Hepaticogastrostomy or choledochoduodenostomy for distal malignant biliary obstruction after failed ERCP: Is there any difference?

摘要: Background EUS-guided biliary drainage (BD) is an evolving alternative technique for patients with malignant obstruction which ERCP failed. Objective To compare the outcomes of 2 nonanatomic BD routes: hepaticogastrostomy (HPG) and choledochoduodenostomy (CD). Design Prospective, randomized trial. Setting Tertiary endoscopic referral center. Patients Forty-nine unresectable distal failed were included. The HPG group had 25 CD 24 patients. Interventions or CD. In all procedures, a puncture 19-gauge needle followed by cholangiography, wire advancement, track dilation, self-expandable metal stent deployment performed. Main Outcome Measurements Technical clinical success, quality life, adverse events, survival. Results technical success rate was 96% 91% 77% mean procedural time 47.8 minutes 48.8 scores life similar during follow-up. overall event 16.3% (20% 12.5% group). One patient bile leak required percutaneous biloma drainage. There no statistical difference between techniques regard to survival 2 groups. Limitations Single-center study. Conclusion are in efficacy safety. Both seem valid alternative options after ERCP.