Endoscopic ultrasound-guided hepaticogastrostomy versus percutaneous transhepatic drainage for malignant biliary obstruction after failed endoscopic retrograde cholangiopancreatography: a retrospective expertise-based study from two centers

Adrien Sportes, Marine Camus, Michel Greget, Sarah Leblanc, Romain Coriat, Jürgen Hochberger, Stanislas Chaussade, Sophie Grabar, Frédéric Prat, Adrien Sportes, Marine Camus, Michel Greget, Sarah Leblanc, Romain Coriat, Jürgen Hochberger, Stanislas Chaussade, Sophie Grabar, Frédéric Prat

Abstract

Background: Percutaneous transhepatic biliary drainage (PTBD) is widely performed as a salvage procedure in patients with unresectable malignant obstruction of the common bile duct (CBD) after failed endoscopic retrograde cholangiopancreatography (ERCP) or in case of surgically altered anatomy. Endoscopic ultrasound-guided hepaticogastrostomy (EU-HGS) is a more recently introduced alternative to relieve malignant obstructive jaundice. The aim of this prospective observational study was to compare the outcome, efficacy and adverse events of EU-HGS and PTBD.

Methods: From April 2012 to August 2015, consecutive patients with malignant CBD obstruction who underwent EU-HGS or PTBD in two tertiary-care referral centers were included. The primary endpoint was the clinical success rate. Secondary endpoints were technical success, overall survival, procedure-related adverse events, incidence of adverse events, and reintervention rate.

Results: A total of 51 patients (EU-HGS, n = 31; PTBD, n = 20) were included. Median survival was 71 days (range 25-75th percentile; 30-95) for the EU-HGS group and 78 days (range 25-75th percentile; 42-108) for the PTBD group (p = 0.99). Technical success was achieved in all patients in both groups. Clinical success was achieved in 25 (86%) of 31 patients in the EU-HGS group and in 15 (83%) of 20 patients in the PTBD group (p = 0.88). There was no difference in adverse events rates between the two groups (EU-HGS: 16%; PTBD: 10%) (p = 0.69). Four deaths within 1 month (two hemorrhagic and two septic) were considered procedure related (two in the EU-HGS group and two in the PTBD group). Overall reintervention rate was significantly lower after EU-HGS (n = 2) than after PTBD (n = 21) (p = 0.0001). Length of hospital stay was shorter after EU-HGS (8 days versus 15 days; p = 0.002).

Conclusions: EU-HGS can be an effective and safe mini invasive-procedure alternative to PTBD, with similar success and adverse-event rates, but with lower rates of reintervention and length of hospitalization.

Keywords: ERCP; EUS; PTBD; jaundice; pancreatic cancer.

Conflict of interest statement

Conflict of interest statement: The authors declare that there is no conflict of interest.

Figures

Figure 1a.
Figure 1a.
Biliary puncture under endoscopic ultrasound control.
Figure 1b.
Figure 1b.
Cholangiographic view after transhepatogastric stent release in a patient with previously stented duodenal obstruction and distal biliary stricture. With arrow: intraductal stent end; long black arrow: intragastric stent end; short black arrows: stent portion traversing the liver parenchyma.
Figure 1c.
Figure 1c.
Endoscopic view of a transhepatogastric fully covered self-expanding metal stents (FCSEMS) with bile outflow inserted through the posterior and upper gastric wall and stitched with a clip to the mucosa.
Figure 2.
Figure 2.
Flowchart of patient selection. EUS, endoscopic ultrasound; ERCP, endoscopic retrograde cholangiopancreatography.
Figure 3.
Figure 3.
Survival after biliary drainage according to procedure (Kaplan–Meier’s survival calculation).

