A Comparative Evaluation of EUS-Guided Biliary Drainage and Percutaneous Drainage in Patients with Distal Malignant Biliary Obstruction and Failed ERCP

Mouen Khashab, Ali Kord Valeshabad, Elham Afghani, Vikesh Singh, Vivek Kumbhari, Ahmed Messallam, Payal Saxena, Mohamad El Zein, Anne Marie O'Broin-Lennon, Marcia Canto, Anthony N Kalloo

Research output: Contribution to journalArticle

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 

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.

Original languageEnglish (US)
Pages (from-to)557-565
Number of pages9
JournalDigestive Diseases and Sciences
Volume60
Issue number2
DOIs
StatePublished - 2015

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Endoscopic Retrograde Cholangiopancreatography
Drainage
Safety
Costs and Cost Analysis
Jaundice
Stents

Keywords

  • ERCP
  • EUS
  • Jaundice
  • Pancreatic cancer
  • PTBD

ASJC Scopus subject areas

  • Gastroenterology
  • Physiology
  • Medicine(all)

Cite this

@article{d65757fa3eb94f4e904ccf72312f74cc,
title = "A Comparative Evaluation of EUS-Guided Biliary Drainage and Percutaneous Drainage in Patients with Distal Malignant Biliary Obstruction and Failed ERCP",
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 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.",
keywords = "ERCP, EUS, Jaundice, Pancreatic cancer, PTBD",
author = "Mouen Khashab and Valeshabad, {Ali Kord} and Elham Afghani and Vikesh Singh and Vivek Kumbhari and Ahmed Messallam and Payal Saxena and {El Zein}, Mohamad and O'Broin-Lennon, {Anne Marie} and Marcia Canto and Kalloo, {Anthony N}",
year = "2015",
doi = "10.1007/s10620-014-3300-6",
language = "English (US)",
volume = "60",
pages = "557--565",
journal = "Digestive Diseases and Sciences",
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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

AU - Valeshabad, Ali Kord

AU - Afghani, Elham

AU - Singh, Vikesh

AU - Kumbhari, Vivek

AU - Messallam, Ahmed

AU - Saxena, Payal

AU - El Zein, Mohamad

AU - O'Broin-Lennon, Anne Marie

AU - Canto, Marcia

AU - Kalloo, Anthony N

PY - 2015

Y1 - 2015

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 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.

AB - 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 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.

KW - ERCP

KW - EUS

KW - Jaundice

KW - Pancreatic cancer

KW - PTBD

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