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Comparison of EUS-guided choledochoduodenostomy and percutaneous drainage for distal biliary obstruction: A multicenter cohort study
Tarek Sawas1, Natashay J Bailey2, Kit Ying Kitty Au Yeung3, Theodore W James4, Sumana Reddy4, Chad J Fleming5, Neil B Marya6, Andrew C Storm7, Barham K Abu Dayyeh7, Bret T Petersen7, John A Martin7, Michael J Levy7, Todd H Baron4, Anthony Yuen Bun Teoh3, Vinay Chandrasekhara7
1 Division of Digestive and Liver Diseases, University of Texas Southwestern, Dallas, TX, USA
2 Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
3 Department of Surgery, The Prince of Wales Hospital, Hong Kong, China
4 Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, USA
5 Department of Radiology, Mayo Clinic, Rochester, MN, USA
6 Division of Astroenterology and Hepatology, University of Massachusetts, Worcester, MA, USA
7 Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
Correspondence Address:
Vinay Chandrasekhara
Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Ave., S.W. Rochester, MN 55905
USA
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/EUS-D-21-00031
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Background and Objectives: Percutaneous transhepatic biliary drainage (PTBD) and EUS-guided choledochoduodenostomy (EUS-CD) are alternate therapies to endoscopic retrograde cholangiopancreatography with stent placement for biliary decompression. The primary outcome of this study is to compare the technical and clinical success of PTBD to EUS-CD in patients with distal biliary obstruction. Secondary outcomes were adverse events (AEs), need for reintervention, and survival. Methods: A multicenter retrospective cohort study from three different centers was performed. Cox regression was used to compare time to reintervention and survival and logistic regression to compare technical and clinical success and AE rates. Subgroup analysis was performed in patients with malignant biliary obstruction (MBO). Results: A total of 86 patients (58 PTBD and 28 EUS-CD) were included. The two groups were similar with respect to age, gender, and cause of biliary obstruction, with malignancy being the most common etiology (80.2%). EUS-CD utilized lumen-apposing metal stents in 15 patients and self-expandable metal biliary stents in 13 patients. Technical success was similar been EUS-CD (100%) and PTBD (96.6%; P = 0.3). EUS-CD was associated with higher clinical success compared to PTBD (84.6% vs. 62.1%; P = 0.04). There was a trend toward lower rates of AEs with EUS-CD 14.3% versus PTBD 29.3%, odds ratio: 0.40 (95% confidence interval [CI]: 0.12–1.33, P = 0.14). The need for reintervention was significantly lower among patients who underwent EUS-CD (10.7%) compared to PTBD (77.6%) (hazard ratio: 0.07, 95% CI: 0.02–0.24; P < 0.001). A sensitivity analysis of only patients with MBO demonstrated similar rate of reintervention between the groups in individuals who survived 50 days or less after the biliary decompression. However, reintervention rates were lower for EUS-CD in those with longer survival. Conclusion: EUS-CD is a technically and clinically highly successful procedure with a trend toward lower AEs compared to PTBD. EUS-CD minimizes the need for reintervention, which may enhance end-of-life quality in patients with MBO and expected survival longer than 50 days.
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