Endoscopic ultrasound guided–antegrade biliary stenting vs percutaneous transhepatic biliary stenting for unresectable distal malignant biliary obstruction in patients with surgically altered anatomy

Abstract

Background/Purpose: Unresectable distal malignant biliary obstruction (DMBO) in patients with surgically altered anatomy is traditionally managed with percutaneous transhepatic biliary drainage (PTBD) and stenting because the anatomical features complicate the endoscopic approach to the biliary orifice. EUS-guided approaches recently emerged as alternative treatments; however, limited data comparing the procedures are available. The aim of this study was to compare EUS-antegrade biliary stenting (ABS) with PTBD for DMBO in patients with surgically altered anatomy. Methods: The medical records of patients who underwent EUS-ABS or PTBD for the management of DMBO and had a history of upper intestinal surgery at two tertiary centers between 2007 and 2019 were retrospectively evaluated. The study outcomes were technical, clinical, and internalization success rates and adverse event rates. Results: Of the 64 enrolled patients, 35 underwent EUS-ABS and 29 had PTBD. Basic characteristics including age, sex, performance status, primary malignancy, and reconstruction method did not differ significantly between groups. The technical, clinical, and internalization success rates in the EUS-ABS and PTBD groups were 97.1% vs 96.6% (P = 1.00), 97.1% vs 93.1% (P = .586), and 97.1% vs 75.9% (P = .01), respectively. The adverse event rate was 11.4% vs 27.6% (P = .119). No significant long-term difference was seen in time to recurrent biliary obstruction and survival. Multivariate analysis confirmed EUS-ABS was not an independent risk factor for survival. Conclusions: Similar to PTBD, EUS-ABS can effectively and safely manage DMBO in patients with surgically altered anatomy. Further well-designed trials are warranted to confirm these findings. K E Y W O R D S antegrade technique, ERCP, EUS-AG, EUS-BD, EUS-guided biliary drainage | 969 IWASHITA eT Al. How to cite this article: Iwashita T, Uemura S, Mita N, et al. Endoscopic ultrasound guided-antegrade biliary stenting vs percutaneous transhepatic biliary stenting for unresectable distal malignant biliary obstruction in patients with surgically altered anatomy.

Radiofrequency ablation of hyperplasia at an uncovered portion of a partially covered metal stent in endoscopic ultrasound‐guided hepaticogastrostomy (with video)

“…A 66‐year‐old‐male who had undergone endoscopic ultrasound‐guided hepaticogastrostomy (EUS‐HGS) using an 8 × 100‐mm partially covered metal stent (MS) (Modified Giobor stent; Taewoong Medical, Seoul) for obstructive jaundice 1–4 due to unresectable gallbladder cancer after failed endoscopic retrograde cholangiopancreatography (ERCP) owing to duodenal invasion was admitted because of the second recurrent biliary obstruction (RBO). The first RBO developed due to hyperplasia at an uncovered portion and was treated with adding an uncovered MS 3 months prior.…”

Efficacy of primary drainage by endoscopic ultrasound‐guided biliary drainage for unresectable pancreatic adenocarcinoma

“…Furthermore, Iwashita et al . reported that EUS‐BD was comparable to PTBD in terms of efficacy and safety for distal biliary obstruction due to a malignant tumor 14 . Considering these facts, we prefer the EUS‐BD approach to the PTBD approach, after ERCP‐BD failure.…”

Comparison of Radiation Exposure between Endoscopic Ultrasound-Guided Hepaticogastrostomy and Hepaticogastrostomy with Antegrade Stenting

“…EUS-guided hepaticogastrostomy (EUS-HGS) is one of the EUS-BD techniques in which trans-gastrointestinal drainage is performed on the dilated intrahepatic bile duct due to MBO ( Figure 1 a). Additionally, the usefulness of EUS-guided antegrade stenting (EUS-AS) combined with EUS-HGS (EUS-HGAS) has also been reported ( Figure 1 b) [ 6 , 7 , 8 ].…”