Multicenter study on endoscopic ultrasound-guided expandable biliary metal stent placement: choice of access route, direction of stent insertion, and drainage route.
OBJECTIVE
Endoscopic ultrasonography-guided biliary drainage (EUS-BD) using expandable biliary metal stents has emerged as an acceptable alternative in patients with failed endoscopic retrograde cholangiopancreatography for malignant biliary obstruction. However, there is no consensus over the preferred access route (transhepatic or extrahepatic), direction of stent insertion (antegrade or retrograde) or drainage route (transluminal or transpapillary) in patients potentially suitable for multiple methods. The present study compares success and complication rates in patients undergoing EUS-BD via different methods.


METHODS
This was a multicenter retrospective analysis. Records of patients who underwent EUS-BD for malignant obstructive jaundice at four centers were entered in a standard database. Success and complications were compared for different techniques.


RESULTS
Sixty-eight patients were analyzed. EUS-BD was successful in 65 patients (95.6%). There was no significant difference in the success rates of different techniques. Complications were seen in 14 patients (20.6%) and mortality in three patients (4.4%). Complications were significantly higher for the transhepatic route compared to the transduodenal route (30.5% vs 9.3%, P=0.03). There was no significant difference in complication rates among transluminal and transpapillary stent placements, or direct and rendezvous stenting. Logistic regression analysis showed transhepatic access to be the only independent risk factor for complications (P=0.031, t=2.2).


CONCLUSIONS
EUS-BD can be carried out with high success rates regardless of the choice of access route, stent direction or drainage route. However, complications are significantly higher with transhepatic access. The transduodenal route should be chosen for EUS-guided and rendezvous stent placements, when both routes are available.
Baldota Institute of Digestive Sciences, Global Hospital, Mumbai, India.
Vinay
V
Dhir
Everson L A
EL
Artifon
Kapil
K
Gupta
Juan J
JJ
Vila
Roberta
R
Maselli
Mariana
M
Frazao
Amit
A
Maydeo
D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000379:methods; D002779:Cholestasis / Q000000981:diagnostic imaging* / Q000601:surgery*; D015331:Cohort Studies; D004322:Drainage / Q000379:methods*; D004386:Duodenum; D019160:Endosonography / Q000379:methods*; D005260:Female; D006801:Humans; D008099:Liver; D016015:Logistic Models; D008297:Male; D008670:Metals; D008875:Middle Aged; D061214:Patient Safety; D011474:Prosthesis Design; D012189:Retrospective Studies; D018570:Risk Assessment; D015607:Stents; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
D008670:Metals
biliary drainage; endoscopic retrograde cholangiopancreatography (ERCP); endoscopic ultrasonography-guided biliary drainage; metal stent; rendezvous