Endoscopic Ultrasound-Guided Biliary Drainage (EUS-BD) for malignant biliary obstruction after failed endoscopic retrograde cholangiography (ERC) in patients with surgically altered anatomy

Abstract To assess the effectiveness and safety of EUS-BD in patients with jaundice due to malignant biliary obstruction and post-surgically altered anatomy of the upper GI tract who failed prior ERC. Over a defined study period, all consecutive patients, who had undergone EUS-BD, were analyzed retrospectively using a computer-based registry. Overall, 118 patients were registered (mean age, 69 range, 38–88 years; sex ratio f:m, 71:47) from 2005–2020. Technical and clinical success rates were 92.4 % and 93.6 %, respectively. 103 self-expandable metallic stents (SEMS), 2 lumen-apposing metal stents (LAMS), and 22 plastic stents were used. The successful access routes to the bile duct system were trans-gastric (n=69), trans-jejunal (n=39), and trans-esophageal (n=2). Adverse events (AE) occurred in 19.5 % and re-interventions were necessary in 27.9 % of cases. The median post-interventional survival time was 85 (95% CI: 45–256) days. The following parameters were associated with a significantly shorter survival time: CRP > 50 mg/L, bilirubin serum level > 200 µmol/L, high tumor burden, Karnofsky index < 80, and manifest malnutrition status. EUS-BD in malignant biliary obstruction is a safe and effective method, even with surgically altered anatomy of the upper GI tract, in experienced hands of interventional EUS.