TY - JOUR
T1 - EUS-guided biliary drainage by using a standardized approach for malignant biliary obstruction
T2 - Rendezvous versus direct transluminal techniques (with videos)
AU - Khashab, Mouen A.
AU - Valeshabad, Ali Kord
AU - Modayil, Rani
AU - Widmer, Jessica
AU - Saxena, Payal
AU - Idrees, Mehak
AU - Iqbal, Shahzad
AU - Kalloo, Anthony N.
AU - Stavropoulos, Stavros N.
PY - 2013/11
Y1 - 2013/11
N2 - 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.
AB - 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.
KW - EGBD
KW - ERC
KW - EUS-guided biliary drainage
KW - SEMS
KW - endoscopic retrograde cholangiography
KW - self-expandable metal stent
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U2 - 10.1016/j.gie.2013.05.013
DO - 10.1016/j.gie.2013.05.013
M3 - Article
C2 - 23886353
AN - SCOPUS:84885376196
SN - 0016-5107
VL - 78
SP - 734
EP - 741
JO - Gastrointestinal endoscopy
JF - Gastrointestinal endoscopy
IS - 5
ER -