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CC BY-NC-ND 4.0 · Endosc Int Open 2024; 12(01): E108-E115
DOI: 10.1055/a-2220-2740
Original article

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

Nicholas J Koutlas
1   Gastroenterology, Wake Forest School of Medicine, Winston-Salem, United States (Ringgold ID: RIN12279)
,
Swati Pawa
1   Gastroenterology, Wake Forest School of Medicine, Winston-Salem, United States (Ringgold ID: RIN12279)
,
Greg Russell
2   Biostatistics, Wake Forest School of Medicine, Winston-Salem, United States (Ringgold ID: RIN12279)
,
Taylor Ferris
3   Department of Medicine, Wake Forest School of Medicine, Winston-Salem, United States (Ringgold ID: RIN12279)
,
Janardhana Ponnatapura
4   Interventional Radiology, Wake Forest School of Medicine, Winston-Salem, United States (Ringgold ID: RIN12279)
,
Rishi Pawa 
1   Gastroenterology, Wake Forest School of Medicine, Winston-Salem, United States (Ringgold ID: RIN12279)
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Choose the best alternative wisely for biliary interventions after failed ERCP!Endosc Int Open 2024; 12(01): E176-E178
DOI: 10.1055/a-2230-8540

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


Publication History

Received: 19 July 2023

Accepted after revision: 16 November 2023

Article published online:
19 January 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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