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Efficacy of EUS- and ERCP-guided biliary drainage for malignant biliary obstruction: prospective randomized controlled study.

Efficacy of EUS- and ERCP-guided biliary drainage for malignant biliary obstruction: prospective randomized controlled study.
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Park JK, Woo YS, Noh D, Yang JI, Bae SY, Yun HS, Lee JK, Lee KT, Lee KH,


Park JK, Woo YS, Noh D, Yang JI, Bae SY, Yun HS, Lee JK, Lee KT, Lee KH, (click to view)

Park JK, Woo YS, Noh D, Yang JI, Bae SY, Yun HS, Lee JK, Lee KT, Lee KH,

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Gastrointestinal endoscopy 2018 03 29() pii S0016-5107(18)30250-5
Abstract
BACKGROUND AND AIMS
ERCP-guided biliary drainage (ERCP-BD is a criterion standard treatment for malignant biliary obstruction when curative surgery is not an option. Alternative methods such as PTBD would significantly lower the quality of life. EUS-guided biliary drainage (EUS-BD) has been developed and performed by experienced endoscopists. Therefore, the aims of this study were to evaluate the efficacy and safety of EUS-BD compared with ERCP in malignant biliary obstruction.

METHODS
The prospective randomized controlled study was conducted and 30 patients were enrolled; 15 for each EUS-BD and ERCP-BD arm. The technical success, procedural time, clinical success, and adverse events were evaluated.

RESULTS
Thirty patients had extrahepatic malignant biliary tract obstruction (19 males, 11 females). Twenty-seven patients had unresectable PDACs, 1 patient had distal common bile duct (CBD) cancer, and 2 patients had metastatic malignant lymphadenopathy. There were no significant differences both in terms of technical success rate and clinical success rate; 100% versus 93% and 93% versus 100% in ERCP-BD versus EUS-BD, respectively (p=1.00, p=1.00). Four patients (31%) had tumor ingrowth-caused stent dysfunction in the ERCP-BD group, whereas 2 patients had food impaction and 2 patients had stent migration in the EUS-BD group. No significant procedure-related adverse events occurred in either group.

CONCLUSIONS
This prospective randomized controlled study suggests that EUS-BD has similar safety to ERCP-BD. EUS-BD was not superior to ERCP-BD in terms of relief of malignant biliary obstruction. EUS-BD may have fewer cases of tumor ingrowth but may also have more cases of food impaction or stent migration. (ClinicalTrials.gov number, NCT01421836.).

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