Int J Gastrointest Interv.  2024 Apr;13(2):29-36. 10.18528/ijgii240007.

Primary endoscopic ultrasound-guided choledochoduodenostomy versus endoscopic retrograde cholangiopancreatography for the drainage of distal malignant biliary obstruction: An Egyptian multicenter, prospective, comparative study

• Ghoneem E
• Atalla H
• Abdallah O
• Hammouda MA
• Abdel-Hameed M
• Katamish H
• Ragab K

• KMID: 2555559
• DOI: http://doi.org/10.18528/ijgii240007

Abstract

Background
Endoscopic ultrasound-guided biliary drainage is widely accepted due to its high success rate, minimal need for re-intervention, and low incidence of pancreatitis. Our objective was to investigate the feasibility, efficacy, and outcomes of primary EUS-guided choledochoduodenostomy (EUS-CDS) compared to endoscopic retrograde cholangiopancreatography (ERCP) in patients with malignant distal biliary obstruction (MDBO).
Methods
In this prospective multicenter study conducted between May 2021 and April 2023, patients with unresectable MDBO were assigned to either EUS-CDS or ERCP. Technical and clinical success were the primary endpoints.
Results
A total of 73 patients at three tertiary centers were enrolled, of whom 37 underwent EUS-CDS and 36 underwent ERCP. Pancreatic cancer was present in 62 patients (84.9%). The technical and clinical success rates were comparable (97.3% and 97.2% for EUS-CDS vs. 94.4% and 100% for ERCP, respectively), with nearly the same procedure duration (P = 0.982) and with no significant difference in adverse events between both groups. Pancreatitis occurred in one patient after ERCP. Short-term re-intervention (within 3 months) was only required in two patients in the EUS-CDS group.
Conclusion
Primary EUS-CDS—even in developing countries—is feasible, with comparable safety and non-inferior efficacy to ERCP for palliation in MDBO cases if a highly experienced team is present.

Keyword

Endoscopic retrograde cholangiopancreatography; Endoscopic ultrasound; Malignant biliary obstruction; Primary EUS-CDS; Self-expanding metallic stent