In:
Digestive Endoscopy, Wiley, Vol. 29, No. 2 ( 2017-03), p. 218-225
Abstract:
Endoscopic ultrasonography ‐guided biliary drainage ( EUS ‐ BD ), first reported as an alternative to percutaneous transhepatic biliary drainage ( PTBD ) after failed endoscopic retrograde cholangiopancreatography ( ERCP) , is increasingly reported as a primary procedure without failed ERCP . The present study aims to evaluate the outcomes of therapeutic biliary ERCP and to compare the safety and effectiveness of primary EUS ‐ BD with those of ERCP , rescue EUS ‐ BD and PTBD . Methods We retrospectively studied therapeutic biliary ERCP as well as subsequent rescue PTBD and EUS ‐ BD . Additionally, indications, safety and technical success of primary EUS ‐ BD were evaluated. Results Between August 2013 and September 2015, a total of 520 therapeutic biliary ERCP with a native papilla were analyzed. We encountered 23 cases with inaccessible papilla and 22 cases with failed cannulation, which were rescued by 21 PTBD , 16 EUS ‐ BD and two repeat ERCP . Additionally, 40 primary EUS ‐ BD were carried out during the same period as a result of 10 recurrent cholangitis cases after transpapillary drainage, five outside failed cannulation, four altered anatomy, two history of ERCP ‐related adverse events ( AE ), two technical difficulties in stenting under enteroscopy‐assisted ERCP and 17 on study protocol. Technical success and AE rates were 95.6% and 14.5% in ERCP , 90.5% and 33.3% in rescue PTBD , 93.8% and 18.8% in rescue EUS ‐ BD , and 95.0% and 22.5% in primary EUS ‐ BD , respectively. Conclusions Rescue EUS ‐ BD was used in 3.1% among all ERCP . Given the comparable technical success and AE rates of both primary and rescue EUS ‐ BD , primary EUS ‐ BD without failed ERCP can be a treatment option if it provides advantages over ERCP .
Type of Medium:
Online Resource
ISSN:
0915-5635
,
1443-1661
DOI:
10.1111/den.2017.29.issue-2
Language:
English
Publisher:
Wiley
Publication Date:
2017
detail.hit.zdb_id:
2020071-7
Permalink
