Endoscopy 2020; 52(S 01): S146-S147
DOI: 10.1055/s-0040-1704452
ESGE Days 2020 ePoster Podium presentations
Thursday, April 23, 2020 11:30 – 12:00 Biliary drainage ePoster Podium 3
© Georg Thieme Verlag KG Stuttgart · New York

COMPARISON OF LONG-TERM SUCCESS RATES OF EUS GUIDED BILIARY DRAINAGE VIA EUS GUIDED TRANSMURAL AND TRANSPAPILLARY APPROACH - A SINGLE CENTER RETROSPECTIVE COMPARATIVE STUDY

S Dharamsi
Deenanath Mangeshkar Hospital and Research Center, Shivanand Desai Center for Digestive Disorders, Pune, India
,
P Dashatwar
Deenanath Mangeshkar Hospital and Research Center, Shivanand Desai Center for Digestive Disorders, Pune, India
,
G Lakamaji
Deenanath Mangeshkar Hospital and Research Center, Shivanand Desai Center for Digestive Disorders, Pune, India
,
R Pujari
Deenanath Mangeshkar Hospital and Research Center, Shivanand Desai Center for Digestive Disorders, Pune, India
,
H Gadhikar
Deenanath Mangeshkar Hospital and Research Center, Shivanand Desai Center for Digestive Disorders, Pune, India
,
A Bapaye
Deenanath Mangeshkar Hospital and Research Center, Shivanand Desai Center for Digestive Disorders, Pune, India
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

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    Aims EUS guided biliary drainage (EUS-BD) is an accepted treatment after failed ERCP in patients with malignant biliary obstruction (MBO). Transpapillary (TP) [antegrade, rendezvous] or Transmural (TM) [choledochoduodenostomy, hepatogastrostomy] approach may be used. This study compares long-term success rates of EUS-BD by TM or TP.

    Methods Retrospective analysis ofprospectively maintained database of patients undergoing EUS-BD for MBO and failed ERCP. Study duration - 8 years (2011 - 2019). Patients underwent EUS BD by TP or TM approach using self-expandable metal stents (SEMS).Patients followed up until stent occlusion or death, whichever was earlier. Stent patency and adverse events were compared.

    Results Total N = 93; TM - 60 (64.8%), TP - 33 (35.2%). Median age = 64.7years (IQR 39 - 96); 55 (59.2%) males. Both groups were comparable for demographic and clinical characteristics. Level of biliary obstruction was comparable in both groups - distal - TM - 44 (73.3%); TP - 24 (72.2%), p=1.00; proximal - TM - 16 (26.7 %); TP - 9 (27.8%), p=1.00. EUS-BD was technically successful in all except one in TM group. Follow up - median 69 days (IQR 16-324) for cohort; TM - 68 (26 - 324); TP - 85 (16-275); p=0.30. Stent occlusion was significantly more frequent in TP than TM group [11/33 (33%) vs 5/60 (8.3%); p=0.02]. Stent migrationwas more frequent in TM group. Overall stent related adverse events were comparable inboth groups (TP - 10/33, 30.3%; TM - 9/60, 15%, p=0.19). Median stent patency after TM = 54 days (35 - 98) vs. TP = 65 days (32 - 105), p=1.07. Kaplan Meier survival graph revealed superior survival for TM group.

    Conclusions For patients undergoing EUS-BD for MBO, stent patency after TM approach was significantly superior to TP approach. Stent migration occurred more in TM group. Further randomized studies are recommended to confirm these findings.


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