EFFICACY AND SAFETY OF ENDOSCOPIC ULTRASOUND-GUIDED BILIARY DRAINAGE IN PATIENTS OF FAILED ERCP

Background Endoscopic retrograde cholangiography (ERCP) is widely used as a first-line intervention for biliary obstruction. However, ERCP occasionally fails owing to surgically altered anatomy or duodenal stenosis. Endoscopic ultrasound-guided biliary drainage (EUS-BD) has emerged as an alternative biliary drainage method after failed ERCP. We report our practices of EUS-BD, including its technical success rate, clinical success rate, and occurrence of adverse events. Methods We retrospectively reviewed 19 patients who underwent EUS-BD between February 2017 and July 2018 in Beijing Friendship Hospital. Results In total, 19 patients underwent EUS-BD (median age 70). The reasons for EUS-BD were altered anatomy after surgery in 7/19, failed ERCP in 7/19, and duodenal stenosis in 5/19. Causes of biliary obstruction included pancreatic cancer(7/19), cholangiocarcinoma(6/19), choledocholithiasis(3/19), postoperative anastomotic stenosis(2/19), and gallbladder cancer(1/19). Biliary drainage was completed by EUS-transmural stenting in 15/19, by EUS-rendezvous technique in 3/19, and by EUS-antegrade stenting in 1/19. Overall technical success was achieved in 18/19, while clinical success was achieved in 16/19. Adverse events included abdominal pain(5/19), cholangitis(4/19), bile leak(1/19), and death(1/19), most of which improved with conservative treatment. Of the three unsuccessful patients, two developed pan-peritonitis and improved after percutaneous transhepatic biliary drainage (PTBD) or surgery, respectively. Another patient died of pancreatic cancer shortly after EUS-BD (table 1). Conclusions EUS-BD has a high technical and clinical success rate, and a low adverse events rate.