Aims
The aim of this study was to evaluate the technical success, clinical success, and safety of endoscopic ultrasound-guided choledochal drainage (EUS-CD) in patients with biliary obstruction, comparing its use as a primary procedure versus as a secondary/rescue procedure after failed endoscopic retrograde cholangiopancreatography (ERCP).
Methods
A retrospective review was conducted using prospectively maintained records of 75 patients with biliary obstruction who underwent EUS-CD. Among these, 31 patients (41.3%) underwent primary EUS-CD, while 44 patients (58.7%) underwent secondary or rescue EUS-CD following failed ERCP. The most common indications for drainage were malignancies, including pancreatic head mass, ampullary cancer, duodenal cancer, and cholangiocarcinoma.
Results
Technical success was achieved in 100% of patients in both groups. Clinical success was observed in 96.77% of patients in the primary EUS-CD group and 100% in the secondary group, with no statistically significant difference (P = 0.2304). Adverse events were rare and included isolated cases of bile leak, bleeding, and mortality, with comparable rates between the two groups. Overall, there was no statistically significant difference in complication rates between primary and secondary EUS-CD
|
Variables |
EUS CD Primary |
EUS CD secondary/rescue (n=44) |
P VALUE |
|
(n=31) |
|||
|
Age (Median, IQR) |
70, 58-74 years |
62, 48.5-76 years |
0.2963 |
|
Male |
20 (64.52%) |
31(70.45%) |
0.5872 |
|
Ascites |
7(22.58%) |
19(43.18%) |
0.9881 |
|
Indication for biliary drainage |
|
|
|
|
HOP mass |
21(67.74%) |
23(52.27%) |
0.1804 |
|
Ampullary cancer |
1(3.23%) |
9(20.45%) |
0.0307 |
|
Duodenal cancer |
4(12.90%) |
2(4/55%) |
0.1889 |
|
Cholangiocarcinoma |
2(6.45%) |
7(15.91%) |
0.2146 |
|
Lymph nodes |
2(6.45%) |
1(2.27%) |
0.3631 |
|
BBS stone |
2(6.45%) |
5(11.36%) |
0.4715 |
|
Previous plastic stent in bile duct |
1(3.23%) |
3(6.82%) |
0.4954 |
|
Location of Stent |
|
|
|
|
Transduodenal |
|
|
|
|
Transgastric |
|
|
|
|
Type of stent |
|
|
|
|
Gioborr |
6(19.35%) |
10(22.73%) |
0.7255 |
|
PC-SEMS 6 cm |
15(48.39%) |
25(56.82%) |
0.471 |
|
FC SEMS 6 cm |
9(31.03%) |
6(13.64%) |
0.101 |
|
FC SEMS 4 cm |
1(3.23%) |
3(6.82%) |
0.4954 |
|
Lumen Apposing Metal Stent (Axios) |
0(0.0%) |
1(2.27%) |
0.398 |
|
Technical Success |
31(100%) |
44(100%) |
NA |
|
Clinical Success |
30(96.77%) |
44(100%) |
0.2304 |
|
Adverse Events |
|
|
|
|
Bile leak |
|
|
|
|
Bleeding |
|
|
|
|
Mortality |
1(3.23%) |
1(2.27%) |
0.8008 |
Conclusions
There was no significant difference in success rates or adverse events in performing EUS-CD as a primary procedure vs. secondary/rescue procedure.
Hence the proposed endoscopic ultrasound-guided choledochal drainage (EUS-CD) in biliary obstruction as a rescue procedure after failed ERP is a safe alternative with high technical and clinical success rates and minimum adverse event rate.