Feasibility and Safety of Endoscopic Ultrasound-Guided Biliary Drainage (EUS-BD) for Malignant Biliary Obstruction Associated with Ascites: Results of a Pilot Study
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It has been suggested that EUS-BD may be a feasible and safer alternative to percutaneous transhepatic biliary drainage (PTBD) after failed ERCP in patients with ascites. To date, no study has specifically evaluated the performance of EUS-BD in this context.
Retrospective analysis was done for patients with and without ascites who underwent EUS-BD for malignant biliary obstruction after failed ERCP between July 2010 and September 2014. Complications and technical and clinical successes between the two groups were compared.
A total of 31 patients were included: 20 patients without ascites (group 1) and 11 with ascites (group 2). Nineteen patients underwent EUS-hepaticogastrostomy (six in group 2), and 12 underwent EUS-choledochoduodenostomy (five in group 2). Technical success was achieved in all patients. Clinical success was observed in 95% (n = 19) in group 1 and 64% (n = 7) in group 2 (p = 0.042). In three out of four patients without clinical success in group 2, the follow-up period was not long enough to observe the clinical response because of early death within the 2 weeks after EUS-BD secondary to disease progression or preprocedural unresponsive sepsis. No significant differences were observed between groups 1 and 2 either in the overall rates of procedural-related complications (20 and 9%, respectively, p = 0.63) or in the rates of major complications (15 vs 9%, respectively, p = 0.639). Stent migration occurred in one patient in each group, intra- or post-procedural bleeding occurred in two patients in group 1, which was conservatively managed, and one patient in group 1 presented biliary leakage. Stent patency and the number of re-interventions were not significantly different.
EUS-BD is technically feasible in patients with ascites. Our results suggest that EUS-BD may be a clinically effective and safe alternative after failed ERCP in patients with ascites.
KeywordsMalignant biliary obstruction Endoscopic ultrasound-guided biliary drainage Ascites Hepaticogastrostomy Choledocoduonenostomy Endoscopic retrograde cholangiopancreatography
All the above authors meet the criteria for authorship as per the guidelines of the International Committee of Medical Journal Editors (ICMJE): substantial contributions to the study design, manuscript drafting, data analysis, critical revision, and final approval. All authors agree with the contents of the manuscript and confirm that the paper is not being published or under consideration elsewhere.
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Conflict of Interest
Bertrand Napoléon and Fabien Fumex received educational fees from Boston Scientific S.A. Drs. María-Victoria Alvarez-Sánchez, Olivia B. Luna, Inés Oria, Katherine Marchut, Gaetan Singier, and Angel Salgado have no conflicts of interest or financial ties to disclose.
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