Endoscopic ultrasound-guided biliary drainage versus percutaneous transhepatic biliary drainage: predictors of successful outcome in patients who fail endoscopic retrograde cholangiopancreatography

被引：85

作者：

Sharaiha, Reem Z. ^{[1
]}

Kumta, Nikhil A. ^{[1
]}

Desai, Amit P. ^{[1
]}

DeFilippis, Ersilia M. ^{[1
]}

Gabr, Moamen ^{[1
]}

Sarkisian, Alex M. ^{[1
]}

Salgado, Sanjay ^{[1
]}

Millman, Jennifer ^{[1
]}

Benvenuto, Andrea ^{[1
]}

Cohen, Michelle ^{[1
]}

Tyberg, Amy ^{[1
]}

Gaidhane, Monica ^{[1
]}

Kahaleh, Michel ^{[1
]}

机构：

[1] New York Presbyterian Weill Cornell Med Coll, Dept Gastroenterol & Hepatol, New York, NY 10021 USA

来源：

SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES | 2016年 / 30卷 / 12期

关键词：

Biliary drainage; Endoscopic ultrasound; Endoscopic retrograde cholangiopancreatography; ADVERSE EVENTS; OBSTRUCTION; CHOLEDOCHODUODENOSTOMY; ERCP; BENIGN; COMPLICATIONS; CHOICE; BYPASS;

D O I：

10.1007/s00464-016-4913-y

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

Patients with failed endoscopic retrograde cholangiopancreatography (ERCP) are conventionally offered percutaneous transhepatic biliary drainage (PTBD). While PTBD is effective, it is associated with catheter-related complications, pain, and poor quality of life. Endoscopic ultrasound-guided biliary drainage (EUS-BD) is a minimally invasive endoscopic option increasingly offered as an alternative to PTBD. We compare outcomes of EUS-BD and PTBD in patients with biliary obstruction at a single tertiary care center. A retrospective review was performed in patients with biliary obstruction who underwent EUS-BD or PTBD after failed ERCP from June 2010 through December 2014 at a single tertiary care center. Patient demographics, procedural data, and clinical outcomes were documented for each group. The aim was to compare efficacy and safety of EUS-BD and PTBD and evaluate predictors of success. A total of 60 patients were included (mean age 67.5 years, 65 % male). Forty-seven underwent EUS-BD, and thirteen underwent PTBD. Technical success rates of PTBD and EUS-BD were similar (91.6 vs. 93.3 %, p = 1.0). PTBD patients underwent significantly more re-interventions than EUS-BD patients (mean 4.9 versus 1.3, p < 0.0001), had more late (> 24-h) adverse events (53.8 % vs. 6.6 %, p = 0.001) and experienced more pain (4.1 vs. 1.9, p = 0.016) post-procedure. In univariate analysis, clinical success was lower in the PTBD group (25 vs. 62.2 %, p = 0.03). In multivariable logistic regression analysis, EUS-BD was the sole predictor of clinical success and long-term resolution (OR 21.8, p = 0.009). Despite similar technical success rates compared to PTBD, EUS-BD results in a lower need for re-intervention, decreased rate of late adverse events, and lower pain scores, and is the sole predictor for clinical success and long-term resolution. EUS-BD should be the treatment of choice after a failed ERCP.

引用

页码：5500 / 5505

页数：6

共 33 条

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