Biliary decompression: an institutional comparison of percutaneous and endoscopic methods.

Abstract

Endoscopically performed biliary drainage (EPBD) is now an alternative to percutaneous biliary drainage. The morbidity, mortality, and survival statistics of 97 patients with obstructive jaundice who had undergone percutaneous transhepatic biliary drainage (PTBD) and surgery, PTBD alone, EPBD and surgery, or EPBD alone were compared. Overall, the EPBD group had fewer complications and lower mortality than the other groups. When palliative treatment of patients with malignancies was compared, the complication rates associated with EPBD and PTBD were similar; however, mortality was lower with EPBD. No negative effect on survival was found with EPBD. In addition, EPBD offered several additional advantages over PTBD, including fewer bleeding complications, better patient acceptance, and avoidance of external catheter care. EPBD should be considered as a viable alternative to PTBD. Additional studies are needed to determine whether it is to be considered the initial drainage procedure of choice in patients with obstructive jaundice.

Endoscopic ultrasonography-guided biliary drainage: an alternative to percutaneous transhepatic puncture

“…It was reported that the technical success rate of PTBD ranges from 75% to 100%, its clinical success rate ranges from 65% to 92%, and its complication rate ranges from 9% to 31%. [61][62][63][64] The average complication rate of the combined data for each EUS-guided drainage procedure in our review was not higher than that of the papers for PTBD in the past 2 decades. In recent years, many papers have reported on EUS-guided drainage as an alternative procedure to PTBD.…”

Palliation of Malignant Obstructive Jaundice

“…Table 3 summarizes the data [28,[92][93][94][95]. It is generally perceived that trans-hepatic drainage carries a higher risk of morbidity than does endoscopic drainage, with four of the five studies reviewed demonstrating this, although only one study by Speer et al found this difference to be statistically significant.…”

Surgical palliation in patients with pancreatic cancer

“…Up to now, in most of the centers where both techniques are applicable, the endoscopic route is regarded as the first choice, while transhepatic access is used in case of endoscopic failure or inapplicability [12,13].…”