Endoscopic ultrasound-guided versus percutaneous versus endoscopic retrograde cholangiopancreatography biliary drainage in patients with malignant biliary obstruction: A case–controlled study from a large referral center

Abstract

Background:Endoscopic retrograde cholangiopancreatography (ERCP) with transpapillary stenting is the first-line biliary drainage in patients with malignant biliary obstruction (MBO). Percutaneous transhepatic biliary drainage (PTBD) and EUS-guided biliary drainage (EUS-BD) are alternative methods.Objectives:To compare efficacy and safety of these three methods as a case–controlled study.Methods:From January 2014 to September 2016, 144 patients were followed for their clinical recurrent biliary obstruction (RBO) or their death or 1-year follow-up.Results:EUS-BD, PTBD, and ERCP were performed in 30, 60, and 54 patients, respectively. Technical success rate (TSR) of EUS-BD was significantly lower than both PTBD and ERCP (84% vs. 100% and 100%, respectively, P < 0.001). PTBD had significantly lower clinical success rate (CSR) than ERCP (65% vs. 85%, respectively, P < 0.001). RBO rates of PTBD were significantly higher than those of EUS-BD and ERCP (52% vs. 17% vs. 13%, respectively, P < 0.001). The survival analysis is not statistically significant among the three methods (P = 0.07, log-rank test).Conclusions:In patients with MBO, ERCP with transpapillary drainage should be selected as the first choice because ERCP provided the high TSR and CSR. EUS-BD and PTBD should be selected as the next alternatives because EUS-BD provided lower TSR and PTBD had lower CSR and higher RBO.