Su1441 INITIAL EXPERIENCE OF EUS-GUIDED BILIARY DRAINAGE IN A GENERAL HOSPITAL IN JAPAN

Abstract

Over the past decade, endoscopic ultrasound-guided biliary drainage (EUS-BD) has emerged as an effective alternative biliary drainage method after unsuccessful ERCP. EUS-BD is an efficient technique, but is associated with significant morbidity that makes it a challenging procedure to introduce to general hospitals. The aim of this study is to investigate the initial treatment outcomes of EUS-BD in a general hospital. Retrospective analyses of all consecutive patients with biliary obstruction who underwent EUS-BD after failed ERCP in our institution between January 2011 and November 2017. The technical success, clinical success, and adverse events rates were evaluated. During the study period, a total of 6035 ERCP procedures were attempted, and EUS-BD was performed in 31 of 6035 procedures (0.5 %). The mean age was 75.8 years old, 18 patients were men and 13 patients were women. The etiologies of bile duct obstruction were malignant in 27 patients (87%) and benign in four patients (13%). Reasons for failed ERCP included duodenal stenosis caused by tumor invasion in 13 patients (41.9%), failed deep biliary cannulation in 11 patients (35.5%), and surgically altered anatomy in 7 patients (22.6%). The technical and clinical success rates for EUS-BD were 90.3% (28/31) and 96.4% (27/28), respectively. Adverse event rate was 25% (7/28). EUS-BD consists of EUS-guided choledochoduodenostomy (EUS-CDS), EUS-guided hepaticogastrostomy (EUS-HGS), EUS-guided antegrade stenting (EUS-AG), and EUS-guided rendezvous technique (EUS-RV). Biliary drainage could be achieved from two different approach routes: the extrahepatic bile duct access or the intrahepatic bile duct access. For the intrahepatic bile duct access group, there were 26 patients. 23 patients underwent HGS (including AG) and three patients underwent RV. The technical and clinical success rates were 88.4% (23/26), and 95.6% (22/23) respectively. The adverse event rate was 26% (6/23). The adverse events were two cases of stent migration, three cases of stent occlusion, and one case of mediastinitis in HGS (including AG). As for the extrahepatic bile duct access group, there were five patients. Four patients underwent CDS and one patient underwent RV. The technical and clinical success rates were 100% (5/5) and 100% (5/5) respectively. The adverse event rate was 20% (1/5). The adverse event was one case of bile peritonitis in RV. Given the potential serious adverse events associated to the with the procedure, EUS-BD is yet to be widely used in current medical practice in general hospitals. However, even though our institution is not a high volume nor an academic institution, the results of EUS-BD was relatively acceptable. Due to the limitations of the number of patients, further study is needed.