Efficacy and safety in case of technical success of endoscopic ultrasound-guided transhepatic antegrade biliary drainage: A report of a monocentric study.

Background And Objectives: Endoscopic ultrasound (EUS)-guided biliary drainage techniques are alternative procedures in cases of obstructive jaundice with altered anatomy or failed ERCP. Complications related to EUS-guided antegrade drainage (EUS-AD) are still present in up to 10% of cases, and combination of procedures is sometimes suggested to avoid adverse events. The purpose of our study is to evaluate the efficacy and safety of EUS-AD with transhepatic access in case of technical success.

Methods: We retrospectively reviewed patients who underwent EUS-AD in a single, tertiary care center.

Results: Twenty patients were included (mean age 68), malignant stenosis in 95%. The reasons for EUS-AD were failed ERCP in 13/20, duodenal stenosis in 4/20, and altered anatomy after surgery in 3/20. A cystostome 6 Fr was always used to create the hepaticogastric tract, without puncture site closure. Self-expandable metallic stent (SEMS) was transpapillary in 95%. Drainage was completed in intraoperative stage by a EUS-hepaticogastrostomy (EUS-HGS) in 1/20 and by percutaneous drainage of the right liver (percutaneous transhepatic biliary drainage) in one out of 20. Overall clinical success was 17/20 (85%). One out of 20 presented a persistent obstructive cholangitis treated by another SEMS through ERCP. Two out of 20 patients died of infectious complications with incomplete drainage, in case of advanced neoplastic disease. One of these two patients was treated by EUS-AD and EUS-HGS at the same time. None of the 20 patients developed bilioma or bile leakage.

Conclusion: EUS-AD by transhepatic way is clinically effective and safe. Closure of the gastric puncture site is not mandatory and complementary methods for biliary decompression should be combined in case of incomplete drainage and not to prevent potential adverse events.