EUS-guided biliary drainage with transluminal stenting after failed ERCP: predictors of adverse events and long-term results

Gastrointest Endosc. 2011 Dec;74(6):1276-84. doi: 10.1016/j.gie.2011.07.054. Epub 2011 Oct 1.


Background: EUS-guided biliary drainage (EUS-BD) has been proposed as an effective alternative for percutaneous transhepatic biliary drainage (PTBD) after failed ERCP. To date, the risk factors for adverse events and long-term outcomes of EUS-BD with transluminal stenting (EUS-BDS) have not been fully explored.

Objective: To evaluate risk factors for adverse events and long-term outcomes of EUS-BDS.

Design: Prospective follow-up study.

Setting: Tertiary-care academic center.

Patients: This study involved 57 consecutive patients with malignant or benign biliary obstruction undergoing EUS-BDS after failed ERCP.

Intervention: EUS-guided hepaticogastrostomy (EUS-HGS) and EUS-guided choledochoduodenostomy with transluminal stenting (EUS-CDS).

Main outcome measurements: Risk factors for postprocedure and late adverse events and clinical outcomes of EUS-BDS.

Results: The overall technical and functional success rates, respectively, in the EUS-BDS group were 96.5% (intention-to-treat, n = 55/57) and 89% (per-protocol, n = 49/55). Postprocedure adverse events developed after EUS-BDS in 11 patients (20%, n = 11/55). This included bile peritonitis (n = 2), mild bleeding (n = 2), and self-limited pneumoperitoneum (n = 7). In multivariate analysis, needle-knife use was the single risk factor for postprocedure adverse events after EUS-BDS (odds ratio 12.4; P = .01). A late adverse event in EUS-BDS was distal stent migration (7%, n = 4/55). The mean stent patencies with EUS-HGS and EUS-CDS were 132 days and 152 days, respectively.

Limitations: Single-operator performed, nonrandomized study.

Conclusion: EUS-HGS and EUS-CDS may be relatively safe and can be used as an alternative to PTBD after failed ERCP. Both techniques offer durable and comparable stent patency. The use of a needle-knife for fistula dilation in EUS-BDS should be avoided if possible.

Publication types

  • Comparative Study

MeSH terms

  • Bile Ducts / diagnostic imaging*
  • Bile Ducts / surgery
  • Cholangiopancreatography, Endoscopic Retrograde*
  • Choledochostomy / adverse effects
  • Choledochostomy / methods*
  • Cholestasis / diagnostic imaging
  • Cholestasis / etiology
  • Cholestasis / surgery*
  • Drainage / methods*
  • Endosonography / methods*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Risk Factors
  • Stents*
  • Time Factors
  • Treatment Failure