Endoscopy 2019; 51(04): S96
DOI: 10.1055/s-0039-1681453
ESGE Days 2019 oral presentations
Saturday, April 6, 2019 08:30 – 10:30: EUS therapeutic bile South Hall 1B
Georg Thieme Verlag KG Stuttgart · New York

EUS-GUIDED BILIARY DRAINAGE AFTER ERCP FAILURE IN ONCOLOGY PATIENTS

C Casamali
1   Endoscopy, Instituto do Cancer do Estado de São Paulo, Sao Paulo, Brazil
,
B Costa Martins
1   Endoscopy, Instituto do Cancer do Estado de São Paulo, Sao Paulo, Brazil
,
R Corsato Scomparim
1   Endoscopy, Instituto do Cancer do Estado de São Paulo, Sao Paulo, Brazil
,
LM Azeredo Coutinho
1   Endoscopy, Instituto do Cancer do Estado de São Paulo, Sao Paulo, Brazil
,
O Okazaki
1   Endoscopy, Instituto do Cancer do Estado de São Paulo, Sao Paulo, Brazil
,
G Andrade de Paulo
1   Endoscopy, Instituto do Cancer do Estado de São Paulo, Sao Paulo, Brazil
,
L Lenz
1   Endoscopy, Instituto do Cancer do Estado de São Paulo, Sao Paulo, Brazil
,
S Eiji Matuguma
1   Endoscopy, Instituto do Cancer do Estado de São Paulo, Sao Paulo, Brazil
,
M Coronel
1   Endoscopy, Instituto do Cancer do Estado de São Paulo, Sao Paulo, Brazil
,
M Cavalcante Franco
1   Endoscopy, Instituto do Cancer do Estado de São Paulo, Sao Paulo, Brazil
,
A Vaz Safatle-Ribeiro
1   Endoscopy, Instituto do Cancer do Estado de São Paulo, Sao Paulo, Brazil
,
CMP Pennacchi
1   Endoscopy, Instituto do Cancer do Estado de São Paulo, Sao Paulo, Brazil
,
F Maluf-Filho
1   Endoscopy, Instituto do Cancer do Estado de São Paulo, Sao Paulo, Brazil
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

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Aims:

Evaluate the technical and clinical success, survival, patency time of the stents and complications related to the procedure.

Methods:

A retrospective analysis of consecutive procedures performed between January 2010 and October 2018 in a tertiary oncology hospital. Patients included had unresectable malignant biliary neoplasia and had undergone ERCP without success. Patients submitted to percutaneous transhepatic or surgical drainage were excluded.

Results:

During the study period, we performed 1,230 ERCP's. Among the failure cases, 23 (1.9%) patients underwent EUS-BD. The proportion of female/male patients was 13/10. Median age was 65 years (IQR 56 – 73). Regarding performance status, 11 (48%) were ECOG 0 – 1 and 12 (52%) ECOG 2 – 3. All had advanced neoplasms, stages III (26%) or IV (74%). Regarding the indications of EUS-BD, 17 had inaccessible papilla, 5 cannulation failure and 2 complete common bile duct stenosis. In relation to the drainage route, 18 had choledochoduodenostomy, 2 hepaticogastrostomy 2 rendezvous and 1 hepaticojejunal. We used biliary self-expanding metal stents, 11 (48%) partially covered, 8 (35%) fully covered and 4 (17%) uncovered. Technical success was 100% and clinical success was 74% (N = 17). There were 10 adverse events within 2 weeks: 4 bleedings (2 required transfusion – no deaths); 3 peri-hepatic fluid collections (1 required surgery; 2 died) and 3 cholangitis (2 deaths). 30-day mortality was 35% (8/23 patients). Median survival was 40 days (IQR 19 – 73). Three (13%) required reintervention due to cholangitis, two of which were submitted to ERCP and one to transhepatic drainage.

Conclusions:

Considering the advanced cancer context and the factors that may interfere in the outcome of these patients, EUS-biliary drainage is feasible when ERCP fails. It is rarely needed (1.9%) in centers with expertise in ERCP. The clinical success rate and adverse events probably reflects the severity of the patients included.