Abstract
Purpose
To evaluate clinical outcomes of endoscopic ultrasound (EUS)-guided biliary drainage (EUS-BD) for unresectable malignant biliary obstruction for cases in which endoscopic retrograde cholangiopancreatography (ERCP) failed at a high-volume center.
Methods
All 99 EUS-BD cases of unresectable malignant biliary obstruction at Sendai City Medical Center between February 2007 and September 2017 were retrospectively evaluated. ERCP is strictly prioritized over EUS-BD during the study period, and EUS-BD was performed in cases wherein ERCP was impossible or ineffective. Technical success, clinical success, adverse events, and time to recurrence of biliary obstruction were evaluated.
Results
EUS-BD was technically successful in 98% of the patients (97/99). The clinical success rate was 93% (90/97). Adverse events that were definitely related to the procedure were observed in ten patients (10%; peritonitis in six, acute cholecystitis in four). Of six patients with bile peritonitis, four suffered from mild localized peritonitis that improved with conservative treatment, whereas two developed pan-peritonitis that improved with additional intervention. Other three patients with a poor performance status succumbed shortly after the successful EUS-BD, with a possible association between the procedure and death. In the 68 patients with a bilioenteric stent, the median time to recurrence of biliary obstruction was 339 days (95% confidence interval (CI), 14–664 days) during the mean follow-up period of 136 ± 173 days.
Conclusion
EUS-BD was found to be feasible. However, there were a few patients with an unfavorable course after successful EUS-BD.
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This study received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
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All authors had access to the study data and reviewed and approved the final manuscript.
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Both the EUS-BD procedure and this study were approved by the Institutional Review Board of Sendai City Medical Center. Written informed consent for EUS-BD was obtained with presenting risks and benefits in comparison with other possible options from all patients before the procedure.
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The authors declare that they have no conflicts of interest.
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Kanno, Y., Koshita, S., Ogawa, T. et al. EUS-Guided Biliary Drainage for Unresectable Malignant Biliary Obstruction: 10-Year Experience of 99 Cases at a Single Center. J Gastrointest Canc 50, 469–477 (2019). https://doi.org/10.1007/s12029-018-0096-1
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DOI: https://doi.org/10.1007/s12029-018-0096-1