Koutlas Nicholas J, Pawa Swati, Russell Greg, Ferris Taylor, Ponnatapura Janardhana, Pawa Rishi
Gastroenterology, Wake Forest School of Medicine, Winston-Salem, United States.
Biostatistics, Wake Forest School of Medicine, Winston-Salem, United States.
Endosc Int Open. 2024 Jan 19;12(1):E108-E115. doi: 10.1055/a-2220-2740. eCollection 2024 Jan.
Percutaneous transhepatic biliary drainage (PTBD) is the traditional second-line option after unsuccessful endoscopic retrograde cholangiopancreatography (ERCP). Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HG) is a viable alternative to PTBD. Our study aimed to compare outcomes of EUS-HG and PTBD for benign and malignant biliary diseases following failed ERCP. This single-center study retrospectively analyzed patients undergoing EUS-HG and PTBD for benign and malignant biliary disorders. A propensity score-matched analysis was performed using age, sex, and Charlson Comorbidity Index. The primary outcome was clinical success, which we defined as a decrease in total bilirubin by ≥ 50% at 2 weeks for malignant disease and resolution of the biliary disorder for benign disease. In total, 41 patients underwent EUS-HG and 138 patients underwent PTBD. After propensity score matching in a 1:2 ratio, 32 EUS-HG patients were matched with 64 PTBD. Technical success was achieved in 29 of 32 (91%) for EUS-HG and 63 of 64 (98%) for PTBD ( =0.11). Clinical success was 100% for EUS-HG and 75% for PTBD ( =0.0021). EUS-HG was associated with a lower adverse event rate (EUS-HG 13% vs. PTBD 58%, <0.0001), shorter procedure duration (median 60 vs. 115 minutes, <0.0001), shorter post-procedure length of stay (median 2 vs. 4 days, <0.0001), and fewer reinterventions (median 1 vs. 3, <0.0001). Our results suggest that EUS-HG is superior to PTBD in the treatment of benign and malignant biliary disorders after failed ERCP.
经皮经肝胆道引流术（PTBD）是内镜逆行胰胆管造影术（ERCP）失败后的传统二线选择。内镜超声引导下肝胃吻合术（EUS-HG）是PTBD的一种可行替代方案。我们的研究旨在比较ERCP失败后EUS-HG和PTBD治疗良性和恶性胆道疾病的疗效。这项单中心研究回顾性分析了接受EUS-HG和PTBD治疗良性和恶性胆道疾病的患者。使用年龄、性别和查尔森合并症指数进行倾向评分匹配分析。主要结局是临床成功，对于恶性疾病，我们将其定义为2周时总胆红素下降≥50%，对于良性疾病，定义为胆道疾病得到解决。共有41例患者接受了EUS-HG，138例患者接受了PTBD。按1:2的比例进行倾向评分匹配后，32例EUS-HG患者与64例PTBD患者匹配。EUS-HG组32例中有29例（91%）技术成功，PTBD组64例中有63例（98%）技术成功（P=0.11）。EUS-HG组临床成功率为100%，PTBD组为75%（P=0.0021）。EUS-HG的不良事件发生率较低（EUS-HG为13%，PTBD为58%，P<0.0001），手术时间较短（中位数60分钟对115分钟，P<0.0001），术后住院时间较短（中位数2天对4天，P<0.0001），再次干预较少（中位数1次对3次，P<0.0001）。我们的结果表明，在ERCP失败后治疗良性和恶性胆道疾病方面，EUS-HG优于PTBD。
