EUS-guided hepaticogastrostomy versus percutaneous transhepatic biliary drainage after failed ERCP: A propensity score-matched analysis

Abstract

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.

Keywords

Biliary tract - Endoscopic ultrasonography - Intervention EUS - Stones - Strictures

Publikationsverlauf

Eingereicht: 19. Juli 2023

Angenommen nach Revision: 16. November 2023

Artikel online veröffentlicht:
19. Januar 2024

• References

• 1 Giovannini M. EUS-guided hepaticogastrostomy. Endosc Ultrasound 2019; 8: S35-S39
• 2 Ferrucci JT, Mueller PR, Harbin WP. Percutaneous transhepatic biliary drainage: technique, results, and applications. Radiology 1980; 135: 1-13
• 3 Nakayama T, Ikeda A, Okuda K. Percutaneous transhepatic drainage of the biliary tract: technique and results in 104 cases. Gastroenterology 1978; 74: 554-559
• 4 Isayama H. Pancreato-biliary endoscopy: History of endoscopic biliary drainage. Digest Endosc 2022; 34: 111-115
• 5 James TW, Fan YC, Baron TH. EUS-guided hepaticoenterostomy as a portal to allow definitive antegrade treatment of benign biliary diseases in patients with surgically altered anatomy. Gastrointest Endosc 2018; 88: 547-554
• 6 Giovannini M, Moutardier V, Pesenti C. et al. Endoscopic ultrasound-guided bilioduodenal anastomosis: a new technique for biliary drainage. Endoscopy 2001; 33: 898-900
• 7 Khashab MA, Valeshabad AK, Afghani E. et al. A comparative evaluation of EUS-guided biliary drainage and percutaneous drainage in patients with distal malignant biliary obstruction and failed ERCP. Dig Dis Sci 2015; 60: 557-565
• 8 Bapaye A, Dubale N, Aher A. Comparison of endosonography-guided vs. percutaneous biliary stenting when papilla is inaccessible for ERCP. United Europ Gastroenterol J 2013; 1: 285-293
• 9 Sharaiha RZ, Kumta NA, Desai AP. et al. Endoscopic ultrasound-guided biliary drainage versus percutaneous transhepatic biliary drainage: predictors of successful outcome in patients who fail endoscopic retrograde cholangiopancreatography. Surg Endosc 2016; 30: 5500-5505
• 10 Yoon WJ, Shah ED, Lee TH. et al. Endoscopic ultrasound-guided versus percutaneous transhepatic biliary drainage in patients with malignant biliary obstruction: Which is the optimal cost-saving strategy after failed ERCP?. Front Oncol 2022; 12: 844083
• 11 Burmester E, Niehaus J, Leinweber T. et al. EUS-cholangio-drainage of the bile duct: report of 4 cases. Gastrointest Endosc 2003; 57: 246-251
• 12 Paik WH, Park DH. Outcomes and limitations: EUS-guided hepaticogastrostomy. Endosc Ultrasound 2019; 8: S44-S49
• 13 Khoo S, Do NDT, Kongkam P. Efficacy and safety of EUS biliary drainage in malignant distal and hilar biliary obstruction: A comprehensive review of literature and algorithm. Endosc Ultrasound 2020; 9: 369-379
• 14 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
• 15 Marx M, Caillol F, Autret A. et al. EUS-guided hepaticogastrostomy in patients with obstructive jaundice after failed or impossible endoscopic retrograde drainage: A multicenter, randomized phase II Study. Endosc Ultrasound 2022; 11: 495-502
• 16 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
• 17 Ogura T, Okuda A, Miyano A. et al. EUS-guided versus percutaneous biliary access in patients with obstructive jaundice due to gastric cancer. Digest Liver Dis 2019; 51: 247-252
• 18 Hathorn KE, Canakis A, Baron TH. EUS-guided transhepatic biliary drainage: a large single-center U.S. experience. Gastrointest Endosc 2022; 95: 443-451
• 19 Ogura T, Higuchi K. Endoscopic ultrasound-guided hepaticogastrostomy: technical review and tips to prevent adverse events. Gut Liver 2021; 15: 196-205
• 20 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
• 21 Hamada T, Isayama H, Nakai Y. et al. Duodenal invasion is a risk factor for the early dysfunction of biliary metal stents in unresectable pancreatic cancer. Gastrointest Endosc 2011; 74: 548-555
• 22 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. Endoscopy 2016; 48: 156-163
• 23 Koutlas NJ, LePage EM, Lucioni T. et al. Preoperative endoscopic ultrasound-guided hepaticogastrostomy facilitates decompression and diagnosis in patients with suspected malignant biliary obstruction: a case series. Cureus 2022; 14: e23209
• 24 Abdelfatah MM, Baron TH. Preoperative decompression and diagnosis of pancreatic head adenocarcinoma in a patient with Roux-en-Y gastric bypass by means of EUS-guided gastric pouch hepaticogastrostomy. VideoGIE 2017; 2: 143-144
• 25 Hosmer A, Abdelfatah MM, Law R. et al. Endoscopic ultrasound-guided hepaticogastrostomy and antegrade clearance of biliary lithiasis in patients with surgically-altered anatomy. Endosc Int Open 2018; 6: E127-E130
• 26 Kawakami H, Itoi T, Ban T. Intrahepatic biliary stones extraction via an EUS-guided hepaticogastrostomy route confirmed by peroral transluminal video cholangioscopy (with video). J Hepatobiliary Pancreat Sci 2020; 27: E11-E12
• 27 Sato T, Nakai Y, Kogure H. et al. Electrohydraulic lithotripsy through a fistula of EUS-guided hepaticogastrostomy: a new approach for right intrahepatic stones. VideoGIE 2019; 4: 420-422