Original articleClinical endoscopyHepaticogastrostomy or choledochoduodenostomy for distal malignant biliary obstruction after failed ERCP: Is there any difference?
Section snippets
Methods
Between April 2010 and December 2013, a total of 1759 ERCP procedures for malignant obstructive jaundice relief were performed at the Hospital das Clinicas da Universidade de Sao Paulo for treatment of the malignant biliary obstruction. All patients with unresectable distal malignant biliary obstruction undergoing ERCP consented to undergo possible EUS-guided BD in case of a failed ERCP. Before providing consent, the patients received an explanation and information about the possible drainage
Results
A total of 49 patients (24 female/25 male) were included in the study; 25 patients underwent HPG and 24 underwent CD. Patient demographic and clinical information is summarized in Table 1. The Karnofsky performance status in both groups was similar (P = .201). All patients had intra- and extrahepatic biliary dilation. In 40 patients, the papilla was not accessible and the patients were directly randomized to HPG or CD. The rendezvous maneuver was attempted in 30 patients and failed in 9
Discussion
After the first description of EUS-guided CD13 and EUS-guided HPG,14 many improvements and variations of the technique were described.15 Many retrospective studies showed that EUS-guided BD is at least as good as the current alternatives for BD in expert hands for patients with failed ERCP.16, 17, 18, 19 Recently, EUS-guided biliary technique was compared with the current standard alternatives for BD in patients in whom ERCP failed.20, 21 An international consortium of experts in therapeutic
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DISCLOSURE: Dr Kahaleh has received research grants from Boston Scientific, Mauna Kea, W.L. Gore, and Xlumena and is a consultant for Boston Scientific. All other authors disclosed no financial relationships relevant to this article.