Impact of Interventional Biliary EUS (EUS-BD) on Outcomes of Biliary Drainage in a Tertiary Care Setting

Aims To assess whether EUS-BD has affected the outcomes of biliary drainage in terms of success, adverse events, costs, and duration of hospitalization. The primary end point was rate of successful endoscopic drainage (ERCP+EUS-BD). The secondary endpoints were adverse events, duration of hospitalization, and procedure costs related to secondary procedures.

Methods EUS-BD was introduced at our centre in 2009. We analyzed obstructive jaundice patients over two six month periods, in 2008 (January 2008 to June 2008) and 2019(June to December 2019). The indication, primary procedure, success, secondary procedure, and adverse events were noted. Additional Procedure costs of secondary procedures and duration of hospitalization were calculated.

Results Of 239 patients in 2008, 113 patient had benign obstruction, and 126 had malignant obstruction. Of 346 patients in 2019, 162 had benign obstruction, and 184 had malignant obstruction. In benign group there was no difference in endoscopy success rate between 2008 (113,100 %) and 2019 (162,100 %). In the malignant group, Endoscopic biliary drainage (ERCP+EUS-BD) was significantly more successful in 2019 (164, 98.9 %) compared with 2008 (117,92.8 %, p = 0.008)). For malignant obstruction in 2008, 117(92.8 %) had successful ERCP whilst 9 patients (7.4 %) underwent PTBD. In 2019, 164(90.1 %) had successful ERCP, 18(9.7 %) patients had EUS-BD, 2 patients (1 %) had PTBD. In 2019 significantly less adverse events were noted 6.5 % (pancreatitis-4, cholangitis-5, bleeding-3) versus 13.5 % (pancreatitis-6, cholangitis-8, bleeding-3) in 2008 (P=0.047). The duration of hospital stay was 6.4±2.19 days in PTBD patients versus 1.6±0.49 days in EUS-BD patients (p = 0.001), and additional procedure cost was INR173166±3816 for PTBD group versus INR 125923±2798 for EUS-BD group (P=0.0001).

Conclusions For malignant biliary obstruction, EUS-BD increases the success rate of endoscopic biliary drainage, and reduces the need for PTBD. EUS-BD had lesser adverse events, duration of hospitalization, and procedure costs compared to PTBD . No significant change was observed for benign biliary obstruction.

Citation: Dhir V, Udawat P, Shah R. OP95 IMPACT OF INTERVENTIONAL BILIARY EUS (EUS-BD) ON OUTCOMES OF BILIARY DRAINAGE IN A TERTIARY CARE SETTING. Endoscopy 2021; 53: S40.

Publication History

Article published online:
19 March 2021