Urgent and early EUS-guided biliary drainage in patients with acute cholangitis
Shuntaro Mukai1, Takao Itoi1, Atsushi Sofuni1, Takayoshi Tsuchiya1, Kentaro Ishii1, Reina Tanaka1, Ryosuke Tonozuka1, Mitsuyoshi Honjo1, Kenjiro Yamamoto1, Kazumasa Nagai1, Yukitoshi Matsunami1, Yasutsugu Asai1, Takashi Kurosawa1, Hiroyuki Kojima1, Toshihiro Homma1, Hirohito Minami1, Yuichi Nagakawa2
1 Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
2 Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo
Source of Support: None, Conflict of Interest: None
Background and Objectives: EUS-guided biliary drainage (EUS-BD) has been reported as an effective alternative drainage technique. However, clinical data on EUS-BD for patients with acute cholangitis (AC) are limited. The aim of this study was to analyze the clinical outcomes of EUS-BD in patients with AC. Patients and Methods: Nineteen patients with AC who underwent urgent or early drainage (within 96 h) by EUS-guided hepaticoenterostomy (EUS-HES) between January 2014 and November 2019 were retrospectively reviewed. Furthermore, the clinical outcomes of EUS-HES using a plastic stent in the AC group (n = 15) were compared to those in the non-AC group (n = 88). Results: In the 19 AC cases, the technical and clinical success rate was 100% with 5.3% of moderate adverse events (biliary peritonitis [n = 1]). Regarding the comparison between the AC group and the non-AC group, the clinical success rate was 100% in both groups and the adverse event rate was not statistically significantly different (P = 0.88). Although the recurrent biliary obstruction (RBO) rate was not statistically significantly different (P = 0.43), the early RBO rate was statistically significantly higher in the AC group (26.7% vs. 3.4%, P < 0.001). Kaplan–Meier curves showed that AC was associated with a shorter time to RBO (P = 0.046). The presence of AC was found to be an independent risk factor of early RBO (odds ratio = 10.3; P = 0.005). Conclusions: Urgent or early biliary drainage (within 96 h) by EUS-BD can be a feasible and safe alternative procedure for patients with AC, although there is a tendency of early RBO.