Effectiveness of endoscopic ultrasound (EUS)-guided choledochoduodenostomy vs. EUS-guided gallbladder drainage for jaundice in patients with malignant distal biliary obstruction after failed endoscopic retrograde cholangiopancreatography: Retrospective, multicenter study (GALLBLADEUS Study)

Antoine Debourdeau; Jules Daniel; Ludovic Caillo; Eric Assenat; Martin Bertrand; Thomas Bardol; François-Régis Souche; Philippe Pouderoux; Romain Gerard; Diane Lorenzo; Jean-François Bourgaux

doi:10.1111/den.14750

Effectiveness of endoscopic ultrasound (EUS)-guided choledochoduodenostomy vs. EUS-guided gallbladder drainage for jaundice in patients with malignant distal biliary obstruction after failed endoscopic retrograde cholangiopancreatography: Retrospective, multicenter study (GALLBLADEUS Study)

Dig Endosc. 2024 Feb 21. doi: 10.1111/den.14750. Online ahead of print.

Authors

Affiliations

¹ Hepatogastroenterology Department, Nimes University Hospital, University of Montpellier, Nimes, France.
² Hepatogastroenterology Department, Montpellier University Hospital, University of Montpellier, Montpellier, France.
³ Surgery Department, Nimes University Hospital, University of Montpellier, Nimes, France.
⁴ Surgery Department, Montpellier University Hospital, University of Montpellier, Montpellier, France.
⁵ Hepatogastroenterology Department, Lille University Hospital, Lille University, Lille, France.
⁶ Hepatogastroenterology Department, Beaujon University Hospital, Paris Cité University, Paris, France.

^# Contributed equally.

PMID: 38380564
DOI: 10.1111/den.14750

Abstract

Objectives: The aim of this study was to compare endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) vs. EUS-gallbladder drainage (EUS-GBD) in cases of failed endoscopic retrograde cholangiopancreatography (ERCP) for jaundice resulting from malignant distal biliary obstruction (MDBO).

Methods: This multicenter retrospective study included patients with obstructive jaundice secondary to MDBO who underwent EUS-GBD or EUS-CDS with lumen-apposing metal stents after failed ERCP. The primary end-point was clinical success rate. Secondary end-points were technical success, periprocedural adverse events rate (<24 h), late adverse events rate (>24 h), overall survival, and time to recurrent biliary obstruction.

Results: A total of 78 patients were included: 41 underwent EUS-GBD and 37 underwent EUS-CDS. MDBO was mainly the result of pancreatic cancer (n = 63/78, 80.7%). Clinical success rate was similar for both procedures: 87.8% for EUS-GBD and 89.2% for EUS-CDS (P = 0.8). Technical success rate was 100% for EUS-GBD and 94.6% for EUS-CDS (P = 0.132). Periprocedural morbidity (<24 h) rates were similar between both groups: 4/41 (9.8%) for EUS-GBD and 5/37 (13.5%) for EUS-CDS (P = 0.368). There was a significantly higher rate of late morbidity (>24 h) among patients in the EUS-CDS group (8/37 [21.6%]) than in the EUS-GBD group (3/41 [7.3%]) (P = 0.042). The median follow-up duration was 4.7 months. Overall survival and time to recurrent biliary obstruction did not significantly differ between the groups.

Discussion: After failed ERCP for MDBO, EUS-GBD and EUS-CDS show comparable clinical success rates and technical success. EUS-GBD appears to be a promising alternative for MDBO, even as a second-line treatment after failed ERCP. Further studies are needed to validate these findings and compare the long-term outcomes of EUS-GBD and EUS-CDS.

Keywords: EUS; biliary drainage; endoscopy; gallbladder; pancreatic cancer.