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. 2017 Jun;10(6):483-493.
doi: 10.1177/1756283X17702096. Epub 2017 Apr 10.

Endoscopic ultrasound-guided hepaticogastrostomy versus percutaneous transhepatic drainage for malignant biliary obstruction after failed endoscopic retrograde cholangiopancreatography: a retrospective expertise-based study from two centers

Adrien Sportes  1 , Marine Camus  1 , Michel Greget  2 , Sarah Leblanc  1 , Romain Coriat  1 , Jürgen Hochberger  3 , Stanislas Chaussade  1 , Sophie Grabar  4 , Frédéric Prat  5
Affiliations

Endoscopic ultrasound-guided hepaticogastrostomy versus percutaneous transhepatic drainage for malignant biliary obstruction after failed endoscopic retrograde cholangiopancreatography: a retrospective expertise-based study from two centers

Adrien Sportes et al. Therap Adv Gastroenterol. 2017 Jun.

Abstract

Background: Percutaneous transhepatic biliary drainage (PTBD) is widely performed as a salvage procedure in patients with unresectable malignant obstruction of the common bile duct (CBD) after failed endoscopic retrograde cholangiopancreatography (ERCP) or in case of surgically altered anatomy. Endoscopic ultrasound-guided hepaticogastrostomy (EU-HGS) is a more recently introduced alternative to relieve malignant obstructive jaundice. The aim of this prospective observational study was to compare the outcome, efficacy and adverse events of EU-HGS and PTBD.

Methods: From April 2012 to August 2015, consecutive patients with malignant CBD obstruction who underwent EU-HGS or PTBD in two tertiary-care referral centers were included. The primary endpoint was the clinical success rate. Secondary endpoints were technical success, overall survival, procedure-related adverse events, incidence of adverse events, and reintervention rate.

Results: A total of 51 patients (EU-HGS, n = 31; PTBD, n = 20) were included. Median survival was 71 days (range 25-75th percentile; 30-95) for the EU-HGS group and 78 days (range 25-75th percentile; 42-108) for the PTBD group (p = 0.99). Technical success was achieved in all patients in both groups. Clinical success was achieved in 25 (86%) of 31 patients in the EU-HGS group and in 15 (83%) of 20 patients in the PTBD group (p = 0.88). There was no difference in adverse events rates between the two groups (EU-HGS: 16%; PTBD: 10%) (p = 0.69). Four deaths within 1 month (two hemorrhagic and two septic) were considered procedure related (two in the EU-HGS group and two in the PTBD group). Overall reintervention rate was significantly lower after EU-HGS (n = 2) than after PTBD (n = 21) (p = 0.0001). Length of hospital stay was shorter after EU-HGS (8 days versus 15 days; p = 0.002).

Conclusions: EU-HGS can be an effective and safe mini invasive-procedure alternative to PTBD, with similar success and adverse-event rates, but with lower rates of reintervention and length of hospitalization.

Keywords: ERCP; EUS; PTBD; jaundice; pancreatic cancer.

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Conflict of interest statement

Conflict of interest statement: The authors declare that there is no conflict of interest.

Figures

Figure 1a.
Figure 1a.
Biliary puncture under endoscopic ultrasound control.
Figure 1b.
Figure 1b.
Cholangiographic view after transhepatogastric stent release in a patient with previously stented duodenal obstruction and distal biliary stricture. With arrow: intraductal stent end; long black arrow: intragastric stent end; short black arrows: stent portion traversing the liver parenchyma.
Figure 1c.
Figure 1c.
Endoscopic view of a transhepatogastric fully covered self-expanding metal stents (FCSEMS) with bile outflow inserted through the posterior and upper gastric wall and stitched with a clip to the mucosa.
Figure 2.
Figure 2.
Flowchart of patient selection. EUS, endoscopic ultrasound; ERCP, endoscopic retrograde cholangiopancreatography.
Figure 3.
Figure 3.
Survival after biliary drainage according to procedure (Kaplan–Meier’s survival calculation).
See this image and copyright information in PMC

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