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Palliative Endoscopic Ultrasound Biliary Drainage for Advanced Malignant Biliary Obstruction: Should It Replace the Percutaneous Approach?
Case Rep Gastroenterol. 2019 Sep-Dec; 13(3):385-397.CR

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic biliary drainage (PTBD) are the standard of care in malignant biliary obstruction cases. Recently, endoscopic ultrasound-guided biliary drainage (EUS-BD) has been widely used after unsuccessful ERCP. However, the patient's clinical impact of EUS-BD over PTBD is still not obvious. Therefore, this case series study aims to evaluate the clinical outcomes of patients with advanced malignant biliary obstruction who underwent EUS-BD after failed ERCP. A retrospective database study was performed between January 2016 and June 2018 in patients with advanced malignant biliary obstruction. Patients were consecutively enrolled without randomization. Treatment options consisted of ERCP and PTBD or EUS-BD if ERCP failed. Based on 144 biliary obstruction cases, 38 patients were enrolled; 24 (63.2%) were men. The patients' mean age was 66.8 ± 12.36 years. The most common cause of malignant biliary obstruction was pancreatic cancer (44.7%). Biliary drainage was achieved by ERCP (39.5%), PTBD (39.5%), and EUS-BD (21.1%). The technical success rate was 86.7% by PTBD and 87.5% by EUS-BD (p = 1.000), while the clinical success rate was 93.3% by PTBD and 62.5% by EUS-BD (p = 0.500). The median survival in patients who underwent PTBD versus those wo underwent EUS-BD was 11 versus 3 months (log-rank p = 0.455). In conclusion, there is no significant advantage of EUS-BD when compared to PTBD in terms of clinical success and survival benefit in advanced malignant biliary obstruction.

Authors+Show Affiliations

Digestive Disease and Gastrointestinal Oncology Center, Medistra Hospital, Jakarta, Indonesia. Hepatobiliary Division, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Medical Faculty Universitas Indonesia, Jakarta, Indonesia.Hepatobiliary Division, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Medical Faculty Universitas Indonesia, Jakarta, Indonesia.Hepatobiliary Division, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Medical Faculty Universitas Indonesia, Jakarta, Indonesia.Hepatobiliary Division, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Medical Faculty Universitas Indonesia, Jakarta, Indonesia.Division of Gastroenterology, Department of Medicine, National University Hospital, Singapore, Singapore.Department of Gastroenterology and Endoscopy, SL Raheja Hospital, A Fortis Associate Mahim, Mumbai, India. Department of Gastroenterology and Endoscopy, Asian Cancer Institute, Somaiya Ayurvihar, Mumbai, India.Digestive Disease and Gastrointestinal Oncology Center, Medistra Hospital, Jakarta, Indonesia.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

31616233

Citation

Lesmana, C Rinaldi A., et al. "Palliative Endoscopic Ultrasound Biliary Drainage for Advanced Malignant Biliary Obstruction: Should It Replace the Percutaneous Approach?" Case Reports in Gastroenterology, vol. 13, no. 3, 2019, pp. 385-397.
Lesmana CRA, Gani RA, Hasan I, et al. Palliative Endoscopic Ultrasound Biliary Drainage for Advanced Malignant Biliary Obstruction: Should It Replace the Percutaneous Approach? Case Rep Gastroenterol. 2019;13(3):385-397.
Lesmana, C. R. A., Gani, R. A., Hasan, I., Sulaiman, A. S., Ho, K. Y., Dhir, V., & Lesmana, L. A. (2019). Palliative Endoscopic Ultrasound Biliary Drainage for Advanced Malignant Biliary Obstruction: Should It Replace the Percutaneous Approach? Case Reports in Gastroenterology, 13(3), 385-397. https://doi.org/10.1159/000502835
Lesmana CRA, et al. Palliative Endoscopic Ultrasound Biliary Drainage for Advanced Malignant Biliary Obstruction: Should It Replace the Percutaneous Approach. Case Rep Gastroenterol. 2019 Sep-Dec;13(3):385-397. PubMed PMID: 31616233.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Palliative Endoscopic Ultrasound Biliary Drainage for Advanced Malignant Biliary Obstruction: Should It Replace the Percutaneous Approach? AU - Lesmana,C Rinaldi A, AU - Gani,Rino A, AU - Hasan,Irsan, AU - Sulaiman,Andri Sanityoso, AU - Ho,Khek Yu, AU - Dhir,Vinay, AU - Lesmana,Laurentius A, Y1 - 2019/09/25/ PY - 2019/07/25/received PY - 2019/08/20/accepted PY - 2019/10/17/entrez PY - 2019/10/17/pubmed PY - 2019/10/17/medline KW - Endoscopic retrograde cholangiopancreatography KW - Endoscopic ultrasound-guided biliary drainage KW - Endoscopic ultrasound-guided choledochoduodenostomy KW - Malignant biliary obstruction KW - Percutaneous transhepatic biliary drainage SP - 385 EP - 397 JF - Case reports in gastroenterology JO - Case Rep Gastroenterol VL - 13 IS - 3 N2 - Endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic biliary drainage (PTBD) are the standard of care in malignant biliary obstruction cases. Recently, endoscopic ultrasound-guided biliary drainage (EUS-BD) has been widely used after unsuccessful ERCP. However, the patient's clinical impact of EUS-BD over PTBD is still not obvious. Therefore, this case series study aims to evaluate the clinical outcomes of patients with advanced malignant biliary obstruction who underwent EUS-BD after failed ERCP. A retrospective database study was performed between January 2016 and June 2018 in patients with advanced malignant biliary obstruction. Patients were consecutively enrolled without randomization. Treatment options consisted of ERCP and PTBD or EUS-BD if ERCP failed. Based on 144 biliary obstruction cases, 38 patients were enrolled; 24 (63.2%) were men. The patients' mean age was 66.8 ± 12.36 years. The most common cause of malignant biliary obstruction was pancreatic cancer (44.7%). Biliary drainage was achieved by ERCP (39.5%), PTBD (39.5%), and EUS-BD (21.1%). The technical success rate was 86.7% by PTBD and 87.5% by EUS-BD (p = 1.000), while the clinical success rate was 93.3% by PTBD and 62.5% by EUS-BD (p = 0.500). The median survival in patients who underwent PTBD versus those wo underwent EUS-BD was 11 versus 3 months (log-rank p = 0.455). In conclusion, there is no significant advantage of EUS-BD when compared to PTBD in terms of clinical success and survival benefit in advanced malignant biliary obstruction. SN - 1662-0631 UR - https://www.unboundmedicine.com/medline/citation/31616233/Palliative_Endoscopic_Ultrasound_Biliary_Drainage_for_Advanced_Malignant_Biliary_Obstruction:_Should_It_Replace_the_Percutaneous_Approach L2 - https://www.karger.com?DOI=10.1159/000502835 DB - PRIME DP - Unbound Medicine ER -
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