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Comparative Study
. 2025 Jul;57(7):719-729.
doi: 10.1055/a-2543-5672. Epub 2025 Feb 20.

Biliary drainage prior to pancreatoduodenectomy with endoscopic ultrasound-guided choledochoduodenostomy versus conventional ERCP: propensity score-matched study and surgeon survey

Jeska A Fritzsche  1   2   3 , Mike J P de Jong  4 , Bert A Bonsing  5 , Olivier R Busch  2   3   6 , Freek Daams  2   3   6 , Wouter J M Derksen  7   8 , Lydi M J W van Driel  9 , Sebastiaan Festen  10 , Erwin-Jan M van Geenen  4 , Frederik J H Hoogwater  11 , Akin Inderson  12 , Sjoerd D Kuiken  13 , Mike S L Liem  14 , Daan J Lips  14 , Maarten W Nijkamp  11 , Hjalmar C van Santvoort  7   8 , Peter D Siersema  4   9 , Martijn W J Stommel  15 , Niels G Venneman  16 , Robert C Verdonk  17 , Frank P Vleggaar  18 , Roeland F de Wilde  19 , Marc G Besselink  2   3   6 , Roy L J van Wanrooij  2   3   20 , Rogier P Voermans  1   2   3 ; Dutch Pancreatic Cancer Group (DPCG), Dutch Pancreatic Cancer Audit (DPCA) and the pancreatoduodenectomy after EUS-CDS investigators
Collaborators, Affiliations
Comparative Study

Biliary drainage prior to pancreatoduodenectomy with endoscopic ultrasound-guided choledochoduodenostomy versus conventional ERCP: propensity score-matched study and surgeon survey

Jeska A Fritzsche et al. Endoscopy. 2025 Jul.

Abstract

Background: Preoperative endoscopic biliary drainage may lead to complications (16 %-24 %), potentially hampering surgical exploration. Endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) may reduce drainage-related complications; however, in the absence of surgeon-reported outcomes, it is unknown whether EUS-CDS may hamper surgical exploration. This study assessed the impact of preoperative EUS-CDS on pancreatoduodenectomy.

Method: Consecutive patients who underwent pancreatoduodenectomy after preoperative biliary drainage were included in all eight centers performing EUS-CDS in the mandatory Dutch Pancreatic Cancer Audit (Jan 2020-Dec 2022). The primary outcome was major postoperative complications. Secondary outcomes included bile leak grade B/C, postoperative pancreatic fistula (POPF) grade B/C, and overall postoperative complications. A propensity score-matching (1:3) analysis was performed. Surgeons performing pancreatoduodenectomy after EUS-CDS completed a survey on surgical difficulty.

Results: 937 patients with pancreatoduodenectomy after preoperative biliary drainage were included (42 EUS-CDS, 895 endoscopic retrograde cholangiopancreatography [ERCP]). Major postoperative complications occurred in 8 patients (19.0 %) in the EUS-CDS group and 292 (32.6 %) in the ERCP group (relative risk [RR] 0.50; 95 %CI 0.23-1.07). No significant differences were observed in overall complications (RR 0.95; 95 %CI 0.51-1.76), bile leak (RR 1.25; 95 %CI 0.31-4.98), or POPF (RR 0.62; 95 %CI 0.25-1.56). Results were similar after matching. The survey was completed for 29 pancreatoduodenectomies; surgery was not (13, 45 %), "slightly" (9, 31 %), "clearly" (5,17 %), and "severely" (2, 7 %) more complex because of EUS-CDS.

Conclusion: This early experience suggests that preoperative biliary drainage with EUS-CDS does not increase the rate of complications after pancreatoduodenectomy and only infrequently hampers surgical exploration.

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Conflict of interest statement

F. Daams reports research grants from Medtronic, and has received speaker fees from Medtronic, and proctoring fees from Intuitive. L. van Driel has received speaker fees from Viatris. P. Fockens reports consultancy for Olympus and Cook Endoscopy. E.M. van Geenen reports research grants from Olympus, Boston Scientific, and MTW Endoskopie. P.D. Siersema reports research grants from Pentax and Fujifilm. R.C. Verdonk has received speaker fees from Viatris. R.L.J. van Wanrooij reports consultancy for Boston Scientific. R.P. Voermans reports research grants from Boston Scientific and Prion Medical, consultancy for Boston Scientific, and has received speaker fees from Mylan and Zambon. All outside the submitted work. The remaining authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Flow chart of the screening and inclusion process. DPCA, Dutch Pancreatic Cancer Audit; EUS-CDS, endoscopic ultrasound-guided choledochoduodenostomy; ERCP, endoscopic retrograde cholangiopancreatography.
Fig. 2
Fig. 2
Intraoperative image of endoscopic ultrasound-guided choledochoduodenostomy. Green, bile duct; blue, duodenum.
See this image and copyright information in PMC

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