Comparison of intraductal ultrasonography-directed and cholangiography-directed endoscopic retrograde biliary drainage in patients with a biliary obstruction.
OBJECTIVE
Endoscopic retrograde biliary drainage (ERBD) has become a standard procedure in patients with a biliary obstruction. Intraductal ultrasonography (IDUS) has emerged as a new tool for managing extrahepatic biliary diseases. IDUS-directed ERBD can be performed without conventional cholangiography (CC). The goal of this study was to assess the effectiveness and safety of IDUS-directed ERBD compared to CC-directed ERBD in patients with an extrahepatic biliary obstruction.


METHODS
A total of 210 patients who had undergone IDUS-directed ERBD (IDUS-ERBD, n = 105) and CC-directed ERBD (CC-ERBD, n = 105) between October 2013 and April 2014 were analyzed retrospectively. The primary outcome measure was the procedural success rate. Secondary outcome measures included clinical outcomes, total procedure time, radiation exposure time, and overall complication rates.


RESULTS
The total technical success rate of ERBD was 100% (105/105) in the IDUS-ERBD and CC-ERBD groups. Mean procedure time was slightly prolonged in the IDUS-ERBD group than that in the CC-ERBD group (32.1 ± 9.9 minutes vs. 28.4 ± 11.6 minutes, p = 0.023). Mean radiation exposure time was one-third less in the IDUS-ERBD group than that in the CC-ERBD group (28.0 ± 49.3 seconds vs. 94.2 ± 57.3 seconds, p < 0.001). No significant differences in complication rates were detected between the groups.


CONCLUSIONS
IDUS-ERBD was equally effective and safe as CC-ERBD in patients with an extrahepatic biliary obstruction. Although IDUS-ERBD increased total procedure time, it significantly decreased radiation exposure.
Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
Soo-Jung
SJ
Rew
Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
Du-Hyeon
DH
Lee
Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
Chang-Hwan
CH
Park
Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
Jin
J
Jeon
Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
Hyun-Soo
HS
Kim
Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
Sung-Kyu
SK
Choi
Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
Jong-Sun
JS
Rew
D000368:Aged; D000369:Aged, 80 and over; D002758:Cholangiography; D002760:Cholangiopancreatography, Endoscopic Retrograde; D001651:Cholestasis, Extrahepatic / Q000000981:diagnostic imaging* / Q000628:therapy*; D004322:Drainage / Q000379:methods; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018084:Ultrasonography, Interventional
Cholangiography; Cholangiopancreatography, endoscopic retrograde; Ultrasonography