Management of ERCP Failure in Malignant Biliary Obstruction: Comparative Effectiveness and Safety of EUS-Guided Gallbladder Drainage Versus Choledocoduodenostomy

IF 4.7 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Digestive Endoscopy Pub Date : 2026-04-08 DOI:10.1111/den.70145

Benedetto Mangiavillano, Gianluca Franchellucci, Francesco Auriemma, Daryl Ramai, Alessandro Fugazza, Marco Spadaccini, Carmelo Barbera, Giuseppe Vanella, Germana De Nucci, Andrew Fuller, Belén Martínez-Moreno, Roberto Di Mitri, Francesco Di Matteo, Carlos Robles Medranda, Andrea Anderloni, Luca De Luca, Anthony Yuen Bun Teoh, Jorge Vargas-Madrigal, Edoardo Forti, Michiel Bronswijk, Santi Mangiafico, Helga Bertani, Sundeep Lakhtakia, Khanh Do-Cong Pham, Stefano Francesco Crinò, Sridhar Sundaram, Alessandro Repici, Antonio Facciorusso, EUS International Group

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引用次数: 0

Abstract

Objectives

It is unclear which is the best approach for the drainage of malignant distal biliary obstruction (MDBO) after failed endoscopic retrograde cholangiopancreatography (ERCP). We compared endoscopic ultrasound (EUS)-guided gallbladder drainage (GBD) and EUS-guided choledocoduodenostomy (CDS) with lumen-apposing metal stents (LAMS) as rescue treatment in the case of ERCP failure.

Methods

This was an international multicenter retrospective observational study at 28 tertiary-care centers. Outcomes were compared using propensity score matching (PSM). Clinical success was the primary outcome, with technical success, adverse event (AE) rate, and overall survival being the secondary outcomes.

Results

Five hundred twenty-nine patients underwent EUS-guided drainage, of which 136 underwent EUS-GBD, and 393 underwent EUS-CDS. After 1-to-1 PSM, 112 patients per group were selected. EUS-GBD and EUS-CDS had similar technical success (97.3% and 91%; p = 0.08) and clinical success rates (83% and 85.7%; p = 0.17). AE rate was 19.6% in the EUS-GBD group and 12.5% in the EUS-CDS group (p = 0.20), of which 10 (8.9%) and 7 (6.2%) were severe AEs respectively (p = 0.61). Bleeding occurred in seven patients (6.1%) after EUS-GBD and three patients (2.5%) after EUS-CDS, whereas five infectious events were registered after EUS-GBD (4.4%) and four cases (3.5%) after EUS-CDS (p = 0.29). No treatment-related deaths were observed.

Conclusion

In patients with MDBO after failed ERCP, EUS-GBD or EUS-CDS were comparable with similar rates of efficacy and safety. EUS-GBD could represent an easy and safe option in MDBO patients without previous cholecystectomy and with a clear patency of the cystic duct.

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恶性胆道梗阻ERCP失败的处理：eus引导胆囊引流与胆十二指肠吻合术的有效性和安全性比较。

目的：目前尚不清楚内镜逆行胆管造影（ERCP）失败后恶性胆道远端梗阻（MDBO）的最佳引流方法。我们比较了内镜下超声（EUS）引导下的胆囊引流（GBD）和内镜下胆道十二指肠吻合（CDS）与腔内金属支架（LAMS）作为ERCP失败病例的抢救治疗。方法：这是一项在28个三级保健中心进行的国际多中心回顾性观察研究。使用倾向评分匹配（PSM）对结果进行比较。临床成功是主要结局，技术成功、不良事件（AE）率和总生存率是次要结局。结果：529例患者行eus引导引流，其中EUS-GBD 136例，EUS-CDS 393例。1对1 PSM后，每组选取112例患者。EUS-GBD和EUS-CDS具有相似的技术成功率（97.3%和91%，p = 0.08）和临床成功率（83%和85.7%,p = 0.17）。EUS-GBD组和EUS-CDS组AE发生率分别为19.6%和12.5% (p = 0.20)，其中严重AE分别为10例（8.9%）和7例（6.2%）（p = 0.61）。EUS-GBD术后出血7例（6.1%），EUS-CDS术后出血3例（2.5%），而EUS-GBD术后感染5例（4.4%），EUS-CDS术后感染4例（3.5%）（p = 0.29）。未观察到与治疗相关的死亡。结论：在ERCP失败后的MDBO患者中，EUS-GBD或EUS-CDS的疗效和安全性相似。EUS-GBD对于既往无胆囊切除术且胆囊管通畅的MDBO患者是一种简单安全的选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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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.