Value of endoscopic ultrasonography-guided biliary drainage for malignant obstructive jaundice(with video)

Abstract

Objective To analyze the efficacy of endoscopic ultrasonography-guided biliary drainage (EUS-BD) for malignant obstructive jaundice and the management of adverse events. Methods Clinical data of 12 patients with malignant obstructive jaundice, who underwent EUS-BD between April 2016 and January 2017, were retrospectively analyzed. All patients received EUS-BD after unsuccessful ERCP, including EUS-guided hepaticogastrostomy (EUS-HGS), EUS-guided antegrade stenting (EUS-AS), and EUS-guided choledochoduodenostomy(EUS-CDS). Procedure outcomes, serum bilirubin and liver enzyme levels before the procedure and 1 week after, complications, treatment results, hospitalization time and follow-up were recorded. Results Two patients underwent EUS-HGS, 3 underwent EUS-AS, and 7 underwent EUS-CDS. Total bilirubin (t=3.462, P=0.005), direct bilirubin (t=3.351, P=0.006), alanine transaminase (t=2.399, P=0.037), γ-glutamate transpeptidase (t=3.256, P=0.031) reduced significantly after the procedure. Two patients (16.67%) developed complications. A patient undergoing EUS-HGS developed bile leakage, biliary peritonitis, and pneumoperitoneum. A patient undergoing EUS-CDS developed upper gastrointestinal bleeding. Both patients were successfully treated. There were no other adverse events, such as acute pancreatitis, subcutaneous emphysema, pneumothorax and emphysema. No procedure-related death occurred. The mean hospital stay was 13.75 ±6.92 days (range 5-26 days). Conclusion EUS-BD is a safe substitute after unsuccessful ERCP when performed by experienced biliary endoscopists. However, intensive care is necessary after the procedure for early detection and management of complications. Key words: Endosonography; Biliary drainage; Hepaticogastrostomy; Choledochoduodenostomy; Complication