Tags

Type your tag names separated by a space and hit enter

Endoscopic ultrasound-guided biliary drainage versus percutaneous transhepatic biliary drainage: predictors of successful outcome in patients who fail endoscopic retrograde cholangiopancreatography.
Surg Endosc. 2016 12; 30(12):5500-5505.SE

Abstract

BACKGROUND

Patients with failed endoscopic retrograde cholangiopancreatography (ERCP) are conventionally offered percutaneous transhepatic biliary drainage (PTBD). While PTBD is effective, it is associated with catheter-related complications, pain, and poor quality of life. Endoscopic ultrasound-guided biliary drainage (EUS-BD) is a minimally invasive endoscopic option increasingly offered as an alternative to PTBD. We compare outcomes of EUS-BD and PTBD in patients with biliary obstruction at a single tertiary care center.

METHODS

A retrospective review was performed in patients with biliary obstruction who underwent EUS-BD or PTBD after failed ERCP from June 2010 through December 2014 at a single tertiary care center. Patient demographics, procedural data, and clinical outcomes were documented for each group. The aim was to compare efficacy and safety of EUS-BD and PTBD and evaluate predictors of success.

RESULTS

A total of 60 patients were included (mean age 67.5 years, 65 % male). Forty-seven underwent EUS-BD, and thirteen underwent PTBD. Technical success rates of PTBD and EUS-BD were similar (91.6 vs. 93.3 %, p = 1.0). PTBD patients underwent significantly more re-interventions than EUS-BD patients (mean 4.9 versus 1.3, p < 0.0001), had more late (>24-h) adverse events (53.8 % vs. 6.6 %, p = 0.001) and experienced more pain (4.1 vs. 1.9, p = 0.016) post-procedure. In univariate analysis, clinical success was lower in the PTBD group (25 vs. 62.2 %, p = 0.03). In multivariable logistic regression analysis, EUS-BD was the sole predictor of clinical success and long-term resolution (OR 21.8, p = 0.009).

CONCLUSION

Despite similar technical success rates compared to PTBD, EUS-BD results in a lower need for re-intervention, decreased rate of late adverse events, and lower pain scores, and is the sole predictor for clinical success and long-term resolution. EUS-BD should be the treatment of choice after a failed ERCP.

Authors+Show Affiliations

Department of Gastroenterology and Hepatology, New York Presbyterian-Weill Cornell Medical College, New York, NY, 10021, USA.Department of Gastroenterology and Hepatology, New York Presbyterian-Weill Cornell Medical College, New York, NY, 10021, USA.Department of Gastroenterology and Hepatology, New York Presbyterian-Weill Cornell Medical College, New York, NY, 10021, USA.Department of Gastroenterology and Hepatology, New York Presbyterian-Weill Cornell Medical College, New York, NY, 10021, USA.Department of Gastroenterology and Hepatology, New York Presbyterian-Weill Cornell Medical College, New York, NY, 10021, USA.Department of Gastroenterology and Hepatology, New York Presbyterian-Weill Cornell Medical College, New York, NY, 10021, USA.Department of Gastroenterology and Hepatology, New York Presbyterian-Weill Cornell Medical College, New York, NY, 10021, USA.Department of Gastroenterology and Hepatology, New York Presbyterian-Weill Cornell Medical College, New York, NY, 10021, USA.Department of Gastroenterology and Hepatology, New York Presbyterian-Weill Cornell Medical College, New York, NY, 10021, USA.Department of Gastroenterology and Hepatology, New York Presbyterian-Weill Cornell Medical College, New York, NY, 10021, USA.Department of Gastroenterology and Hepatology, New York Presbyterian-Weill Cornell Medical College, New York, NY, 10021, USA.Department of Gastroenterology and Hepatology, New York Presbyterian-Weill Cornell Medical College, New York, NY, 10021, USA.Department of Gastroenterology and Hepatology, New York Presbyterian-Weill Cornell Medical College, New York, NY, 10021, USA. mkahaleh@gmail.com.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

