Application and Value of Endoscopic Ultrasonography Guided Biliary Interventional Therapy in Patients With Biliary Obstruction and Surgically Altered Anatomy.

AIM: The aim of this study was to evaluate the efficacy and safety of endoscopic ultrasound-guided biliary drainage (EUS-BD) in patients with biliary obstruction and surgically altered anatomy.

PATIENTS AND METHODS: This was a retrospective study. We collected data from 60 patients with biliary obstruction and surgically altered anatomies who undergone EUS-BD (group A, 33 cases) and percutaneous transhepatic biliary drainage (PTBD) (group B, 27 cases) after unsuccessful endoscopic retrograde cholangiopancreatography from January 2016 to January 2018. The operation success rate, the clinical success rate, complications, hospital stay were observed.

RESULTS: In group A, 31 cases of 33 patients were successfully operated and placed stents or drainage tube by endoscopic ultrasound puncture [endoscopic ultrasonography (EUS) guided rendezvous 8, EUS-guided hepaticogastrostomy 14, EUS-guided choledochoduodenostomy 11], 28 had a significant decrease in jaundice. The complications rate was 9.1% (biliary bleeding 2; acute cholangitis 1). There was statistically significant difference in the complications [9.09% (3/33) vs. 33.33% (9/27), χ=5.45, P<0.05] and length of hospital stay (14.45±5.78 vs. 18.52±8.64 d, t=10.03, P<0.01) between group A and group B. There was not statistical significance in the technical and clinical success rate between 2 groups [93.94% (31/33) vs. 92.60% (25/27), 84.85% (28/33) vs. 85.19% (23/27), χ1=0.10, χ2=0.11, P>0.05].

CONCLUSION: EUS-BD may be the first choice for patients with biliary obstruction and surgically altered anatomy after a failed endoscopic retrograde cholangiography in centers with expertise in EUS-BD procedures.