Vinay Dhir1, Takao Itoi2, Mouen A Khashab3, Do Hyun Park4, Anthony Yuen Bun Teoh5, Rajeev Attam6, Ahmed Messallam3, Shyam Varadarajulu7, Amit Maydeo1. 1. Department of Endoscopy and Endosonography, Baldota Institute of Digestive Sciences, Mumbai, India. 2. Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan. 3. Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA. 4. Department of Gastroenterology and Hepatology, Asan Medical Centre, Seoul, South Korea. 5. Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong. 6. Department of Gastroenterology and Hepatology, University of Minnesota Medical Centre, Minneapolis, Minnesota, USA. 7. Center for Interventional Endoscopy, Florida Hospital, Orlando, Florida, USA.
Abstract
BACKGROUND: A single session of EUS-guided biliary drainage (EUS-BD) may be a viable alternative to ERCP in patients with malignant distal common bile duct (CBD) obstruction. There is no study comparing EUS-BD and ERCP for the relief of distal malignant biliary obstruction. OBJECTIVE: To compare the outcomes of self-expandable metal stent (SEMS) placement for malignant distal biliary obstruction by using ERCP and EUS-BD. STUDY DESIGN: Multicenter, retrospective analysis. SETTING: Tertiary referral centers. PATIENTS: Patients with malignant distal CBD obstruction requiring SEMS placement. INTERVENTIONS: Patients in the EUS-BD group underwent EUS-guided choledochoduodenostomy (EUS-CDS) or EUS-guided antegrade (EUS-AG) procedures after 1 or more failed ERCP attempts. Patients in the ERCP group underwent retrograde SEMS placement. MAIN OUTCOME MEASUREMENTS: Composite success (the ability to complete the intended therapeutic procedure in a single session and resulting in a greater than 50% decrease in bilirubin over 2 weeks). RESULTS: The study included 208 patients, 104 treated with ERCP and 104 treated with EUS-BD (68 EUS-CDS, 36 EUS-AG). SEMS placement was successful in 98 patients in the ERCP group and 97 in the EUS-BD group (94.23% vs 93.26%, P = 1.00). The frequency of adverse events in the ERCP and EUS-BD groups was 8.65% and 8.65%, respectively. Postprocedure pancreatitis rates were higher in the ERCP group (4.8% vs 0, P = .059). The mean procedure times in the ERCP and EUS-BD groups were similar (30.10 and 35.95 minutes, P = .05). LIMITATIONS: Retrospective analysis. CONCLUSIONS: In patients with malignant distal CBD obstruction requiring SEMS placement, the short-term outcome of EUS-BD is comparable to that of ERCP.
BACKGROUND: A single session of EUS-guided biliary drainage (EUS-BD) may be a viable alternative to ERCP in patients with malignant distal common bile duct (CBD) obstruction. There is no study comparing EUS-BD and ERCP for the relief of distal malignant biliary obstruction. OBJECTIVE: To compare the outcomes of self-expandable metal stent (SEMS) placement for malignant distal biliary obstruction by using ERCP and EUS-BD. STUDY DESIGN: Multicenter, retrospective analysis. SETTING: Tertiary referral centers. PATIENTS: Patients with malignant distal CBD obstruction requiring SEMS placement. INTERVENTIONS:Patients in the EUS-BD group underwent EUS-guided choledochoduodenostomy (EUS-CDS) or EUS-guided antegrade (EUS-AG) procedures after 1 or more failed ERCP attempts. Patients in the ERCP group underwent retrograde SEMS placement. MAIN OUTCOME MEASUREMENTS: Composite success (the ability to complete the intended therapeutic procedure in a single session and resulting in a greater than 50% decrease in bilirubin over 2 weeks). RESULTS: The study included 208 patients, 104 treated with ERCP and 104 treated with EUS-BD (68 EUS-CDS, 36 EUS-AG). SEMS placement was successful in 98 patients in the ERCP group and 97 in the EUS-BD group (94.23% vs 93.26%, P = 1.00). The frequency of adverse events in the ERCP and EUS-BD groups was 8.65% and 8.65%, respectively. Postprocedure pancreatitis rates were higher in the ERCP group (4.8% vs 0, P = .059). The mean procedure times in the ERCP and EUS-BD groups were similar (30.10 and 35.95 minutes, P = .05). LIMITATIONS: Retrospective analysis. CONCLUSIONS: In patients with malignant distal CBD obstruction requiring SEMS placement, the short-term outcome of EUS-BD is comparable to that of ERCP.
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