EUS-guided intrahepatic biliary drainage: a large retrospective series and subgroup comparison between percutaneous drainage in hilar stenoses or postsurgical anatomy

Giuseppe Vanella; Michiel Bronswijk; Geert Maleux; Hannah van Malenstein; Wim Laleman; Schalk Van der Merwe

doi:10.1055/a-1264-7511

Endoscopy International Open, Table of Contents

CC BY-NC-ND 4.0 · Endosc Int Open 2020; 08(12): E1782-E1794
DOI: 10.1055/a-1264-7511

Original article

EUS-guided intrahepatic biliary drainage: a large retrospective series and subgroup comparison between percutaneous drainage in hilar stenoses or postsurgical anatomy

Giuseppe Vanella

¹Department of Gastroenterology and Hepatology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium

²Pancreatobiliary Endoscopy and Endosonography Division, IRCSS San Raffaele Scientific Institute, Milan, Italy

,

Michiel Bronswijk

¹Department of Gastroenterology and Hepatology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium

,

Geert Maleux

³Department of Interventional Radiology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium

,

Hannah van Malenstein

¹Department of Gastroenterology and Hepatology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium

,

Wim Laleman

¹Department of Gastroenterology and Hepatology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium

,

Schalk Van der Merwe

¹Department of Gastroenterology and Hepatology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium

› Author Affiliations

Abstract

Background and study aims Endoscopic ultrasound-guided intrahepatic biliary drainage (EUS-IBD) struggles to find a place in management algorithms, especially compared to percutaneous drainage (PTBD). In the setting of hilar stenoses or postsurgical anatomy data are even more limited.

Patients and methods All consecutive EUS-IBDs performed in our tertiary referral center between 2012 – 2019 were retrospectively evaluated. Rendez-vous (RVs), antegrade stenting (AS) and hepatico-gastrostomies (HGs) were compared. The predefined subgroup of EUS-IBD patients with proximal stenosis/surgically-altered anatomy was matched 1:1 with PTBD performed for the same indications. Efficacy, safety and events during follow-up were compared.

Results One hundred four EUS-IBDs were included (malignancies = 87.7 %). These consisted of 16 RVs, 43 ASs and 45 HGs. Technical and clinical success rates were 89.4 % and 96.2 %, respectively. Any-degree, severe and fatal adverse events (AEs) occurred in 23.3 %, 2.9 %, and 0.9 % respectively. Benign indications were more common among RVs while proximal stenoses, surgically-altered anatomy, and disconnected left ductal system among HGs. Procedures were shorter with HGs performed with specifically designed stents (25 vs. 48 minutes, P = 0.004) and there was also a trend toward less dysfunction with those stents (6.7 % vs. 30 %, P = 0.09) compared with previous approaches. Among patients with proximal stenosis/surgically-altered anatomy, EUS-IBD vs. PTBD showed higher rates of clinical success (97.4 % vs. 79.5 %, P = 0.01), reduced post-procedural pain (17.8 % vs. 44.4 %, p = 0.004), shorter median hospital stay (7.5 vs 11.5 days, P = 0.01), lower rates of stent dysfunction (15.8 % vs. 42.9 %, P = 0.01), and the mean number of reinterventions was lower (0.4 vs. 2.8, P < 0.0001).

Conclusions EUS-IBD has high technical and clinical success with an acceptable safety profile. HGs show comparable outcomes, which are likely to further improve with dedicated tools. For proximal strictures and surgically-altered anatomy, EUS-IBD seems superior to PTBD.

