A comparison between endoscopic ultrasound-guided and percutaneous biliary drainage after failed endoscopic retrograde cholangiopancreatography for malignant biliary obstruction: A retrospective cohort study

Aim: Endoscopic ultrasonography-guided biliary drainage (EUS-BD) is increasingly used as an alternative therapeutic modality to percutaneous transhepatic biliary drainage (PTBD) for malignant biliary obstruction in patients who fail endoscopic retrograde cholangiopancreatography (ERCP). We conducted a retrospective study comparing the success rate and safety of the two drainage methods. Patients and Methods: There were 121 consecutive patients undergoing EUS-BD or PTBD who had malignant biliary obstruction that failed to be treated by ERCP at Princess Margaret Hospital between August 2015 and May 2021. Thirty-five patients with biliary obstruction at or proximal to hilar level were excluded from this study. A retrospective cohort study was performed for 26 patients who underwent EUS-BD (choledochoduodenostomy or hepaticogastrostomy) and 60 patients who underwent PTBD. Their clinical data and endoscopic data, demographic data, diagnosis, laboratory data, complications, number of re-interventions, in-hospital death and length of hospitalisation were extracted and compared. Results: The clinical success rates for EUS-BD and PTBD were 25 out of 26 (96.2%) and 43 out of 60 (71.7%), respectively (P = .01). The technical success rates were 25 out of 26 (96.2%) and 57 out of 60 (95.0%), respectively (P > .99). Among those technically successful cases, complications were significantly fewer in the EUS-BD group (4%) than in the PTBD group (33.3%). There were significantly fewer re-interventions, shorter length of hospitalisation and fewer in-hospital death in the EUS-BD group. No significant difference in stent/PTBD patency was noted between the two groups. Conclusion: EUS-BD is a safe and effective method of BD in patients with malignant biliary obstruction who failed ERCP. EUS-BD has a higher rate of clinical success, is associated with fewer complications and has a shorter length of in-hospital stay compared with PTBD. The overall technical success and stent patency are comparable to PTBD.