, and specificity. Given the similar performance outcomes, either technique can be considered based on clinical preference and availability. Further studies may be warranted to explore potential benefits in specific patient subgroups. [ABSTRACT FROM AUTHOR]