EUS-guided transmural Biliary Drainage (EUS-BD)

(Objective)We prospectively followed up and evaluated the safety and the efficacy of EUS-BD with malignant lower biliary tract obstruction.(Subjects) We performed EUS-guided biliary access in 162 cases including EUS-guided choledochoduodenostomy (EUS-CDS) in 97patients, and EUS-guided hepaticoenterostomy (EUS-HS) in 24patients with malignant lower biliary tract obstructions from 2003 to 2014. (Results)1. Overall Success rate for EUS-CDS was 97% (94/97), and EUS-HS was 75% (18/24) according to intention to treat analysis.2. Median time for EUS-CDS was 28 min (range: 10-75 min), and EUS-HS was 51min (range: 15-170 min).3. Functional success rate of EUS-CDS was 100% (34/34) in the PS group, and 97% (58/60) in the CMS group. Likewise, EUS-HS was 50% (2/4) in the PS group, and 100% (14/14) in the CMS group.4. Bile peritonitis was seen in 21% (7/34) with PS, and 5% (3/60) with CMS in EUS-CDS. EUS-HS was 25% (1/4) with PS, and 21% (3/14) with CMS.5. 50% stent patency according to Kaplan-Meier analysis in EUS-CDS was 120 days in the PS group, and was 350days in the CMS group. EUS-HS was 6 days in the PS group, and was 115 days in the CMS group. (Conclusion)Compared with EUS-HS, EUS-CDS is higher success rate and lower complication rate. Using CMS in EUS-CDS may prevent the occurrence of peritonitis and prolong the stent patency. EUS-CDS with CMS is safety and useful procedure.