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)

IF 4.7 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Digestive Endoscopy Pub Date : 2024-02-21 DOI:10.1111/den.14750

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

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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.

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内镜逆行胰胆管造影术失败后的恶性远端胆道梗阻患者，内镜超声（EUS）引导下胆总管十二指肠造口术与 EUS 引导下胆囊引流术治疗黄疸的效果对比：回顾性多中心研究（GALLBLADEUS 研究）。

研究目的本研究旨在比较内镜超声引导下胆总管十二指肠造口术（EUS-CDS）与内镜逆行胰胆管造影术（ERCP）治疗恶性远端胆道梗阻（MDBO）所致黄疸失败病例的内镜胆囊引流术（EUS-GBD）：这项多中心回顾性研究纳入了因恶性远端胆道梗阻（MDBO）引起的梗阻性黄疸患者，这些患者在ERCP失败后接受了EUS-GBD或EUS-CDS，并使用了腔内金属支架。主要终点是临床成功率。次要终点为技术成功率、围手术期不良事件发生率（24 小时）、总生存率和复发胆道梗阻时间：结果：共纳入 78 名患者：结果：共纳入 78 例患者：41 例接受了 EUS-GBD 术，37 例接受了 EUS-CDS 术。MDBO主要由胰腺癌引起（n = 63/78，80.7%）。两种手术的临床成功率相似：EUS-GBD为87.8%，EUS-CDS为89.2%（P = 0.8）。EUS-GBD 的技术成功率为 100%，EUS-CDS 为 94.6%（P = 0.132）。EUS-CDS 组患者的围手术期发病率（24 h）（8/37 [21.6%]）高于 EUS-GBD 组（3/41 [7.3%]）（P = 0.042）。中位随访时间为 4.7 个月。两组患者的总生存率和复发胆道梗阻时间无明显差异：讨论：ERCP治疗MDBO失败后，EUS-GBD和EUS-CDS的临床成功率和技术成功率相当。EUS-GBD似乎是治疗MDBO的一种很有前景的选择，即使是ERCP失败后的二线治疗。还需要进一步的研究来验证这些发现，并比较 EUS-GBD 和 EUS-CDS 的长期疗效。

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来源期刊

Digestive Endoscopy 医学-外科

CiteScore

10.10

自引率

15.10%

发文量

291

审稿时长

6-12 weeks

期刊介绍： Digestive Endoscopy (DEN) is the official journal of the Japan Gastroenterological Endoscopy Society, the Asian Pacific Society for Digestive Endoscopy and the World Endoscopy Organization. Digestive Endoscopy serves as a medium for presenting original articles that offer significant contributions to knowledge in the broad field of endoscopy. The Journal also includes Reviews, Original Articles, How I Do It, Case Reports (only of exceptional interest and novelty are accepted), Letters, Techniques and Images, abstracts and news items that may be of interest to endoscopists.