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Journal Article Ahead of print 1 citation

PubMed: 42572882 DOI: 10.14309/ajg.0000000000004182

Advanced cannulation techniques vs early EUS-BD in case of difficult biliary cannulation in patients with DMBO: an international propensity score-matched analysis.

Am J Gastroenterol

Authors: Marco Spadaccini, Jérémie Albouys, Cecilia Binda, Aurelio Mauro, Arnaldo Amato, Michele Amata, Filippo Antonini, José Ramón Aparicio Tormo, Paolo Giorgio Arcidiacono, Giovanni Aragona, Alexander Arlt, Debora Berretti, Torsten Beyna, Ivo Boskoski, Lucio Carrozza, Natalia Causada Calo, Anna Cominardi, Giuseppe Dell'Anna, Giovanna Del Vecchio Blanco, Roberto Di Mitri, Gianfranco Donatelli, Francesco Ferrara, Alessandro Fugazza, Pietro Fusaroli, Joan B Gornals, Mateusz Jagielski, Kareem Khalaf, Romain Legreos, Andrea Lisotti, Giovanni Lombardi, Ludovic Lukenga Safu, Alberto Martino, Belen Martínez-Moreno, Tajana Pavic, Enrique Perez-Cuadrado Robles, Ulrich Rosien, Valeria Poletti, Abdulrahman Qatomah, Daryl Ramai, Gianenrico Rizzatti, Giacomo Emanuele Maria Rizzo, Andrada Seicean, Cristiano Spada, Albert Sumalla-Garcia, Ilaria Tarantino, Maria Terrin, Viveksandeep Thoguluva Chandrasekar, Edoardo Troncone, Giuseppe Vanella, Thomas Veiser … and 6 other authors

Affiliations

  • Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
  • IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
  • Hepatogastroenterology Unit, CHU de Limoges, Limoges, France.
  • Digestive Endoscopy and Gastroenterology Unit, Forlì-Cesena Hospitals, Azienda Unita Sanitaria Locale della Romagna, Forlì-Cesena, Italy.
  • Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
  • Digestive Endoscopy and Gastroenterology Department, Ospedale A. Manzoni, Lecco, Italy.
  • Gastroenterology and Endoscopy Unit, ARNAS Civico - Di Cristina - Benfratelli Hospital, Palermo, Italy.
  • Gastroenterology and Interventional Endoscopy Unit, C. e G. Mazzoni Hospital, Ascoli Piceno, Marche, Italy.
  • Endoscopy Unit, ISABIAL, Hospital General University Dr. Balmis, Alicante, Spain.
  • Division of Biliopancreatic Endoscopy and Endoscopic Ultrasonography Unit, IRCCS San Raffaele Hospital, Milan, Italy.
  • Gastroenterology and Hepatology Unit, Ospedale Civile, AUSL Piacenza, Piacenza, Italy.
  • Department of Gastroenterology, Israelitisches Krankenhaus, Hamburg, Germany.
  • Gastroenterology Unit, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy.
  • Department of Gastroenterology and Hepatology, Evangalisches Krankenhaus Düsseldorf, Düsseldorf, Germany.
  • Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
  • Gastroenterology Unit, Papardo Hospital, Messina, Italy.
  • Division of Gastroenterology St. Michael's Hospital, University of Toronto, Toronto, Canada.
  • Gastroenterology and Endoscopy Unit, IRCCS Policlinico San Donato, San Donato Milanese, IT.
  • Unité d'Endoscopie Interventionnelle, Hopital Privé des Peupliers, Ramsay Générale de Santé, Paris, France.
  • Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.
  • Department of Surgery, Oncology and Gastroenterology, Endoscopy Unit, Padova University Hospital, Padova, Italy.
  • Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola, BO, Italy.
  • Department of Digestive Diseases, Hospital Universitari de Bellvitge, Barcelona, Catalonia, Spain.
  • Department of General, Gastroenterological, and Oncological Surgery, Collegium Medicum Nicolaus Copernicus University, Toruń, Poland.
  • Department of Gastroenterology and Digestive Endoscopy, AORN "Antonio Cardarelli", Napoli, Italy.
  • Interventional Endoscopy, Department of Gastroenterology, Georges-Pompidou European Hospital, Paris, France.
  • Department of Gastroenterology and Hepatology, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia.
  • Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts.
  • Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS - ISMETT, Palermo, Italy.
  • Department of Internal Medicine, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
  • Wellstar Health/Augusta University Medical Center, Augusta, GA, United States.

Abstract

BACKGROUND AND OBJECTIVES

Biliary drainage(BD)in distal malignant biliary obstruction(DMBO)is often hampered by difficult biliary cannulation(DBC)during endoscopic retrograde cholangiopancreatography(ERCP). Advanced cannulation techniques(aERCP)may overcome DBC but still fail in up to 15% of cases, increasing the risk of adverse events(AEs). Early endoscopic ultrasound-guided BD(eEUS-BD)is a potential alternative. The aim of this study is to directly compare safety and efficacy of EUS-BD and aERCP.

METHODS

This is a retrospective, multicentric study(29 centres in United States, Canada, Europe), including patients with DMBO and common bile duct(CBD)diameter >12 mm, treated up to 2024. DBC cases managed with either eEUS-BD or aERCP were analysed. A 1:2 propensity score-matched cohort was generated to ensure comparability, with regression modeling and inverse probability of treatment weighting(IPTW)performed as sensitivity analyses. AEs rate was the primary outcome; secondary outcomes included BD failure and clinical success.

RESULTS

Standard cannulation failed in 2066/10,738(19.2%)ERCPs. aERCP and eEUS-BD were attempted in 1733 and 333 cases, respectively. After matching, 313 patients per EUS-BD group and 626 patients per aERCP group were analyzed. AEs occurred in 18.2% of aERCPs and 9.3% of eEUS-BD(p<0.01), with post-procedural pancreatitis the most frequent AE after aERCP(55 cases, 12.0%). Both regression and IPTW confirmed the robustness of these findings on the entire cohort. Technical success was significantly lower with aERCP(82.0% vs. 95.9%, p<0.01), clinical success was comparable(94.5% vs. 96.4%, p=0.89).

CONCLUSIONS

In patients with DMBO and dilated CBD, eEUS-BD is associated with fewer AEs and higher technical success than aERCP, supporting its role as a safer, more effective option in DBC.

MeSH

Cholangiopancreatography, Endoscopic Retrograde, Gastroenterology, Jaundice, Propensity Score, Pancreas