title: Multicenter comparative evaluation of endoscopic placement of expandable metal stents for malignant distal common bile duct obstruction by ERCP or EUS-guided approach.
abstract: BACKGROUND
  A single session of EUS-guided biliary drainage (EUS-BD) may be a viable alternative to ERCP in patients with malignant distal common bile duct (CBD) obstruction. There is no study comparing EUS-BD and ERCP for the relief of distal malignant biliary obstruction.
  
  
  OBJECTIVE
  To compare the outcomes of self-expandable metal stent (SEMS) placement for malignant distal biliary obstruction by using ERCP and EUS-BD.
  
  
  METHODS
  Multicenter, retrospective analysis.
  
  
  METHODS
  Tertiary referral centers.
  
  
  METHODS
  Patients with malignant distal CBD obstruction requiring SEMS placement.
  
  
  METHODS
  Patients in the EUS-BD group underwent EUS-guided choledochoduodenostomy (EUS-CDS) or EUS-guided antegrade (EUS-AG) procedures after 1 or more failed ERCP attempts. Patients in the ERCP group underwent retrograde SEMS placement.
  
  
  METHODS
  Composite success (the ability to complete the intended therapeutic procedure in a single session and resulting in a greater than 50% decrease in bilirubin over 2 weeks).
  
  
  RESULTS
  The study included 208 patients, 104 treated with ERCP and 104 treated with EUS-BD (68 EUS-CDS, 36 EUS-AG). SEMS placement was successful in 98 patients in the ERCP group and 97 in the EUS-BD group (94.23% vs 93.26%, P = 1.00). The frequency of adverse events in the ERCP and EUS-BD groups was 8.65% and 8.65%, respectively. Postprocedure pancreatitis rates were higher in the ERCP group (4.8% vs 0, P = .059). The mean procedure times in the ERCP and EUS-BD groups were similar (30.10 and 35.95 minutes, P = .05).
  
  
  CONCLUSIONS
  Retrospective analysis.
  
  
  CONCLUSIONS
  In patients with malignant distal CBD obstruction requiring SEMS placement, the short-term outcome of EUS-BD is comparable to that of ERCP.
authors.affiliation: Department of Endoscopy and Endosonography, Baldota Institute of Digestive Sciences, Mumbai, India.
authors.forename: Vinay
authors.initials: V
authors.lastname: Dhir
authors.affiliation: Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Itoi
authors.affiliation: Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Mouen A
authors.initials: MA
authors.lastname: Khashab
authors.affiliation: Department of Gastroenterology and Hepatology, Asan Medical Centre, Seoul, South Korea.
authors.forename: Do Hyun
authors.initials: DH
authors.lastname: Park
authors.affiliation: Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong.
authors.forename: Anthony
authors.initials: A
authors.lastname: Yuen Bun Teoh
authors.affiliation: Department of Gastroenterology and Hepatology, University of Minnesota Medical Centre, Minneapolis, Minnesota, USA.
authors.forename: Rajeev
authors.initials: R
authors.lastname: Attam
authors.affiliation: Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Messallam
authors.affiliation: Center for Interventional Endoscopy, Florida Hospital, Orlando, Florida, USA.
authors.forename: Shyam
authors.initials: S
authors.lastname: Varadarajulu
authors.affiliation: Department of Endoscopy and Endosonography, Baldota Institute of Digestive Sciences, Mumbai, India.
authors.forename: Amit
authors.initials: A
authors.lastname: Maydeo
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects; D001651:Cholestasis, Extrahepatic / Q000209:etiology / Q000628:therapy*; D003135:Common Bile Duct / Q000000981:diagnostic imaging / Q000601:surgery*; D004322:Drainage / Q000379:methods; D004380:Duodenal Obstruction / Q000209:etiology / Q000628:therapy; D004386:Duodenum / Q000601:surgery*; D019160:Endosonography / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D061646:Operative Time; D010195:Pancreatitis / Q000209:etiology; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D000069322:Self Expandable Metallic Stents; D018084:Ultrasonography, Interventional