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Unresectable malignant obstructive jaundice: a 2-year experience of EUS-guided biliary drainage
  1. Robert Staroń1,
  2. Mateusz Rzucidło1,
  3. Adam Macierzanka2,
  4. Marcin Krawczyk3,4,
  5. Krzysztof Gutkowski1 and
  6. Lukasz Krupa1
  1. 1Department of Gastroenterology and Hepatology with Internal Disease Unit, Specialist Voivodeship Hospital Frederic Chopin in Rzeszow, 35-055 Rzeszow, Poland
  2. 2Department of Colloid and Lipid Science, Gdańsk University of Technology, Gdansk, Województwo pomorskie, Poland
  3. 3Department of Medicine II, Saarland University Medical Centre, Saarland University, Homburg, Saarland, Germany
  4. 4Laboratory of Metabolic Liver Diseases, Centre for Preclinical Research, Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
  1. Correspondence to Dr Lukasz Krupa, Department of Gastroenterology and Hepatology with Internal Disease Unit, Specialist Voivodship Hospital Frederic Chopin in Rzeszow, Rzeszow, Poland; krupasl{at}yahoo.com

Abstract

Objectives Endoscopic biliary drainage is a first-line treatment in patients with unresectable malignant biliary obstruction. In most cases the drainage is conducted using endoscopic retrograde cholangiopancreatography (ERCP). Percutaneous transhepatic biliary drainage or endosonography-guided biliary drainage (EUS-BD) represents therapeutic options after unsuccessful ERCP. Here we report on 2 years experience in the management of patients diagnosed with malignant biliary obstruction using EUS-BD.

Methods Retrospective data were collected on patients who underwent EUS-BD due to malignant biliary obstruction at our centre between April 2016 and April 2018. Only patients who had two unsuccessful attempts of ERCP prior to EUS-BD were included. We analysed the technical success (ie, creation of anastomosis and successful placement of a stent) and complication rate of EUS-BD, and monitored changes in serum bilirubin and liver function tests after 2 days, and at least 2 weeks, following the procedure.

Results Screening of 1781 ERCP procedures performed in our department during the inclusion period led to the identification of 31 patients (18 women, age range 51–92 years, 58% with pancreatic cancer) who fulfilled the inclusion criteria. Hepaticogastrostomy and choledochoduodenostomy were performed in 12 and 19 patients, respectively. The technical success rate was 97% and the complication rate was 12.9%. EUS-BD resulted in a significant decrease in serum bilirubin (p<0.01).

Conclusions EUS-BD represents a reasonable therapeutic option after unsuccessful ERCP in patients with malignant biliary obstruction. Possible complications have to be kept in mind and this procedure should be performed at centres experienced in ERCP and EUS.

  • pancreatic
  • jaundice

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Footnotes

  • Contributors All authors contributed to the writing up of the manuscript and the designing of the study.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The local ethical committee approved the retrospective analysis.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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