OUTCOMES OF ENDOSCOPIC ULTRASOUND GUIDED BILIARY DRAINAGE - A PROSPECTIVE OBSERVATIONAL STUDY

Aims EUS-guided biliary drainage (EUS-BD) is useful for biliary access, but the success and complication rates vary with different techniques. Hence, we aim to study the outcomes of these techniques.

Methods Consecutive patients undergoing EUS-BD after a failed ERCP or with surgically altered anatomy were prospectively enrolled from September 2017 to August 2019. EUS-guided rendezvous (EUS-RV) or EUS guided antegrade drainage (EUS-AG) was attempted in patients with normal anatomy after failed ERCP. EUS-choledochoduodenostomy (EUS-CDS) and EUS-guided hepaticogastrostomy (EUS-HGS) were attempted in duodenal obstruction or surgically altered anatomy. Technical success was successful stent placement for biliary drainage and clinical success was improvements in biochemical parameters after stenting. Patient characteristics, procedural indications, stent type (plastic and metallic), procedure time, complications, and short to medium term follow-up were documented.

Results 116 patients [72(62.1%), male] successfully underwent EUS-BD with a median age of 41 (range 25-63 years). The commonest indication was failed ERCP in 53(45.7%) followed by duodenal narrowing 43(37.1%) and surgically altered anatomy in 20(17.2%). Technical success was achieved in 109(94 %). EUS-HGS was done in 23(19.8%), EUS-CDS in 22(19%), EUS-RV in 42(36.2%) and EUS-Antegrade in 22(19%). 7(6%) had failure hence underwent successful Percutaneous transhepatic biliary drainage. The mean (SD) procedural time for EUS-BD was 32.3 (1.8) mins. The mean serum total bilirubin reduced significantly from baseline 11.03 (6.6) to 4.2 (2.4) at 7 days (p< 0.001). SEMS were used in 75(64.6%) while plastic stents were used in 34(29.3%). The median follow up was 263 (range 55-414 days). Complications included cholangitis in 5(4.3%), bleeding 4 (3.4%), bile leak 4(3.4%) and stripping of wire in 2(1.7%) patients.

Conclusions EUS-BD is safe and effective for biliary access; the outcomes are promising at our center. EUS-RV serves as a rescue therapy in patients with failed ERCP with normal anatomy, although there was no significant difference in complication rates among the techniques.