Endoscopic Retrograde Cholangiopancreatography-guided Biliary Drainage with Duckbill-type Anti-reflux Metal Stent versus Endoscopic Ultrasound-guided Hepaticogastrostomy for Malignant Distal Biliary Obstruction in Pancreatic Cancer with Duodenal Invasion.

BACKGROUND

Duodenal invasion is a risk factor for early recurrent biliary obstruction (RBO) due to the increased risk of duodenobiliary reflux. Transpapillary biliary drainage using anti-reflux metal stents (ARMS) and endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) are two different strategies for this condition.

METHODS

We retrospectively reviewed unresectable pancreatic cancer (PC) patients with duodenal invasion who underwent either transpapillary biliary drainage using duckbill-type ARMS (D-ARMS) or EUS-HGS for malignant distal biliary obstruction (MDBO). Technical and clinical success, causes of RBO, non-RBO adverse events (AEs), time to RBO (TRBO), and endoscopic reintervention (ERI) were compared between groups.

RESULTS

Forty-four patients were included (D-ARMS: 22, EUS-HGS: 22). Technical and clinical success rates, and non-RBO AE rates (9.1% vs. 36.4%,  = 0.069) were not significantly different between groups. Common causes of RBO were biliary debris/stones in the D-ARMS group and hyperplasia in the EUS-HGS group. Overall RBO rates (33.3% vs. 45.0%,  = 0.53), median TRBO (246 vs. 222 days,  = 0.98), and outcomes after ERI were comparable between groups.

CONCLUSIONS

Transpapillary biliary drainage using D-ARMS may be a viable option in managing MDBO with duodenal invasion, especially for non-high-volume centers, when both procedures are technically feasible.