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EUS-guided biliary drainage in patients with moderate–severe cholangitis is safe and effective: a multi-center experience

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Abstract

Background

Patients with moderate–severe cholangitis require urgent/early biliary drainage and failed endoscopic retrograde cholangiopancreatography (ERCP) warrants use of percutaneous drainage. While endoscopic ultrasound-guided biliary drainage (EUS-BD) has evolved as an effective salvage modality but its safety and efficacy data in moderate–severe cholangitis are limited.

Patients and methods

All consecutive moderate–severe cholangitis patients, with failed/technically non-feasible ERCP requiring EUS-BD in two tertiary care centers were included. Baseline laboratory and demographic parameters were documented. Technical and clinical success were primary outcome measures. Additionally, effective biliary drainage, adverse events due to procedure, hospital stay, ICU stay, and mortality were noted.

Results

Of the 49 patients (23 male; 46.9%) presenting with moderate/severe cholangitis, 23 (46.9%) had severe cholangitis. The median Charleston comorbidity index was 7.0 (IQR 2.0). Majority had malignant disease (87.8%) and 25 (51.0%) had inaccessible papilla. Technical success was achieved in 48 cases (98.0%), while clinical success with improvement of cholangitis was noted in 44 of 48 cases (91.7%). Effective biliary drainage was noted in 85.4% (41/48) cases. Adverse events in the form of mostly bleeding and bile leak were noted in 5 cases (10.2%) but managed conservatively. Distal obstruction exhibited significantly better clinical success (100% vs. 78.9%; p = 0.02) than hilar obstruction. Severe cholangitis had significantly lower clinical success (81.8% vs. 100%; p = 0.04) than moderate cholangitis.

Conclusion

EUS-BD can be a safe and effective alternative option for patients with moderate to severe cholangitis, even with significant pre-morbid conditions, with acceptable adverse events rate.

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  1. Jayanta Samanta and Sridhar Sundaram have contributed equally and are co-first authors.

Authors and Affiliations

  1. Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Sector -12, Chandigarh, 160012, India

    Jayanta Samanta, Jahnvi Dhar, Pankaj Gupta, Saroj Kant Sinha & Rakesh Kochhar

  2. Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India

    Sridhar Sundaram, Kiran Mane, Prachi Patil & Shaesta Mehta

  3. Department of GI Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India

    Vikas Gupta

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  1. Jayanta Samanta
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Contributions

JS, SS contributed to conception and design, data interpretation, data analysis, drafting the work, patient care, and doing the procedure and final approval. JD, KM contributed to data acquisition, data interpretation, patient care, intellectual review of the work, and final approval. PG, VG, PP, SKS, RK, SM contributed to data acquisition, patient care, intellectual review of the work, and final approval. All the authors have approved the final version of the work.

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Correspondence to Jayanta Samanta.

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Disclosures

The authors Drs. Jayanta Samanta, Sridhar Sundaram, Jahnvi Dhar, Kiran Mane, Pankaj Gupta, Vikas Gupta, Prachi Patil, Saroj Kant Sinha, Rakesh Kochhar, and Shaesta Mehta have no conflicts of interest or financial ties to disclose.

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Samanta, J., Sundaram, S., Dhar, J. et al. EUS-guided biliary drainage in patients with moderate–severe cholangitis is safe and effective: a multi-center experience. Surg Endosc 37, 298–308 (2023). https://doi.org/10.1007/s00464-022-09495-1

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  • DOI: https://doi.org/10.1007/s00464-022-09495-1

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