Comparative Evaluation of Percutaneous Transhepatic Biliary Drainage and Endoscopic Ultrasound-Guided Biliary Drainage for Preoperative Management of Malignant Distal Bile Duct Obstruction After Failed ERCP: A Multicenter Retrospective Analysis

IF 4.7 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Digestive Endoscopy Pub Date : 2025-10-22 DOI:10.1111/den.70048

Masahiro Itonaga, Mamoru Takenaka, Hideyuki Shiomi, Koh Kitagawa, Shuhei Shintani, Hirotsugu Maruyama, Ryota Sagami, Tsukasa Ikeura, Takeshi Ogura, Yusuke Ishida, Koichiro Mandai, Satoshi Sugimori, Yoshiki Imamura, Atsuhiro Masuda, Kenji Ikezawa, Atsushi Shimizu, Atsushi Nakai, Minako Nagai, Ryota Nakano, Ke Wan, Toshio Shimokawa, Masayuki Kitano

{"title":"Comparative Evaluation of Percutaneous Transhepatic Biliary Drainage and Endoscopic Ultrasound-Guided Biliary Drainage for Preoperative Management of Malignant Distal Bile Duct Obstruction After Failed ERCP: A Multicenter Retrospective Analysis","authors":"Masahiro Itonaga, Mamoru Takenaka, Hideyuki Shiomi, Koh Kitagawa, Shuhei Shintani, Hirotsugu Maruyama, Ryota Sagami, Tsukasa Ikeura, Takeshi Ogura, Yusuke Ishida, Koichiro Mandai, Satoshi Sugimori, Yoshiki Imamura, Atsuhiro Masuda, Kenji Ikezawa, Atsushi Shimizu, Atsushi Nakai, Minako Nagai, Ryota Nakano, Ke Wan, Toshio Shimokawa, Masayuki Kitano","doi":"10.1111/den.70048","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Objectives</h3>\n \n <p>This multicenter retrospective study aimed to compare surgery-related adverse events (AEs) of percutaneous transhepatic biliary drainage (PTBD) with those of endoscopic ultrasound-guided biliary drainage (EUS-BD) for preoperative management of malignant distal bile duct obstruction (MDBO).</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>We reviewed data from 15 centers in Japan between 2012 and 2021. Patients with MDBO who underwent PTBD or EUS-BD after failed endoscopic retrograde cholangiopancreatography (ERCP) and later underwent pancreaticoduodenectomy (PD) were included. The primary outcome was surgery-related AEs. Secondary outcomes included drainage-related outcomes, surgery-related outcomes, disease-free survival (DFS), and overall survival (OS). Risk factors associated with surgery-related AEs were also evaluated.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>In total, 2350 patients received biliary drainage before PD. Of the 73 patients in whom ERCP failed, 65 underwent PTBD and 11 underwent EUS-BD. EUS-BD showed a significantly higher internalization rate (100% vs. 28%, <i>p</i> < 0.001), fewer sessions (median 1 vs. 2, <i>p</i> = 0.006), and shorter hospital stay (10 vs. 22 days, <i>p</i> = 0.002). Surgery-related AEs were similar between groups. In the multivariate analysis, age ≥ 71 years and ASA-PS ≥ 2 were identified as significant risk factors for surgery-related AEs, whereas the drainage method was not a significant factor. No significant differences were observed in DFS or OS between the groups.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Surgical-related outcomes, DFS, and OS after EUS-BD were comparable to those after PTBD; however, EUS-BD allowed a higher internalization rate, fewer sessions, and a shorter hospital stay, making it the preferred option for preoperative biliary drainage after failed ERCP.</p>\n </section>\n </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 1","pages":""},"PeriodicalIF":4.7000,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Digestive Endoscopy","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/den.70048","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Objectives

This multicenter retrospective study aimed to compare surgery-related adverse events (AEs) of percutaneous transhepatic biliary drainage (PTBD) with those of endoscopic ultrasound-guided biliary drainage (EUS-BD) for preoperative management of malignant distal bile duct obstruction (MDBO).

Methods

We reviewed data from 15 centers in Japan between 2012 and 2021. Patients with MDBO who underwent PTBD or EUS-BD after failed endoscopic retrograde cholangiopancreatography (ERCP) and later underwent pancreaticoduodenectomy (PD) were included. The primary outcome was surgery-related AEs. Secondary outcomes included drainage-related outcomes, surgery-related outcomes, disease-free survival (DFS), and overall survival (OS). Risk factors associated with surgery-related AEs were also evaluated.

Results

In total, 2350 patients received biliary drainage before PD. Of the 73 patients in whom ERCP failed, 65 underwent PTBD and 11 underwent EUS-BD. EUS-BD showed a significantly higher internalization rate (100% vs. 28%, p < 0.001), fewer sessions (median 1 vs. 2, p = 0.006), and shorter hospital stay (10 vs. 22 days, p = 0.002). Surgery-related AEs were similar between groups. In the multivariate analysis, age ≥ 71 years and ASA-PS ≥ 2 were identified as significant risk factors for surgery-related AEs, whereas the drainage method was not a significant factor. No significant differences were observed in DFS or OS between the groups.

Conclusions

Surgical-related outcomes, DFS, and OS after EUS-BD were comparable to those after PTBD; however, EUS-BD allowed a higher internalization rate, fewer sessions, and a shorter hospital stay, making it the preferred option for preoperative biliary drainage after failed ERCP.

查看原文本刊更多论文

经皮经肝胆道引流与超声内镜引导下胆道引流在ERCP失败后恶性胆管远端梗阻术前的比较评价：一项多中心回顾性分析。

目的：本多中心回顾性研究旨在比较经皮经肝胆道引流术（PTBD）与超声内镜引导胆道引流术（EUS-BD）在恶性胆管远端梗阻（MDBO）术前治疗中的手术相关不良事件（ae）。方法：我们回顾了2012年至2021年间日本15个中心的数据。包括内镜逆行胆管造影（ERCP）失败后行PTBD或EUS-BD的MDBO患者，后来行胰十二指肠切除术（PD）。主要结局是手术相关的不良事件。次要结局包括引流相关结局、手术相关结局、无病生存期（DFS）和总生存期（OS）。与手术相关不良事件相关的危险因素也进行了评估。结果：共有2350例患者在PD前接受了胆道引流。在ERCP失败的73例患者中，65例接受了PTBD， 11例接受了EUS-BD。结论：EUS-BD术后的手术相关结果、DFS和OS与PTBD术后相当；然而，EUS-BD的内化率更高，疗程更少，住院时间更短，使其成为ERCP失败后术前胆道引流的首选。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Digestive Endoscopy 医学-外科

CiteScore

10.10

自引率

15.10%

发文量

291

审稿时长

6-12 weeks

期刊介绍： Digestive Endoscopy (DEN) is the official journal of the Japan Gastroenterological Endoscopy Society, the Asian Pacific Society for Digestive Endoscopy and the World Endoscopy Organization. Digestive Endoscopy serves as a medium for presenting original articles that offer significant contributions to knowledge in the broad field of endoscopy. The Journal also includes Reviews, Original Articles, How I Do It, Case Reports (only of exceptional interest and novelty are accepted), Letters, Techniques and Images, abstracts and news items that may be of interest to endoscopists.