Endoscopy 2021; 53(01): 55-62
DOI: 10.1055/a-1195-8197
Original article

ERCP plus endoscopic ultrasound-guided biliary drainage versus percutaneous transhepatic biliary drainage for malignant hilar biliary obstruction: a multicenter observational open-label study

Pradermchai Kongkam
1  Gastrointestinal Endoscopy Excellence Center and Division of Gastroenterology, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
2  Pancreas Research Unit, Chulalongkorn University, Bangkok, Thailand
3  Thai Association for Gastrointestinal Endoscopy, Bangkok, Thailand
,
Theerapat Orprayoon
1  Gastrointestinal Endoscopy Excellence Center and Division of Gastroenterology, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
3  Thai Association for Gastrointestinal Endoscopy, Bangkok, Thailand
,
Chaloemphon Boonmee
3  Thai Association for Gastrointestinal Endoscopy, Bangkok, Thailand
4  Department of Surgery, Tha-Bo Crown Prince Hospital, Ministry of Public Health, Nong Khai, Thailand
,
Passakorn Sodarat
3  Thai Association for Gastrointestinal Endoscopy, Bangkok, Thailand
5  Department of Surgery, Roi-Et Hospital, Ministry of Public Health, Roi-Et, Thailand
,
Orathai Seabmuangsai
3  Thai Association for Gastrointestinal Endoscopy, Bangkok, Thailand
5  Department of Surgery, Roi-Et Hospital, Ministry of Public Health, Roi-Et, Thailand
,
Chatchawan Wachiramatharuch
3  Thai Association for Gastrointestinal Endoscopy, Bangkok, Thailand
5  Department of Surgery, Roi-Et Hospital, Ministry of Public Health, Roi-Et, Thailand
,
Yutthaya Auan-Klin
1  Gastrointestinal Endoscopy Excellence Center and Division of Gastroenterology, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
,
Khanh Cong Pham
1  Gastrointestinal Endoscopy Excellence Center and Division of Gastroenterology, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
,
Abbas Ali Tasneem
1  Gastrointestinal Endoscopy Excellence Center and Division of Gastroenterology, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
3  Thai Association for Gastrointestinal Endoscopy, Bangkok, Thailand
,
Stephen J. Kerr
6  Biostatistics Excellence Centre, Chulalongkorn University, Bangkok, Thailand
,
Rommel Romano
1  Gastrointestinal Endoscopy Excellence Center and Division of Gastroenterology, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
3  Thai Association for Gastrointestinal Endoscopy, Bangkok, Thailand
,
Sureeporn Jangsirikul
1  Gastrointestinal Endoscopy Excellence Center and Division of Gastroenterology, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
3  Thai Association for Gastrointestinal Endoscopy, Bangkok, Thailand
,
Wiriyaporn Ridtitid
1  Gastrointestinal Endoscopy Excellence Center and Division of Gastroenterology, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
3  Thai Association for Gastrointestinal Endoscopy, Bangkok, Thailand
,
Phonthep Angsuwatcharakon
1  Gastrointestinal Endoscopy Excellence Center and Division of Gastroenterology, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
3  Thai Association for Gastrointestinal Endoscopy, Bangkok, Thailand
,
Thawee Ratanachu-ek
3  Thai Association for Gastrointestinal Endoscopy, Bangkok, Thailand
7  Department of Surgery, Rajavithi Hospital, Ministry of Public Health, Bangkok, Thailand
,
Rungsun Rerknimitr
1  Gastrointestinal Endoscopy Excellence Center and Division of Gastroenterology, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
3  Thai Association for Gastrointestinal Endoscopy, Bangkok, Thailand
› Author Affiliations
Trial Registration: Thai Clinical Trials Registry Registration number (trial ID): TCTR20180711004 Type of study: Multicenter observational open-label study

Abstract

Background Endoscopic retrograde cholangiopancreatography (ERCP) may not provide complete biliary drainage in patients with Bismuth III/IV malignant hilar biliary obstruction (MHBO). Complete biliary drainage is accomplished by adding percutaneous transhepatic biliary drainage (PTBD). We prospectively compared recurrent biliary obstruction (RBO) rates between combined ERCP and endoscopic ultrasound-guided biliary drainage (EUS-BD) vs. bilateral PTBD.

Methods Patients with MHBO undergoing endoscopic procedures (group A) were compared with those undergoing bilateral PTBD (group B). The primary outcome was the 3-month RBO rate.

Results 36 patients were recruited into groups A (n = 19) and B (n = 17). Rates of technical and clinical success, and complications of group A vs. B were 84.2 % (16/19) vs. 100 % (17/17; P = 0.23), 78.9 % (15/19) vs. 76.5 % (13/17; P > 0.99), and 26.3 % (5/19) vs. 35.3 % (6/17; P = 0.56), respectively. Within 3 and 6 months, RBO rates of group A vs. group B were 26.7 % (4/15) vs. 88.2 % (15/17; P  = 0.001) and 22.2 % (2/9) vs. 100 % (9/9; P = 0.002), respectively. At 3 months, median number of biliary reinterventions in group A was significantly lower than in group B (0 [interquartile range] 0–1 vs. 1 [1–2.5]), respectively (P < 0.001). Median time to development of RBO was longer in group A than in group B (92 [56–217] vs. 40 [13.5–57.8] days, respectively; P  =  0.06).

Conclusions Combined ERCP and EUS procedures provided significantly lower RBO rates at 3 and 6 months vs. bilateral PTBD, with similar complication rates and no significant mortality difference.

Supplementary material



Publication History

Received: 28 December 2019

Accepted: 08 June 2020

Publication Date:
08 June 2020 (online)

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