EUS-guided biliary drainage or enteroscopy-assisted ERCP in patients with surgical anatomy and biliary obstruction: an international comparative study
2016
Background and study aims: How enteroscopy-assisted ERCP (e-ERCP) and
endoscopic ultrasound-guided biliary drainage (EUS-BD) compare in patients with
surgically altered upper gastrointestinal anatomy is currently unknown. The aims
of this study were to compare efficacy and safety of both techniques and study
predictors of these outcomes. Patients and methods: This was an international, multicenter comparative
cohort study at 10 tertiary centers. Outcomes data included technical success
(biliary access with cholangiography and stent placement [when indicated]),
clinical success (resolution of biliary obstruction) and adverse events (AEs)
(graded according to the ASGE lexicon). Results: A total of 98 patients underwent EUS-BD (n = 49) or e-ERCP
(n = 49). Technical success was achieved in 48 (98 %) patients in the EUS-BD
group as compared to 32 (65.3 %) patients in the e-ERCP group (OR 12.48,
P = 0.001). Clinical success was attained in 88 % of patients in
EUS-BD group as compared to 59.1 % in the e-ERCP group (OR 2.83,
P = 0.03). Procedural time was significantly shorter in the EUS-BD group
(55 min vs 95 min, P < 0.0001). AEs occurred more commonly in the
EUS-BD group (20 % vs. 4 %, P = 0.01). However, the majority (90 %) of
AEs were mild/moderate. Length of stay was significantly longer in the EUS-BD
group (6.6 d vs. 2.4 d, P Conclusions: EUS-BD can be performed with a higher degree of clinical
efficacy and shorter procedure time than e-ERCP in patients with
surgically-altered upper gastrointestinal anatomy. Whether or not this approach
should be first-line therapy in this patient population is highly dependent on
the indication for the procedure, the patient’s anatomy, and local practice and
expertise.
Keywords:
- Correction
- Source
- Cite
- Save
- Machine Reading By IdeaReader
16
References
50
Citations
NaN
KQI