Primary endoscopic ultrasound-guided choledochoduodenostomy versus endoscopic retrograde cholangiopancreatography for the drainage of distal malignant biliary obstruction: An Egyptian multicenter, prospective, comparative study

Theodor Bilharz Research Institute

Bibliographic Information

Authors: Ghoneem E.; Atalla H.; Abdallah O.; Hammouda M.A.; Abdel-Hameed M.; Katamish H.; Ragab K.

Journal: International Journal of Gastrointestinal Intervention

Publisher: Society of Gastrointestinal Intervention

Publication Date: 30 April 2024

Volume / Issue: Volume 13 / Issue 2

Pages: 29–36

ISSN: 26360012

DOI: 10.18528/ijgii240007

Scopus: View on Scopus

Document Type: Article

Access: All Open Access; Gold Open Access; Green Open Access

Authors and Affiliations

Ghoneem E., Gastroenterology and Hepatology Unit, Department of Internal Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt, Egyptian Liver Research Institute and Hospital (ELRIAH), Mansoura, Egypt; Atalla H., Gastroenterology and Hepatology Unit, Department of Internal Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt; Abdallah O., Gastroenterology and Hepatology Unit, Department of Internal Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt; Hammouda M.A., Gastroenterology and Hepatology Unit, Department of Internal Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt; Abdel-Hameed M., Department of Hepatogastroenterology, Theodor Bilharz Research Institute, Giza, Egypt; Katamish H., Department of Hepatogastroenterology, Theodor Bilharz Research Institute, Giza, Egypt; Ragab K., Department of Hepatogastroenterology, Theodor Bilharz Research Institute, Giza, Egypt

Abstract

Background: Endoscopic ultrasound-guided biliary drainage is widely accepted due to its high success rate, minimal need for re-intervention, and low incidence of pancreatitis. Our objective was to investigate the feasibility, efficacy, and outcomes of primary EUS-guided choledochoduodenostomy (EUS-CDS) compared to endoscopic retrograde cholangiopancreatography (ERCP) in patients with malignant distal biliary obstruction (MDBO). Methods: In this prospective multicenter study conducted between May 2021 and April 2023, patients with unresectable MDBO were assigned to either EUS-CDS or ERCP. Technical and clinical success were the primary endpoints. Results: A total of 73 patients at three tertiary centers were enrolled, of whom 37 underwent EUS-CDS and 36 underwent ERCP. Pancreatic cancer was present in 62 patients (84.9%). The technical and clinical success rates were comparable (97.3% and 97.2% for EUS-CDS vs. 94.4% and 100% for ERCP, respectively), with nearly the same procedure duration (P = 0.982) and with no significant difference in adverse events between both groups. Pancreatitis occurred in one patient after ERCP. Short-term re-intervention (within 3 months) was only required in two patients in the EUS-CDS group. Conclusion: Primary EUS-CDS-even in developing countries-is feasible, with comparable safety and non-inferior efficacy to ERCP for palliation in MDBO cases if a highly experienced team is present. © 2024, Society of Gastrointestinal Intervention.

Keywords

Endoscopic retrograde cholangiopancreatography; Endoscopic ultrasound; Malignant biliary obstruction; Primary EUS-CDS; Self-expanding metallic stent; adult; aged; Article; biliary tract drainage; choledochoduodenostomy; cholestasis; Doppler flowmetry; Egyptian; female; human; major clinical study; male; multicenter study; pancreas cancer; pancreatitis; prospective study

Citation Information

Scopus Citations: 2

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