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
{"title":"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。","authors":"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","doi":"10.1111/den.70145","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Objectives</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>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%; <i>p</i> = 0.08) and clinical success rates (83% and 85.7%; <i>p</i> = 0.17). AE rate was 19.6% in the EUS-GBD group and 12.5% in the EUS-CDS group (<i>p</i> = 0.20), of which 10 (8.9%) and 7 (6.2%) were severe AEs respectively (<i>p</i> = 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 (<i>p</i> = 0.29). No treatment-related deaths were observed.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>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.</p>\n </section>\n </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 4","pages":""},"PeriodicalIF":4.7000,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Management of ERCP Failure in Malignant Biliary Obstruction: Comparative Effectiveness and Safety of EUS-Guided Gallbladder Drainage Versus Choledocoduodenostomy\",\"authors\":\"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\",\"doi\":\"10.1111/den.70145\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Objectives</h3>\\n \\n <p>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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>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%; <i>p</i> = 0.08) and clinical success rates (83% and 85.7%; <i>p</i> = 0.17). AE rate was 19.6% in the EUS-GBD group and 12.5% in the EUS-CDS group (<i>p</i> = 0.20), of which 10 (8.9%) and 7 (6.2%) were severe AEs respectively (<i>p</i> = 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 (<i>p</i> = 0.29). No treatment-related deaths were observed.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusion</h3>\\n \\n <p>In patients with MDBO after failed ERCP, EUS-GBD or EUS-CDS were comparable with similar rates of efficacy and safety. 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Management of ERCP Failure in Malignant Biliary Obstruction: Comparative Effectiveness and Safety of EUS-Guided Gallbladder Drainage Versus Choledocoduodenostomy
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.
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.
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