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Publications

Journal Article Ppublish

PubMed: 42257926 DOI: 10.1007/s00464-026-12722-8

Choledochoduodenostomy versus transpapillary stent by endoscopic retrograde cholangiopancreatography for preoperative biliary drainage before pancreatoduodenectomy: a French multicenter retrospective cohort study.

Surg Endosc 40(6):4859-4874

Authors: Nadiya Belfil, Shani Diai, Jean-Michel Gonzalez, Sophie Chopinet, Jean Hardwigsen, Philippe Grandval, Mohamed Gasmi, Johan Gagniere, Théophile Guilbaud, Vincent Moutardier, Stéphane Berdah, Marc Barthet, David Jérémie Birnbaum

Affiliations

  • Department of Digestive Surgery, Aix-Marseille University, APHM, Hôpital Nord, Chemin Des Bourrely, 13015, Marseille, France.
  • Public Health Laboratory, Aix-Marseille University, Hôpital de La Timone, Marseille, France.
  • Department of Gastroenterology, Aix-Marseille University, APHM, Hôpital Nord, Marseille, France.
  • Department of Digestive Surgery and Liver Transplantation, Aix-Marseille University, APHM, Hôpital de La Timone, Marseille, France.
  • Department of Gastroenterology, Aix-Marseille University, APHM, Hôpital de La Timone, Marseille, France.
  • Department of Digestive Surgery, Hôpital Estaing, Clermont-Ferrand, France.
  • Department of Digestive Surgery, Aix-Marseille University, APHM, Hôpital Nord, Chemin Des Bourrely, 13015, Marseille, France.

Abstract

BACKGROUND

Few studies have compared the different types of endoscopic biliary drainage, particularly endoscopic retrograde cholangiopancreatography (ERCP) versus Endoscopic ultrasound guided-Choledochoduodenostomy (EUS-CD), for jaundice caused by malignant biliary obstruction prior to pancreatoduodenectomy.

METHODS

Patients were divided into two groups for biliary drainage: ERCP versus EUS-CD. Groups were compared in terms of post-procedure and postoperative morbidity and mortality rates. Overall survival (OS) and disease-free survival (DFS) rates were compared according to the type of BD in patients with pancreatic ductal adenocarcinoma (PDAC).

RESULTS

Between June 2016 and April 2023, 110 patients were included (EUS-CD, n = 32; ERCP, n = 78). There were no differences in terms of demographic characteristics, post-procedure morbidity, length of hospital stay, postoperative morbidity, and mortality after propensity score matching. Technical and clinical success rates were similar. Oncological safety did not differ between the groups. Soft pancreatic gland texture was the only factor influencing the occurrence of clinically relevant postoperative pancreatic fistula (p = 0.002). In the matched PDAC subgroup, extended resections were the only factor independently associated with overall survival (p = 0.015), whereas BD type (p = 0.020), patient sex (p = 0.032), and CA 19-9 levels (p = 0.032) were independently associated with disease-free survival. The ERCP group had numerically higher 1-, 3-, and 5-year OS rates than the EUS-CD group, without reaching statistical significance (p = 0.127). No significant difference in DFS was observed between groups (p = 0.694).

CONCLUSION

Postoperative morbidity and mortality were comparable between groups, with no significant differences observed in long-term survival outcomes.

MeSH

Cholangiopancreatography, Endoscopic Retrograde, Drainage, Stents, Mortality, Disease-Free Survival, Pancreaticoduodenectomy, Cohort Studies, Endoscopy, Morbidity