ERCP plus endoscopic ultrasound-guided biliary drainage versus percutaneous transhepatic biliary drainage for malignant hilar biliary obstruction: a multicenter observational open-label study

医学 胆道引流 四分位间距 内镜逆行胰胆管造影术 内镜超声 经皮 B组 胃肠病学 胆道 外科 内科学 胰腺炎
作者
Pradermchai Kongkam,Theerapat Orprayoon,Chaloemphon Boonmee,Passakorn Sodarat,Orathai Seabmuangsai,Chatchawan Wachiramatharuch,Yutthaya Auan-Klin,Khanh Cong Pham,Abbas Ali Tasneem,Stephen J. Kerr,Rommel Romano,Sureeporn Jangsirikul,Wiriyaporn Ridtitid,Phonthep Angsuwatcharakon,Thawee Ratanachu‐ek,Rungsun Rerknimitr
出处
期刊:Endoscopy [Thieme Medical Publishers (Germany)]
卷期号:53 (01): 55-62 被引量:60
标识
DOI:10.1055/a-1195-8197
摘要

Abstract Background Endoscopic retrograde cholangiopancreatography (ERCP) may not provide complete biliary drainage in patients with Bismuth III/IV malignant hilar biliary obstruction (MHBO). Complete biliary drainage is accomplished by adding percutaneous transhepatic biliary drainage (PTBD). We prospectively compared recurrent biliary obstruction (RBO) rates between combined ERCP and endoscopic ultrasound-guided biliary drainage (EUS-BD) vs. bilateral PTBD. Methods Patients with MHBO undergoing endoscopic procedures (group A) were compared with those undergoing bilateral PTBD (group B). The primary outcome was the 3-month RBO rate. Results 36 patients were recruited into groups A (n = 19) and B (n = 17). Rates of technical and clinical success, and complications of group A vs. B were 84.2 % (16/19) vs. 100 % (17/17; P = 0.23), 78.9 % (15/19) vs. 76.5 % (13/17; P > 0.99), and 26.3 % (5/19) vs. 35.3 % (6/17; P = 0.56), respectively. Within 3 and 6 months, RBO rates of group A vs. group B were 26.7 % (4/15) vs. 88.2 % (15/17; P = 0.001) and 22.2 % (2/9) vs. 100 % (9/9; P = 0.002), respectively. At 3 months, median number of biliary reinterventions in group A was significantly lower than in group B (0 [interquartile range] 0–1 vs. 1 [1–2.5]), respectively (P < 0.001). Median time to development of RBO was longer in group A than in group B (92 [56–217] vs. 40 [13.5–57.8] days, respectively; P = 0.06). Conclusions Combined ERCP and EUS procedures provided significantly lower RBO rates at 3 and 6 months vs. bilateral PTBD, with similar complication rates and no significant mortality difference.
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