title: Endoscopic ultrasound-guided choledochoduodenostomy vs. transpapillary stenting for distal biliary obstruction.
abstract: OBJECTIVE
  Endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) has gained popularity as an alternative to percutaneous biliary drainage for patients in whom endoscopic retrograde cholangiopancreatography has failed. There are no previous studies comparing EUS-CDS with endoscopic transpapillary stenting (ETS) as first-line treatment for distal malignant obstruction. The aim of this study was to compare the clinical efficacy and safety of EUS-CDS and ETS as first-line treatment in patients with distal malignant biliary obstruction.
  
  
  METHODS
  A total of 82 patients with distal malignant biliary obstruction underwent initial biliary drainage using self-expandable metal stents at a tertiary care university hospital. ETS was performed between June 2009 and May 2012, and EUS-CDS was performed between May 2012 and March 2014. Clinical success rates, adverse event rates, and reintervention rates were retrospectively evaluated for EUS-CDS and ETS.
  
  
  RESULTS
  A total of 26 patients underwent EUS-CDS and 56 underwent ETS. Clinical success rates were equivalent between the groups (EUS-CDS 96.2 %, ETS 98.2 %; P = 0.54). The mean procedure time was significantly shorter with EUS-CDS than with ETS (19.7 vs. 30.2 minutes; P < 0.01). The rate of overall adverse events was not significantly different between the groups (EUS-CDS 26.9 %, ETS 35.7 %; P = 0.46). Post-procedural pancreatitis was only observed in the ETS group (0 % vs. 16.1 %; P = 0.03). The reintervention rate at 1 year was 16.6 % and 13.6 % for EUS-CDS and ETS, respectively (P = 0.50).
  
  
  CONCLUSIONS
  EUS-CDS performed by expert endoscopists was associated with a short procedure time and no risk of pancreatitis, and would therefore be feasible as a first-line treatment for patients with distal malignant biliary obstruction.
authors.affiliation: Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Kazumichi
authors.initials: K
authors.lastname: Kawakubo
authors.affiliation: Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Sapporo, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kawakami
authors.affiliation: Division of Endoscopy, Hokkaido University Hospital, Sapporo, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Kuwatani
authors.affiliation: Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Sapporo, Japan.
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Kubota
authors.affiliation: Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Sapporo, Japan.
authors.forename: Shuhei
authors.initials: S
authors.lastname: Kawahata
authors.affiliation: Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Sapporo, Japan.
authors.forename: Kimitoshi
authors.initials: K
authors.lastname: Kubo
authors.affiliation: Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Naoya
authors.initials: N
authors.lastname: Sakamoto
mesh_terms: D000368:Aged; D002768:Choledochostomy / Q000379:methods*; D002779:Cholestasis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D004379:Duodenal Neoplasms / Q000150:complications; D004385:Duodenostomy / Q000379:methods*; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D010190:Pancreatic Neoplasms / Q000150:complications; D012189:Retrospective Studies; D015607:Stents; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome