Thai Journal of Gastroenterology

Article :
A Pilot Comparative Study of Endoscopic Ultrasound-guided Biliary Drainage (EUS-BD) with Percutaneous Transhepatic Biliary Drainage (PTBD) in the Treatment of Malignant Biliary Obstruction

Author :
Jongboonyanuparp T
Attasaranya S
Sottisuporn J
Netinatsunton N
Rookkapan S
Pakdeejit S
Hongsakul K
Sungsiri J
Sangthong R
Ovartlanporn B

Abstract :
Background: Biliary obstruction is a common complication of malignant diseases involving biliary tract. Endoscopic retrograde cholangiography (ERC) with biliary stenting is accepted as the standard treatment of unresectable malignant biliary obstruction. Percutaneous transhepatic biliary drainage (PTBD) is an alternative option when failed standard endoscopic drainage. Endoscopic ultrasonography (EUS)-guided cholangiography and EUS-guided biliary drainage (EUS-BD) have been reported in case series as another alternative treatment option in malignant biliary obstruction. However, there was no reported comparative study between PTBD and EUS-BD for biliary drainage in this patient population. Aim: To compare the success and complication rate of EUS-BD and PTBD in unresectable malignant biliary tract obstruction who failed standard endoscopic biliary drainage Patients and Methods: Ten patients with unresectable malignant biliary obstruction were enrolled from Songklanagarind hospital to this prospective randomized trial. Only those who failed ERC with biliary stenting were randomized to one of two treatment groups, EUS-BD or PTBD. All patients were hospitalized for at least 24 hrs following the procedure. Technical success, treatment success and complication were recorded. Further follow up was scheduled at day 7, day 28 and then every 4 week after the procedure. Results: Technical success was achieved in 4/5 cases in EUS-BD group and in 5/5 cases in PTBD group. All patients with technical success achieved treatment success in term of relieving obstructive jaundice. One fatal complication with bile leak and intraabdominal sepsis occurred following failed EUS-BD. Two cases of minor complications; bile leak and cholangitis, occurred in EUS-BD and PTBD group respectively. All stents in EUS-BD group were patent until patients died with the longest duration of 184 day. Conclusions: EUS-BD and PTBD appeared to offer comparable efficacy in treatment of patients with malignant biliary obstruction who failed ERC with biliary stenting. However, EUS-BD is a technically demanding procedure rendering potentially serious complications. Further studies are required to define the “rescue” treatment options in this difficult situation.

Keyword :
Endoscopic retrograde cholangiography, EUS-BD, percutaneous transhepatic biliary drainage, PTBD, biliary obstruction

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