EUS-guided hepaticogastrostomy versus percutaneous transhepatic biliary drainage after failed ERCP: A propensity score-matched analysis

Nicholas J Koutlas; Swati Pawa; Greg Russell; Taylor Ferris; Janardhana Ponnatapura; Rishi Pawa

doi:10.1055/a-2220-2740

EUS-guided hepaticogastrostomy versus percutaneous transhepatic biliary drainage after failed ERCP: A propensity score-matched analysis

Endosc Int Open. 2024 Jan 19;12(1):E108-E115. doi: 10.1055/a-2220-2740. eCollection 2024 Jan.

Authors

Nicholas J Koutlas¹, Swati Pawa¹, Greg Russell², Taylor Ferris³, Janardhana Ponnatapura⁴, Rishi Pawa¹

Affiliations

¹ Gastroenterology, Wake Forest School of Medicine, Winston-Salem, United States.
² Biostatistics, Wake Forest School of Medicine, Winston-Salem, United States.
³ Department of Medicine, Wake Forest School of Medicine, Winston-Salem, United States.
⁴ Interventional Radiology, Wake Forest School of Medicine, Winston-Salem, United States.

Abstract

Background and study aims 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. Patients and methods 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. Results 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 ( P =0.11). Clinical success was 100% for EUS-HG and 75% for PTBD ( P =0.0021). EUS-HG was associated with a lower adverse event rate (EUS-HG 13% vs. PTBD 58%, P <0.0001), shorter procedure duration (median 60 vs. 115 minutes, P <0.0001), shorter post-procedure length of stay (median 2 vs. 4 days, P <0.0001), and fewer reinterventions (median 1 vs. 3, P <0.0001). Conclusions Our results suggest that EUS-HG is superior to PTBD in the treatment of benign and malignant biliary disorders after failed ERCP.

Keywords: Biliary tract; Endoscopic ultrasonography; Intervention EUS; Stones; Strictures.

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