References

    1. Cotton PB. Cannulation of the papilla of Vater by endoscopy and retrograde cholangiopancreatography (ERCP). Gut 1972; 13: 1014–1025.
    1. ASGE guidelines for clinical application. The role of ERCP in diseases of the biliary tract and pancreas. American Society for Gastrointestinal Endoscopy. Gastrointest Endosc 1999; 50: 915–920.
    1. Fogel EL, Sherman S, Devereaux BM, et al. Therapeutic biliary endoscopy. Endoscopy 2001; 33: 31–38.
    1. Ekkelenkamp VE, de Man RA, Ter Borg F, et al. Prospective evaluation of ERCP performance: results of a nationwide quality registry. Endoscopy 2015; 47: 503–507.
    1. Baron TH, Petersen BT, Mergener K, et al. Quality indicators for endoscopic retrograde cholangiopancreatography. Gastrointest Endosc 2006; 63 (Suppl. 4): S29–S34.
    1. Li M, Bai M, Qi X, et al. Percutaneous transhepatic biliary metal stent for malignant hilar obstruction: results and predictive factors for efficacy in 159 patients from a single center. Cardiovasc Intervent Radiol 2015; 38: 709–721.
    1. Winick AB, Waybill PN, Venbrux AC. Complications of percutaneous transhepatic biliary interventions. Tech Vasc Interv Radiol 2001; 4: 200–206.
    1. Giovannini M, Moutardier V, Pesenti C, et al. Endoscopic ultrasound-guided bilioduodenal anastomosis: a new technique for biliary drainage. Endoscopy 2001; 33: 898–900.
    1. Isayama H, Nakai Y, Kawakubo K, et al. The endoscopic ultrasonography-guided rendezvous technique for biliary cannulation: a technical review. J Hepato-Biliary-Pancreat Sci 2013; 20: 413–420.
    1. Dhir V, Bhandari S, Bapat M, et al. Comparison of EUS-guided rendezvous and precut papillotomy techniques for biliary access (with videos). Gastrointest Endosc 2012; 75: 354–359.
    1. Song TJ, Hyun YS, Lee SS, et al. Endoscopic ultrasound-guided choledochoduodenostomies with fully covered self-expandable metallic stents. World J Gastroenterol 2012; 18: 4435–4440.
    1. Park DH. Endoscopic ultrasonography-guided hepaticogastrostomy. Gastrointest Endosc Clin N Am 2012; 22: 271–280.
    1. Shah JN, Marson F, Weilert F, et al. Single-operator, single-session EUS-guided anterograde cholangiopancreatography in failed ERCP or inaccessible papilla. Gastrointest Endosc 2012; 75: 56–64.
    1. Khashab MA, Valeshabad AK, Modayil R, et al. EUS-guided biliary drainage by using a standardized approach for malignant biliary obstruction: rendezvous versus direct transluminal techniques (with videos). Gastrointest Endosc 2013; 78: 734–741.
    1. Kim YS, Gupta K, Mallery S, et al. Endoscopic ultrasound rendezvous for bile duct access using a transduodenal approach: cumulative experience at a single center. A case series. Endoscopy 2010; 42: 496–502.
    1. Khashab MA, Dewitt J. EUS-guided biliary drainage: is it ready for prime time? Yes! Gastrointest Endosc 2013; 78: 102–105.
    1. Henry WA, Singh VK, Kalloo AN, et al. Simultaneous EUS-guided transbulbar pancreaticobiliary drainage (with video). Gastrointest Endosc 2012; 76: 1065–1067, e1–e2.
    1. Itoi T, Yamao K. EUS 2008 Working Group. EUS 2008 Working Group document: evaluation of EUS-guided choledochoduodenostomy (with video). Gastrointest Endosc 2009; 69 (Suppl. 2): S8–S12.
    1. Artifon ELA, Marson FP, Gaidhane M, et al. Hepaticogastrostomy or choledochoduodenostomy for distal malignant biliary obstruction after failed ERCP: is there any difference? Gastrointest Endosc 2015; 81: 950–959.
    1. Wang K, Zhu J, Xing L, et al. Assessment of efficacy and safety of EUS-guided biliary drainage: a systematic review. Gastrointest Endosc 2015; 83: 1218–1227.
    1. Artifon ELA, Aparicio D, Paione JB, et al. Biliary drainage in patients with unresectable, malignant obstruction where ERCP fails: endoscopic ultrasonography-guided choledochoduodenostomy versus percutaneous drainage. J Clin Gastroenterol 2012; 46: 768–774.
    1. Bapaye A, Dubale N, Aher A. Comparison of endosonography-guided vs. percutaneous biliary stenting when papilla is inaccessible for ERCP. United Eur Gastroenterol J 2013; 1: 285–293.
    1. Khashab MA, Valeshabad AK, Afghani E, et al. A comparative evaluation of EUS-guided biliary drainage and percutaneous drainage in patients with distal malignant biliary obstruction and failed ERCP. Dig Dis Sci 2015; 60: 557–565.
    1. Lee TH, Choi J-H, Park DH, et al. Similar efficacies of endoscopic ultrasound-guided transmural and percutaneous drainage for malignant distal biliary obstruction. Clin Gastroenterol Hepatol 2016; 14: 1011–1019.e3.
    1. Fang Y, Gurusamy KS, Wang Q, et al. Meta-analysis of randomized clinical trials on safety and efficacy of biliary drainage before surgery for obstructive jaundice. Br J Surg 2013; 100: 1589–1596.
    1. Khashab MA, El Zein M, Sharzehi K, et al. International multicenter comparative trial of EUS-guided biliary drainage vs. enteroscopy-assisted ERCP in patients with surgical anatomy and biliary obstruction. United Eur Gastroenterol J 2015; 3 (Suppl. 5): 1–145.
    1. Kao LS, Tyson JE, Blakely ML, et al. Clinical research methodology I: introduction to randomized trials. J Am Coll Surg 2008; 206: 361–369.
    1. Devereaux PJ, Bhandari M, Clarke M, et al. Need for expertise based randomised controlled trials. Br Med J 2005; 330: 88.
    1. Giovannini M, Bories E. EUS-guided biliary drainage. Gastroenterol Res Pract 2012; 2012: 348719.
    1. Kawakubo K, Kawakami H, Kuwatani M, et al. Endoscopic ultrasound-guided choledochoduodenostomy vs. transpapillary stenting for distal biliary obstruction. Endoscopy 2016; 48: 164–169.

Source: PubMed

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