Full Text

References

References
1 Enochsson L, Swahn F, Arnelo U. et al. Nationwide, population-based data from 11,074 ERCP procedures from the Swedish Registry for Gallstone Surgery and ERCP. Gastrointest Endosc 2010; 72 Epub ahead of print
2 Khashab M, El Zein M, Sharzehi K. et al. EUS-guided BD or enteroscopy-assisted ERCP in patients with surgical anatomy and biliary obstruction: an international comparative study. Endosc Int Open 2016; 04: E1322-E1327
3 Giovannini M. EUS-guided hepaticogastrostomy. Endosc Ultrasound 2019; 8: 35
4 Anderloni A, Fugazza A, Troncone E. et al. Single-stage EUS-guided choledochoduodenostomy using a lumen-apposing metal stent for malignant distal biliary obstruction. Gastrointest Endosc 2019; 89: 69-76
5 Park JK, Woo YS, Noh DH. et al. Efficacy of EUS-guided and ERCP-guided biliary drainage for malignant biliary obstruction: prospective randomized controlled study. Gastrointest Endosc 2018; 88: 277-282
6 Bang JY, Navaneethan U, Hasan M. et al. Stent placement by EUS or ERCP for primary biliary decompression in pancreatic cancer: a randomized trial (with videos). Gastrointest Endosc 2018; 88: 9-17
7 Khan MA, Akbar A, Baron TH. et al. Endoscopic ultrasound-guided biliary drainage: a systematic review and meta-analysis. New York LLC: Springer;
8 Dhir V, Artifon ELA, Gupta K. et al. Multicenter study on endoscopic ultrasound-guided expandable biliary metal stent placement: Choice of access route, direction of stent insertion, and drainage route. Dig Endosc 2014; 26: 430-435
9 Cotton PB, Eisen GM, Aabakken L. et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010; 71: 446-454
10 Sha J, Dong Y, Niu H. A prospective study of risk factors for in-hospital mortality in patients with malignant obstructive jaundice undergoing percutaneous biliary drainage. Medicine (Baltimore) 2019; 98: e15131
11 Takahashi K, Tsuyuguchi T, Saiga A. et al. Risk factors of ineffective drainage in uncovered self-expandable metal stenting for unresectable malignant hilar biliary strictures. Oncotarget 2018; 9: 28185-28194
12 Kanno Y, Ito K, Koshita S. et al. EUS-guided biliary drainage for malignant perihilar biliary strictures after further transpapillary intervention has been judged to be impossible or ineffective. Intern Med 2017; 56: 3145-3151
13 Nakai Y, Isayama H, Yamamoto N. et al. Conversion to endoscopic ultrasound-guided biliary drainage by temporary nasobiliary drainage placement in patients with prior biliary stenting. Endosc Ultrasound 2017; 6: 323-328
14 Panpimanmas S, Ratanachu-Ek T. Endoscopic ultrasound-guided hepaticogastrostomy for advanced cholangiocarcinoma after failed stenting by endoscopic retrograde cholangiopancreatography. Asian J Surg 2013; 36: 154-158
15 Ardengh JC, Lopes CV, Kemp R. et al. Different options of endosonography-guided biliary drainage after endoscopic retrograde cholangio-pancreatography failure. World J Gastrointest Endosc 2018; 10: 99-108
16 Gupta K, Perez-Miranda M, Kahaleh M. et al. Endoscopic ultrasound-assisted bile duct access and drainage: Multicenter, long-term analysis of approach, outcomes, and complications of a technique in evolution. J Clin Gastroenterol 2014; 48: 80-87
17 Sassatelli R, Cecinato P, Lupo M. et al. Endoscopic ultrasound-guided biliary drainage for malignant biliary obstruction after failed ERCP in low performance status patients. Dig Liver Dis 2019; Epub ahead of print
18 Khashab M, Van der Merwe S, Kunda R. et al. Prospective international multicenter study on endoscopic ultrasound-guided biliary drainage for patients with malignant distal biliary obstruction after failed endoscopic retrograde cholangiopancreatography. Endosc Int Open 2016; 04: E487-E496
19 De Cassan C, Bories E, Pesenti C. et al. Use of partially covered and uncovered metallic prosthesis for endoscopic ultrasound-guided hepaticogastrostomy: Results of a retrospective monocentric study. Endosc Ultrasound 2017; 6: 329
