The 4th Joint Session between JDDW-KDDW-TDDW3(JDDW)
Thu. November 5th   9:00 - 11:15   Room 10: Portopia Hotel Waraku
JKT3-2
 EUS-guided versus ERCP-guided biliary drainage with metal stenting for primary treatment of distal malignant biliary obstruction
Do Hyun Park
Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center
ERCP is the standard care for the primary palliation of distal malignant biliary obstruction. However, ERCP is not always successful because of the anatomical alterations or inaccessibility to the major papilla. When ERCP fails, percutaneous transhepatic biliary drainage (PTBD) has been the standard method as a rescue therapy.1 EUS-guided biliary drainage (EUS-BD) has emerged as an alternative procedure to PTBD after failed ERCP. Theoretically, EUS-BD has some advantages over ERCP and PTBD. EUS-BD is possible in surgically altered anatomy or inability to access the papilla. One of the major concerns of ERCP is post-ERCP pancreatitis, which occurs at a rate of 5 to 15%. In EUS-BD, because traumatic papillary manipulation may be avoided, the risk of procedure-related pancreatitis may be extremely low.1 The stent patency could be longer in EUS-BD than in ERCP-BD because the stents are not needed to be placed across the stricture site; therefore, the risk of tumor ingrowth or overgrowth would be less common. EUS-BD shows similar efficacy compared to PTBD when performed by expertise and may be more comfortable and physiologic to the patients than PTBD because of internal drainage.1 In addition, EUS-BD can be performed by a same operator in a same session of failed ERCP.1
Recently, three prospective randomized clinical trials comparing EUS-BD with ERCP-BD for the primary palliation of distal malignant biliary obstruction have been published simultaneously. Although the study design and primary outcomes were different, the conclusion of theses prospective studies were similar that the efficacy and safety of EUS-BD were not inferior to those of ERCP-BD. After the above three prospective clinical trials were published, several meta-analyses for supporting these results were published. In this lecture, preparation before the procedures, technical aspects, indications, efficacy, and safety between ERCP-BD and EUS-BD will be compared and discussed based on the results of recent randomized clinical trials and meta-analysis for the primary treatment of distal malignant biliary obstruction.
Reference
1. Paik WH, Park DH. EUS-Guided Versus ERCP-Guided Biliary Drainage for Primary Treatment of Distal Malignant Biliary Obstruction Current Treatment Options in Gastroenterology volume 2020 vol. 18, pages188–199
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