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. 2017 Mar;29(2):218-225.
doi: 10.1111/den.12752. Epub 2016 Nov 10.

Indications for endoscopic ultrasonography (EUS)-guided biliary intervention: Does EUS always come after failed endoscopic retrograde cholangiopancreatography?

Yousuke Nakai  1 , Hiroyuki Isayama  1 , Natsuyo Yamamoto  1 , Saburo Matsubara  1 , Hirofumi Kogure  1 , Suguru Mizuno  1 , Tsuyoshi Hamada  1 , Naminatsu Takahara  1 , Rie Uchino  1 , Dai Akiyama  1 , Kaoru Takagi  1 , Takeo Watanabe  1 , Gyotane Umefune  1 , Kazunaga Ishigaki  1 , Minoru Tada  1 , Kazuhiko Koike  1
Affiliations

Indications for endoscopic ultrasonography (EUS)-guided biliary intervention: Does EUS always come after failed endoscopic retrograde cholangiopancreatography?

Yousuke Nakai et al. Dig Endosc. 2017 Mar.

Abstract

Background and aim: Endoscopic ultrasonography-guided biliary drainage (EUS-BD), first reported as an alternative to percutaneous transhepatic biliary drainage (PTBD) after failed endoscopic retrograde cholangiopancreatography (ERCP), is increasingly reported as a primary procedure without failed ERCP. The present study aims to evaluate the outcomes of therapeutic biliary ERCP and to compare the safety and effectiveness of primary EUS-BD with those of ERCP, rescue EUS-BD and PTBD.

Methods: We retrospectively studied therapeutic biliary ERCP as well as subsequent rescue PTBD and EUS-BD. Additionally, indications, safety and technical success of primary EUS-BD were evaluated.

Results: Between August 2013 and September 2015, a total of 520 therapeutic biliary ERCP with a native papilla were analyzed. We encountered 23 cases with inaccessible papilla and 22 cases with failed cannulation, which were rescued by 21 PTBD, 16 EUS-BD and two repeat ERCP. Additionally, 40 primary EUS-BD were carried out during the same period as a result of 10 recurrent cholangitis cases after transpapillary drainage, five outside failed cannulation, four altered anatomy, two history of ERCP-related adverse events (AE), two technical difficulties in stenting under enteroscopy-assisted ERCP and 17 on study protocol. Technical success and AE rates were 95.6% and 14.5% in ERCP, 90.5% and 33.3% in rescue PTBD, 93.8% and 18.8% in rescue EUS-BD, and 95.0% and 22.5% in primary EUS-BD, respectively.

Conclusions: Rescue EUS-BD was used in 3.1% among all ERCP. Given the comparable technical success and AE rates of both primary and rescue EUS-BD, primary EUS-BD without failed ERCP can be a treatment option if it provides advantages over ERCP.

Keywords: EUS-guided biliary drainage; choledocholithiasis; endoscopic retrograde cholangiopancreatography; endoscopic ultrasonography (EUS); malignant biliary obstruction.

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