Su1324 ENDOSCOPIC ULTRASOUND-GUIDED BILIARY DRAINAGE FOLLOWING FAILED ERCP: EXPERIENCE FROM A UNITED KINGDOM TERTIARY REFERRAL CENTRE 2016-2019

Abstract

Percutaneous transhepatic biliary drainage (PTBD) is associated with significant morbidity and prolonged hospital stays [1,2]. Endosonography-guided biliary drainage (EUS-BD) is an alternative to PTBD when endoscopic retrograde pancreatography (ERCP) has failed. The aims of this study were to review the technical success and adverse events with EUS-BD procedures performed at a tertiary care referral centre. A prospectively-collected database of EUS-BD procedures performed at a single centre from 1st August 2016 to 20th November 2019 was reviewed retrospectively. Procedures were performed by two experienced operators. Recorded variables were technical success, adverse events, length of stay and 30-day all-cause mortality. A total of 82 procedures were performed. 45 patients were male (55%) and median age was 70 years (range 20-90 years). Indications for drainage were malignant obstruction secondary due to pancreaticobiliary malignancy (n =55), choledocholithiasis (n=14), other metastatic malignancies (n=7), chronic pancreatitis (n=5) and benign duodenal stricture (n=1). Reasons for failed ERCP were inaccessible papilla due to gastric outlet obstruction (n=29), tumour infiltration of ampulla (n=26), obscured intradiverticular ampulla (n=16) and failure to transverse biliary stricture (n=11). The route of attempted biliary drainage was choledochoduodenostomy in 56, EUS-guided rendezvous in 14 and hepaticogastrostomy in 12. The procedures were technically successful in 95.1%. The adverse event rate was 7.3%. Failures and adverse events are detailed in the table. The median length of stay was 3 days (range 0-120) days. Two patients died within 30 days, both of multiorgan failure in the context of pre-existing sepsis which did not resolve following EUS-BD. This study adds to the existing literature supporting EUS-BD [3-5] as an effective and safe alternative to PTBD after failed ERCP. The rendezvous technique seems less successful than choledochoduodenostomy or hepaticogastrostomy in this series. Further prospective randomised studies are needed to compare outcomes for EUS-guided versus percutaneous drainage.