20 Oh D, Park DH, Song TJ. et al. Optimal biliary access point and learning curve for endoscopic ultrasound-guided hepaticogastrostomy with transmural stenting. Therap Adv Gastroenterol 2017; 10: 42-53
21 Paik WH, Lee TH, Park DH. et al. EUS-guided biliary drainage versus ERCP for the primary palliation of malignant biliary obstruction: a multicenter randomized clinical trial. Am J Gastroenterol 2018; 113: 987-997
22 Lee TH, Choi JH, Park DH. et al. Similar efficacies of endoscopic ultrasound-guided transmural and percutaneous drainage for malignant distal biliary obstruction. Clin Gastroenterol Hepatol 2016; 14: 1011-1019.e3
23 Artifon ELA, Aparicio D, Paione JB. et al. Biliary drainage in patients with unresectable, malignant obstruction where ERCP fails: Endoscopic ultrasonography-guided choledochoduodenostomy versus percutaneous drainage. J Clin Gastroenterol 2012; 46: 768-774
24 Han SY, Kim SO, So H. et al. EUS-guided biliary drainage versus ERCP for first-line palliation of malignant distal biliary obstruction: A systematic review and meta-analysis. Sci Rep 2019; Epub ahead of print
25 Miller CS, Barkun AN, Martel M. et al. Endoscopic ultrasound-guided biliary drainage for distal malignant obstruction: a systematic review and meta-analysis of randomized trials. Endosc Int Open 2019; 7: E1563-E1573
26 Artifon ELA, Marson FP, Gaidhane M. et al. Hepaticogastrostomy or choledochoduodenostomy for distal malignant biliary obstruction after failed ERCP: Is there any difference?. Gastrointest Endosc 2015; 81: 950-959
27 Wang K, Zhu J, Xing L. et al. Assessment of efficacy and safety of EUS-guided biliary drainage: A systematic review. Gastrointest Endosc 2016; 83: 1218-1227
28 Ogura T, Chiba Y, Masuda D. et al. Comparison of the clinical impact of endoscopic ultrasound-guided choledochoduodenostomy and hepaticogastrostomy for bile duct obstruction with duodenal obstruction. [Erratum appears in Endoscopy. 2016 Feb;48(2):163; PMID: 26418074]. Endoscopy 2016; 48: 156-163
29 Sharaiha RZ, Khan MA, Kamal F. et al. Efficacy and safety of EUS-guided biliary drainage in comparison with percutaneous biliary drainage when ERCP fails: a systematic review and meta-analysis. Gastrointestinal Endoscopy 2017; 85: 904-914
30 Sportes A, Camus M, Greget M. et al. Endoscopic ultrasound-guided hepaticogastrostomy versus percutaneous transhepatic drainage for malignant biliary obstruction after failed endoscopic retrograde cholangiopancreatography: A retrospective expertise-based study from two centers. Therap Adv Gastroenterol 2017; 10: 483-493
31 Bapaye A, Dubale N, Aher A. Comparison of endosonography-guided vs. Percutaneous biliary stenting when papilla is inaccessible for ERCP. United Eur Gastroenterol J 2013; 1: 285-293
32 Ogura T, Onda S, Takagi W. et al. Clinical utility of endoscopic ultrasound-guided biliary drainage as a rescue of re-intervention procedure for high-grade hilar stricture. J Gastroenterol Hepatol 2017; 32: 163-168
33 Minaga K, Takenaka M, Kitano M. et al. Rescue EUS-guided intrahepatic biliary drainage for malignant hilar biliary stricture after failed transpapillary re-intervention. Surg Endosc 2017; 31: 4764-4772
34 Paik WH, Lee NK, Nakai Y. et al. Conversion of external percutaneous transhepatic biliary drainage to endoscopic ultrasound-guided hepaticogastrostomy after failed standard internal stenting for malignant biliary obstruction. Endoscopy 2017; 49: 544-548
35 Park DH, Lee TH, Paik WH. et al. Feasibility and safety of a novel dedicated device for one-step EUS-guided biliary drainage: A randomized trial. J Gastroenterol Hepatol 2015; 30: 1461-1466
36 Paik W, Park D. Outcomes and limitations: EUS-guided hepaticogastrostomy. Endosc Ultrasound 2019; 8: 44
37 Tyberg A, Desai AP, Kumta NA. et al. EUS-guided biliary drainage after failed ERCP: a novel algorithm individualized based on patient anatomy. Gastrointest Endosc 2016; 84: 941-946

Supplementary Material

Supplementary material