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EUS-guided transhepatic biliary drainage: a large single-center U.S. experience

Published:October 17, 2021DOI:https://doi.org/10.1016/j.gie.2021.10.013

      Background and Aims

      EUS-guided hepaticogastrostomy has been performed for many years with most published experience from outside the United States. The luminal access point can be from the esophagus, stomach, duodenum, or jejunum; biliary access can be either into the right or left intrahepatic system. Thus, we prefer the term EUS-guided transhepatic biliary drainage (ETBD). We describe what is believed to be the largest single-center U.S. experience of ETBD for management of benign and malignant biliary disease.

      Methods

      This was a retrospective study of all ETBD conducted by 1 endoscopist between September 2014 and May 2021.

      Results

      Two hundred fifteen patients underwent attempted ETBD: 85 for benign disease and 130 for malignant disease. Ninety-two patients (43%) had surgically altered anatomy (SAA). In 94 patients previously endoscopic attempts failed. The approach was transesophageal in 9, transgastric in 188, transduodenal in 5, and transjejunal in 5 patients. In 1 patient a bilateral approach was used. Standard fully covered self-expandable stents of 4- to 10-cm lengths and 8- or 10-mm diameters were used. Technical success was 95.3% and clinical success was 87.25%. Forty patients (18.6%) experienced adverse events (13 mild, 21 moderate, and 6 severe according to the modified American Society for Gastrointestinal Endoscopy lexicon). Mean follow-up was 257.31 ± 308.11 days for all patients (124.53 ± 229.86 days for benign disease and 457.27 ± 466.31 days for malignant disease). Seventy-four patients (34.4%) had died at the time of data collection (66 in the malignant cohort, 8 in the benign cohort). Of those with malignancy surviving >6 months, 17.4% required reintervention.

      Conclusions

      ETBD is effective in the management of benign and malignant biliary obstruction for patients with SAA as well as native anatomy, with a modest adverse event rate.

      Abbreviations:

      AE (adverse event), ERC (endoscopic retrograde cholangiography), ETBD (EUS-guided transhepatic biliary drainage), EUS-BD (EUS-guided biliary drainage), PTBD (percutaneous transhepatic biliary drainage), SAA (surgically altered anatomy), SEMS (self-expandable metal biliary stent)
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      Linked Article

      • EUS-guided transhepatic biliary drainage for next-generation ERCPists
        Gastrointestinal EndoscopyVol. 95Issue 3
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          ERCP is the standard treatment of choice for benign and malignant biliary obstructions. However, it is not always successful and often can be challenging in patients with surgically altered anatomy or duodenal obstruction. For several years, percutaneous transhepatic biliary drainage (PTBD) has been the standard of care in these situations. Recently, EUS-guided biliary drainage (EUS-BD), including hepaticogastrostomy (HGS) and choledochoduodenostomy, has emerged as an alternative treatment in patients with ERCP failure.
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