PDF | https://doi.org/10.46613/congastro2023-125
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Robles C1, Alcivar J1, Puga M1, Egas M1, Baquerizo J1, Arevalo M1, Cunto D1, Del Valle R1, Alvarado H1, Pitanga H1
1Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
BACKGROUND: The first-line treatment for obstructed biliary or pancreatic ducts is endoscopic retrograde cholangiopancreatography (ERCP); 10-15% have failed access due to the inability to cannulate the papilla. Endoscopic ultrasound-guided biliary drainage (EUS-BD) or pancreatic duct drainage (EUS-PDD) are direct real-time access to the ducts. They are alternatives to high morbimortality percutaneous drainage.
AIM: To assess anterograde’s clinical and technical success in non-neoplastic biliary and pancreatic duct drainage.
METHODS: Retrospective analysis (Jan/2021-Oct/2022). The endpoints were clinical and technical success, adverse events, re-stenosis, and reintervention.
RESULTS: Twenty patients were included (15/20 EUS-BD, 5/20 EUS-PDD). EUS-BD: inability to cannulate the papilla was due to stenosis secondary to 6/15 laparoscopic cholecystectomy, 7/15 conventional cholecystectomy, 1/15 gallbladder neoplasia, 1/15 Y-Roux. In 4/15 a previous attempt was performed: 1/4 balloon dilation, 1/4 percutaneous transhepatic biliary drainage and 2/4 stenting. Anterograde drainage was performed on 7/15 using a single pigtail, 5/15 double pigtail and 3/15 lumen-apposing metal stent (LAMS). Stomach puncture was the preferred approach site (13/15). A 15/15 technical success was achieved, but a 9/15 clinical success based on bilirubin decreased. Adverse events in 3/15 cases: bleeding, cholangitis and subhepatic fluid collection. Stent migrated in 3/15 cases. There was no re-stenosis; reintervention was necessary on 8/15. One patient died. EUS-PDD: anterograde drainage was decided due to chronic pancreatitis and recurrent choledocholithiasis in 3/5 and 2/5 cases, respectively. In 3/5 there was necessary cautery-assisted dilation. In 1/5 there was also necessary balloon dilation. Used stents included single and double pigtail, LAMS and self-expandable metal stent (SEMS). Technical and clinical success was achieved in 5/5, with no adverse events.
CONCLUSIONS: Anterograde EUS-BD and EUS-PDD for managing non-neoplastic obstructed biliary and pancreatic ducts are valuable alternatives when ERCP is not feasible. Reintervention after EUS-BD and EUS-PDD appears to be related to stent migration and re-stenosis, respectively.