Endoscopy 2019; 51(04): S94-S95
DOI: 10.1055/s-0039-1681448
ESGE Days 2019 oral presentations
Saturday, April 6, 2019 08:30 – 10:30: EUS therapeutic bile South Hall 1B
Georg Thieme Verlag KG Stuttgart · New York

EUS-GUIDED TRANSMURAL BILIARY DRAINAGE SHOULD BE THE FIRST CHOICE THERAPY IN PATIENTS WITH UNFEASIBLE PAPILLARY CANNULATION

JJ Vila
1   Endoscopy Unit. Gastroenterology Dpt., Complejo Hospitalario de Navarra, Pamplona, Spain
,
G González
1   Endoscopy Unit. Gastroenterology Dpt., Complejo Hospitalario de Navarra, Pamplona, Spain
,
L Aburruza
1   Endoscopy Unit. Gastroenterology Dpt., Complejo Hospitalario de Navarra, Pamplona, Spain
,
J Costa
2   Gastroenterology Dpt., Hospital de Braga, Braga, Portugal
,
J Carvalho
3   Gastroenterology Dpt., Hospital Lisboa Norte, Lisboa, Portugal
,
C Prieto
1   Endoscopy Unit. Gastroenterology Dpt., Complejo Hospitalario de Navarra, Pamplona, Spain
,
I Fernández-Urién
1   Endoscopy Unit. Gastroenterology Dpt., Complejo Hospitalario de Navarra, Pamplona, Spain
,
J Carrascosa
1   Endoscopy Unit. Gastroenterology Dpt., Complejo Hospitalario de Navarra, Pamplona, Spain
,
JF Juanmartiñena
1   Endoscopy Unit. Gastroenterology Dpt., Complejo Hospitalario de Navarra, Pamplona, Spain
,
M Gómez
1   Endoscopy Unit. Gastroenterology Dpt., Complejo Hospitalario de Navarra, Pamplona, Spain
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

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Aims:

To compare the outcomes of EUS-guided rendezvous technique (RVT) versus EUS-guided transmural technique (TMT) for biliary drainage after ERCP failure.

Methods:

Outcomes of RVT vs. TMT performed in consecutive patients with unfeasible papillary cannulation were analyzed retrospectively from january 2014 until June 2017, and prospectively since the latter until June 2018. Inclusion criteria: patients with benign or malignant biliary disease with impossible biliary cannulation in whom EUS-guided biliary drainage was accomplished. Variables studied: age, sex, technique performed, type of disease, access point, technical success and adverse events clasiffied according to ASGE lexicon. EUS-guided technique was decided individually according to patients characteristics. Fisher test and logistic regression analysis were used.

Results:

73 patients were included: 42 RVT and 31 TMT (28 hepaticogastrostomies, 3 choledochoduodenostomies). Mean age: 74,26 ± 13,25 (range: 30 – 94), 27 women. 70% of patients had malignant disease and 78% had biliary stenosis. An ERCP was attempted in the same session of EUS-guided technique more frequently in RVT group (22% vs. 60%, p = 0,002). Technical success was higher with TMT (90.3% vs. 62%, p = 0.007) and adverse events were higher with RVT (9.7% vs. 31%, p = 0.04). Adverse events: pancreatitis (6), bleeding (3), infection (2), biliary peritonitis (4) and pulmonary thromboembolism (1). Adverse events were classified: 6 moderate, 5 severe and 5 fatal. Severe and fatal adverse events happened more frequently with RVT (3.2% vs. 21.4%, p = 0.03). In patients with malignant stenosis, TMT had also a higher technical success (89.7% vs. 63.6%, p = 0.03) and lower adverse event rate (10.3% vs. 31.8%, p = 0.07). With multivariate analysis, technical success and adverse event rates were only influenced by the technique performed favouring TMT: (p = 0.02, OR = 5.2, IC95%= 1.2 – 22.3) and (p = 0.05, OR = 4.87;IC95%= 0.9 – 24.8) respectively.

Conclusions:

EUS-guided biliary drainage by means of TMT offers a higher technical success and lower adverse events which are also less severe than with RVT. Thus, in patients with malignant biliary stenosis and unfeasible ERCP, TMT should be the first choice therapy for biliary drainage.