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Impact of sarcopenia on recurrent biliary obstruction after EUS-guided biliary drainage in patients with malignant biliary obstruction

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Abstract

Background and aims

Sarcopenia is an important prognostic factor for cancer patients. The aim of this study was to assess the ability of sarcopenia to predict recurrent biliary obstruction (RBO) in patients with unresectable cancer after EUS-guided biliary drainage (EUS-BD).

Methods

The study enrolled 113 patients who underwent EUS-BD using the self-expandable metal stent (SEMS) for unresectable malignant biliary obstruction (MBO) between April 2016 and December 2021 at Wakayama Medical University Hospital. The skeletal muscle index at the third lumbar spine level (L3) was calculated from computed tomography images. We analyzed the cumulative incidence of RBO at 180 days after stent insertion. Univariate and multivariate analyses were performed to identify variables significantly associated with RBO.

Results

Seventy-six patients were assigned to the sarcopenia group, and 37 were assigned to the non-sarcopenia group. The 180-day cumulative incidence of RBO was 11% in the non-sarcopenia group and 29% in the sarcopenia group (p = 0.034). The time to RBO was significantly shorter for the sarcopenia group (p = 0.028; Gray’s test). Multivariate analyses identified sarcopenia as an independent prognostic factor for RBO (present vs absent; HR 4.61; 95% CI 1.76–12.10, p = 0.001). The rates of biliary sludge/food impaction were significantly higher in the sarcopenia group for the causes of RBO (p = 0.048). There were no significant differences between the sarcopenia and the non-sarcopenia groups with respect to related EUS-BD adverse events.

Conclusion

Sarcopenia is an independent indicator of RBO in patients with MBO who receive EUS-BD with SEMS.

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Funding

This study was supported by Olympus.

Author information

Authors and Affiliations

  1. Department of Gastroenterology, Wakayama Rosai Hospital, 93-1 Kinomoto, Wakayama, 640-8505, Japan

    Tomoya Emori & Kazuhiro Fukatsu

  2. Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-0012, Japan

    Masahiro Itonaga, Reiko Ashida, Takashi Tamura, Yuki Kawaji, Keiichi Hatamaru, Yasunobu Yamashita & Masayuki Kitano

  3. Clinical Study Support Center, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-0012, Japan

    Toshio Shimokawa

  4. Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-0012, Japan

    Masataka Koike & Tetsuo Sonomura

  5. Second Department of Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-0012, Japan

    Manabu Kawai

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  1. Tomoya Emori
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Correspondence to Masayuki Kitano.

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Conflict of interest

M.K. has received honoraria from Olympus Corporation for spoken lectures at conferences. The other authors declare that they have no conflict of interest regarding the publication of this paper.

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Supplementary figure 1.

Cumulative survival probability between groups with and without RBO in each group. (A) Overall survival (calculated using the Kaplan–Meier method) in the sarcopenia group between without RBO (solid line) and with RBO (dotted line). Supplementary file1 (TIF 24930 KB)

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Emori, T., Itonaga, M., Ashida, R. et al. Impact of sarcopenia on recurrent biliary obstruction after EUS-guided biliary drainage in patients with malignant biliary obstruction. Int J Clin Oncol 29, 286–296 (2024). https://doi.org/10.1007/s10147-023-02455-2

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  • DOI: https://doi.org/10.1007/s10147-023-02455-2

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