The Role of EUS-BD in the Management of Malignant Biliary Obstruction: The Indonesian Perspective

Makmun, Dadang; Fauzi, Achmad; Abdullah, Murdani; Syam, Ari Fahrial

doi:10.1155/2017/4856276

Cited by 12 publications

(10 citation statements)

References 24 publications

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“…Currently, EUS-BD is not the first-line management of malignant biliary obstruction in Indonesia or most developing Asian countries. Many studies have shown the advantage of performing EUS-BD after a failed ERCP cannulation [12, 13, 14, 15]. However, EUS-BD requires high levels of experience and technique as most studies were performed in highly expert centers.…”

Section: Discussionmentioning

confidence: 99%

Palliative Endoscopic Ultrasound Biliary Drainage for Advanced Malignant Biliary Obstruction: Should It Replace the Percutaneous Approach?

Lesmana

Gani

Hasan

et al. 2019

Case Rep Gastroenterol

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Endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic biliary drainage (PTBD) are the standard of care in malignant biliary obstruction cases. Recently, endoscopic ultrasound-guided biliary drainage (EUS-BD) has been widely used after unsuccessful ERCP. However, the patient's clinical impact of EUS-BD over PTBD is still not obvious. Therefore, this case series study aims to evaluate the clinical outcomes of patients with advanced malignant biliary obstruction who underwent EUS-BD after failed ERCP. A retrospective database study was performed between January 2016 and June 2018 in patients with advanced malignant biliary obstruction. Patients were consecutively enrolled without randomization. Treatment options consisted of ERCP and PTBD or EUS-BD if ERCP failed. Based on 144 biliary obstruction cases, 38 patients were enrolled; 24 (63.2%) were men. The patients' mean age was 66.8 ± 12.36 years. The most common cause of malignant biliary obstruction was pancreatic cancer (44.7%). Biliary drainage was achieved by ERCP (39.5%), PTBD (39.5%), and EUS-BD (21.1%). The technical success rate was 86.7% by PTBD and 87.5% by EUS-BD (p = 1.000), while the clinical success rate was 93.3% by PTBD and 62.5% by EUS-BD (p = 0.500). The median survival in patients who underwent PTBD versus those wo underwent EUS-BD was 11 versus 3 months (log-rank p = 0.455). In conclusion, there is no significant advantage of EUS-BD when compared to PTBD in terms of clinical success and survival benefit in advanced malignant biliary obstruction.

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Section: Discussionmentioning

confidence: 99%

Palliative Endoscopic Ultrasound Biliary Drainage for Advanced Malignant Biliary Obstruction: Should It Replace the Percutaneous Approach?

Lesmana

Gani

Hasan

et al. 2019

Case Rep Gastroenterol

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“…For example, EUS-CDS is not suitable for proximal (hilar) biliary obstruction, where an intrahepatic EUS-BD approach is required. In the specific situation of hilar malignancy EUS-guided HGS was found to be safe and effective[52,53], although the duration of efficacy was limited[40] and lower clinical success rates were demonstrated than for distal obstruction[41].…”

Section: Indicationsmentioning

confidence: 99%

Endoscopic ultrasound-guided drainage of the biliary system: Techniques, indications and future perspectives

Hindryckx¹,

Degroote²,

Tate³

et al. 2019

WJGE

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Over the last decade, endoscopic ultrasound-guided biliary drainage (EUS-BD) has evolved into a widely accepted alternative to the percutaneous approach in cases of biliary obstruction with failed endoscopic retrograde cholangiopancreaticography (ERCP). The available evidence suggests that, in experienced hands, EUS-BD might even replace ERCP as the first-line procedure in specific situations such as malignant distal bile duct obstruction. The aim of this review is to summarize the available data on EUS-BD and propose an evidence-based algorithm clarifies the role of the different EUS-BD techniques in the management of benign and malignant biliary obstructive disease.

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“…[ 5 ] Therefore, EUS-BD is a therapeutic option that can be applied as initial drainage or for reintervention. [ 6 7 8 9 10 11 12 13 14 ] The alternative to EUS-BD drainage is percutaneous transhepatic drainage. Studies have shown a similar success rate, but EUS-BD drainage seems to have more advantages with lower rates of intervention.…”

Section: Introductionmentioning

confidence: 99%

Feasibility of EUS-guided hepaticogastrostomy for inoperable malignant hilar biliary strictures

et al. 2021

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Background and Objectives: EUS-guided biliary drainage (EUS-BD) has emerged as a complementary technique for primary drainage or as a rescue technique after failed endoscopic retrograde cholangiography. The objective of this study was to demonstrate the feasibility of EUS-BD for malignant hilar stenosis (MHS), both as an initial and rescue procedure. Patients and Methods: This study was a retrospective work based on a prospective registry of patients with malignant drainage stenosis of the hilum. For this analysis, only patients who underwent EUS-BD drainage were included. The drainage procedure could be performed by EUS-BD alone or in combination with another technique, for initial drainage or reintervention. Results: Between January 2015 and September 2018, 20 patients were included. The mean patient age was 68 years. Seven patients had primary liver tumors and 13 had obstructions caused by metastasis. Four patients had Type II stenosis, 7 had Type IIIA, 2 had Type IIIb, and 7 had Type IV stenosis. Sixteen patients underwent EUS-guided hepaticogastrostomy (EUS-HGS) for initial drainage and four as reintervention. For initial drainage, 2 patients underwent EUS-HGS alone and 14 underwent EUS-HGS in combination with another technique: 11 combined with endoscopic retrograde cholangiopancreatography (ERCP), 2 with percutaneous transhepatic drainage, and 1 with ERCP and percutaneous transhepatic drainage. The technical success rate for EUS-HGS in the drainage of MHS was 100%, and the clinical success rate was 95%. The mean percentage of liver drained was 84%, with an average 1.7 endoscopic sessions and an average 2.7 protheses. The early complication rate was 35% and the mortality rate was 5%. Five EUS-HGS/ERCP combination drainage procedures were performed in one session and six were performed in two sessions with similar complication rates and percentages of liver segments drained. Conclusion: EUS-BD is a feasible and safe technique for initial drainage and for reintervention procedures. The EUS-HGS/ERCP combination seemed to be useful in cases of complex stenosis and could be performed during the same session or in two sessions.

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The Role of EUS-BD in the Management of Malignant Biliary Obstruction: The Indonesian Perspective

Cited by 12 publications

References 24 publications

Palliative Endoscopic Ultrasound Biliary Drainage for Advanced Malignant Biliary Obstruction: Should It Replace the Percutaneous Approach?

Palliative Endoscopic Ultrasound Biliary Drainage for Advanced Malignant Biliary Obstruction: Should It Replace the Percutaneous Approach?

Endoscopic ultrasound-guided drainage of the biliary system: Techniques, indications and future perspectives

Feasibility of EUS-guided hepaticogastrostomy for inoperable malignant hilar biliary strictures

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