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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

Doi : 10.1016/j.gie.2014.09.054 
Vinay Dhir, MD 1, ⁎, Takao Itoi, MD 2, Mouen A. Khashab, MD 3, Do Hyun Park, MD 4, Anthony Yuen Bun Teoh, FRCSEd 5, Rajeev Attam, MD 6, Ahmed Messallam, MD 3, Shyam Varadarajulu, MD 7, Amit Maydeo, MD 1
1 Department of Endoscopy and Endosonography, Baldota Institute of Digestive Sciences, Mumbai, India 
2 Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan 
3 Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA 
4 Department of Gastroenterology and Hepatology, Asan Medical Centre, Seoul, South Korea 
5 Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong 
6 Department of Gastroenterology and Hepatology, University of Minnesota Medical Centre, Minneapolis, Minnesota, USA 
7 Center for Interventional Endoscopy, Florida Hospital, Orlando, Florida, USA 

∗Reprint requests: Vinay Dhir, MD, Baldota Institute of Digestive Sciences, Parel, Mumbai, India 400012.

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.

Il testo completo di questo articolo è disponibile in PDF.

Abbreviations : CBD, CS, DS, EUS-AG, EUS-BD, EUS-CDS, EUS-HGS, EUS-RV, FS, PTBD, SEMS, TS


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 DISCLOSURE: All authors disclosed no financial relationships relevant to this article.
 See CME section; p. 976.
 If you would like to chat with an author of this article, you may contact Dr Dhir at vinaydhir@gmail.com.


© 2015  American Society for Gastrointestinal Endoscopy. Pubblicato da Elsevier Masson SAS. Tutti i diritti riservati.
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