Efficacy and safety of endoscopic ultrasound-guided biliary drainage on obstructive jaundice patients who had failed in the endoscopic retrograde cholangiography (with video)

Abstract

Objective To investigate the efficacy and safety of endoscopic ultrasound-guided biliary drainage (EUS-BD) on obstructive jaundice patients who had failed in the endoscopic retrograde cholangiography (ERC). Methods Seventeen obstructive jaundice patients who underwent EUS-BD at Nanjing Drum Tower Hospital from October 2015 to July 2017 were enrolled in the study. The types of biliary drainage, technical success rate, clinical efficacy, post-procedure adverse events, and follow-up were analyzed. Results EUS-BD was successfully performed in 16 out of 17 patients, with technical success rate of 94.1%. Operation pathway included 12 EUS-guided hepaticogastrostomy, 2 EUS-guided antegrade stenting, 1 EUS-guided rendezvous, and 1 EUS-guided choledochoduodenostomy. All the 16 patients′ bilirubin decreased at different levels after operation, and the clinical success rate was 94.1% (16/17). Post-operation complications included 5 cases of cholangitis, 2 of bile leakage, and 1 of pneumoperitoneum and duodenal perforation. The patients were followed up for 14-390 days after procedures. Two patients died of underlying disease one month after operation. Jaundice in another 2 patients worsened during follow-up and were improved after replacement of previous stent. Conclusion EUS-BD has a relatively high technical success rate, and can be considered as an alternative choice for patients with obstructive jaundice after failure of ERC. Operation pathway should be decided according to patient′s condition. Key words: Jaundice, obstructive; Endoscopic ultrasound-guided biliary drainage; Efficacy