Biliary drainage prior to pancreatoduodenectomy with endoscopic ultrasound-guided choledochoduodenostomy versus conventional ERCP: propensity score-matched study and surgeon survey

Abstract

Background Preoperative endoscopic biliary drainage may lead to complications (16 %–24 %), potentially hampering surgical exploration. Endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) may reduce drainage-related complications; however, in the absence of surgeon-reported outcomes, it is unknown whether EUS-CDS may hamper surgical exploration. This study assessed the impact of preoperative EUS-CDS on pancreatoduodenectomy.

Method Consecutive patients who underwent pancreatoduodenectomy after preoperative biliary drainage were included in all eight centers performing EUS-CDS in the mandatory Dutch Pancreatic Cancer Audit (Jan 2020–Dec 2022). The primary outcome was major postoperative complications. Secondary outcomes included bile leak grade B/C, postoperative pancreatic fistula (POPF) grade B/C, and overall postoperative complications. A propensity score-matching (1:3) analysis was performed. Surgeons performing pancreatoduodenectomy after EUS-CDS completed a survey on surgical difficulty.

Results 937 patients with pancreatoduodenectomy after preoperative biliary drainage were included (42 EUS-CDS, 895 endoscopic retrograde cholangiopancreatography [ERCP]). Major postoperative complications occurred in 8 patients (19.0 %) in the EUS-CDS group and 292 (32.6 %) in the ERCP group (relative risk [RR] 0.50; 95 %CI 0.23–1.07). No significant differences were observed in overall complications (RR 0.95; 95 %CI 0.51–1.76), bile leak (RR 1.25; 95 %CI 0.31–4.98), or POPF (RR 0.62; 95 %CI 0.25–1.56). Results were similar after matching. The survey was completed for 29 pancreatoduodenectomies; surgery was not (13, 45 %), “slightly” (9, 31 %), “clearly” (5,17 %), and “severely” (2, 7 %) more complex because of EUS-CDS.

Conclusion This early experience suggests that preoperative biliary drainage with EUS-CDS does not increase the rate of complications after pancreatoduodenectomy and only infrequently hampers surgical exploration.

^* These authors share senior authorship.

Publikationsverlauf

Eingereicht: 03. Oktober 2024

Angenommen nach Revision: 19. Februar 2025

Accepted Manuscript online:
20. Februar 2025

Artikel online veröffentlicht:
14. Mai 2025

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