A retrospective comparative study of biliary drainage using balloon endoscopy and endoscopic ultrasound for malignant obstruction in patients with surgically altered anatomy

期刊论文
发表日期：

2024年10月14日

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Ryunosuke Hakuta,
Kota Ishida,
Yousuke Nakai,
Hirofumi Kogure,
Hiroto Nishio,
Kouhei Kurihara,
Shuichi Tange,
Rintaro Fukuda,
Shinya Takaoka,
Yukari Suzuki,
Hiroki Oyama,
Sachiko Kanai,
Kensaku Noguchi,
Tatsunori Suzuki,
Tatsuya Sato,
Kazunaga Ishigaki,
Tomotaka Saito,
Tsuyoshi Hamada,
Naminatsu Takahara,
Mitsuhiro Fujishiro

摘要

Background and aims

Endoscopic biliary drainage for malignant biliary obstruction (MBO) in patients with surgically altered anatomy is challenging, and technical difficulty could differ by the anatomy. Balloon endoscopy-assisted endoscopic retrograde cholangiopancreatography (BE-ERCP) and endoscopic ultrasonography-guided biliary drainage (EUS-BD) are both emerging procedures, and we conducted the single-center, retrospective study to compare clinical outcomes of BE-ERCP and EUS-BD for MBO.

Methods

Consecutive patients with surgically altered anatomy who underwent BE-ERCP or EUS-BD for MBO were retrospectively studies. Technical and clinical success rates, adverse events (AEs), and time to recurrent biliary obstruction (TRBO) were compared.

Results

Patient characteristics were comparable between BE-ERCP (n = 118) and EUS-BD (n = 32), other than more patients with hepaticojejunostomy in the BE-ERCP group (66% vs. 44%, P = 0.03). Technical success rate was significantly higher in the EUS-BD group (70% vs. 94%, P = 0.005), but clinical success rates (84% vs. 90%, P = 0.55), early AE (14% vs. 22%, P = 0.29) and late AE rates (42% vs. 38%, P = 0.84), and RBO rates (31% vs. 34%, P = 0.67) were comparable between the groups. TRBO was 170 and 206 days in the BE-ERCP and EUS-BD group (P = 0.37). In the subgroup analysis of patients with the intact papilla, the technical success rate of BE-ERCP was as low as 55%, compared to 94% in EUS-BD (P = 0.003).

Conclusion

EUS-BD was associated with higher technical success rate than BE-ERCP for MBO in patients with surgically altered anatomy.