Endoscopy 2011; 43 - A25
DOI: 10.1055/s-0031-1292096

EUS-guided transluminal versus percutaneous transhepatic biliary drainage in malignant biliary obstruction after failed ERCP; an international multicenter controlled study

Park Do Hyun 1, 3, Kitano Masayuki 2, KJ Chang 1, JG Lee 1, Lee Sang Soo 3, Seo Dong Wan 3, Lee Sung Koo 3, Kim Myung-Hwan 3, Kudo Masatoshi 2
  • 1Division of Gastroenterology, Department of Medicine, H. H. Chao Comprehensive Digestive Disease Center, University of California, Irvine, Orange, California, U.S.A.
  • 2Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka-sayama, Japan
  • 3Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea

Background: Although endoscopic ultrasound-guided biliary drainage (EUS-BD) may be a useful alternative method for patients with biliary obstruction in whom endoscopic transpapillary biliary drainage fails, there is limited data on the outcomes and complications of EUS-BD with transluminal stent compared with those of percutaneous transhepatic biliary drainage (PTBD).

Aim: To compare the efficacy and safety of EUS-BD vs. PTBD after failed ERCP in patients with malignant biliary obstruction in an international multicenter study.

Methods: From January 2009 to March 2010, 111 (3.5%) out of 3214 ERCPs for biliary decompression was unsuccessful. Among these, PTBD was attempted in 69 patients and EUS-BD was attempted in 42 patients. Among the EUS-BD group, 23 underwent EUS-guided hepatico-gastrostomy (EUS-HG) and the remaining 19 underwent EUS-guided choledocho-duodenostomy (EUS-CD).

Results: Overall technical success rate for placement of transluminal stent in the EUS-BD group was 90% (38/42, as intention to treat: 21/23 (91%) in EUS-HG and 17/19 (89%) in EUS-CD. In one patient, a failed EUS-HG was salvaged by PTBD. EUS-guided rendezvous technique was successfully performed to salvage the remaining three who failed EUS-HG (1) or EUS-CD (2) due to insufficient bile duct dilation for stent insertion. PTBD was not attempted in two patients from the PTBD group due to multiple intrahepatic metastasis or ascites. Technical success rate of PTBD, therefore, was 97% (67/69, as intention to treat). There was no significant difference in technical success rates of both groups (90% vs. 97%; p=0.2). Successful biliary drainage was accomplished in 71% (15/21) in EUS-HG and 100% (17/17) in EUS-CD. Overall rate of successful biliary drainage by EUS-BD was 84% (32/38, as per protocol) as compared to 94% (63/67, as per protocol) by PTBD (p=0.16). Major complications occurred in 8% (3/38) in EUS-BD vs. 4.5% (3/67) in PTBD (p=0.67). The incidence of minor complications was 15.8% (6/38) in EUS-BD vs. 19.4% (13/67) in PTBD (p=0.79). The overall complication rate was not significantly different between EUS-BD and PTBD (23.7% vs. 23.9%, p=1.0).

Conclusions: EUS-BD with transluminal stenting is technically feasible and can offer clinically effective drainage in patients with malignant biliary obstruction. The major and minor complication rates were similar between EUS-BD and PTBD.