Endoscopy 2020; 52(S 01): S82
DOI: 10.1055/s-0040-1704246
ESGE Days 2020 oral presentations
Friday, April 24, 2020 08:30 – 10:30 EUS-guided interventions Liffey Meeting Room 3
© Georg Thieme Verlag KG Stuttgart · New York

EUS-GUIDED INTRAHEPATIC ACCESS FOR RETROGRADE, ANTEGRADE OR TRANSGASTRIC BILIARY DRAINAGE: INDICATIONS, EFFICACY AND SAFETY FROM AN 8-YEAR TERTIARY CENTRE EXPERIENCE

G Vanella
1   University Hospitals Leuven, KU Leuven, Department of Gastroenterology and Hepatology, Leuven, Belgium
,
M Bronswijk
1   University Hospitals Leuven, KU Leuven, Department of Gastroenterology and Hepatology, Leuven, Belgium
,
H van Malenstein
1   University Hospitals Leuven, KU Leuven, Department of Gastroenterology and Hepatology, Leuven, Belgium
,
W Laleman
1   University Hospitals Leuven, KU Leuven, Department of Gastroenterology and Hepatology, Leuven, Belgium
,
S van der Merwe
1   University Hospitals Leuven, KU Leuven, Department of Gastroenterology and Hepatology, Leuven, Belgium
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

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Aims Intrahepatic access for EUS-guided biliary drainage (IH-EBD) still lacks convincing evidence on advantages and risks over comparators. We revised the 8-year experience of a tertiary, academic, referral centre.

Methods All consecutive IH-EBDs performed between 2012-2019 were retrospectively included. Variables are reported as proportions or median[interquartile range]. χ-squared, Kruskal-Wallis test and Kaplan-Meier curves were used.

Results 104 IH-EBDs were identified [(malignancies=87(83.7%); failed ERCP=81(77.9%); post-surgical anatomy=23(22.1%)]. Distal, hilar and anastomotic strictures represented 50%, 28.9% and 14.4% of indications.

16 transhepatic ERCP-rendez-vous (RVs), 43 transhepatic antegrade biliary stentings (ASs) and 45 hepatico-gastrostomies (HGs) were identified.

Overall technical success was 89.4%, while clinical success (lowering bilirubin or management of choledocholithiasis) was 94%. Using the ASGE lexicon, overall, severe and fatal complication rates were 16.7%, 3.0% and 0.9% respectively. Median hospital stay was 7[2-10] days, 4.5[1-9] in case of no complications. Stent dysfunction occurred in 17.1% after a median of 103.5[42.5-168.0] days. 6-months probability of stent-dysfunction-free survival was 72%.

Comparing the 3 techniques, benign diseases were more prevalent among RVs (p=0.0004), while hilar/anastomotic strictures were mainly managed through HGs (p< 0.0001). Technical failures were higher among RVs. No difference in clinical success or severe adverse events was identified. A lesser bilirubin decrease was noticed among HGs (≥50% decrease in 53.3% vs. 66.7% and 96% of RVs and ASs; p=0.007), justifiable by the significantly higher rate of disconnected ducts (53.5% vs. 6.2 and 2.2%, p< 0.0001). A trend towards reduced stent dysfunction was noted when HGs were created with half-covered purpose-specific stents (N=17[38%]) vs. older stents (6.7% vs. 31.6%, p=0.0789).

Conclusions The intrahepatic route for EUS-guided biliary drainage in failed ERCPs or surgically altered anatomy has a good clinical efficacy, a relatively low dysfunction rate and an acceptable safety profile. These results seem especially valuable for indications in which the only alternative would be percutaneous drainage.