ENDOSCOPIC ULTRASOUND-GUIDED HEPATICOGASTROSTOMY VERSUS PERCUTANEOUS TRANSHEPATIC DRAINAGE FOR MALIGNANT HILAR OBSTRUCTION AFTER FAILED ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY: EFFICACY AND SAFETY ANALYSIS

Aims Percutaneous transhepatic biliary drainage (PTBD) is conventionally performed as a salvage procedure in patients with unresectable malignant hilar obstruction (MHO) after failed endoscopic retrograde cholangiopancreatography (ERCP) or for inaccessible papilla. Endoscopic ultrasound-guided hepaticogastrostomy (EU-HGS) is a recent alternative and this study is aimed to compare the outcome, efficacy and adverse events of EU-HGS and PTBD for MHO.

Methods All consecutive patients of MHO with failed/unfeasible ERCP who underwent EUS-HGS or PTBD in a tertiary care centre from September 2018 to August 2021 were included in the study. Demographic, laboratory and clinical parameters were documented at baseline. Primary outcome was clinical success. Other outcome parameters included technical success, adverse events, hospital stay.

Results Of the 46 patients (median age 50 [IQR 17.5] yrs; male 20 [43.5%)]) included, 19 underwent EUS-HGS and rest PTBD (n=27). The commonest etiology was carcinoma gallbladder (30; 65.2%) followed by hilar cholangiocarcinoma (9; 19.6%). Cholangitis was present in 37 (80.4%) of which 24 (52.2%) had severe cholangitis with coagulopathy in 20 (43.5%). The most common block was type 2 (24; 52.5%) followed by type 3a (12; 26.1%). Technical success was 100% in both the groups. Clinical success was similar in the two groups (78.6% vs 96.0%; p=0.12). Overall adverse events were higher in the PTBD group (44.4% vs 15.8%; p=0.04) with prolonged hospital stay (11.0 vs. 6.0 days; p=0.007), although none had procedure related deaths.

Table 1

	EUS-HGS (n=19)	PTBD (n=27)	p value
Clinical Success	11 (78.6%)	24 (96.0%)	0.12
Overall adverse events	3 (15.8%)	12 (44.4%)	0.04
Hospital stay (days) (median [interquartile range])	6.0 (9.0)	11.0 (7.0)	0.007
Mortality related to the procedure	0 (0)%	0 (0%)

Conclusions EUS-HGS is an effective and safe alternative to PTBD, with similar success rates but lower adverse-event rates and length of hospitalization.

Publication History

Article published online:
14 April 2022