Biliary drainage in patients with unresectable, malignant obstruction where ERCP fails: endoscopic ultrasonography-guided choledochoduodenostomy versus percutaneous drainage.
BACKGROUND
Endoscopic retrograde cholangiopancreatography may fail because of malignant involvement of the second portion of the duodenum and the major papilla. Alternatives include percutaneous transhepatic biliary drainage (PTBD) or surgical bypass. Endoscopic ultrasonography-guided choledochoduodenostomy (EUS-CD) has been reported as an alternative.


OBJECTIVE
To prospectively compare EUS-CD and PTBD in patients with unresectable malignant biliary obstruction.


METHODS
Prospective and randomized study.


METHODS
Tertiary center.


METHODS
Success and efficacy comparison EUS-CD with PTBD.


RESULTS
Twenty-five subjects were randomized (13 EUS-CD and 12 PTBD). Mean age was 67 years (SD, 11.9). The 2 groups were similar before intervention in terms of quality of life [EUS-CD (58.3) vs. PTBD (57.8); P=0.78], total bilirubin (16.4 vs. 17.2; P=0.7), alkaline phosphatase (539 vs. 518; P=0.7), and gamma-glutamyl transferase (554.3 vs. 743.5; P=0.56). All procedures were technically and clinically successful in both groups. At 7-day follow-up there was a significant reduction in total bilirubin in both the groups (EUS-CD, 16.4 to 3.3; P=0.002 and PTBD, 17.2 to 3.8; P=0.01), although no difference was noted comparing the 2 groups (EUS-CD to PTBD; 3.3 vs. 3.8; P=0.2). There was no difference between the complication rates in the 2 groups (P=0.44), EUS-CD (2/13; 15.3%) and PTBD (3/12; 25%). Costs were similar in the 2 groups also ($5673-EUS-CD vs. $7570-PTBD; P=0.39).


CONCLUSIONS
Small sample size and single center study.


CONCLUSIONS
EUS-CD can be an effective and safe alternative to PTBD with similar success, complication rate, cost, and quality of life.
University of Sao-Paulo Medical School, Sao Paulo, Brazil.
Everson L A
EL
Artifon
Dayse
D
Aparicio
Jose B
JB
Paione
Simon K
SK
Lo
Andre
A
Bordini
Carolina
C
Rabello
Jose P
JP
Otoch
Kapil
K
Gupta
D000368:Aged; D001650:Bile Duct Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy; D001652:Bile Ducts / Q000000981:diagnostic imaging* / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods; D002768:Choledochostomy / Q000379:methods*; D004322:Drainage / Q000379:methods*; D019160:Endosonography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome