The Role of EUS-BD in the Management of Malignant Biliary Obstruction: The Indonesian Perspective

Abstract

Aims: To evaluate the success rate and related factors of endoscopic ultrasound guided-biliary drainage (EUS-BD).

Material and methods: We conducted a retrospective study among 24 patients with malignant biliary obstruction who underwent EUS-BD after failed ERCP from January 2015 to December 2016 in a tertiary health center. The bilirubin levels before and after the procedure were used to define the clinical success rate, while the stent deployment was used to define the technical success rate. We placed either transluminal biliary stents or transpapillary biliary stents.

Results: Among 24 patients, choledochoduodenostomy technique was conducted in 23 patients (95.8%) and hepaticogastrostomy technique in 1 patient (4.2%). Transluminal stent placement was conducted in 23 patients, while transpapillary stent placement was conducted in 1 patient. The clinical success rate was 78.2% (18) in choledochoduodenostomy route and 100% (1) in hepaticogastrostomy route. EUS-BD was 2.37 times and 2.11 times more likely to be successful in reducing the bilirubin level in patients with tumor of the head of pancreas and periampullary tumor, respectively, but not in cholangiocarcinoma.

Conclusions: EUS-BD is an effective and efficient procedure to achieve biliary drainage among patients with malignant biliary obstruction after ERCP failure.

Figure 1

EUS-BD in a patient with a periampullary tumor with unidentifiable ampulla and failed ERCP: (a) endoscopy view of the periampullary tumor; (b) EUS imaging of the puncture into dilated CBD; (c) puncture point enlargement using Cystotome; (d) dilated intra- and extrahepatic CBD; (e) transduodenal plastic biliary stent placement; (f) bile drainage through the stent.