Prospective international multicenter study on endoscopic ultrasound-guided biliary drainage for patients with malignant distal biliary obstruction after failed endoscopic retrograde cholangiopancreatography

Mouen A. Khashab; Schalk Van der Merwe; Rastislav Kunda; Mohamad H. El Zein; Anthony Y. Teoh; Fernando P. Marson; Carlo Fabbri; Ilaria Tarantino; Shyam Varadarajulu; Rani J. Modayil; Stavros N. Stavropoulos; Irene Peñas; Saowanee Ngamruengphong; Vivek Kumbhari; Joseph Romagnuolo; Raj Shah; Anthony N. Kalloo; Manuel Perez-Miranda; Everson L. Artifon

doi:10.1055/s-0042-102648

Endoscopy International Open, Table of Contents

Endoscopy 2016; 04(04): E487-E496
DOI: 10.1055/s-0042-102648

Original article

Prospective international multicenter study on endoscopic ultrasound-guided biliary drainage for patients with malignant distal biliary obstruction after failed endoscopic retrograde cholangiopancreatography

Authors

Mouen A. Khashab

¹Johns Hopkins Medical Institute, Baltimore, MD, USA
Schalk Van der Merwe

²Department of Hepatology, Division of Liver, and Pancreatico-Biliary Disorders, University Hospital Gastuisberg, University of Leuven, Leuven Belgium
Rastislav Kunda

³Aarhus University Hospital, Aarhus, Denmark
Mohamad H. El Zein

¹Johns Hopkins Medical Institute, Baltimore, MD, USA
Anthony Y. Teoh

⁴Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
Fernando P. Marson

⁵Department of Surgery, University of Sao Paulo, Sao Paulo, Brazil
Carlo Fabbri

⁶Unit of Gastroenterology and Digestive Endoscopy, AUSL Bologna Bellaria-Maggiore Hospital, Bologna, Italy
Ilaria Tarantino

⁷Endoscopy Service, Department of Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy
Shyam Varadarajulu

⁸Center for Interventional Endoscopy, Florida Hospital, Orlando, FL, USA
Rani J. Modayil

⁹Winthrop University Hospital, Mineola, NY, USA
Stavros N. Stavropoulos

⁹Winthrop University Hospital, Mineola, NY, USA
Irene Peñas

¹⁰Hospital Universitario Rio Hortega, Valladolid, Spain
Saowanee Ngamruengphong

¹Johns Hopkins Medical Institute, Baltimore, MD, USA
Vivek Kumbhari

¹Johns Hopkins Medical Institute, Baltimore, MD, USA
Joseph Romagnuolo

¹¹Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, SC, USA
Raj Shah

¹²Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
Anthony N. Kalloo

¹Johns Hopkins Medical Institute, Baltimore, MD, USA
Manuel Perez-Miranda

¹⁰Hospital Universitario Rio Hortega, Valladolid, Spain
Everson L. Artifon

⁵Department of Surgery, University of Sao Paulo, Sao Paulo, Brazil

Abstract

Background and aims: Endoscopic ultrasound-guided biliary drainage (EUS-BD) has emerged as an alternative to traditional radiologic and surgical drainage procedures after failed endoscopic retrograde cholangiopancreatography (ERCP). However, prospective multicenter data are lacking. The aims of this study were to prospectively assess the short- and long-term efficacy and safety of EUS-BD in patients with malignant distal biliary obstruction.

Patients and methods: Consecutive patients at 12 tertiary centers (5 US, 5 European, 1 Asian, 1 South American) with malignant distal biliary obstruction and failed ERCP underwent EUS-BD. Technical success was defined as successful stent placement in the desired position. Clinical success was defined as a reduction in bilirubin by 50 % at 2 weeks or to below 3 mg/dL at 4 weeks. Adverse events were prospectively tracked and graded according to the American Society for Gastrointestinal Endoscopy (ASGE) lexicon’s severity grading system. Overall survival and duration of stent patency were calculated using Kaplan–Meier analysis.

Results: A total of 96 patients (mean age 66 years, female 45 %, pancreatic cancer 55 %) underwent EUS-BD. Stent placement (technical success) was achieved in 92 (95.8 %) patients (metallic stent 84, plastic stent 8). Mean procedure time was 40 minutes. Clinical success was achieved in 86 (89.5 %) patients. A total of 10 (10.5 %) adverse events occurred: pneumoperitoneum (n = 2), sheared wire (n = 1), bleeding (n = 1), bile leak (n = 3), cholangitis (n = 2), and unintentional perforation (n = 1); 4 graded as mild, 4 moderate, 1 severe, and 1 fatal (due to perforation). A total of 38 (44 %) patients died of disease progression during the study period. The median patient survival was 167 days (95 %CI 112 – 221) days. The 6-month stent patency rate was 95 % (95 %CI 94.94 – 95.06 %) and the 1-year stent patency was 86 % (95 %CI 85.74 – 86.26 %).

Conclusion: This study on EUS-BD demonstrates excellent efficacy and safety of EUS-BD when performed by experts.

Study registration: NCT01889953

Full Text

References

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