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CC BY 4.0 · Endoscopy
DOI: 10.1055/a-2580-1316
Original article

Endoscopic ultrasound-guided choledochoduodenostomy results in fewer complications than percutaneous drainage following failed ERCP in malignant distal biliary obstruction

Mike J.P. de Jong 
1   Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, Netherlands (Ringgold ID: RIN6034)
2   Research and Development, St Antonius Hospital, Nieuwegein, Netherlands (Ringgold ID: RIN6028)
,
Foke van Delft
1   Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, Netherlands (Ringgold ID: RIN6034)
,
Erwin-Jan M. van Geenen
1   Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, Netherlands (Ringgold ID: RIN6034)
,
Auke Bogte
3   Gastroenterology and Hepatology, UMC Utrecht, Utrecht, Netherlands (Ringgold ID: RIN8124)
,
Robert C. Verdonk
4   Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, Netherlands (Ringgold ID: RIN6028)
,
Niels G. Venneman
5   Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede, Netherlands (Ringgold ID: RIN3231)
,
Jan Maarten Vrolijk
6   Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, Netherlands (Ringgold ID: RIN1322)
,
Jan-Willem A. Straathof
7   Gastroenterology and Hepatology, Maxima Medical Centre, Veldhoven, Netherlands (Ringgold ID: RIN89569)
,
Rogier P. Voermans 
8   Gastroenterology and Hepatology, Amsterdam University Medical Centres, Amsterdam, Netherlands (Ringgold ID: RIN522567)
,
Rina A. Bijlsma
9   Gastroenterology and Hepatology, Martini Hospital, Groningen, Netherlands (Ringgold ID: RIN61363)
,
Sjoerd D. Kuiken
10   Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands (Ringgold ID: RIN10215)
,
Rutger Quispel 
11   Gastroenterology and Hepatology, Reinier de Graaf Gasthuis, Delft, Netherlands (Ringgold ID: RIN84744)
,
Muhammed Hadithi
12   Gastroenterology and Hepatology, Maasstad Hospital, Rotterdam, Netherlands (Ringgold ID: RIN7000)
,
Kirill Basiliya 
13   Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, Netherlands (Ringgold ID: RIN4501)
,
Frank P. Vleggaar
14   Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, Netherlands (Ringgold ID: RIN8124)
,
Tanya M. Bisseling
1   Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, Netherlands (Ringgold ID: RIN6034)
,
Thomas R. de Wijkerslooth
15   Gastrointestinal Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands (Ringgold ID: RIN1228)
,
Marco J. Bruno
16   Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands (Ringgold ID: RIN6993)
,
Roy L.J. van Wanrooij 
17   Gastroenterology and Hepatology, Amsterdam UMC Locatie VUmc, Amsterdam, Netherlands (Ringgold ID: RIN1209)
,
Peter D. Siersema
1   Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, Netherlands (Ringgold ID: RIN6034)
16   Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands (Ringgold ID: RIN6993)
› Author Affiliations Clinical Trial: Registration number (trial ID): NCT05519605, Trial registry: ClinicalTrials.gov (http://www.clinicaltrials.gov/), Type of Study: Prospective investigator-initiated multicenter registry
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Abstract

Background

Percutaneous transhepatic biliary drainage (PTBD) and endoscopic ultrasound-guided biliary drainage (EUS-BD), including choledochoduodenostomy (EUS-CDS), are alternative methods for biliary drainage in patients with distal malignant biliary obstruction (MBO) after failed endoscopic retrograde cholangiopancreatography (ERCP). Data on long-term outcomes, adverse events (AEs), and quality of life (QoL) after EUS-CDS and PTBD are limited. Therefore, we created a registry to evaluate the outcomes of both drainage procedures.

Methods

Patients with distal MBO who underwent EUS-CDS or PTBD after unsuccessful ERCP were included in this multicenter investigator-initiated prospective registry over an 18-month inclusion period. Primary end points were procedure-related AEs and mortality within 90 days post-procedure. Secondary end points included technical and clinical success, reinterventions, hospital stay, and QoL.

Results

55 patients were included, with 12 patients undergoing PTBD (technical success 100%) and 43 patients EUS-CDS (technical success 97.7%). Prior to ERCP, 7/12 patients in the PTBD group and 12/43 patients in the EUS-CDS group opted for best supportive care. The 90-day mortality rate was 66.7% in the PTBD group and 20.9% in the EUS-CDS group (P = 0.005). Furthermore, 11/12 patients (91.7%) in the PTBD group and 19/43 (44.2%) in the EUS-CDS group developed one or more AEs (P = 0.004). The median post-procedural hospital stay was 4 days (interquartile range [IQR] 2–6) in the PTBD group vs. 1 day (IQR 1–2) in the EUS-CDS group (P = 0.001).

Conclusion

When both modalities were available and technically feasible, gastroenterologists preferred EUS-CDS over PTBD. EUS-CDS seems to be associated with lower mortality and AE rates, shorter hospital admission, and fewer reinterventions, but a randomized controlled trial should confirm these observations.

Supplementary Material



Publication History

Received: 30 September 2024

Accepted after revision: 19 March 2025

Accepted Manuscript online:
10 April 2025

Article published online:
21 May 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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