Derivaciones biliodigestivas en obstrucción maligna. Drenaje guiado por ultrasonido endoscópico vs. percutáneo. Un estudio comparativo

Abstract

IntroductionThe current method of reference for malignant biliary obstruction is endoscopic retrograde cholangio-pancreatography (ERCP); however, this is not always successful or possible. In these cases, percutaneous drainage is the alternative option, but this is associated, among other adverse events, with patient discomfort and a high re-intervention rate. Endoscopic ultrasound (EUS)-guided drainage is currently being introduced as a new approach when ERCP fails, as it can be performed during the same intervention with internal drainage. ObjectiveTo compare EUS-guided and percutaneous biliary drainage in patients with malignant biliary obstruction with failed ERCP. Material and methodsThe study included all patients with malignant biliary obstruction in which EUS-guided or percutaneous drainage was performed after a failed ERCP. The patients were divided into two groups; those that underwent percutaneous drainage and those who had EUS-guided drainage performed. Variables of interest included: technical and clinical success, early and late complications, and re-interventions. ResultsThe EUS-guided drainage group (A) included 27 patients, with 29 procedures, and 31 patients in the percutaneous drainage group (B), with 55 interventions. Technical success in group A was 79.3%, and clinical success 92.8%. In group B technical success was 90.9%, and clinical success was 68.7%, (P=.13 and P=.07, respectively). There were early complications in 13.7% in group A vs 9.0% in group B (P=.50), while late complications and re-interventions were significantly higher in group B (P=<.002) ConclusionsClinical success was better in patients with EUS-guided biliary drainage, and complications and re-interventions were lower than in patients with percutaneous drainage. EUS-guided biliary drainage seems a better alternative than percutaneous drainage when ERCP fails.