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Endoscopic Ultrasound-Guided Antegrade Stent Placement in Patients with Failed ERCP as a Modality of Preoperative and Palliative Biliary Drainage

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Abstract

Background

No large studies have addressed the role of endoscopic-ultrasound biliary drainage (EUS-BD) as preoperative biliary drainage (PBD) for malignant extrahepatic biliary obstruction (MEBO). We aimed to discuss the outcomes of EUS antegrade stent placement (EUS-AG) in the preoperative and palliative setting.

Methods

Retrospective review of patients who underwent EUS-AG for MEBO between December 2019 and December 2021 was done. Primary outcome measures were technical success and clinical success. Secondary outcome measures were number of days of hospitalization postprocedure, adverse events related to EUS-AG procedure, morbidity related to surgery, and 3-month mortality after surgery.

Results

54 patients underwent attempt for EUS-AG (mean age 54.8 ± 12.1 years; female 44.4%). Most common primary cancer was pancreatic cancer in 42.1% (23/54) patients. Indication was palliative in 34 (62.9%) patients and PBD in 20 (37%) patients. Level of block was distal in 35 (64.8%) and proximal in 19 (35.1%) patients. Technical success of EUS-AG was 88.7% (47/53). Clinical success was seen in 95.7% (45/47) patients. Median number of days of hospitalization postprocedure was 1 day. No procedure-related severe adverse events were seen. Of 20 patients who underwent EUS-AG as PBD, 19 had technical success (95%) with clinical success in 94.5% (18/19). Surgery was performed in 11 patients, of whom 10 patients underwent successful PPPD (one intraoperative liver metastasis). Two patients had Clavein–Dindo III/IV complication post-PPPD, with one mortality within 30 days of surgery.

Conclusion

EUS-AG is safe and effective after failed ERCP in both preoperative and palliative setting.

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Authors and Affiliations

  1. Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Mumbai, India

    Sridhar Sundaram, Kiran Mane, Prachi Patil, Raosaheb Rathod, Aadish Kumar Jain, Unique Tyagi & Shaesta Mehta

  2. Homi Bhabha National Institute, Parel, Mumbai, 400012, India

    Sridhar Sundaram, Kiran Mane, Prachi Patil, Raosaheb Rathod, Aadish Kumar Jain, Unique Tyagi & Shaesta Mehta

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  1. Sridhar Sundaram
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Sundaram, S., Mane, K., Patil, P. et al. Endoscopic Ultrasound-Guided Antegrade Stent Placement in Patients with Failed ERCP as a Modality of Preoperative and Palliative Biliary Drainage. Dig Dis Sci 68, 1551–1558 (2023). https://doi.org/10.1007/s10620-022-07655-w

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