Su1289 COMPARISON OF EUS-GUIDED RENDEZVOUS AND PERCUTANEOUS BILIARY DRAINAGE IN PATIENTS FAILED STANDARD ERCP

Abstract

Endoscopic retrograde cholangiography (ERCP) is the procedure of choice for biliary decompression in patients with obstructive jaundice. In cases of failed procedure, percutaneous biliary drainage (PBD) is currently the mainstream of alternative care. On the other hand, EUS-guided rendezvous (EUS-RV) drainage is gaining popularity of reported high technical success. Current literature mostly focuses on EUS-guided transluminal drainage, while only few studied on the role of EUS-RV. We aimed to compare the success rate, efficacy and safety of EUS-RV drainage over standard care as the rescue therapy. This is a retrospective cohort study reviewing cases underwent ERCP for both malignant and benign biliary obstruction at Prince of Wales Hospital in Hong Kong, an university-affiliated tertiary referral center. From January 2013 to October 2019, a total of 6294 ERCPs were performed with 179 (2.84%) failed. 32 cases underwent EUS-RV drainage while 23 cases were referred to intervention radiologists for either urgent percutaneous cholecystostomy (PTC) or percutaneous transhepatic biliary drainage (PTBD). Comparisons were made between the two groups regarding technical success, clinical achievement of biliary drainage, duration of hospital stay and adverse outcomes after procedure. Majority (71.8%) of EUS-RV cases suffered from biliary stone diseases. About half (53.1%) failed ERCP despite prior attempt of precut sphincterotomy. Over 70% of patients managed to access biliary tree with one single puncture only. In total, four cases failed EUS-RV drainage, while two succeeded after switching puncture site from transduodenal to transgastric. Patients in the EUS-RV drainage group were significantly older than the PBD arm (81 years-old vs 71 years-old, p = 0.012). In terms of technical success of biliary drainage, EUS-RV drainage was comparable to PBD (87.5% vs 87%, p=0.952) with similar degree of bilirubin drop by greater than 50% in 1 week (51.9% vs 44.4%, p=0.63). Fewer patients required repeated biliary intervention within 2 weeks after EUS-RV drainage than PBD (1/32 vs 5/23, p = 0.006). The mean length of hospital stay after procedure was 8 days shorter in the EUS-RV than the PBD group (9.6 days vs 17.7 days, p=0.076). Although overall complication rate of EUS-RV (21.9%) was slightly higher than that of PBD (13.7%), most were due to post-ERCP pancreatitis and the difference was not clinically significant (p=0.40). Only one procedure-related death due to bleeding was reported in the PBD group, while none from the EUS-RV group. EUS-RV drainage is a feasible alternative to PBD in patients with biliary obstruction after failing ERCP with precut. It showed a promising success rate up to 87.5% when expertise available, lower rate of re-intervention and shorter post-procedural hospital stay.View Large Image Figure ViewerDownload Hi-res image Download (PPT)