Palliative Endoscopic Ultrasound Biliary Drainage for Advanced Malignant Biliary Obstruction: Should It Replace the Percutaneous Approach?

• Published in: Case reports in gastroenterology Vol. 13; no. 3; pp. 385 - 397
• Main Authors: Lesmana, C. Rinaldi A., Gani, Rino A., Hasan, Irsan, Sulaiman, Andri Sanityoso, Ho, Khek Yu, Dhir, Vinay, Lesmana, Laurentius A.
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland S. Karger AG 01.09.2019; Karger Publishers
• Subjects: Bile; Case reports; Case Series; Clinical outcomes; Endoscopic retrograde cholangiopancreatography; Endoscopic ultrasound-guided biliary drainage; Endoscopic ultrasound-guided choledochoduodenostomy; Endoscopy; Fistula; Kidney cancer; Malignant biliary obstruction; Medical prognosis; Metastasis; Pancreatic cancer; Patients; Percutaneous transhepatic biliary drainage; Success; Systematic review; Ultrasonic imaging; Endoscopic ultrasound-guided biliary drainage; Endoscopic retrograde cholangiopancreatography; Malignant biliary obstruction; Endoscopic ultrasound-guided choledochoduodenostomy; Percutaneous transhepatic biliary drainage
• ISSN: 1662-0631; 1662-0631
• DOI: 10.1159/000502835

Endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic biliary drainage (PTBD) are the standard of care in malignant biliary obstruction cases. Recently, endoscopic ultrasound-guided biliary drainage (EUS-BD) has been widely used after unsuccessful ERCP. However, the patient’s clinical impact of EUS-BD over PTBD is still not obvious. Therefore, this case series study aims to evaluate the clinical outcomes of patients with advanced malignant biliary obstruction who underwent EUS-BD after failed ERCP. A retrospective database study was performed between January 2016 and June 2018 in patients with advanced malignant biliary obstruction. Patients were consecutively enrolled without randomization. Treatment options consisted of ERCP and PTBD or EUS-BD if ERCP failed. Based on 144 biliary obstruction cases, 38 patients were enrolled; 24 (63.2%) were men. The patients’ mean age was 66.8 ± 12.36 years. The most common cause of malignant biliary obstruction was pancreatic cancer (44.7%). Biliary drainage was achieved by ERCP (39.5%), PTBD (39.5%), and EUS-BD (21.1%). The technical success rate was 86.7% by PTBD and 87.5% by EUS-BD (p = 1.000), while the clinical success rate was 93.3% by PTBD and 62.5% by EUS-BD (p = 0.500). The median survival in patients who underwent PTBD versus those wo underwent EUS-BD was 11 versus 3 months (log-rank p = 0.455). In conclusion, there is no significant advantage of EUS-BD when compared to PTBD in terms of clinical success and survival benefit in advanced malignant biliary obstruction.