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EUS-guided choledochoduodenostomy for malignant biliary obstruction: A multicenter comparative study between plastic and metallic stents

1 General Surgery Department, University of São Paulo Medical School, São Paulo; Alfa Institute of Gastroenterology, HC/EBSERH, Federal University of Minas Gerais, Belo Horizonte, Brazil
2 Gastroenterology Department, University of São Paulo Medical School, São Paulo, Brazil
3 Center for Digestive Endoscopy, Surgery and Anatomy Department, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
4 General Surgery Department, University of São Paulo Medical School, São Paulo, Brazil
5 University of São Paulo Medical School, São Paulo, Brazil

Correspondence Address:
Vitor Ottoboni Brunaldi,
Bandeirantes Av. 3900, Ribeirão Preto City, São Paulo State
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/EUS-D-21-00221

Background and Objectives: EUS-guided choledochoduodenostomy (EUS-CDS) is commonly employed to address malignant biliary obstruction (MBO) after a failed ERCP. In this context, both self-expandable metallic stents (SEMSs) and double-pigtail stents (DPSs) are suitable devices. However, few data comparing the outcomes of SEMS and DPS exist. Therefore, we aimed to compare the efficacy and safety of SEMS and DPS at performing EUS-CDS. Methods: We conducted a multicenter retrospective cohort study between March 2014 and March 2019. Patients diagnosed with MBO were considered eligible after at least one failed ERCP attempt. Clinical success was defined as a drop of direct bilirubin levels ≥ 50% at 7 and 30 postprocedural days. Adverse events (AEs) were categorized as early (≤7 days) or late (>7 days). The severity of AEs was graded as mild, moderate, or severe. Results: Forty patients were included, 24 in the SEMS group and 16 in the DPS group. Demographic data were similar between the groups. Technical success rates and clinical success rates at 7 and 30 days were similar between the groups. Similarly, we found no statistical difference in the incidence of early or late AEs. However, there were two severe AEs (intracavitary migration) in the DPS group and none in the SEMS cohort. Finally, there was no difference in median survival (DPS 117 days vs. SEMS 217 days; P = 0.99). Conclusion: EUS-guided CDS is an excellent alternative to achieve biliary drainage after a failed ERCP for MBO. There is no significant difference regarding the effectiveness and safety of SEMS and DPS in this context.

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    -  da Silva RR
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    -  Brunaldi VO
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