Endoscopic Ultrasound-Guided Biliary Drainage (EUS-BD) for malignant biliary obstruction after failed endoscopic retrograde cholangiography (ERC) in patients with surgically altered anatomy

Sabine Thuemer; Frank Meyer; Frank Fueldner; Uwe Will

doi:10.1055/a-2644-0656

Zeitschrift für Gastroenterologie, Table of Contents

Z Gastroenterol 2025; 63(10): 1025-1036
DOI: 10.1055/a-2644-0656

Original Manuscript

Endoscopic Ultrasound-Guided Biliary Drainage (EUS-BD) for malignant biliary obstruction after failed endoscopic retrograde cholangiography (ERC) in patients with surgically altered anatomy

Endoskopische Ultraschall-geführte biliäre Drainage (EUS-BD) für die maligne Obstruktion nach frustraner endoskopischer retrograder Cholangiographie (ERC) bei Patienten mit chirurgisch-operativ veränderter Oberbauchanatomie

Authors

Sabine Thuemer

¹Dept. of Gastroenterology, Hepatology, Diabetology and General Internal Medicine, Municipal Hospital (“SRH Wald-Klinikum Gera”), Gera, Germany
Frank Meyer

²Dept. of General, Abdominal, Vascular and Transplant Surgery, Otto-von-Guericke University with University Hospital, Magdeburg, Germany
Frank Fueldner

¹Dept. of Gastroenterology, Hepatology, Diabetology and General Internal Medicine, Municipal Hospital (“SRH Wald-Klinikum Gera”), Gera, Germany
Uwe Will

¹Dept. of Gastroenterology, Hepatology, Diabetology and General Internal Medicine, Municipal Hospital (“SRH Wald-Klinikum Gera”), Gera, Germany

Abstract

Aim

To assess the effectiveness and safety of EUS-BD in patients with jaundice due to malignant biliary obstruction and post-surgically altered anatomy of the upper GI tract who failed prior ERC.

Methods

Over a defined study period, all consecutive patients, who had undergone EUS-BD, were analyzed retrospectively using a computer-based registry.

Results

Overall, 118 patients were registered (mean age, 69 [range, 38–88] years; sex ratio [f:m], 71:47) from 2005–2020. Technical and clinical success rates were 92.4 % and 93.6 %, respectively. 103 self-expandable metallic stents (SEMS), 2 lumen-apposing metal stents (LAMS), and 22 plastic stents were used.

The successful access routes to the bile duct system were trans-gastric (n=69), trans-jejunal (n=39), and trans-esophageal (n=2).

Adverse events (AE) occurred in 19.5 % and re-interventions were necessary in 27.9 % of cases. The median post-interventional survival time was 85 (95% CI: 45–256) days. The following parameters were associated with a significantly shorter survival time: CRP > 50 mg/L, bilirubin serum level > 200 µmol/L, high tumor burden, Karnofsky index < 80, and manifest malnutrition status.

Conclusion

EUS-BD in malignant biliary obstruction is a safe and effective method, even with surgically altered anatomy of the upper GI tract, in experienced hands of interventional EUS.

Zusammenfassung

Ziel

Bestimmung von Effektivität und Sicherheit der EUS-BD bei Patienten mit Ikterus infolge einer malignen biliären Obstruktion und chirurgisch-operativ alterierter Anatomie des oberen GI-Trakts nach gescheiterter ERC.

Methode

Über einen definierten Studienzeitraum wurden alle konsekutiven Patienten, die einer EUS-BD unterzogen worden waren, retrospektiv mittels Computer-basiertem Datenregister analysiert.

Ergebnisse

Insgesamt wurden 118 Patienten dokumentiert (mittleres Alter: 69 [Streubreite: 38–88] Jahre; Sex ratio [f:m]: 71:47) von 2005–2020. Technische und klinische Erfolgsraten lagen bei 92,4 bzw. 93,6 %. 103 selbst-expandierbare Metallstents (SEMS), 2 Lumen-approximierende Metallstents (LAMS) und 22 Plastikstents wurden verwendet.

Die erfolgreich angewandten Zugangswege zum biliären System umfassten: transgastral (n=69), transjejunal (n=39) und transesophageal (n=2).

Nebenwirkungen (AE) traten bei 19,5% auf und Re-interventionen wurden bei 27,9% der Fälle beobachtet. Die mediane postinterventionelle Überlebenszeit betrug 85 (95%-KI: 45–256) d. Die folgenden Parameter waren mit einer signifikant kürzeren Überlebenszeit assoziiert: CRP >50 mg/l, Bilirubin im Serum >200 µmol/l, hohe Tumorlast, Karnofsky-Index <80 und manifester Malnutrition-Status.

Schlussfolgerung

Die EUS-BD stellt bei der malignen biliären Obstruktion in erfahrenen Händen der interventionellen EUS eine sichere und effektive Methode dar, sogar bei chirurgisch-operativ veränderter Anatomie des oberen GI-Trakts.

Keywords

Endoscopic Ultrasonography-Guided Biliary Drainage (EUS-BD) - Malignant biliary obstruction - Endoscopic retrograde cholangiography (ERC) - Percutaneous transhepatic cholangiodrainage (PTCD) - Technical/Clinical success rate - Survival time - Prognostic factors

Schlüsselwörter

Endoskopische Ultraschall-geführte biliäre Drainage (EUS-BD) - maligne biliäre Obstruktion - endoskopische retrograde Cholangiographie (ERC) - perkutane transhepatische Cholangiodrainage (PTCD) - technische/klinische Erfolgsrate - Überlebenszeit - Prognosefaktoren

Full Text

References

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