Surgery or EUS-guided choledochoduodenostomy for malignant distal biliary obstruction after ERCP failure

Everson L.A. Artifon, Jarbas F. Loureiro, Todd H. Baron, Kaie Fernandes, Michel Kahaleh, Fernando P. Marson

Research output: Contribution to journalArticlepeer-review

40 Scopus citations

Abstract

Background and Objectives: Endoscopic retrograde cholangiopancreatography (ERCP) is the method of choice for drainage in patients with distal malignant biliary obstruction, but it fails in up to 10% of cases. Percutaneous transhepatic cholangiography (PTC) and surgical bypass are the traditional drainage alternatives. This study aimed to compare technical and clinical success, quality of life, and survival of surgical biliary bypass or hepaticojejunostomy (HJT) and endoscopic ultrasound (EUS)-guided choledochoduodenostomy (CDT) in patients with distal malignant bile duct obstruction and failed ERCP. Patients and Methods: A prospective, randomized trial was conducted. From March 2011 to September 2013, 32 patients with malignant distal biliary obstruction and failed ERCP were studied. The HJT group consisted of 15 patients and the CDT group consisted of 14 patients. Technical and clinical success, quality of life, and survival were assessed prospectively. Results: Technical success was 94% (15/16) in the HJT group and 88% (14/16) in the CDT group (P = 0.598). Clinical successoccurred in 14 (93%) patients in the HJT group and in 10 (71%) patients in the CDT group (P = 0.169). During follow-up, a statistically significant difference was seen in mean functional capacity scores, physical health, pain, social functioning, and emotional and mental health aspects in both techniques (P < 0.05). The median survival time in both groups was the same (82 days). Conclusion: Data relating to technical and clinical success, quality of life, and survival were similar in patients who underwent HJT and CDT drainage after failed ERCP for malignant distal biliary obstruction.

Original languageEnglish (US)
Pages (from-to)235-243
Number of pages9
JournalEndoscopic Ultrasound
Volume4
Issue number3
DOIs
StatePublished - 2015
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Hepatology
  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

Keywords

  • Biliary duct neoplasms
  • Drainage
  • Endoscopic ultrasound
  • Obstructive jaundice
  • Palliative treatment
  • Pancreatic neoplasms

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