ERCP With and Without EUS Guided HGS for Bilateral Biliary Decompression in Malignant Hilar Biliary Obstruction

NCT ID: NCT06613945

Last Updated: 2024-09-26

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

72 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-09-01

Study Completion Date

2026-10-30

Brief Summary

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A prospective randomized clinical trial to evaluate efficacy and safety of combined EUS-HGS and ERCP compared to ERCP for bilateral biliary decompression in advanced malignant hilar biliary obstruction. The primary outcome will be technical success, clinical success, procedural duration, and re-interventions. Secondary outcomes will be the rate of adverse events. patients will be followed up at 1 and 3 month intervals

Detailed Description

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Bilateral stenting by Endoscopic Retrograde Cholangiopancreatography in malignant hilar biliary obstructions (MHBO) is challenging and technically difficult. EUS hepaticogastrostomy (EUS-HGS) has been increasingly used as an alternative method to achieve internal biliary drainage in MHBO. Because of the difficulty of ERCP in such scenario, the combination of EUS-HGS and ERCP provides a possible chance of longer stent patency with less event of stent clogging Aim of the work: to evaluate efficacy and safety of combined EUS-HGS and ERCP compared to ERCP for bilateral biliary decompression in advanced MHBO.

The inclusion criteria will be presence of inoperable MHBO with elevated liver tests with serum bilirubin at least 3 times above the upper limit of normal The study patients will be randomized in 1:1 ratio to: ERCP biliary drainage (ERCP-BD) group: bilateral metallic stents insertion will be attempted by transpapilary approach. Combined ERCP and EUS-HGS group: unilateral metallic stent will be inserted on right side by transpapilary approach and a transmural stent will be inserted on left side by EUS.

technical success, clinical success, procedural duration, and re-interventions and adverse events will be assesed

Conditions

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Malignant Hilar Stricture

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Investigators

Study Groups

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Combined EUS-HGS and ERCP biliary drainage

unilateral metallic stent will be inserted on right side through ERCP and a hepaticogastrostomy transmural stent will be inserted on left side by EUS to secure biliary drainage

Group Type ACTIVE_COMPARATOR

Combined ERCP and EUS-HGS biliary drainage

Intervention Type PROCEDURE

unilateral metallic stent will be inserted on right side by ERCP and a hepaticogastrostomy transmural stent will be inserted on left side by EUS to secure biliary drainage.

ERCP biliary drainage

bilateral metallic stents insertion will be attempted through ERCP to secure biliary drainage

Group Type ACTIVE_COMPARATOR

ERCP biliary drainage

Intervention Type PROCEDURE

bilateral metallic stents insertion will be attempted through ERCP to secure biliary drainage

Interventions

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ERCP biliary drainage

bilateral metallic stents insertion will be attempted through ERCP to secure biliary drainage

Intervention Type PROCEDURE

Combined ERCP and EUS-HGS biliary drainage

unilateral metallic stent will be inserted on right side by ERCP and a hepaticogastrostomy transmural stent will be inserted on left side by EUS to secure biliary drainage.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Presence of inoperable malignant hilar biliary obstruction on magnetic resonance cholangiography, computed tomography and/or direct cholangiography bismuth type III \& IV only.
* Histologically confirmed malignant hilar biliary obstruction.
* Elevated serum bilirubin at least 3 times above the upper limit of normal (1.2 mg/dL).
* Absence of duodenal narrowing/obstruction.
* Accept sharing in the study

Exclusion Criteria

* Pregnancy.
* Distal biliary obstruction as the main lesion.
* Benign biliary stenosis.
* Malignant hilar biliary obstruction bismuth type I and II.
* Presence of duodenal obstruction.
* Surgically altered anatomy or inability to access the major duodenal papilla.
* Patients underwent previous intervention for biliary drainage.
* Previously failed biliary cannulation at ERCP.
* Large volume ascites.
* Patients unfit for anesthesia.
* Patients having uncorrectable coagulopathy or thrombocytopenia.
* History of allergy to radiocontrast agents.
* Refuse sharing in the study.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Mansoura University

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Mennatallah E saad, asslecturer

Role: PRINCIPAL_INVESTIGATOR

Mansoura University

Locations

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Mansoura univeristy

Al Mansurah, Dakahlia Governorate, Egypt

Site Status RECRUITING

Countries

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Egypt

Central Contacts

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Mennatallah E Saad, Asslecturer

Role: CONTACT

0502200590 ext. 0502200590

Ahmed Y Altonbary, Assprofessor

Role: CONTACT

0502200590 ext. 0502200590

Facility Contacts

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Ahmed Y Altonbary, Assprofessor

Role: primary

+20 100 5100091 ext. +2

Mennatallah E Saad, Asslecturer

Role: backup

+20 122 2449220 ext. +2

Other Identifiers

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MD.24.08.881

Identifier Type: -

Identifier Source: org_study_id

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