EndoscopyJournal Article
05 May 2025
Biliary drainage in patients with distal malignant biliary obstruction (DMBO) carries a higher risk of difficult biliary cannulation (DBC) during endoscopic retrograde cholangiopancreatography (ERCP). After the failure of standard cannulation, endoscopists may proceed with advanced cannulation techniques and/or with endoscopic ultrasound-guided biliary drainage (EUS-BD).This was a retrospective study of consecutive patients with DMBO and a dilated common bile duct (CBD; >12 mm) who underwent ERCP for endoscopic biliary drainage in four European centers. The rates of DBC, technical and clinical success, and procedure-related adverse events (AEs) were assessed. The predictive factors for AEs were also investigated through regression analysis. The EUS-BD approach was considered either as the first option after standard cannulation failure or as the final option after advanced cannulation failure.1016 patients with DMBO were included in the study, with 524 (51.6%) matching the definition of DBC. Clinical success was achieved in 956 patients (94.1%). Procedure-related AEs were experienced by 167 patients (16.4%). Patients with DBC had a higher risk of AEs (=0.003); however, patients undergoing "early" EUS-BD showed a risk of AEs comparable with those managed with standard cannulation (=0.38). An attempt at any advanced cannulation technique was independently associated with the occurrence of AEs (=0.001).The risk of AEs is higher in patients with DMBO and DBC, this appears to be mainly related to the advanced cannulation techniques. In patients with a dilated CBD (>12 mm), "early" EUS-BD may minimize the risk of AEs.
M. Spadaccini has received speaker’s fees from Boston Scientific. C. Binda has received speaker’s fees from Fujifilm. Q3 Medical, and Boston Scientific. R. Legros has received fees for training from Boston Scientific, Olympus Corp., ERBE, and Fujifilm. M. Colombo has received speaker’s fees from Boston Scientific. J. Albouys has received fees for training from Fujifilm and Boston Scientific. C. Fabbri has received speaker’s fees from Steris, Q3 Medical, and Boston Scientific. A. Anderloni has received consultancy fees from Olympus Corp. and Boston Scientific. C. Hassan has received consultancy fees from Fujifilm and Medtronic. J. Jacques has received fees for training from Boston Scientific and Olympus Corp., for consultancy and training from ERBE and Fujifilm, and for training from Pentax. A. Repici has received consultancy fees from Fujifilm, Olympus Corp., Medtronic, and Boston Scientific. A. Fugazza has received consultancy fees from Boston Scientific. A. Mauro, M. Giacchetto, M. Andreozzi, S. Carrara, D. Ramai, S. Mazza, C. Coluccio, and A. Facciorusso declare that they have no conflict of interest.
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