{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T22:44:45Z","timestamp":1788993885545,"version":"build-2803163510"},"reference-count":28,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2024,10,6]],"date-time":"2024-10-06T00:00:00Z","timestamp":1728172800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["DEN Open"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Malignant double obstruction, defined as the simultaneous presence of biliary and gastric outlet obstruction, represents a challenging clinical scenario. Previous retrospective experiences have demonstrated shorter dysfunction\u2010free survival (DyFS) of endoscopic ultrasound\u2010guided choledochoduodenostomy (EUS\u2010CDS) versus EUS\u2010hepaticogastrostomy (EUS\u2010HGS) in this setting, but no prospective evidence is available.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Twenty consecutive patients with malignant double obstruction, treated with EUS\u2010gastroenterostomy (and EUS\u2010guided biliary drainage, following a previously failed ERCP, were enrolled in a prospective observational study (ClinicalTrials.gov NCT04813055) comparing EUS\u2010CDS versus EUS\u2010HGS. Efficacy and safety were evaluated, with Biliary Dysfunctions as the primary outcome and DyFS using Kaplan\u2010Meier estimates as a primary measure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Twenty patients (75% with pancreatic cancer, 50% with metastatic disease) with EUS\u2010gastroenterostomy\u00a0were included (seven EUS\u2010CDS and 13 EUS\u2010HGS). No significant difference was detected at baseline. Technical success was 100% in both groups. EUS\u2010CDS compared to EUS\u2010HGS showed similar clinical success (100% vs. 92.3%,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.5), a higher rate of post\u2010procedural adverse events (42.9% vs. 7.7%,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.067, mostly related to severe\/fatal cholangitis in the EUS\u2010CDS group) and a higher rate of biliary dysfunctions during follow\u2010up (71.4% vs. 16.7%,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.002).\n                    <\/jats:p>\n                    <jats:p>\n                      DyFS was significantly shorter in the EUS\u2010CDS group (39 [15\u201362] vs. 268 [192\u2013344] days,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.0023), with a 30\u2010days DyFS probability of 57.1% vs. 100% (hazard ratio = 7.8 [1.4\u201344.2]).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this prospective comparison of patients with malignant double obstruction undergoing EUS\u2010gastroenterostomy, treating jaundice with EUS\u2010CDS versus EUS\u2010HGS resulted in a reduced probability of survival without biliary events and an increased risk of biliary dysfunctions (number needed to harm = 1.8), with detection of severe\/fatal cholangitis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/deo2.70024","type":"journal-article","created":{"date-parts":[[2024,10,7]],"date-time":"2024-10-07T01:31:42Z","timestamp":1728264702000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Endoscopic ultrasound\u2010guided choledochoduodenostomy versus hepaticogastrostomy combined with gastroenterostomy in malignant double obstruction (CABRIOLET_Pro): A prospective comparative study"],"prefix":"10.1002","volume":"5","author":[{"given":"Giuseppe","family":"Vanella","sequence":"first","affiliation":[{"name":"Pancreatobiliary Endoscopy and Endosonography Division Pancreas Translational and Clinical Research Center IRCCS San Raffaele Scientific Institute  Milan Italy"},{"name":"Vita\u2010Salute San Raffaele University  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Leone","sequence":"additional","affiliation":[{"name":"Pancreatobiliary Endoscopy and Endosonography Division Pancreas Translational and Clinical Research Center IRCCS San Raffaele Scientific Institute  Milan Italy"},{"name":"Vita\u2010Salute San Raffaele University  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4503-4293","authenticated-orcid":false,"given":"Francesco","family":"Frigo","sequence":"additional","affiliation":[{"name":"Pancreatobiliary Endoscopy and Endosonography Division Pancreas Translational and Clinical Research Center IRCCS San Raffaele Scientific Institute  Milan Italy"},{"name":"University of Turin  Turin Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2039-5022","authenticated-orcid":false,"given":"Michiel","family":"Bronswijk","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology University Hospitals Gasthuisberg University of Leuven  Leuven Belgium"},{"name":"Department of Gastroenterology and Hepatology Imelda General Hospital  Bonheiden Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roy L. J.","family":"van Wanrooij","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Amsterdam UMC University of Amsterdam Amsterdam Gastroenterology Endocrinology &amp; Metabolism  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Domenico","family":"Tamburrino","sequence":"additional","affiliation":[{"name":"Pancreatic Surgery Unit Pancreas Translational and Clinical Research Center IRCCS San Raffaele Scientific Institute  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Orsi","sequence":"additional","affiliation":[{"name":"Medical Oncology Department Pancreas Translational and Clinical Research Center IRCCS San Raffaele Scientific Institute  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulio","family":"Belfiori","sequence":"additional","affiliation":[{"name":"Pancreatic Surgery Unit Pancreas Translational and Clinical Research 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