title: EUS-guided biliary drainage by using a standardized approach for malignant biliary obstruction: rendezvous versus direct transluminal techniques (with videos).
abstract: BACKGROUND
  EUS-guided biliary drainage (EGBD) can be performed via direct transluminal or rendezvous techniques. It is unknown how both techniques compare in terms of efficacy and adverse events.
  
  
  OBJECTIVE
  To describe outcomes of EGBD performed by using a standardized approach and compare outcomes of rendezvous and transluminal techniques.
  
  
  METHODS
  Retrospective analysis of prospectively collected data.
  
  
  METHODS
  Two tertiary-care centers.
  
  
  METHODS
  Consecutive jaundiced patients with distal malignant biliary obstruction who underwent EGBD after failed ERCP between July 2006 and December 2012 were included.
  
  
  METHODS
  EGBD by using a standardized algorithm.
  
  
  METHODS
  Technical success, clinical success, and adverse events.
  
  
  RESULTS
  During the study period, 35 patients underwent EGBD (rendezvous n = 13, transluminal n = 20). Technical success was achieved in 33 patients (94%), and clinical success was attained in 32 of 33 patients (97.0%). The mean postprocedure bilirubin level was 1.38 mg/dL in the rendezvous group and 1.33 mg/dL in the transluminal group (P = .88). Similarly, length of hospital stay was not different between groups (P = .23). There was no significant difference in adverse event rate between rendezvous and transluminal groups (15.4% vs 10%; P = .64). Long-term outcomes were comparable between groups, with 1 stent migration in the rendezvous group at 62 days and 1 stent occlusion in the transluminal group at 42 days after EGBD.
  
  
  CONCLUSIONS
  Retrospective analysis, small number of patients, and selection bias.
  
  
  CONCLUSIONS
  EGBD is safe and effective when the described standardized approach is used. Stent occlusion is not common during long-term follow-up. Both rendezvous and direct transluminal techniques seem to be equally effective and safe. The latter approach is a reasonable alternative to rendezvous EGBD.
authors.affiliation: Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors.forename: Mouen A
authors.initials: MA
authors.lastname: Khashab
authors.forename: Ali Kord
authors.initials: AK
authors.lastname: Valeshabad
authors.forename: Rani
authors.initials: R
authors.lastname: Modayil
authors.forename: Jessica
authors.initials: J
authors.lastname: Widmer
authors.forename: Payal
authors.initials: P
authors.lastname: Saxena
authors.forename: Mehak
authors.initials: M
authors.lastname: Idrees
authors.forename: Shahzad
authors.initials: S
authors.lastname: Iqbal
authors.forename: Anthony N
authors.initials: AN
authors.lastname: Kalloo
authors.forename: Stavros N
authors.initials: SN
authors.lastname: Stavropoulos
mesh_terms: D000230:Adenocarcinoma / Q000150:complications; D000368:Aged; D014670:Ampulla of Vater / Q000601:surgery*; D002277:Carcinoma / Q000150:complications / Q000556:secondary; D018281:Cholangiocarcinoma / Q000150:complications; D002779:Cholestasis / Q000209:etiology / Q000601:surgery*; D003138:Common Bile Duct Neoplasms / Q000150:complications; D004322:Drainage / Q000379:methods*; D004379:Duodenal Neoplasms / Q000150:complications; D019160:Endosonography / Q000379:methods*; D005260:Female; D017219:Gastric Outlet Obstruction / Q000150:complications; D006801:Humans; D041781:Jaundice, Obstructive / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000150:complications / Q000556:secondary; D012189:Retrospective Studies; D015607:Stents; D013274:Stomach Neoplasms / Q000150:complications; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*
keywords: EGBD; ERC; EUS-guided biliary drainage; SEMS; endoscopic retrograde cholangiography; self-expandable metal stent