27129552

Citation

Sharaiha, Reem Z., et al. "Endoscopic Ultrasound-guided Biliary Drainage Versus Percutaneous Transhepatic Biliary Drainage: Predictors of Successful Outcome in Patients Who Fail Endoscopic Retrograde Cholangiopancreatography." Surgical Endoscopy, vol. 30, no. 12, 2016, pp. 5500-5505.
Sharaiha RZ, Kumta NA, Desai AP, et al. Endoscopic ultrasound-guided biliary drainage versus percutaneous transhepatic biliary drainage: predictors of successful outcome in patients who fail endoscopic retrograde cholangiopancreatography. Surg Endosc. 2016;30(12):5500-5505.
Sharaiha, R. Z., Kumta, N. A., Desai, A. P., DeFilippis, E. M., Gabr, M., Sarkisian, A. M., Salgado, S., Millman, J., Benvenuto, A., Cohen, M., Tyberg, A., Gaidhane, M., & Kahaleh, M. (2016). Endoscopic ultrasound-guided biliary drainage versus percutaneous transhepatic biliary drainage: predictors of successful outcome in patients who fail endoscopic retrograde cholangiopancreatography. Surgical Endoscopy, 30(12), 5500-5505.
Sharaiha RZ, et al. Endoscopic Ultrasound-guided Biliary Drainage Versus Percutaneous Transhepatic Biliary Drainage: Predictors of Successful Outcome in Patients Who Fail Endoscopic Retrograde Cholangiopancreatography. Surg Endosc. 2016;30(12):5500-5505. PubMed PMID: 27129552.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endoscopic ultrasound-guided biliary drainage versus percutaneous transhepatic biliary drainage: predictors of successful outcome in patients who fail endoscopic retrograde cholangiopancreatography. AU - Sharaiha,Reem Z, AU - Kumta,Nikhil A, AU - Desai,Amit P, AU - DeFilippis,Ersilia M, AU - Gabr,Moamen, AU - Sarkisian,Alex M, AU - Salgado,Sanjay, AU - Millman,Jennifer, AU - Benvenuto,Andrea, AU - Cohen,Michelle, AU - Tyberg,Amy, AU - Gaidhane,Monica, AU - Kahaleh,Michel, Y1 - 2016/04/29/ PY - 2016/01/25/received PY - 2016/04/02/accepted PY - 2016/5/1/pubmed PY - 2017/8/8/medline PY - 2016/5/1/entrez KW - Biliary drainage KW - Endoscopic retrograde cholangiopancreatography KW - Endoscopic ultrasound SP - 5500 EP - 5505 JF - Surgical endoscopy JO - Surg Endosc VL - 30 IS - 12 N2 - BACKGROUND: Patients with failed endoscopic retrograde cholangiopancreatography (ERCP) are conventionally offered percutaneous transhepatic biliary drainage (PTBD). While PTBD is effective, it is associated with catheter-related complications, pain, and poor quality of life. Endoscopic ultrasound-guided biliary drainage (EUS-BD) is a minimally invasive endoscopic option increasingly offered as an alternative to PTBD. We compare outcomes of EUS-BD and PTBD in patients with biliary obstruction at a single tertiary care center. METHODS: A retrospective review was performed in patients with biliary obstruction who underwent EUS-BD or PTBD after failed ERCP from June 2010 through December 2014 at a single tertiary care center. Patient demographics, procedural data, and clinical outcomes were documented for each group. The aim was to compare efficacy and safety of EUS-BD and PTBD and evaluate predictors of success. RESULTS: A total of 60 patients were included (mean age 67.5 years, 65 % male). Forty-seven underwent EUS-BD, and thirteen underwent PTBD. Technical success rates of PTBD and EUS-BD were similar (91.6 vs. 93.3 %, p = 1.0). PTBD patients underwent significantly more re-interventions than EUS-BD patients (mean 4.9 versus 1.3, p < 0.0001), had more late (>24-h) adverse events (53.8 % vs. 6.6 %, p = 0.001) and experienced more pain (4.1 vs. 1.9, p = 0.016) post-procedure. In univariate analysis, clinical success was lower in the PTBD group (25 vs. 62.2 %, p = 0.03). In multivariable logistic regression analysis, EUS-BD was the sole predictor of clinical success and long-term resolution (OR 21.8, p = 0.009). CONCLUSION: Despite similar technical success rates compared to PTBD, EUS-BD results in a lower need for re-intervention, decreased rate of late adverse events, and lower pain scores, and is the sole predictor for clinical success and long-term resolution. EUS-BD should be the treatment of choice after a failed ERCP. SN - 1432-2218 UR - https://www.unboundmedicine.com/medline/citation/27129552/Endoscopic_ultrasound_guided_biliary_drainage_versus_percutaneous_transhepatic_biliary_drainage:_predictors_of_successful_outcome_in_patients_who_fail_endoscopic_retrograde_cholangiopancreatography_ L2 - https://dx.doi.org/10.1007/s00464-016-4913-y DB - PRIME DP - Unbound Medicine ER -