Abstract
Aims To evaluate the success rate and related factors of endoscopic ultrasound guided-biliary drainage (EUS-BD). Material and Methods We conducted a retrospective study among 24 patients with malignant biliary obstruction who underwent EUS-BD after failed ERCP from January 2015 to December 2016 in a tertiary health center. The bilirubin levels before and after the procedure were used to define the clinical success rate, while the stent deployment was used to define the technical success rate. We placed either transluminal biliary stents or transpapillary biliary stents. Results Among 24 patients, choledochoduodenostomy technique was conducted in 23 patients (95.8%) and hepaticogastrostomy technique in 1 patient (4.2%). Transluminal stent placement was conducted in 23 patients, while transpapillary stent placement was conducted in 1 patient. The clinical success rate was 78.2% (18) in choledochoduodenostomy route and 100% (1) in hepaticogastrostomy route. EUS-BD was 2.37 times and 2.11 times more likely to be successful in reducing the bilirubin level in patients with tumor of the head of pancreas and periampullary tumor, respectively, but not in cholangiocarcinoma. Conclusions EUS-BD is an effective and efficient procedure to achieve biliary drainage among patients with malignant biliary obstruction after ERCP failure.
Highlights
Obstructive jaundice occurs when there is an obstruction to the passage of bile from the liver to the duodenum
This study found that patients with malignant biliary obstruction who required the endoscopic ultrasound guided-biliary drainage (EUS-BD) procedure after failed endoscopic retrograde cholangiopancreatography (ERCP) were more often male than female, with the proportions being 54.2% and 45.8%, respectively
Our study found that the incidence of malignant biliary obstructions that required a Endoscopic ultrasonography (EUS)-BD procedure was more common in patients < 60 years (54.2%) than in patients ≥ 60 years (45.8%), with a mean age of 59 years
Summary
Obstructive jaundice occurs when there is an obstruction to the passage of bile from the liver to the duodenum. The cause of this condition varies from benign conditions to malignant conditions in the biliary system. Obstructive jaundice is not a definitive diagnosis; it requires additional examinations and diagnostic procedures to determine the primary disease. The mortality and morbidity of obstructive jaundice depend on the cause of the obstruction [1]. Endoscopic retrograde cholangiopancreatography (ERCP) is the main therapeutic procedure used in the management of biliary obstruction. Percutaneous transhepatic biliary drainage (PTBD) and surgical interventions have been the alternative procedures when ERCP failed to achieve biliary drainage, but those methods have been related to high-risk complications and prolonged hospitalization [2, 3]
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