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CC BY 4.0 · Endoscopy 2025; 57(07): 719-729
DOI: 10.1055/a-2543-5672
Original article

Biliary drainage prior to pancreatoduodenectomy with endoscopic ultrasound-guided choledochoduodenostomy versus conventional ERCP: propensity score-matched study and surgeon survey

Jeska A. Fritzsche 
1   Department of Gastroenterology and Hepatology, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
2   Amsterdam Gastroenterology Endocrinology Metabolism, the Netherlands
3   Cancer Center Amsterdam, the Netherlands
,
Mike J. P. de Jong 
4   Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands
,
Bert A. Bonsing
5   Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
,
Olivier R. Busch
2   Amsterdam Gastroenterology Endocrinology Metabolism, the Netherlands
3   Cancer Center Amsterdam, the Netherlands
6   Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
,
Freek Daams
2   Amsterdam Gastroenterology Endocrinology Metabolism, the Netherlands
3   Cancer Center Amsterdam, the Netherlands
6   Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
,
Wouter J. M. Derksen
7   Department of Surgery, St Antonius Hospital, Nieuwegein, the Netherlands
8   Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
,
Lydi M. J. W. van Driel
9   Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
,
Sebastiaan Festen
10   Department of Surgery, OLVG, Amsterdam, the Netherlands
,
Erwin-Jan M. van Geenen
4   Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands
,
Frederik J. H. Hoogwater
11   Department of Surgery, Universitair Medisch Centrum Groningen, Groningen, the Netherlands
,
Akin Inderson
12   Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, the Netherlands
,
Sjoerd D. Kuiken
13   Department of Gastroenterology and Hepatology, OLVG, Amsterdam, the Netherlands
,
Mike S. L. Liem
14   Medisch Spectrum Twente, Department of Surgery, Enschede, the Netherlands
,
Daan J. Lips
14   Medisch Spectrum Twente, Department of Surgery, Enschede, the Netherlands
,
Maarten W. Nijkamp
11   Department of Surgery, Universitair Medisch Centrum Groningen, Groningen, the Netherlands
,
Hjalmar C. van Santvoort
7   Department of Surgery, St Antonius Hospital, Nieuwegein, the Netherlands
8   Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
,
Peter D. Siersema
4   Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands
9   Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
,
Martijn W. J. Stommel
15   Radboud University Medical Centre, Department of Surgery, Nijmegen, the Netherlands
,
Niels G. Venneman
16   Medisch Spectrum Twente, Department of Gastroenterology and Hepatology, Enschede, the Netherlands
,
Robert C. Verdonk
17   St Antonius Hospital, Department of Gastroenterology and Hepatology, Nieuwegein, the Netherlands
,
Frank P. Vleggaar
18   University Medical Centre Utrecht, Department of Gastroenterology and Hepatology, Utrecht, the Netherlands
,
Roeland F. de Wilde
19   Department of Surgery, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
,
Marc G. Besselink
2   Amsterdam Gastroenterology Endocrinology Metabolism, the Netherlands
3   Cancer Center Amsterdam, the Netherlands
6   Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
,
Roy L. J van Wanrooij    *
2   Amsterdam Gastroenterology Endocrinology Metabolism, the Netherlands
3   Cancer Center Amsterdam, the Netherlands
20   Department of Gastroenterology and Hepatology, Amsterdam UMC, location Vrije Universiteit, Amsterdam, the Netherlands
,
Rogier P. Voermans    *
1   Department of Gastroenterology and Hepatology, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
2   Amsterdam Gastroenterology Endocrinology Metabolism, the Netherlands
3   Cancer Center Amsterdam, the Netherlands
,
on behalf of the Dutch Pancreatic Cancer Group (DPCG), Dutch Pancreatic Cancer Audit (DPCA) and the pancreatoduodenectomy after EUS-CDS investigators
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Einführung zu diesem Artikel:

Author commentary on Jeska A. Fritzsche et al.Endoscopy 2025; 57(07): v23-v23
DOI: 10.1055/a-2598-5849

Abstract

Background Preoperative endoscopic biliary drainage may lead to complications (16 %–24 %), potentially hampering surgical exploration. Endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) may reduce drainage-related complications; however, in the absence of surgeon-reported outcomes, it is unknown whether EUS-CDS may hamper surgical exploration. This study assessed the impact of preoperative EUS-CDS on pancreatoduodenectomy.

Method Consecutive patients who underwent pancreatoduodenectomy after preoperative biliary drainage were included in all eight centers performing EUS-CDS in the mandatory Dutch Pancreatic Cancer Audit (Jan 2020–Dec 2022). The primary outcome was major postoperative complications. Secondary outcomes included bile leak grade B/C, postoperative pancreatic fistula (POPF) grade B/C, and overall postoperative complications. A propensity score-matching (1:3) analysis was performed. Surgeons performing pancreatoduodenectomy after EUS-CDS completed a survey on surgical difficulty.

Results 937 patients with pancreatoduodenectomy after preoperative biliary drainage were included (42 EUS-CDS, 895 endoscopic retrograde cholangiopancreatography [ERCP]). Major postoperative complications occurred in 8 patients (19.0 %) in the EUS-CDS group and 292 (32.6 %) in the ERCP group (relative risk [RR] 0.50; 95 %CI 0.23–1.07). No significant differences were observed in overall complications (RR 0.95; 95 %CI 0.51–1.76), bile leak (RR 1.25; 95 %CI 0.31–4.98), or POPF (RR 0.62; 95 %CI 0.25–1.56). Results were similar after matching. The survey was completed for 29 pancreatoduodenectomies; surgery was not (13, 45 %), “slightly” (9, 31 %), “clearly” (5,17 %), and “severely” (2, 7 %) more complex because of EUS-CDS.

Conclusion This early experience suggests that preoperative biliary drainage with EUS-CDS does not increase the rate of complications after pancreatoduodenectomy and only infrequently hampers surgical exploration.

* These authors share senior authorship.


Supplementary material



Publikationsverlauf

Eingereicht: 03. Oktober 2024

Angenommen nach Revision: 19. Februar 2025

Accepted Manuscript online:
20. Februar 2025

Artikel online veröffentlicht:
14. Mai 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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