Surgery or EUS-guided choledochoduodenostomy for malignant distal biliary obstruction after ERCP failure

Abstract

Background and Objectives:Endoscopic retrograde cholangiopancreatography (ERCP) is the method of choice for drainage in patients with distal malignant biliary obstruction, but it fails in up to 10% of cases. Percutaneous transhepatic cholangiography (PTC) and surgical bypass are the traditional drainage alternatives. This study aimed to compare technical and clinical success, quality of life, and survival of surgical biliary bypass or hepaticojejunostomy (HJT) and endoscopic ultrasound (EUS)-guided choledochoduodenostomy (CDT) in patients with distal malignant bile duct obstruction and failed ERCP.Patients and Methods:A prospective, randomized trial was conducted. From March 2011 to September 2013, 32 patients with malignant distal biliary obstruction and failed ERCP were studied. The HJT group consisted of 15 patients and the CDT group consisted of 14 patients. Technical and clinical success, quality of life, and survival were assessed prospectively.Results:Technical success was 94% (15/16) in the HJT group and 88% (14/16) in the CDT group (P = 0.598). Clinical success occurred in 14 (93%) patients in the HJT group and in 10 (71%) patients in the CDT group (P = 0.169). During follow-up, a statistically significant difference was seen in mean functional capacity scores, physical health, pain, social functioning, and emotional and mental health aspects in both techniques (P < 0.05). The median survival time in both groups was the same (82 days).Conclusion:Data relating to technical and clinical success, quality of life, and survival were similar in patients who underwent HJT and CDT drainage after failed ERCP for malignant distal biliary obstruction.

Consensus guidelines on the optimal management in interventional EUS procedures: results from the Asian EUS group RAND/UCLA expert panel

“…Procedure-related adverse events were 8.8% in the EUS-BD group compared with 31.2% in the PTBD group (P=0.022), while the mean frequency of unscheduled re-intervention was 0.34 in the EUS-BD group and 0.93 in the PTBD group (P=0.02). EUS-BD (choledochoduodenostomy) has also been compared with surgical hepaticojejunostomy in a small randomised trial 95. Technical and clinical success was comparable between the two groups.…”

Endoscopic Ultrasound-Guided Pancreatobiliary Endoscopy in Surgically Altered Anatomy

“…EUS-BD for distal biliary strictures using CD or antegrade drainage appeared comparable to ERCP in technical and clinical success rates, procedural time, and adverse event rate in a multicenter, retrospective study that included more than 200 patients, among whom only 5 patients had SAA [51]. Similarly, a randomized trial including 32 patients (only 1 with SAA) with malignant distal biliary obstruction demonstrated no difference in technical and clinical success, quality of life, and survival among patients who underwent EUS-guided CD versus surgical bypass after failed ERCP [52]. When compared to percutaneous biliary drainage, EUS-BD had equivalent clinical success, stent patency, and survival, and was associated with decreased adverse events, rate of reinterventions, and total hospital charges following failed ERCP in 73 patients, among whom none were clearly identified to have SAA [53].…”

Endoscopic ultrasound-guided biliary drainage: Complications and their management

“…EUS-guided biliary drainage (EUS-BD) is used as a salvage technique when conventional ERCP fails or is difficult. [1][2][3] In such situations, percutaneous procedures are necessary. However, percutaneous procedures tend to impair the quality of life (QOL) of patients.…”