Endoscopic ultrasound-guided biliary drainage: Experience from a tertiary center

Abstract

Background and Objectives:Endoscopic retrograde cholangiopancreatography (ERCP) and palliative biliary stenting are an established therapy for malignant biliary obstruction that is unsuitable for curative surgery. In ERCP failure, EUS-guided biliary drainage (EUS-BD) procedures are evolving alternative endoscopic techniques.Methods:This was a retrospective analysis of patients who underwent EUS-BD.Results:There were 16 patients who underwent EUS-BD in the last 5 years. Male to female ratio was 9:7. Mean age was 63.56 years. Seven patients had carcinoma pancreas; six had periampullary carcinoma and one patient each had duodenal carcinoma, carcinoma colon with infiltration, and hepatocellular carcinoma with hepatic duct stricture. Indication for EUS-BD was inaccessible ampulla in ten, unidentified ampulla in one, failed biliary cannulation in four, and proximal migration of biliary plastic stent in one. Fifteen (93.75%) underwent EUS-guided choledochoduodenostomy (EUS-CDS), while one had EUS-guided hepaticogastrostomy (EUS-HGS). Covered biliary self-expandable metallic stent was used for EUS-CDS and Giobor biliary stent for EUS-HGS. The procedure was technically successful in all. There were no major immediate postprocedure complications. There was significant symptomatic and biochemical improvement in all. Thirty-day survival was 100%.Conclusion:In malignant biliary obstruction with failed ERCP, EUS-guided bile duct drainage has a high potential as an alternative biliary decompression procedure.