Endoscopic Ultrasonography-Guided Biliary Intervention Is Safe And Effective In Pre-Comorbid Patients With Moderate/Severe Cholangitis: A Tertiary Care Center Experience

Aims Although endoscopic retrograde cholangiopancreatography (ERCP) is the first-line approach for endoscopic biliary access, it might fail or might not be feasible. Endoscopic ultrasonography-guided biliary drainage (EUS-BD) is used as a salvage procedure but is fraught with technical hurdles. Data on its safety in patients with comorbidities and cholangitis is limited and is the aim of this study.

Methods Patients with cholangitis with failed ERCP/inaccessible papilla underwent various types of EUS-BD techniques such as hepatico-gastrostomy (HGS), antegrade drainage (AG), choledocho-duodenostomy (CDS), and rendezvous procedure (RV) as per indications. Technical success defined as successful placement of stent or wire. Clinical success was defined as improvement in cholangitis. Effective drainage defined as a reduction in the serum bilirubin to < 50 % after 2 weeks. Various co-morbidities were noted. Outcome parameters and adverse events were documented.

Tab. 1

Procedures performed	Underlying conditions	Type of block
Hepaticogastrostomy (n = 15)	Pancreatic cancer – 3 Carcinoma gall bladder- 10 Periampullary carcinoma – 1 Carcinoma stomach - 1	Type 2 – 5 Type 3a -6 Type 3b - 4
Antegrade drainage (n = 3)	Pancreatic cancer – 2 Benign stricture - 1	Lower CBD
Choledochoduodenostomy (n = 5)	Pancreatic cancer – 4 Periampullary carcinoma - 1	Lower CBD
Rendezvous procedure (n = 6)	Periampullary diverticulum -3

Results 29 patients (15 female (51.7 %); mean age 51.9±9.6 years) with cholangitis underwent EUS-BD, of which 22 (75.9 %) had malignant obstruction. 16 (55.2 %) patients had severe cholangitis, while rest had moderate cholangitis. The mean CCI score among malignant cases was 7.13±1.4. Uncorrected coagulopathy was present in 17 (58.6 %) cases. All hilar malignancies (14; 63.6 %) had non-patent primary confluence with high grade (type 3a/3b) block in 10 (71.4 %). Technical success was noted in 27 (93.1 %) with 100 % success in malignant cases. Clinical success was seen in 26 (89.7 %) cases while effective drainage noted in 23 (79.3 %) cases. Adverse events documented in 5 cases (17.2 %); 3 had minor bleeding events not requiring blood transfusion and 1 had wire-related perforation. Only 1 case had aggravation of cholangitis requiring additional radiological drainage but expired.

Conclusions EUS-BD is a safe and effective mode of salvage biliary access in patients with moderate to severe cholangitis, even with pre-comorbid conditions, with good technical & clinical success and acceptable complication rates.

Citation Samanta J, Muktesh G, Dhar J et al. eP434 ENDOSCOPIC ULTRASONOGRAPHY-GUIDED BILIARY INTERVENTION IS SAFE AND EFFECTIVE IN PRE-COMORBID PATIENTS WITH MODERATE/SEVERE CHOLANGITIS: A TERTIARY CARE CENTER EXPERIENCE. Endoscopy 2021; 53: S239.

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Artikel online veröffentlicht:
19. März 2021