title: Endoscopic ultrasound-guided biliary drainage versus percutaneous transhepatic biliary drainage: predictors of successful outcome in patients who fail endoscopic retrograde cholangiopancreatography.
abstract: Patients with failed endoscopic retrograde cholangiopancreatography (ERCP) are conventionally offered percutaneous transhepatic biliary drainage (PTBD). While PTBD is effective, it is associated with catheter-related complications, pain, and poor quality of life. Endoscopic ultrasound-guided biliary drainage (EUS-BD) is a minimally invasive endoscopic option increasingly offered as an alternative to PTBD. We compare outcomes of EUS-BD and PTBD in patients with biliary obstruction at a single tertiary care center.
  
  
  
  A retrospective review was performed in patients with biliary obstruction who underwent EUS-BD or PTBD after failed ERCP from June 2010 through December 2014 at a single tertiary care center. Patient demographics, procedural data, and clinical outcomes were documented for each group. The aim was to compare efficacy and safety of EUS-BD and PTBD and evaluate predictors of success.
  
  
  
  A total of 60 patients were included (mean age 67.5 years, 65 % male). Forty-seven underwent EUS-BD, and thirteen underwent PTBD. Technical success rates of PTBD and EUS-BD were similar (91.6 vs. 93.3 %, p = 1.0). PTBD patients underwent significantly more re-interventions than EUS-BD patients (mean 4.9 versus 1.3, p < 0.0001), had more late (>24-h) adverse events (53.8 % vs. 6.6 %, p = 0.001) and experienced more pain (4.1 vs. 1.9, p = 0.016) post-procedure. In univariate analysis, clinical success was lower in the PTBD group (25 vs. 62.2 %, p = 0.03). In multivariable logistic regression analysis, EUS-BD was the sole predictor of clinical success and long-term resolution (OR 21.8, p = 0.009).
  
  
  
  Despite similar technical success rates compared to PTBD, EUS-BD results in a lower need for re-intervention, decreased rate of late adverse events, and lower pain scores, and is the sole predictor for clinical success and long-term resolution. EUS-BD should be the treatment of choice after a failed ERCP.
authors.affiliation: Department of Gastroenterology and Hepatology, New York Presbyterian-Weill Cornell Medical College, New York, NY, 10021, USA.
authors.forename: Reem Z
authors.initials: RZ
authors.lastname: Sharaiha
authors.affiliation: Department of Gastroenterology and Hepatology, New York Presbyterian-Weill Cornell Medical College, New York, NY, 10021, USA.
authors.forename: Nikhil A
authors.initials: NA
authors.lastname: Kumta
authors.affiliation: Department of Gastroenterology and Hepatology, New York Presbyterian-Weill Cornell Medical College, New York, NY, 10021, USA.
authors.forename: Amit P
authors.initials: AP
authors.lastname: Desai
authors.affiliation: Department of Gastroenterology and Hepatology, New York Presbyterian-Weill Cornell Medical College, New York, NY, 10021, USA.
authors.forename: Ersilia M
authors.initials: EM
authors.lastname: DeFilippis
authors.affiliation: Department of Gastroenterology and Hepatology, New York Presbyterian-Weill Cornell Medical College, New York, NY, 10021, USA.
authors.forename: Moamen
authors.initials: M
authors.lastname: Gabr
authors.affiliation: Department of Gastroenterology and Hepatology, New York Presbyterian-Weill Cornell Medical College, New York, NY, 10021, USA.
authors.forename: Alex M
authors.initials: AM
authors.lastname: Sarkisian
authors.affiliation: Department of Gastroenterology and Hepatology, New York Presbyterian-Weill Cornell Medical College, New York, NY, 10021, USA.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Salgado
authors.affiliation: Department of Gastroenterology and Hepatology, New York Presbyterian-Weill Cornell Medical College, New York, NY, 10021, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Millman
authors.affiliation: Department of Gastroenterology and Hepatology, New York Presbyterian-Weill Cornell Medical College, New York, NY, 10021, USA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Benvenuto
authors.affiliation: Department of Gastroenterology and Hepatology, New York Presbyterian-Weill Cornell Medical College, New York, NY, 10021, USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Cohen
authors.affiliation: Department of Gastroenterology and Hepatology, New York Presbyterian-Weill Cornell Medical College, New York, NY, 10021, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Tyberg
authors.affiliation: Department of Gastroenterology and Hepatology, New York Presbyterian-Weill Cornell Medical College, New York, NY, 10021, USA.
authors.forename: Monica
authors.initials: M
authors.lastname: Gaidhane
authors.affiliation: Department of Gastroenterology and Hepatology, New York Presbyterian-Weill Cornell Medical College, New York, NY, 10021, USA. mkahaleh@gmail.com.
authors.forename: Michel
authors.initials: M
authors.lastname: Kahaleh
mesh_terms: D000328:Adult; D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002779:Cholestasis / Q000000981:diagnostic imaging / Q000628:therapy*; D004322:Drainage / Q000379:methods*; D019160:Endosonography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Biliary drainage; Endoscopic retrograde cholangiopancreatography; Endoscopic ultrasound