IMPACT OF EUS-GUIDED BILIARY DRAINAGE AND GASTROJEJUNOSTOMY IN COMBINED MALIGNANT BILIARY AND GASTRIC OUTLET OBSTRUCTION

Aims Combined malignant gastric outlet obstruction (GOO) and biliary obstruction remain a challenge. EUS-guided biliary transmural drainage (EUS-BD) and gastrojejunal anastomoses (EUS-GJ) are already available alternatives. Comparatives of intraluminal and transmural approaches are scarce.

Methods Retrospective analysis including all patients presenting malignant GOO and biliary obstruction between 2011 and 2021 at a single tertiary care center. Biliary and duodenal drainage method were categorized as transmural (EUS-BD and EUS-GJ) vs transpapillary/intraluminal. Follow-up started at the first endoscopic procedure. Biliary stent dysfunction was defined as cholangitis and/or obstructive jaundice, duodenal dysfunction as recurrent GOO.

Results We included 168 patients, 75.2 years (IQR: 61.5-83.2), 94 males. Most frequent diagnoses were pancreatic adenocarcinoma (62.5%) and cholangiocarcinoma (9.5%). Presentation was simultaneous in 74/168. Most biliary obstructions were distal (150/168). Initial management was transpapillary in 94/168 and EUS-D in 74/168 (46 choledocoduodenostomies, 27 hepaticogastrostomies, 1 gallbladder drainage). Technical success was achieved in 73/74 EUS-Ds and in all transpapillary drainages; clinical success in 83.9% and 88.6%, respectively. Duodenal strictures were mostly Mutignani types I (48.5%) and II (46.5%), managed with SEMS in115/168 cases and EUS-GJ in 53. Clinical success was reached in 95% of EUS-GJ and 94.6% of SEMS. Follow-up (median: 168 days (44-386)) was available in 151 patients. [Figure 1] presents time to first biliary event and EUS-GJ/SEMS dysfunction. Transpapillary biliary drainage presented more biliary dysfunctions (HR: 2.3 (95% CI: 1.2-4.7), while all duodenal events presented in SEMS (log-rank test<0.001)

Fig. 1

Conclusions Our data suggest the transmural approach reduces the need of further endoscopic procedures during follow-up, especially in GOO.

Publication History

Article published online:
14 April 2022