Multicenter comparative evaluation of endoscopic placement of expandable metal stents for malignant distal common bile duct obstruction by ERCP or EUS-guided approach - 21/06/16
Abstract |
Background |
A single session of EUS-guided biliary drainage (EUS-BD) may be a viable alternative to ERCP in patients with malignant distal common bile duct (CBD) obstruction. There is no study comparing EUS-BD and ERCP for the relief of distal malignant biliary obstruction.
Objective |
To compare the outcomes of self-expandable metal stent (SEMS) placement for malignant distal biliary obstruction by using ERCP and EUS-BD.
Study Design |
Multicenter, retrospective analysis.
Setting |
Tertiary referral centers.
Patients |
Patients with malignant distal CBD obstruction requiring SEMS placement.
Interventions |
Patients in the EUS-BD group underwent EUS-guided choledochoduodenostomy (EUS-CDS) or EUS-guided antegrade (EUS-AG) procedures after 1 or more failed ERCP attempts. Patients in the ERCP group underwent retrograde SEMS placement.
Main Outcome Measurements |
Composite success (the ability to complete the intended therapeutic procedure in a single session and resulting in a greater than 50% decrease in bilirubin over 2 weeks).
Results |
The study included 208 patients, 104 treated with ERCP and 104 treated with EUS-BD (68 EUS-CDS, 36 EUS-AG). SEMS placement was successful in 98 patients in the ERCP group and 97 in the EUS-BD group (94.23% vs 93.26%, P = 1.00). The frequency of adverse events in the ERCP and EUS-BD groups was 8.65% and 8.65%, respectively. Postprocedure pancreatitis rates were higher in the ERCP group (4.8% vs 0, P = .059). The mean procedure times in the ERCP and EUS-BD groups were similar (30.10 and 35.95 minutes, P = .05).
Limitations |
Retrospective analysis.
Conclusions |
In patients with malignant distal CBD obstruction requiring SEMS placement, the short-term outcome of EUS-BD is comparable to that of ERCP.
Le texte complet de cet article est disponible en PDF.Abbreviations : CBD, CS, DS, EUS-AG, EUS-BD, EUS-CDS, EUS-HGS, EUS-RV, FS, PTBD, SEMS, TS
Plan
| DISCLOSURE: All authors disclosed no financial relationships relevant to this article. |
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| See CME section; p. 976. |
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| If you would like to chat with an author of this article, you may contact Dr Dhir at vinaydhir@gmail.com. |
Vol 81 - N° 4
P. 913-923 - avril 2015 Retour au numéro
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