Sawas Tarek, Bailey Natashay J, Yeung Kit Ying Kitty Au, James Theodore W, Reddy Sumana, Fleming Chad J, Marya Neil B, Storm Andrew C, Abu Dayyeh Barham K, Petersen Bret T, Martin John A, Levy Michael J, Baron Todd H, Bun Teoh Anthony Yuen, Chandrasekhara Vinay
Division of Digestive and Liver Diseases, University of Texas Southwestern, Dallas, TX, USA.
Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
Endosc Ultrasound. 2022 May-Jun;11(3):223-230. doi: 10.4103/EUS-D-21-00031.
Percutaneous transhepatic biliary drainage (PTBD) and EUS-guided choledochoduodenostomy (EUS-CD) are alternate therapies to endoscopic retrograde cholangiopancreatography with stent placement for biliary decompression. The primary outcome of this study is to compare the technical and clinical success of PTBD to EUS-CD in patients with distal biliary obstruction. Secondary outcomes were adverse events (AEs), need for reintervention, and survival.
A multicenter retrospective cohort study from three different centers was performed. Cox regression was used to compare time to reintervention and survival and logistic regression to compare technical and clinical success and AE rates. Subgroup analysis was performed in patients with malignant biliary obstruction (MBO).
A total of 86 patients (58 PTBD and 28 EUS-CD) were included. The two groups were similar with respect to age, gender, and cause of biliary obstruction, with malignancy being the most common etiology (80.2%). EUS-CD utilized lumen-apposing metal stents in 15 patients and self-expandable metal biliary stents in 13 patients. Technical success was similar been EUS-CD (100%) and PTBD (96.6%; P = 0.3). EUS-CD was associated with higher clinical success compared to PTBD (84.6% vs. 62.1%; P = 0.04). There was a trend toward lower rates of AEs with EUS-CD 14.3% versus PTBD 29.3%, odds ratio: 0.40 (95% confidence interval [CI]: 0.12-1.33, P = 0.14). The need for reintervention was significantly lower among patients who underwent EUS-CD (10.7%) compared to PTBD (77.6%) (hazard ratio: 0.07, 95% CI: 0.02-0.24; P < 0.001). A sensitivity analysis of only patients with MBO demonstrated similar rate of reintervention between the groups in individuals who survived 50 days or less after the biliary decompression. However, reintervention rates were lower for EUS-CD in those with longer survival.
EUS-CD is a technically and clinically highly successful procedure with a trend toward lower AEs compared to PTBD. EUS-CD minimizes the need for reintervention, which may enhance end-of-life quality in patients with MBO and expected survival longer than 50 days.
经皮经肝胆道引流术（PTBD）和超声内镜引导下胆总管十二指肠吻合术（EUS-CD）是内镜逆行胰胆管造影术联合支架置入术用于胆道减压的替代治疗方法。本研究的主要目的是比较PTBD与EUS-CD在远端胆道梗阻患者中的技术成功率和临床成功率。次要结局指标为不良事件（AE）、再次干预的需求和生存率。
进行了一项来自三个不同中心的多中心回顾性队列研究。采用Cox回归比较再次干预时间和生存率，采用逻辑回归比较技术成功率、临床成功率和AE发生率。对恶性胆道梗阻（MBO）患者进行亚组分析。
共纳入86例患者（58例行PTBD，28例行EUS-CD）。两组在年龄、性别和胆道梗阻原因方面相似，恶性肿瘤是最常见的病因（80.2%）。15例EUS-CD患者使用了管腔对合金属支架，13例患者使用了自膨式金属胆道支架。EUS-CD组的技术成功率（100%）与PTBD组（96.6%）相似（P = 0.3）。与PTBD相比，EUS-CD的临床成功率更高（84.6%对62.1%；P = 0.04）。EUS-CD的AE发生率有降低趋势（14.3%对PTBD的29.3%），比值比：0.40（95%置信区间[CI]：0.12 - 1.33，P = 0.14）。与PTBD（77.6%）相比，接受EUS-CD的患者再次干预的需求显著更低（10.7%）（风险比：0.07，95% CI：0.02 - 0.24；P < 0.001）。仅对MBO患者进行的敏感性分析显示，在胆道减压后存活50天或更短时间的个体中，两组的再次干预率相似。然而，在存活时间较长的患者中，EUS-CD的再次干预率较低。
与PTBD相比，EUS-CD在技术和临床方面都非常成功，且AE发生率有降低趋势。EUS-CD将再次干预的需求降至最低，这可能提高MBO患者以及预期生存期超过50天患者的终末期生活质量。
