Background and study aims Percutaneous transhepatic biliary drainage (PTBD) is the traditional second-line option after unsuccessful endoscopic retrograde cholangiopancreatography (ERCP). Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HG) is a viable alternative to PTBD. Our study aimed to compare outcomes of EUS-HG and PTBD for benign and malignant biliary diseases following failed ERCP.
Patients and methods This single-center study retrospectively analyzed patients undergoing EUS-HG and PTBD for benign and malignant biliary disorders. A propensity score-matched analysis was performed using age, sex, and Charlson Comorbidity Index. The primary outcome was clinical success, which we defined as a decrease in total bilirubin by ≥ 50% at 2 weeks for malignant disease and resolution of the biliary disorder for benign disease.
Results In total, 41 patients underwent EUS-HG and 138 patients
underwent PTBD. After propensity score matching in a 1:2 ratio, 32 EUS-HG patients were
matched with 64 PTBD. Technical success was achieved in 29 of 32 (91%) for EUS-HG and 63 of 64
(98%) for PTBD (P=0.11). Clinical success was 100% for EUS-HG and
75% for PTBD (P=0.0021). EUS-HG was associated with a lower adverse
event rate (EUS-HG 13% vs. PTBD 58%, P <0.0001), shorter
procedure duration (median 60 vs. 115 minutes, P <0.0001),
shorter post-procedure length of stay (median 2 vs. 4 days, P
<0.0001), and fewer reinterventions (median 1 vs. 3, P
<0.0001).
Conclusions Our results suggest that EUS-HG is superior to PTBD in the treatment of benign and malignant biliary disorders after failed ERCP.