title: EUS-guided biliary drainage with transluminal stenting after failed ERCP: predictors of adverse events and long-term results.
abstract: BACKGROUND
  EUS-guided biliary drainage (EUS-BD) has been proposed as an effective alternative for percutaneous transhepatic biliary drainage (PTBD) after failed ERCP. To date, the risk factors for adverse events and long-term outcomes of EUS-BD with transluminal stenting (EUS-BDS) have not been fully explored.
  
  
  OBJECTIVE
  To evaluate risk factors for adverse events and long-term outcomes of EUS-BDS.
  
  
  METHODS
  Prospective follow-up study.
  
  
  METHODS
  Tertiary-care academic center.
  
  
  METHODS
  This study involved 57 consecutive patients with malignant or benign biliary obstruction undergoing EUS-BDS after failed ERCP.
  
  
  METHODS
  EUS-guided hepaticogastrostomy (EUS-HGS) and EUS-guided choledochoduodenostomy with transluminal stenting (EUS-CDS).
  
  
  METHODS
  Risk factors for postprocedure and late adverse events and clinical outcomes of EUS-BDS.
  
  
  RESULTS
  The overall technical and functional success rates, respectively, in the EUS-BDS group were 96.5% (intention-to-treat, n = 55/57) and 89% (per-protocol, n = 49/55). Postprocedure adverse events developed after EUS-BDS in 11 patients (20%, n = 11/55). This included bile peritonitis (n = 2), mild bleeding (n = 2), and self-limited pneumoperitoneum (n = 7). In multivariate analysis, needle-knife use was the single risk factor for postprocedure adverse events after EUS-BDS (odds ratio 12.4; P = .01). A late adverse event in EUS-BDS was distal stent migration (7%, n = 4/55). The mean stent patencies with EUS-HGS and EUS-CDS were 132 days and 152 days, respectively.
  
  
  CONCLUSIONS
  Single-operator performed, nonrandomized study.
  
  
  CONCLUSIONS
  EUS-HGS and EUS-CDS may be relatively safe and can be used as an alternative to PTBD after failed ERCP. Both techniques offer durable and comparable stent patency. The use of a needle-knife for fistula dilation in EUS-BDS should be avoided if possible.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. dhpark@amc.seoul.kr
authors.forename: Do Hyun
authors.initials: DH
authors.lastname: Park
authors.forename: Ji Woong
authors.initials: JW
authors.lastname: Jang
authors.forename: Sang Soo
authors.initials: SS
authors.lastname: Lee
authors.forename: Dong-Wan
authors.initials: DW
authors.lastname: Seo
authors.forename: Sung Koo
authors.initials: SK
authors.lastname: Lee
authors.forename: Myung-Hwan
authors.initials: MH
authors.lastname: Kim
mesh_terms: D001652:Bile Ducts / Q000000981:diagnostic imaging* / Q000601:surgery; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002768:Choledochostomy / Q000009:adverse effects / Q000379:methods*; D002779:Cholestasis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D004322:Drainage / Q000379:methods*; D019160:Endosonography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D017211:Treatment Failure