Endoscopic Ultrasound (EUS)-Guided Gallbladder Drainage vs EUS-Guided Bile Duct Drainage for First Line Therapy of Malignant Biliary Obstruction: An International Multicenter Study

Aims Endoscopic ultrasound (EUS)–guided gallbladder (GB) drainage and EUS-guided bile duct (BD) drainage with lumen-apposing metal stents are alternative approaches to endoscopic retrograde cholangiopancreatography (ERCP). We compared EUS-GB and EUS-BD as first line therapies in the management of malignant biliary obstruction (MBO) [1] [2] [3].

Methods This was an international multicenter retrospective observational study at 28 tertiary-care centers through August 2024. Consecutive patients with MBO who underwent EUS-GB or EUS-BD as first line therapy with LAMS placement were included. Outcomes were compared using propensity score matching. Cohorts were compared using Chi-square, Mann-Whitney tests, and logistic regression.

Results Two hundred and ninety-one patients (130 males; average age 74±12 years) underwent EUS guided drainage where 82 patients underwent EUS GB drainage, and 209 patients underwent EUS BD drainage. Most patients developed MBO from pancreatic cancer (79%). AXIOS stents were used in most cases (n=270) compared to SPAXUS (n=21). Overall, technical success was reported in 96% of cases and clinical success in 88% of cases. After 1-to-1 propensity score matching, 154 patients were selected (77 per group). EUS-GB and EUS-BD had similar technical success rates (96% vs 99%, P=0.311) and clinical success rates (86% vs 92%, P=0.199). No statistical differences were reported in adverse events including bleeding (P=1.000), perforation (P=0.316), stent occlusion (P=0.649), stent migration (P=0.173), and acute pancreatitis (P=0.080). Stent type was not associated with technical success (AXIOS 90% vs SPAXUS 75%, P=0.332) or clinical success (AXIOS 91% vs 82%, P=0.298). On univariate analysis, the type of EUS drainage procedure was not a significant predictor of technical success (P=0.335) or clinical success (P=0.205).

Conclusions Our study showed that in patients with MBO, the use of EUS-guided GB or EUS-guided BD were comparable with similar rates of efficacy and safety. These findings provide evidence for greater adoption of EUS-GB and EUS-BD in clinical practice as therapeutic alternatives to ERCP in patients with MBO.

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025

• References

• 1 Mangiavillano B, Moon JH, Facciorusso A, Vargas-Madrigal J, Di Matteo F, Rizzatti G, De Luca L, Forti E, Mutignani M, Al-Lehibi A, Paduano D, Bulajic M, Decembrino F, Auriemma F, Franchellucci G, De Marco A, Gentile C, Shin IS, Rea R, Massidda M, Calabrese F, Mirante VG, Ofosu A, Crinò SF, Hassan C, Repici A, Larghi A.. Endoscopic ultrasound-guided gallbladder drainage as a first approach for jaundice palliation in unresectable malignant distal biliary obstruction: Prospective study. Dig Endosc 2024; 36 (03): 351-358 Epub 2023 Jul 3. PMID: 37253185
• 2 Paduano D, Facciorusso A, De Marco A, Ofosu A, Auriemma F, Calabrese F, Tarantino I, Franchellucci G, Lisotti A, Fusaroli P, Repici A, Mangiavillano B.. Endoscopic Ultrasound Guided Biliary Drainage in Malignant Distal Biliary Obstruction. Cancers (Basel) 2023; 15 (02): 490 PMID: 36672438; PMCID: PMC9856645
• 3 Facciorusso A, Mangiavillano B, Paduano D, Binda C, Crinò SF, Gkolfakis P, Ramai D, Fugazza A, Tarantino I, Lisotti A, Fusaroli P, Fabbri C, Anderloni A.. Methods for Drainage of Distal Malignant Biliary Obstruction after ERCP Failure: A Systematic Review and Network Meta-Analysis. Cancers (Basel) 2022; 14 (13): 3291 PMID: 35805062; PMCID: PMC9266204