Endoscopy 2025; 57(S 02): S125-S126
DOI: 10.1055/s-0045-1805339
Abstracts | ESGE Days 2025
Oral presentation
ERCP strictures: the good, the bad and the ugly 04/04/2025, 15:30 – 16:30 Room 124+125

Advanced cannulation techniques vs EUS-guided biliary drainage in case of difficult biliary cannulation in patients with distal malignant biliary obstruction: an international multi-center propensity score-matched analysis

Authors

  • M Spadaccini

    1   Humanitas Research Hospital, Cascina Perseghetto, Italy

  • C Binda

    2   Forlì-Cesena Hospitals, AUSL Romagna, Forli, Italy

  • A Mauro

    3   Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy

  • L Romain

    4   CHU Dupuytren 1, Limoges, France

  • M C Giacchetto

    1   Humanitas Research Hospital, Cascina Perseghetto, Italy

  • M Andreozzi

    5   Humanitas Research Hospital, Milano, Italy

  • S Carrara

    6   Humanitas Research Hospital, Via Alessandro Manzoni, Rozzano, Italy

  • D Ramai

    7   Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, United States of America

  • A Jeremie

    4   CHU Dupuytren 1, Limoges, France

  • C Coluccio

    2   Forlì-Cesena Hospitals, AUSL Romagna, Forli, Italy

  • A Facciorusso

    8   Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy

  • J Jacques

    4   CHU Dupuytren 1, Limoges, France

  • A De Marco

    1   Humanitas Research Hospital, Cascina Perseghetto, Italy

  • M Colombo

    9   Gastroenterology and Digestive Endoscopy Unit, Humanitas Research Hospital, Rozzano, Italy

  • C Fabbri

    10   Gastroenterology and Digestive Endoscopy Unit, Ospedale “Morgagni – Pierantoni” di Forlì, Forlì, Italy

  • G franchellucci

    11   Humanitas Research Hospital,Department of Gastroenterology and Hepatology, Rozzano, Italy

  • A Anderloni

    12   Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Pavia, Italy

  • S Mazza

    13   Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy

  • C Hassan

    14   Humanitas University, Pieve Emanuele, Italy

  • A Repici

    15   Endoscopy Unit, Humanitas Clinical and Research Hospital, IRCCS, Rozzano, Italy

  • A Fugazza

    1   Humanitas Research Hospital, Cascina Perseghetto, Italy
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Aims Biliary drainage (BD) in patients with distal malignant biliary obstruction (DMBO) implies a higher risk of difficult biliary cannulation (DBC) during endoscopic retrograde cholangiopancreatography (ERCP). When standard techniques, (sphincterotome, and guidewire) fail, the endoscopist may proceed with advanced cannulation techniques, such as the double guidewire technique, needle-knife precut papillotomy or fistulotomy, and transpancreatic sphincterotomy. Despite the higher risk of adverse events, these advanced strategies can still fail in up to 15% of cases. In recent times, endoscopic ultrasound-guided biliary drainage (EUS-BD) emerged as an alternative in case of DBC due to its favorable profile in terms of both technical success, and safety [1] [2] [3] [4].

Methods Multi-center (4 centers), international (Italy, France), retrospective, propensity score- matched study including patients with DMBO, and common bile duct (CBD) diameter>12mm. DBC cases managed with either advanced cannulation techniques (aERCP group), or EUS-guided approach (EUS-BD group) were considered for the analysis. A 2:1 propensity score-matched analysis was performed balancing age, sex, and CBD diameter to reduce confounding, and ensure comparability between groups. The outcomes of interest were the rates BD failure, clinical success, and adverse events (AEs).

Results Standard cannulation techniques failed in 524 cases during the study period. Advanced cannulation techniques, and EUS-guided approach were attempted in 472, and 52 cases, respectively. After matching, 76 (aERCP group), and 38 patients (EUS-BD group) were included in the analysis (age: 77.4+10.5 and 76.7+12.6, male: 70.6% vs 71.1%, CBD diameter: 16.5+2.9 and 17.2+3.3, respectively). In aERCP group, also advanced cannulation techniques failed in 59 (86.8%) cases, however all these patients were successfully treated by EUS-guided approach as a rescue strategy. No cases of BD failure were reported in EUS-BD group (p<0.05). Clinical success was comparable between the two groups (aERCP:91.2%, vs EUS-BD:94.7%, p=0.46). The 20.6% of patients experienced AEs in the aERCP group (7 cholangitis, 6 pancreatitis, 2 bleeding, 2 other), compared to the 7.9% reported in EUS-BD group (2 cholangitis, 1 pancreatitis, 1 bleeding; p=0.14).

Conclusions EUS-guided biliary drainage shows higher technical success rate compared to advanced cannulation techniques, with comparable clinical success. Regarding safety, the observed trend of reduced AEs with the EUS-guided approach may require a larger, adequately powered study to confirm statistical significance. In patients with dilated CBD (> 12mm) EUS-BD may be considered an efficient option in case of DBC, for minimizing the risk of AEs.



Publication History

Article published online:
27 March 2025

© 2025. European Society of Gastrointestinal Endoscopy. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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