PMID- 27995197
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220331
IS  - 2364-3722 (Print)
IS  - 2196-9736 (Electronic)
IS  - 2196-9736 (Linking)
VI  - 4
IP  - 12
DP  - 2016 Dec
TI  - EUS-guided biliary drainage or enteroscopy-assisted ERCP in patients with 
      surgical anatomy and biliary obstruction: an international comparative study.
PG  - E1322-E1327
AB  - Background and study aims: How enteroscopy-assisted ERCP (e-ERCP) and endoscopic 
      ultrasound-guided biliary drainage (EUS-BD) compare in patients with surgically 
      altered upper gastrointestinal anatomy is currently unknown. The aims of this 
      study were to compare efficacy and safety of both techniques and study predictors 
      of these outcomes. Patients and methods: This was an international, multicenter 
      comparative cohort study at 10 tertiary centers. Outcomes data included technical 
      success (biliary access with cholangiography and stent placement [when 
      indicated]), clinical success (resolution of biliary obstruction) and adverse 
      events (AEs) (graded according to the ASGE lexicon). Results: A total of 98 
      patients underwent EUS-BD (n = 49) or e-ERCP (n = 49). Technical success was 
      achieved in 48 (98 %) patients in the EUS-BD group as compared to 32 (65.3 %) 
      patients in the e-ERCP group (OR 12.48, P = 0.001). Clinical success was attained 
      in 88 % of patients in EUS-BD group as compared to 59.1 % in the e-ERCP group (OR 
      2.83, P = 0.03). Procedural time was significantly shorter in the EUS-BD group 
      (55 min vs 95 min, P < 0.0001). AEs occurred more commonly in the EUS-BD group 
      (20 % vs. 4 %, P = 0.01). However, the majority (90 %) of AEs were mild/moderate. 
      Length of stay was significantly longer in the EUS-BD group (6.6 d vs. 2.4 d, 
      P < 0.0001). Conclusions: EUS-BD can be performed with a higher degree of 
      clinical efficacy and shorter procedure time than e-ERCP in patients with 
      surgically-altered upper gastrointestinal anatomy. Whether or not this approach 
      should be first-line therapy in this patient population is highly dependent on 
      the indication for the procedure, the patient's anatomy, and local practice and 
      expertise.
FAU - Khashab, Mouen A
AU  - Khashab MA
AD  - Division of Gastroenterology and Hepatology, The Johns Hopkins Medical 
      Institutions, Baltimore, MD, United States.
FAU - El Zein, Mohamad H
AU  - El Zein MH
AD  - Division of Gastroenterology and Hepatology, The Johns Hopkins Medical 
      Institutions, Baltimore, MD, United States.
FAU - Sharzehi, Kaveh
AU  - Sharzehi K
AD  - Division of Gastroenterology and Hepatology, Temple University Hospital, 
      Philadelphia, PA, United States.
FAU - Marson, Fernando P
AU  - Marson FP
AD  - Hospital Ana Costa. Santos, Brazil.
FAU - Haluszka, Oleh
AU  - Haluszka O
AD  - Division of Gastroenterology and Hepatology, Temple University Hospital, 
      Philadelphia, PA, United States.
FAU - Small, Aaron J
AU  - Small AJ
AD  - Division of Hepatology and Gastroenterology, Virginia Mason Medical Center, 
      Seattle, WA, United States.
FAU - Nakai, Yousuke
AU  - Nakai Y
AD  - Department of Gastroenterology, Graduate School of Medicine, The University of 
      Tokyo, Tokyo, Japan.
FAU - Park, Do Hyun
AU  - Park DH
AD  - Department of Internal Medicine, University of Ulsan College of Medicine, Asan 
      Medical Center, Seoul, South Korea.
FAU - Kunda, Rastislav
AU  - Kunda R
AD  - Department of Surgical Gastroenterology, Aarhus University Hospital, Aarhus, 
      Denmark.
FAU - Teoh, Anthony Y
AU  - Teoh AY
AD  - Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China.
FAU - Penas, Irene
AU  - Penas I
AD  - Hospital Universitario Rio Hortega, Valladolid University, Valladolid, Spain.
FAU - Perez-Miranda, Manuel
AU  - Perez-Miranda M
AD  - Hospital Universitario Rio Hortega, Valladolid University, Valladolid, Spain.
FAU - Kumbhari, Vivek
AU  - Kumbhari V
AD  - Division of Gastroenterology and Hepatology, The Johns Hopkins Medical 
      Institutions, Baltimore, MD, United States.
FAU - Van der Merwe, Schalk
AU  - Van der Merwe S
AD  - Department of Hepatology, KU leuven, Leuven, Belgium.
FAU - Artifon, Everson L
AU  - Artifon EL
AD  - Hospital Ana Costa. Santos, Brazil.
FAU - Ross, Andrew S
AU  - Ross AS
AD  - Division of Hepatology and Gastroenterology, Virginia Mason Medical Center, 
      Seattle, WA, United States.
LA  - eng
PT  - Journal Article
DEP - 20160830
PL  - Germany
TA  - Endosc Int Open
JT  - Endoscopy international open
JID - 101639919
PMC - PMC5161123
COIS- Competing interests: Dr. Khashab is a consultant for Boston Scientific and 
      Xlumena Manuel Perez-Miranda is a consultant for Boston Scientific. Dr. Kunda is 
      a consultant for Boston Scientific, Olympus and Xlumena.
EDAT- 2016/12/21 06:00
MHDA- 2016/12/21 06:01
PMCR- 2016/12/01
CRDT- 2016/12/21 06:00
PHST- 2016/04/18 00:00 [received]
PHST- 2016/06/13 00:00 [accepted]
PHST- 2016/12/21 06:00 [entrez]
PHST- 2016/12/21 06:00 [pubmed]
PHST- 2016/12/21 06:01 [medline]
PHST- 2016/12/01 00:00 [pmc-release]
AID - 10.1055/s-0042-110790 [doi]
PST - ppublish
SO  - Endosc Int Open. 2016 Dec;4(12):E1322-E1327. doi: 10.1055/s-0042-110790. Epub 
      2016 Aug 30.