Endosc Int Open 2016; 04(02): E175-E181
DOI: 10.1055/s-0041-109083
Original article
© Georg Thieme Verlag KG Stuttgart · New York

International multicenter comparative trial of transluminal EUS-guided biliary drainage via hepatogastrostomy vs. choledochoduodenostomy approaches

Mouen A. Khashab
1   Johns Hopkins Medical Institutions, Baltimore, MD, United States
,
Ahmed A. Messallam
1   Johns Hopkins Medical Institutions, Baltimore, MD, United States
,
Irene Penas
2   Hospital Universitario–Roi Hortega, Valladolid, Spain.
,
Yousuke Nakai
3   University of Tokyo, Tokyo, Japan.
,
Rani J. Modayil
4   Winthrop University, Mineola, NY, United States.
,
Carlos De la Serna
2   Hospital Universitario–Roi Hortega, Valladolid, Spain.
,
Kazuo Hara
5   Aichi Cancer Center Hospital, Nagoya, Japan
,
Mohamad El Zein
1   Johns Hopkins Medical Institutions, Baltimore, MD, United States
,
Stavros N. Stavropoulos
4   Winthrop University, Mineola, NY, United States.
,
Manuel Perez-Miranda
2   Hospital Universitario–Roi Hortega, Valladolid, Spain.
,
Vivek Kumbhari
1   Johns Hopkins Medical Institutions, Baltimore, MD, United States
,
Saowanee Ngamruengphong
1   Johns Hopkins Medical Institutions, Baltimore, MD, United States
,
Vinay K. Dhir
6   Baladota Institute of Digestive Sciences, Mumbai, India.
,
Do Hyun Park
7   Asan Medical Center, Seoul, South Korea.
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Publikationsverlauf

Publikationsdatum:
15. Januar 2016 (online)

Background and study aims: Endoscopic ultrasound-guided biliary drainage (EUS-BD) can be performed entirely transgastrically (hepatogastrostomy/EUS-HG) or transduodenally (choledochoduodenostomy/EUS-CDS). It is unknown how both techniques compare. The aims of this study were to compare efficacy and safety of both techniques and identify predictors of adverse events.

Patients and methods: Consecutive jaundiced patients with distal malignant biliary obstruction who underwent EUS-BD at multiple international centers were included. Technical/clinical success, adverse events, stent complications, and survival were assessed.

Results: A total of 121 patients underwent EUS-BD (CDS 60, HG 61). Technical success was achieved in 112 (92.56 %) patients (EUS-CDS 93.3 %, EUS-HG 91.8 %, P = 0.75). Clinical success was attained in 85.5 % of patients who underwent EUS-CDS group as compared to 82.1 % of patients who underwent EUS-HG (P = 0.64). Adverse events occurred more commonly in the EUS-HG group (19.67 % vs. 13.3 %, P = 0.37). Both plastic stenting (OR 4.95, 95 %CI 1.41 – 17.38, P = 0.01) and use of non-coaxial electrocautery (OR 3.95, 95 %CI 1.16 – 13.40, P = 0.03) were independently associated with adverse events. Length of hospital stay was significantly shorter in the CDS group (5.6 days vs. 12.7 days, P < 0.001). Mean follow-up duration was 151 ± 159 days. The 1-year stent patency probability was greater in the EUS-CDS group [0.98 (95 %CI 0.76 – 0.96) vs 0.60 (95 %CI 0.35 – 0.78)] but overall patency was not significantly different. There was no difference in median survival times between the groups (P = 0.36)

Conclusions: Both EUS-CDS and EUS-HG are effective and safe techniques for the treatment of distal biliary obstruction after failed ERCP. However, CDS is associated with shorter hospital stay, improved stent patency, and fewer procedure- and stent-related complications. Metallic stents should be placed whenever feasible and non-coaxial electrocautery should be avoided when possible as plastic stenting and non-coaxial electrocautery were independently associated with occurrence of adverse events.