title: A comparative evaluation of EUS-guided biliary drainage and percutaneous drainage in patients with distal malignant biliary obstruction and failed ERCP.
abstract: OBJECTIVE
  Endoscopic ultrasound-guided biliary drainage (EGBD) may be a safe, alternative technique to percutaneous transhepatic biliary drainage (PTBD) in patients who fail ERCP. However, it is currently unknown how both techniques compare in terms of efficacy, safety, and cost. The aims of this study were to compare efficacy, safety, and cost of EGBD to that of PTBD.
  
  
  METHODS
  Jaundiced patients with distal malignant biliary obstruction who underwent EGBD or PTBD after failed ERCP were included. Technical success, clinical success, and adverse events between the two groups were compared.
  
  
  RESULTS
  A total of 73 patients with failed ERCP subsequently underwent EGBD (n = 22) or PTBD (n = 51). Although technical success was higher in the PTBD group (100 vs. 86.4 %, p = 0.007), clinical success was equivalent (92.2 vs. 86.4 %, p = 0.40). PTBD was associated with higher adverse event rate (index procedure: 39.2 vs. 18.2 %; all procedures including reinterventions: 80.4 vs. 15.7 %). Stent patency and survival were equivalent between both groups. Total charges were more than two times higher in the PTBD group (p = 0.004) mainly due to significantly higher rate of reinterventions (80.4 vs. 15.7 %, p < 0.001).
  
  
  CONCLUSIONS
  EGBD and PTBD are comparably effective techniques for treatment of distal malignant biliary obstruction after failed ERCP. However, EGBD is associated with decreased adverse events rate and is significantly less costly due to the need for fewer reinterventions. Our results suggest that EGBD should be the technique of choice for treatment of these patients at institutions with experienced interventional endosonographers.
authors: Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD, USA, mkhasha1@jhmi.edu.
authors: Mouen A
authors: MA
authors: Khashab
authors: Ali Kord
authors: AK
authors: Valeshabad
authors: Elham
authors: E
authors: Afghani
authors: Vikesh K
authors: VK
authors: Singh
authors: Vivek
authors: V
authors: Kumbhari
authors: Ahmed
authors: A
authors: Messallam
authors: Payal
authors: P
authors: Saxena
authors: Mohamad
authors: M
authors: El Zein
authors: Anne Marie
authors: AM
authors: Lennon
authors: Marcia Irene
authors: MI
authors: Canto
authors: Anthony N
authors: AN
authors: Kalloo
mesh_terms: D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002779:Cholestasis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D003362:Cost-Benefit Analysis; D004322:Drainage / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D019160:Endosonography / Q000009:adverse effects / Q000191:economics; D005260:Female; D017048:Health Care Costs; D006801:Humans; D041781:Jaundice, Obstructive / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D019233:Retreatment; D012189:Retrospective Studies; D017211:Treatment Failure; D018084:Ultrasonography, Interventional / Q000009:adverse effects / Q000191:economics