EUS-guided biliary drainage with transluminal stenting after failed ERCP: predictors of adverse events and long-term results - 02/12/11
Reprint requests: Do Hyun Park, MD, PhD, Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-Ro 43-Gil, Songpa-gu, Seoul 138-736 KoreaRésumé |
Background |
EUS-guided biliary drainage (EUS-BD) has been proposed as an effective alternative for percutaneous transhepatic biliary drainage (PTBD) after failed ERCP. To date, the risk factors for adverse events and long-term outcomes of EUS-BD with transluminal stenting (EUS-BDS) have not been fully explored.
Objective |
To evaluate risk factors for adverse events and long-term outcomes of EUS-BDS.
Design |
Prospective follow-up study.
Setting |
Tertiary-care academic center.
Patients |
This study involved 57 consecutive patients with malignant or benign biliary obstruction undergoing EUS-BDS after failed ERCP.
Intervention |
EUS-guided hepaticogastrostomy (EUS-HGS) and EUS-guided choledochoduodenostomy with transluminal stenting (EUS-CDS).
Main Outcome Measurements |
Risk factors for postprocedure and late adverse events and clinical outcomes of EUS-BDS.
Results |
The overall technical and functional success rates, respectively, in the EUS-BDS group were 96.5% (intention-to-treat, n = 55/57) and 89% (per-protocol, n = 49/55). Postprocedure adverse events developed after EUS-BDS in 11 patients (20%, n = 11/55). This included bile peritonitis (n = 2), mild bleeding (n = 2), and self-limited pneumoperitoneum (n = 7). In multivariate analysis, needle-knife use was the single risk factor for postprocedure adverse events after EUS-BDS (odds ratio 12.4; P = .01). A late adverse event in EUS-BDS was distal stent migration (7%, n = 4/55). The mean stent patencies with EUS-HGS and EUS-CDS were 132 days and 152 days, respectively.
Limitations |
Single-operator performed, nonrandomized study.
Conclusion |
EUS-HGS and EUS-CDS may be relatively safe and can be used as an alternative to PTBD after failed ERCP. Both techniques offer durable and comparable stent patency. The use of a needle-knife for fistula dilation in EUS-BDS should be avoided if possible.
Le texte complet de cet article est disponible en PDF.Abbreviations : EUS-BD, EUS-BDS, EUS-CD, EUS-CDS, EUS-HG, EUS-HGS, FCSEMS, PTBD
Plan
| DISCLOSURE: All authors disclosed no financial relationships relevant to this publication. |
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| If you would like to chat with an author of this article, you may contact Dr Park at dhpark@amc.seoul.kr. |
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| See CME section; p. 1376. |
Vol 74 - N° 6
P. 1276-1284 - décembre 2011 Retour au numéro
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