Metallic biliary drainage: endoscopic ultrasound versus percutaneous approach after failed endoscopic retrograde cholangiopancreatography for distal malignant biliary strictures

Ragab, Khaled M.; Kobeisy, Mohammad A.; Guda, Mohamed; Aly, Abdelhamid M.; Seif, Hany M.A.; Abbas, Wael A.

doi:10.4103/ejs.ejs_342_21

Metallic biliary drainage: endoscopic ultrasound versus percutaneous approach after failed endoscopic retrograde cholangiopancreatography for distal malignant biliary strictures

Authors

Abstract

Background and purpose
After failure of endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasound (EUS)-guided biliary drainage is a feasible and safe alternative to percutaneous transhepatic biliary drainage and surgical bypass for distal malignant biliary strictures (DMBS). The aim of this study was to compare the efficacy, safety, cost, and patency of self-expandable metallic stent insertion by EUS-guided versus percutaneous route for biliary drainage after failure of ERCP.
Patients and methods
A total of 40 patients with DMBS after failure of ERCP were randomized into two groups: group I (20 patients) underwent EUS-BD and group II (20 patients) underwent percutaneous metallic biliary drainage (PMBD); both groups used SEMS.
Results
The technical and clinical success rates for EUS-BD and PMBD groups were 100 and 95% (=0.897). Nonetheless, complications were more common in the PMBD group (10 vs. 25%, =0.212). Fever, cholangitis, and mild bile leakage were early complications in both groups, whereas stent migration (one patient) in EUS-BD group and stent obstruction (four patients) (=0.035) in PMBD group were late complications. Between EUS-BD and PMBD groups, the rate of reintervention was 5 and 20% (=0.171), and cumulative cost of the procedures was 964.32 ± 79.8$ and 1098.61 ± 84.5$, respectively (=0.035).
Conclusion
When compared with PMBD for DMBS after failure of ERCP, EUS-BD is a technically successful and safe procedure with a shorter fluoroscopy duration, less minor complications, longer stent patency, and a lower cost with fewer re-interventions.

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