Background and Aims
EUS-guided biliary drainage (EUS-BD) has been offered for more than a decade as an
alternative to percutaneous biliary drainage. Multiple approaches have been described.
We propose an algorithm for biliary drainage based on patient anatomy. We aim to assess
its validity and safety to guide EUS-BD drainage.
Methods
All patients with biliary obstruction who underwent EUS-BD after failed ERCP from
July 2011 through November 2015 underwent the drainage procedure according to the
novel algorithm and were enrolled in a dedicated prospective registry. Patients with
a dilated intrahepatic biliary tree (IHBT) on cross-sectional imaging received an
intrahepatic (IH) approach with anterograde biliary stent placement or hepaticogastrostomy
stent placement if anterograde placement was not feasible. Patients with a nondilated
IHBT on cross-sectional imaging underwent an extrahepatic (EH) approach with a rendezvous
(RDV) technique or a transenteric stent placement if the RDV technique was not feasible.
If IH drainage was attempted but unsuccessful, conversion to an EH approach was performed.
Results
Fifty-two patients (mean age, 68 ± 12 years; 52% men) were included in the registry.
Technical success was achieved in 50 patients (96%). Twenty-seven of 52 patients (52%)
underwent IH anterograde stent placement, 8 of 52 (15%) underwent hepaticogastrostomy,
11 of 52 (21%) underwent EH drainage with the RDV technique, and 6 of 52 (12%) underwent
EH drainage with transenteric stent placement. Adverse events were observed in 5 patients
(10%) and included a liver abscess requiring percutaneous drainage (n = 1) and bleeding
(n = 4) with 1 postprocedural death secondary to bleeding.
Conclusions
EUS-BD obstruction after failed conventional ERCP is successful and safe when this
novel algorithm is used. (Clinical trial registration number: NCT01438385.)
Abbreviations:
AE (adverse event), EH (extrahepatic), EUS-BD (EUS-guided biliary drainage), IH (intrahepatic), IHBT (intrahepatic biliary tree), RDV (rendezvous)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: May 27, 2016
Accepted:
May 17,
2016
Received:
February 15,
2016
Footnotes
DISCLOSURE: The following author disclosed financial relationships relevant to this publication: M. Kahaleh: Grant support recipient from Boston Scientific, Fujinon, Pentax, MI Tech, EMcison, Xlumena Inc., W.L. Gore, MaunaKea, Apollo Endosurgery, Cook Endoscopy, ASPIRE Bariatrics, GI Dynamics, NinePoint Medical, Merit Medical, and Olympus; consultant for Boston Scientific, Xlumena Inc., Concordia Laboratories Inc., and MaunaKea Tech. All other authors disclosed no financial relationships relevant to this publication.
Identification
Copyright
Copyright © 2016 by the American Society for Gastrointestinal Endoscopy
