Malignant pancreaticobiliary pathology can result in simultaneous gastric outlet obstruction (GOO) and biliary obstruction. Previously, surgical and/or radiological intervention was required to alleviate this combination of symptoms. Endoscopic ultrasound guided gastrojejunostomy (EUS-GJ) and EUS-biliary drainage (EUS-BD) now affords patients endoscopic options for double drainage, relieving both GOO and obstructive jaundice. Real world data on double drainage feasibility is emerging.

A retrospective analysis of patients undergoing both EUS-GJ and EUS-BD was conducted across 2 UK centres over 17 months. Data collected included demographics, indication, sedation approach, drainage approach, technical success rate, clinical success rate, adverse events, re-intervention rate and survival. Univariate analysis was performed to compare outcomes and Cox regression used to determine factors influencing survival.

18 patients underwent double drainage intervention. Mean patient age was 69.7 with 55% male predominance (n=10/18). 78% of procedures were completed under conscious sedation (n=14/18). Pancreatic adenocarcinoma was the most common pathology (44%, n=8/18), followed by duodenal adenocarcinoma (22%, n=4/18). EUS-GB was the most common biliary drainage approach (33%, n=6/18), followed by EUS-CDD (27%, n=5/18). Technical success was achieved in 100% of patients. Clinical success rate was 88.9% (n=16/18) with a significant drop in bilirubin (median pre-bilirubin 158 vs median post-bilirubin 36, p=0.0007). Adverse events were recorded in 16.7% (3/18; acute renal failure, lower respiratory tract infection, CDD stent occlusion). Re-intervention was required in 11% (2/18). Median survival post intervention was 97 days (range 40-171). Palliative chemotherapy post intervention conferred a significant survival benefit, OR 1.2 (95% CI 1.07-1.6).

Real world date demonstrates that EUS double-drainage provides a single session alternative to surgical or radiological drainage options. Clinical success and complication rates were comparable with international standards. Although conscious sedation supported double-drainage is feasible, general anaesthetic remains the preferred sedation approach to facilitate prolonged interventional procedures.