EUS-guided biliary drainage for malignant biliary obstruction in patients with failed ERCP.

BACKGROUND: Most patients with malignant biliary obstruction are diagnosed at an advanced stage. EUS-guided biliary drainage (EBD) may be an alternative to percutaneous transhepatic or surgical drainage for failed access by endoscopic retrograde cholangiopancreatography (ERCP).

OBJECTIVES: To evaluate the efficacy and safety of EBD in patients with malignant biliary obstruction.

METHODS: EUS guided biliary drainage was performed using different approaches depending on the site of entry in patients with malignant obstructive jaundice and failed biliary drainage by ERCP. Assessment included clinical outcomes, quality of life improvement laboratory tests before and after drainage and procedure-related complications.

RESULTS: From April 2010 to September 2011, a total of 749 therapeutic ERCP was performed and 32 patients were included in this study. EBD was technically successful in 90.6% (29/32) with clinical improvement in all (29/29) of the patients in whom biliary drainage was successful. Three (9.4%) patients had technical failure at EBD. EUS-guided choledochoduodenostomy was the most common drainage procedure (58.6%). Duodenal self-expandable metallic stent was placed in 7 (24.1%) cases. There was a significant decrease in bilirubin levels (p<0.001) and patients had improved quality of life after the procedure (p<0.05). Complications occurred in 6 (20.7%) patients and the median survival was 90 days.

CONCLUSION: In patients with malignant biliary obstruction and failed endoscopic drainage with ERCP, EBD may provide a safe and effective alternative for biliary drainage with acceptable complication rates and significant improvement in the quality of survival.