EUS-Guided Biliary Drainage for Unresectable Malignant Biliary Obstruction: 10-Year Experience of 99 Cases at a Single Center
- 13 Downloads
To evaluate clinical outcomes of endoscopic ultrasound (EUS)-guided biliary drainage (EUS-BD) for unresectable malignant biliary obstruction for cases in which endoscopic retrograde cholangiopancreatography (ERCP) failed at a high-volume center.
All 99 EUS-BD cases of unresectable malignant biliary obstruction at Sendai City Medical Center between February 2007 and September 2017 were retrospectively evaluated. ERCP is strictly prioritized over EUS-BD during the study period, and EUS-BD was performed in cases wherein ERCP was impossible or ineffective. Technical success, clinical success, adverse events, and time to recurrence of biliary obstruction were evaluated.
EUS-BD was technically successful in 98% of the patients (97/99). The clinical success rate was 93% (90/97). Adverse events that were definitely related to the procedure were observed in ten patients (10%; peritonitis in six, acute cholecystitis in four). Of six patients with bile peritonitis, four suffered from mild localized peritonitis that improved with conservative treatment, whereas two developed pan-peritonitis that improved with additional intervention. Other three patients with a poor performance status succumbed shortly after the successful EUS-BD, with a possible association between the procedure and death. In the 68 patients with a bilioenteric stent, the median time to recurrence of biliary obstruction was 339 days (95% confidence interval (CI), 14–664 days) during the mean follow-up period of 136 ± 173 days.
EUS-BD was found to be feasible. However, there were a few patients with an unfavorable course after successful EUS-BD.
KeywordsEndosonography Choledochoduodenostomy Hepaticogastrostomy Indication Adverse event
All authors had access to the study data and reviewed and approved the final manuscript.
Compliance with Ethical Standards
Both the EUS-BD procedure and this study were approved by the Institutional Review Board of Sendai City Medical Center. Written informed consent for EUS-BD was obtained with presenting risks and benefits in comparison with other possible options from all patients before the procedure.
Conflict of Interest
The authors declare that they have no conflicts of interest.
- 7.Eastern Cooperative Oncology Group (1999) Common toxicity criteria, version 2.0. http://ctepcancergov/protocolDevelopment/electronic_applications/docs/ctcv20_4-30-992pdf April 30, 1999.
- 12.Khashab MA, Van der Merwe S, Kunda R, El Zein MH, Teoh AY, Marson FP, et al. Prospective international multicenter study on endoscopic ultrasound-guided biliary drainage for patients with malignant distal biliary obstruction after failed endoscopic retrograde cholangiopancreatography. Endosc Int Open. 2016;4:E487–96.CrossRefPubMedPubMedCentralGoogle Scholar
- 16.Tsuchiya T, Teoh AYB, Itoi T, Yamao K, Hara K, Nakai Y, Isayama H, Kitano M (2017) Long-term outcomes of EUS-guided choledochoduodenostomy using a lumen-apposing metal stent for malignant distal biliary obstruction: a prospective multicenter study. Gastrointest EndoscGoogle Scholar