Endoscopy 2018; 50(04): S44
DOI: 10.1055/s-0038-1637157
ESGE Days 2018 oral presentations
20.04.2018 – ERCP 2: bile duct stenosis
Georg Thieme Verlag KG Stuttgart · New York

COMBINATION OF ERCP AND EUS-GUIDED BILIARY DRAINAGE IN HIGH-GRADE MALIGNANT HILAR BILIARY OBSTRUCTION (THE CERES STUDY): A MULTICENTER RETROSPECTIVE STUDY

, CUTARE Group of TAGE (Thai Association of GI Endoscopy)
R Romano
1   Chulalongkorn University, Internal Medicine, Patumwan, Thailand
,
P Kongkam
1   Chulalongkorn University, Internal Medicine, Patumwan, Thailand
,
C Boonmee
2   Tha-Bo Hospital, Surgery, Tha-Bo, Thailand
,
P Sodarat
3   Roi-Et Hospital, Surgery, Muang, Thailand
,
O Seabmuangsai
3   Roi-Et Hospital, Surgery, Muang, Thailand
,
S Jangsirikul
1   Chulalongkorn University, Internal Medicine, Patumwan, Thailand
,
T Thongbai
1   Chulalongkorn University, Internal Medicine, Patumwan, Thailand
,
W Ridtitid
1   Chulalongkorn University, Internal Medicine, Patumwan, Thailand
,
P Angsuwatcharakon
1   Chulalongkorn University, Internal Medicine, Patumwan, Thailand
,
R Rerknimitr
1   Chulalongkorn University, Internal Medicine, Patumwan, Thailand
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

Also available at
 

Aims:

To study the clinical efficacy of EUS-BD with or without ERCP in high-grade malignant hilar biliary obstruction (HG-MHBO).

Methods:

All patients who underwent EUS-BD with or without ERCP in patients with HG-MHBO from 3 referral hospitals including King Chulalongkorn Memorial, Tha-Bor, and Roi-Et Hospitals from January 2016 to October 2017 were recruited into the study. Relevant clinical data were recorded and analyzed.

Results:

Of the 23 included patients, 2 were excluded due to poor ECOG score. EUS-BD was performed on 21 patients (6F; mean age 62.3 ± 12.6 years) with procedures selected based on pattern of MHBO as follows: EUS-guided left hepaticogastrostomy (EUS-LHGS) and ERCP with SEMS-insertion in right intrahepatic bile duct (RIHD) for Bismuth-IV MHBO (n = 5); EUS-LHGS in MHBO with pre-existing ERCP-placed RIHD SEMS (n = 5); EUS-LHGS alone in MHBO with non-functioning right lobe of the liver (n = 5); EUS-guided antegrade or EUS-guided rendezvous SEMS placement in MHBO with non-functioning right lobe and significant ascites (n = 4, n = 1, respectively); and EUS-guided hepaticoduodenostomy (EUS-HDS) in MHBO with non-functioning left lobe (n = 1). Additional PTBD on a persistently-dilated segment 3 IHD was performed in 2 patients with EUS-LHGS on segment 2. Technical and clinical success (total bilirubin reduction> 75% from baseline) were achieved in 19/21 (90.5%) and 18/19 (94.7%) patients, respectively. EUS-BD-related adverse events (AE) occurred in 3/21 (14.3%) patients, namely: pain from bile leak (n = 2), and retroperitoneal guidewire perforation (n = 1). All AEs were successfully managed conservatively. Unscheduled biliary re-intervention within one month was performed in 2/19 patients (10.5%); ERCP with RIHD SEMS-placement from progression of MHBO in a patient with EUS-LHGS alone and PTBD in another patient with kinking of EUS-LHGS SEMS. One patient died from pneumonia at day 27 after the EUS-BD without evidence of biliary tract infection.

Conclusions:

In a large referral centers, EUS-BD for HG-MHBO with or without ERCP feasible and effective with an acceptable 1-month biliary re-intervention rate.