EUS-guided intrahepatic biliary drainage: a large retrospective series and subgroup comparison between percutaneous drainage in hilar stenoses or postsurgical anatomy.

ABSTRACT: Background and study aims ?Endoscopic ultrasound-guided intrahepatic biliary drainage (EUS-IBD) struggles to find a place in management algorithms, especially compared to percutaneous drainage (PTBD). In the setting of hilar stenoses or postsurgical anatomy data are even more limited. Patients and methods ?All consecutive EUS-IBDs performed in our tertiary referral center between 2012?-?2019 were retrospectively evaluated. Rendez-vous (RVs), antegrade stenting (AS) and hepatico-gastrostomies (HGs) were compared. The predefined subgroup of EUS-IBD patients with proximal stenosis/surgically-altered anatomy was matched 1:1 with PTBD performed for the same indications. Efficacy, safety and events during follow-up were compared. Results ?One hundred four EUS-IBDs were included (malignancies?=?87.7?%). These consisted of 16 RVs, 43 ASs and 45 HGs. Technical and clinical success rates were 89.4?% and 96.2?%, respectively. Any-degree, severe and fatal adverse events (AEs) occurred in 23.3?%, 2.9?%, and 0.9?% respectively. Benign indications were more common among RVs while proximal stenoses, surgically-altered anatomy, and disconnected left ductal system among HGs. Procedures were shorter with HGs performed with specifically designed stents (25 vs . 48 minutes, P ?=?0.004) and there was also a trend toward less dysfunction with those stents (6.7?% vs . 30?%, P ?=?0.09) compared with previous approaches. Among patients with proximal stenosis/surgically-altered anatomy, EUS-IBD vs. PTBD showed higher rates of clinical success (97.4?% vs. 79.5?%, P ?=?0.01), reduced post-procedural pain (17.8?% vs. 44.4?%, p?=?0.004), shorter median hospital stay (7.5 vs 11.5 days, P ?=?0.01), lower rates of stent dysfunction (15.8?% vs. 42.9?%, P ?=?0.01), and the mean number of reinterventions was lower (0.4 vs. 2.8, P ?Conclusions ?EUS-IBD has high technical and clinical success with an acceptable safety profile. HGs show comparable outcomes, which are likely to further improve with dedicated tools. For proximal strictures and surgically-altered anatomy, EUS-IBD seems superior to PTBD.

SUBMITTER: Vanella G 

PROVIDER: S-EPMC7671754 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature