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Journal of Gastrointestinal Surgery

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01-07-2018 | Original Article

Feasibility and Safety of Endoscopic Ultrasound-Guided Biliary Drainage (EUS-BD) for Malignant Biliary Obstruction Associated with Ascites: Results of a Pilot Study

Authors: María Victoria Alvarez-Sánchez, O. B. Luna, I. Oria, K. Marchut, F. Fumex, G. Singier, A. Salgado, B. Napoléon

Published in: Journal of Gastrointestinal Surgery | Issue 7/2018

Abstract

Background

It has been suggested that EUS-BD may be a feasible and safer alternative to percutaneous transhepatic biliary drainage (PTBD) after failed ERCP in patients with ascites. To date, no study has specifically evaluated the performance of EUS-BD in this context.

Methods

Retrospective analysis was done for patients with and without ascites who underwent EUS-BD for malignant biliary obstruction after failed ERCP between July 2010 and September 2014. Complications and technical and clinical successes between the two groups were compared.

Results

A total of 31 patients were included: 20 patients without ascites (group 1) and 11 with ascites (group 2). Nineteen patients underwent EUS-hepaticogastrostomy (six in group 2), and 12 underwent EUS-choledochoduodenostomy (five in group 2). Technical success was achieved in all patients. Clinical success was observed in 95% (n = 19) in group 1 and 64% (n = 7) in group 2 (p = 0.042). In three out of four patients without clinical success in group 2, the follow-up period was not long enough to observe the clinical response because of early death within the 2 weeks after EUS-BD secondary to disease progression or preprocedural unresponsive sepsis. No significant differences were observed between groups 1 and 2 either in the overall rates of procedural-related complications (20 and 9%, respectively, p = 0.63) or in the rates of major complications (15 vs 9%, respectively, p = 0.639). Stent migration occurred in one patient in each group, intra- or post-procedural bleeding occurred in two patients in group 1, which was conservatively managed, and one patient in group 1 presented biliary leakage. Stent patency and the number of re-interventions were not significantly different.

Conclusions

EUS-BD is technically feasible in patients with ascites. Our results suggest that EUS-BD may be a clinically effective and safe alternative after failed ERCP in patients with ascites.

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Title: Feasibility and Safety of Endoscopic Ultrasound-Guided Biliary Drainage (EUS-BD) for Malignant Biliary Obstruction Associated with Ascites: Results of a Pilot Study
Authors: María Victoria Alvarez-Sánchez
O. B. Luna
I. Oria
K. Marchut
F. Fumex
G. Singier
A. Salgado
B. Napoléon
Publication date: 01-07-2018
Publisher: Springer US
Published in: Journal of Gastrointestinal Surgery / Issue 7/2018
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-018-3731-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Feasibility and Safety of Endoscopic Ultrasound-Guided Biliary Drainage (EUS-BD) for Malignant Biliary Obstruction Associated with Ascites: Results of a Pilot Study

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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