Tags

Type your tag names separated by a space and hit enter

A comparative evaluation of EUS-guided biliary drainage and percutaneous drainage in patients with distal malignant biliary obstruction and failed ERCP.
Dig Dis Sci. 2015 Feb; 60(2):557-65.DD

Abstract

BACKGROUND AND AIM

Endoscopic ultrasound-guided biliary drainage (EGBD) may be a safe, alternative technique to percutaneous transhepatic biliary drainage (PTBD) in patients who fail ERCP. However, it is currently unknown how both techniques compare in terms of efficacy, safety, and cost. The aims of this study were to compare efficacy, safety, and cost of EGBD to that of PTBD.

METHODS

Jaundiced patients with distal malignant biliary obstruction who underwent EGBD or PTBD after failed ERCP were included. Technical success, clinical success, and adverse events between the two groups were compared.

RESULTS

A total of 73 patients with failed ERCP subsequently underwent EGBD (n = 22) or PTBD (n = 51). Although technical success was higher in the PTBD group (100 vs. 86.4 %, p = 0.007), clinical success was equivalent (92.2 vs. 86.4 %, p = 0.40). PTBD was associated with higher adverse event rate (index procedure: 39.2 vs. 18.2 %; all procedures including reinterventions: 80.4 vs. 15.7 %). Stent patency and survival were equivalent between both groups. Total charges were more than two times higher in the PTBD group (p = 0.004) mainly due to significantly higher rate of reinterventions (80.4 vs. 15.7 %, p < 0.001).

CONCLUSION

EGBD and PTBD are comparably effective techniques for treatment of distal malignant biliary obstruction after failed ERCP. However, EGBD is associated with decreased adverse events rate and is significantly less costly due to the need for fewer reinterventions. Our results suggest that EGBD should be the technique of choice for treatment of these patients at institutions with experienced interventional endosonographers.

Authors+Show Affiliations

Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD, USA, mkhasha1@jhmi.edu.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

25081224

Citation

Khashab, Mouen A., et al. "A Comparative Evaluation of EUS-guided Biliary Drainage and Percutaneous Drainage in Patients With Distal Malignant Biliary Obstruction and Failed ERCP." Digestive Diseases and Sciences, vol. 60, no. 2, 2015, pp. 557-65.
Khashab MA, Valeshabad AK, Afghani E, et al. A comparative evaluation of EUS-guided biliary drainage and percutaneous drainage in patients with distal malignant biliary obstruction and failed ERCP. Dig Dis Sci. 2015;60(2):557-65.
Khashab, M. A., Valeshabad, A. K., Afghani, E., Singh, V. K., Kumbhari, V., Messallam, A., Saxena, P., El Zein, M., Lennon, A. M., Canto, M. I., & Kalloo, A. N. (2015). A comparative evaluation of EUS-guided biliary drainage and percutaneous drainage in patients with distal malignant biliary obstruction and failed ERCP. Digestive Diseases and Sciences, 60(2), 557-65. https://doi.org/10.1007/s10620-014-3300-6
Khashab MA, et al. A Comparative Evaluation of EUS-guided Biliary Drainage and Percutaneous Drainage in Patients With Distal Malignant Biliary Obstruction and Failed ERCP. Dig Dis Sci. 2015;60(2):557-65. PubMed PMID: 25081224.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A comparative evaluation of EUS-guided biliary drainage and percutaneous drainage in patients with distal malignant biliary obstruction and failed ERCP. AU - Khashab,Mouen A, AU - Valeshabad,Ali Kord, AU - Afghani,Elham, AU - Singh,Vikesh K, AU - Kumbhari,Vivek, AU - Messallam,Ahmed, AU - Saxena,Payal, AU - El Zein,Mohamad, AU - Lennon,Anne Marie, AU - Canto,Marcia Irene, AU - Kalloo,Anthony N, Y1 - 2014/08/01/ PY - 2014/04/21/received PY - 2014/07/15/accepted PY - 2014/8/2/entrez PY - 2014/8/2/pubmed PY - 2015/3/19/medline SP - 557 EP - 65 JF - Digestive diseases and sciences JO - Dig. Dis. Sci. VL - 60 IS - 2 N2 - BACKGROUND AND AIM: Endoscopic ultrasound-guided biliary drainage (EGBD) may be a safe, alternative technique to percutaneous transhepatic biliary drainage (PTBD) in patients who fail ERCP. However, it is currently unknown how both techniques compare in terms of efficacy, safety, and cost. The aims of this study were to compare efficacy, safety, and cost of EGBD to that of PTBD. METHODS: Jaundiced patients with distal malignant biliary obstruction who underwent EGBD or PTBD after failed ERCP were included. Technical success, clinical success, and adverse events between the two groups were compared. RESULTS: A total of 73 patients with failed ERCP subsequently underwent EGBD (n = 22) or PTBD (n = 51). Although technical success was higher in the PTBD group (100 vs. 86.4 %, p = 0.007), clinical success was equivalent (92.2 vs. 86.4 %, p = 0.40). PTBD was associated with higher adverse event rate (index procedure: 39.2 vs. 18.2 %; all procedures including reinterventions: 80.4 vs. 15.7 %). Stent patency and survival were equivalent between both groups. Total charges were more than two times higher in the PTBD group (p = 0.004) mainly due to significantly higher rate of reinterventions (80.4 vs. 15.7 %, p < 0.001). CONCLUSION: EGBD and PTBD are comparably effective techniques for treatment of distal malignant biliary obstruction after failed ERCP. However, EGBD is associated with decreased adverse events rate and is significantly less costly due to the need for fewer reinterventions. Our results suggest that EGBD should be the technique of choice for treatment of these patients at institutions with experienced interventional endosonographers. SN - 1573-2568 UR - https://www.unboundmedicine.com/medline/citation/25081224/A_comparative_evaluation_of_EUS_guided_biliary_drainage_and_percutaneous_drainage_in_patients_with_distal_malignant_biliary_obstruction_and_failed_ERCP_ L2 - https://doi.org/10.1007/s10620-014-3300-6 DB - PRIME DP - Unbound Medicine ER -