Endoscopic ultrasound-guided biliary drainage for distal malignant biliary obstruction: a prospective 3-year multicenter Egyptian study

Abstract

Background/Aim: Malignant biliary obstruction (MBO) is often diagnosed at late stages with mostly unresectable lesions. Recently, EUS-guided biliary drainage (EUS-BD) has gained wide acceptance and appears to be a feasible and safe backup option after ERCP failure in such patients. Herein, we aimed to represent a 3-year multi-center Egyptian experience in the application of this challenging procedure for distal MBO as a salvage technique after failed ERCP. Patients and methods: This was a prospective multi-center study of patients underwent EUS-BD for distal MBO in the duration between December 2018 and December 2021, after ERCP failure. Results: Ninety-one patients (59 males, median age: 61 years) were included in the study. EUS-guided extrahepatic approach including choledocho-duodenostomy (CDS) was done for 48 patients (52.8%), followed by choledecho-antrostomy (CAS) in 4 patients (4.4%). The intrahepatic approach included hepaticogastrostomy (HGS) for 35 patients (38.5%) and antegrade stenting (AG) stenting in 2 patients (2.2%), while Rendezvous (RV) approach was performed in 2 patients (2.2%). Technical and Clinical success were achieved in the majority of cases; 93.4% and 94.1% respectively. Adverse events occurred in 13.2% of patients which were mostly mild (8.2%) to moderate (2.4%). Only one patient died within 48h after the procedure with progression of preceding sepsis and organ failure. Conclusion: EUS-BD is a feasible option, even in developing countries, after a failed ERCP, and it is a relatively safe option in patients with MBO once experienced team and resources were present. Majority of cases in our study have achieved technical and clinical success with relatively low incidence of adverse events

Primary endoscopic ultrasound-guided choledochoduodenostomy versus endoscopic retrograde cholangiopancreatography for the drainage of distal malignant biliary obstruction: An Egyptian multicenter, prospective, comparative study

“…Compared to our group's previous publication, 6 the incidence of AEs during the EUS-BD maneuver was significantly reduced, with only one case of stent maldeployment observed. This supports the proposal that the learning curve for EUS-BD is steep and that proficiency linearly increases with the number of cases performed, potentially making it easier to master than ERCP training.…”

“…However, the recent ESGE guidelines published in 2022 have strongly recommended endoscopic ultrasound-guided BD (EUS-BD) over PTBD, as it offers comparable efficacy and better quality of life with a high safety profile. 4 EUS-BD has gained popularity worldwide since it was reported in 2001, 5 even in developing countries, 6 with accumulating evidence of its favorable technical and clinical outcomes. Although major AEs, such as bile leaks and even lethal complications, have been reported, 7 the incidence of these AEs has decreased in more recent publications due to the growing learning curve and increased experience among practitioners.…”