Transmural biliary drainage can be an alternative to transpapillary drainage in patients with an indwelling duodenal stent.
BACKGROUND
Self-expandable metal stents (SEMS) are widely utilized to relieve symptoms of malignant gastric outlet obstruction (GOO), but GOO is frequently complicated by nonresectable distal biliary obstruction. The optimal endoscopic approach to biliary drainage in this setting remains controversial and has yet to be resolved.


OBJECTIVE
To compare the safety and efficacy of endoscopic ultrasound-guided transmural biliary drainage (EUS-BD) and transpapillary drainage in patients with an indwelling duodenal SEMS.


METHODS
Patients who underwent EUS-BD or transpapillary drainage for distal malignant biliary obstruction with an indwelling duodenal SEMS between June 2007 and August 2012 at three Japanese tertiary referral centers were identified retrospectively. We compared times to stent dysfunction, causes of dysfunction, and procedural related complications between these two groups.


RESULTS
Twenty patients were included in the study (7 EUS-BD and 13 transpapillary drainage). EUS-BD was performed via hepaticogastrostomy using a SEMS in three patients and via choledochoduodenostomy using a SEMS or a plastic stent in two patients each. Transpapillary drainage was performed using a SEMS in all patients. The stent patency rate in the EUS-BD group was higher than that in the transpapillary drainage group (100 vs. 71% at 1 month and 83 vs. 29% at 3 months, respectively). The rate of stent dysfunction in the EUS-BD group tended to be lower than that in the transpapillary group (14 vs. 54%; P = 0.157). Complication rates were similar between the groups (P = 1.000), with moderate bleeding in one patient in the EUS-BD group and mild pancreatitis in one patient in the transpapillary group.


CONCLUSIONS
Endoscopic ultrasound-guided transmural biliary drainage is an alternative to transpapillary drainage in patients with an indwelling duodenal SEMS.
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan, hamada-tky@umin.ac.jp.
Tsuyoshi
T
Hamada
Hiroyuki
H
Isayama
Yousuke
Y
Nakai
Hirofumi
H
Kogure
Natsuyo
N
Yamamoto
Kazumichi
K
Kawakubo
Naminatsu
N
Takahara
Rie
R
Uchino
Suguru
S
Mizuno
Takashi
T
Sasaki
Osamu
O
Togawa
Saburo
S
Matsubara
Yukiko
Y
Ito
Kenji
K
Hirano
Takeshi
T
Tsujino
Minoru
M
Tada
Kazuhiko
K
Koike
D000368:Aged; D002779:Cholestasis / Q000209:etiology / Q000628:therapy*; D004322:Drainage / Q000379:methods*; D004386:Duodenum; D019160:Endosonography / Q000379:methods*; D005240:Feasibility Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000150:complications; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome