EUS-guided biliary drainage by using a standardized approach for malignant biliary obstruction: Rendezvous versus direct transluminal techniques (with videos)

Mouen A. Khashab, Ali Kord Valeshabad, Rani Modayil, Jessica Widmer, Payal Saxena, Mehak Idrees, Shahzad Iqbal, Anthony N. Kalloo, Stavros N. Stavropoulos

Research output: Contribution to journalArticle

Abstract

Background: EUS-guided biliary drainage (EGBD) can be performed via direct transluminal or rendezvous techniques. It is unknown how both techniques compare in terms of efficacy and adverse events. Objective: To describe outcomes of EGBD performed by using a standardized approach and compare outcomes of rendezvous and transluminal techniques. Design: Retrospective analysis of prospectively collected data. Setting: Two tertiary-care centers. Patients: Consecutive jaundiced patients with distal malignant biliary obstruction who underwent EGBD after failed ERCP between July 2006 and December 2012 were included. Intervention: EGBD by using a standardized algorithm. Main Outcome Measurements: Technical success, clinical success, and adverse events. Results: During the study period, 35 patients underwent EGBD (rendezvous n = 13, transluminal n = 20). Technical success was achieved in 33 patients (94%), and clinical success was attained in 32 of 33 patients (97.0%). The mean postprocedure bilirubin level was 1.38 mg/dL in the rendezvous group and 1.33 mg/dL in the transluminal group (P =.88). Similarly, length of hospital stay was not different between groups (P =.23). There was no significant difference in adverse event rate between rendezvous and transluminal groups (15.4% vs 10%; P =.64). Long-term outcomes were comparable between groups, with 1 stent migration in the rendezvous group at 62 days and 1 stent occlusion in the transluminal group at 42 days after EGBD. Limitations: Retrospective analysis, small number of patients, and selection bias. Conclusion: EGBD is safe and effective when the described standardized approach is used. Stent occlusion is not common during long-term follow-up. Both rendezvous and direct transluminal techniques seem to be equally effective and safe. The latter approach is a reasonable alternative to rendezvous EGBD.

Original languageEnglish (US)
Pages (from-to)734-741
Number of pages8
JournalGastrointestinal endoscopy
Volume78
Issue number5
DOIs
StatePublished - Nov 1 2013

Keywords

  • EGBD
  • ERC
  • EUS-guided biliary drainage
  • SEMS
  • endoscopic retrograde cholangiography
  • self-expandable metal stent

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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