Efficacy Of EUS-Guided Biliary Drainage For Malignant Hilar Obstruction And Failed/Partial Drainage by ERCP

Aims To assess the safety and efficacy of EUS-BD for malignant hilar obstruction in short and medium term,in patients with failed/partial drainage by ERCP.

Methods Records of patients who underwent EUS-BD for malignant hilar obstruction at our unit from March 2019 to October 2020 were accessed. Indications, type of hilar block on MRCP, previous ERCP, success and short term and long term adverse events were noted.

Results 20 patients underwent EUS-BD (11 Gallbladder cancer, 7 cholangiocarcinoma and 2 nodal compression). MRCP showed Type I (10), type II(3) and Type III (7). All seven type iii blocks were referred after cholangitis following ERCP and right duct stenting. All type I and Type II patients were referred to us for EUS-BD following a failed ERCP. EUS-guided Hepaticogastrostomy(HGS) was done in 10 patients,EUS-guided Antegrade stenting was done in 8 patients, and EUS-guided rendezvous with plastic stenting was done in two patients (financial reasons). All procedures except one (HGS) were successful. One HGS stent migrated inwards and needed a percutaneous drainage. There were no other major complications. Three patients had transient pain for 24 hours. All patients with prior cholangitis improved. On follow up, 7 stents (3 HGS, 2 antegrade, two plastic) blocked at a median follow up of 6 months. Partial migration of HGS stents was seen in 8 patients (5HGS, 3 Antegrade) although all these stents continued to function.

Conclusions EUS-BD provides a safe and effective medium term palliation of malignant obstructive jaundice in patients with malignant hilar obstruction and failed/partial drainage by ERCP.

Citation Dhir V, Shah R, Udawat P. eP424 EFFICACY OF EUS-GUIDED BILIARY DRAINAGE FOR MALIGNANT HILAR OBSTRUCTION AND FAILED/PARTIAL DRAINAGE BY ERCP. Endoscopy 2021; 53: S234.

Publication History

Article published online:
19 March 2021