Patient perception and preference of EUS-guided drainage over percutaneous drainage when endoscopic transpapillary biliary drainage fails: An international multicenter survey

Abstract

Background and Objectives:EUS-guided biliary drainage (EUS-BD) is a feasible procedure when ERCP fails, as is percutaneous transhepatic BD (PTBD). However, little is known about patient perception and preference of EUS-BD and PTBD.Patients and Methods:An international multicenter survey was conducted in seven tertiary referral centers. In total, 327 patients, scheduled to undergo ERCP for suspected malignant biliary obstruction, were enrolled in the study. Patients received decision aids with visual representation regarding the techniques, benefits, and adverse events (AEs) of EUS-BD and PTBD. Patients were then asked the choice between the two simulated scenarios (EUS-BD or PTBD) after failed ERCP, the reasons for their preference, and whether altering AE rates would influence their prior choice.Results:In total, 313 patients (95.7%) responded to the questionnaire and 251 patients (80.2%) preferred EUS-BD. The preference of EUS-BD was 85.7% (186/217) with EUS-BD expertise, compared to 67.7% (65/96) without EUS-BD expertise (P < 0.001). The main reason for choosing EUS-BD was the possibility of internal drainage (78.1%). In multivariate analysis, the availability of EUS-BD expertise was the single independent factor that influenced patient preference (odds ratio: 3.168; 95% of confidence interval, 1.714–5.856; P < 0.001). The preference of EUS-BD increased as AE rates decreased (P < 0.001).Conclusions:In this simulated scenario, approximately 80% of patients preferred EUS-BD over PTBD after failed ERCP. However, preference of EUS-BD declined as its AE rates increased. Further technical innovations and improved proficiency in EUS-BD for reducing AEs may encourage the use of this procedure as a routine clinical practice when ERCP fails.

Relief of biliary obstruction: choosing between endoscopic ultrasound and endoscopic retrograde cholangiopancreatography

“…However, in addition to the high morbidity and reduced quality of life with PTBD, a recent international survey demonstrated that many patients (not surprisingly) would prefer internal BD over an external drain. 86 As a result, a growing number of studies have explored EUS-BD role in managing BBD. 10 11 21 83 87–92…”

Safety and outcomes of endoscopic ultrasound-guided drainage for malignant biliary obstruction using cautery-enabled lumen-apposing metal stent

“…This is due to the risks of accidental dislocation of an external drainage tube and recurrent infections, which have a significant negative impact on quality of life. From a patient standpoint, the possibility of internal drainage is appealing due to convenience and likely improved quality of life, which is supported by a multicenter survey in which more than 80 % of patients preferred EUS-BD over PTBD 4 . Historical surgical biliary bypass is seldom used as the preferred treatment option because it is associated with higher morbidity and mortality 5 6 .…”

Practical applications and learning curve for EUS-guided hepaticoenterostomy: results of a large single-center US retrospective analysis

“…While often technically successful, PTBD has several notable disadvantages including risk of bleeding, bile leakage, pain at the insertion site and cosmetic dissatisfaction 2 3 . As a result, PTBD is associated with a decrease in patient quality of life and patients overwhelmingly prefer internal biliary drainage when possible 4 5 .…”