Long-term outcomes and reintervention of endoscopic ultrasound-guided biliary drainage for malignant biliary obstruction: A multicenter retrospective analysis of 96 cases

Abstract

Background and Objectives:Although EUS-guided biliary drainage (EUS-BD) for malignant biliary obstruction (MBO) is increasingly reported, its long term outcomes are not fully discussed.Methods:Consecutive patients undergoing EUS-BD for unresectable MBO were retrospectively studied. Data on recurrent biliary obstruction (RBO) including re-intervention and other stent-related complications were extracted.Results:Between Aug 2011 and Dec 2016, EUS-BD was performed in 96 patients (82 EUS-HGS and 14 EUS-CDS, 95 covered metal stent [CMS] and 1 plastic stent) at 4 tertiary referral centers. Biliary drainage prior to EUS-BD had been performed in 54%. The major causes of MBO were pancreatic cancer (52%) and biliary tract cancer (28%). Duodenal invasion (64%) and surgically altered anatomy (25%) were two major reasons for EUS-BD. Technical success rate was 98% with two technical failures (1 stent misplacement and 1 failed insertion of CMS delivery). The incidence of RBO was 36% and a median cumulative time to RBO was 6.8 months. The causes of RBO were non-tumor related (hyperplasia 17%, migration 9%, sludge 5%, reflux 2% and kink 2%), other than de novo stricture (2%). Re-intervention was successfully performed via EUS-BD route in 89% (22 stent-in-stent, 5 balloon sweep, 3 stent exchange and 1 additional antegrade stenting). Other re-interventions were 2 conversion to transpapillary stenting, 1 conversion from CDS to HGS and 1 PTBD. The incidence of other complications was 29%.Conclusions:The incidence of RBO necessitating re-interventions was not rare in EUS-BD for MBO but re-intervention via EUS-BD route was technically feasible in most cases.