P-THER-13: Endoscopic ultrasound-guided hepaticoenterostomy for primary drainage in patients with surgically altered upper gastrointestinal anatomy and malignant biliary obstruction

BACKGROUND AND OBJECTIVES: Endoscopic ultrasound-guided hepaticoenterostomy (EUS-HES) has been reported as an alternative to the percutaneous or surgical approach after failed endoscopic retrograde cholangiopancreatography (ERCP). We have performed EUS-HES as a primary drainage in patients with surgically altered upper gastrointestinal anatomy and malignant biliary obstruction without ERCP. The present study aims to evaluate the safety and the efficacy of primary EUS-HES. METHODS: A total of seventy EUS-HES were performed at our institution between January 2012 and February 2017, and 26 of these patients with surgically altered upper gastrointestinal anatomy and malignant biliary obstruction underwent EUS-HES for primary drainage. The patients were prospectively enrolled, and the clinical data were retrospectively collected for these 26 cases. An intention-to-treat analysis was used to investigate the technical success rate. RESULTS: The median age was 68 years (male/female 16/10). The technical success rate was 100% (26/26) and clinical success rate was 96.2% (25/26). Early adverse event rate was 15.4% (4/26). Segmental cholangitis were seen in two cases, fever was seen in one case, and reflux esophagitis due to bile reflux was seen in one case. All cases were treated conservatively. Serious adverse events were not seen. The stent dysfunction was seen in ten patients. The causes of stent dysfunction were biliary sludge (n = 11) and distal stent migration (n = 2). In 12 cases, we could reinsert a new stent easily. In only one patient, we chose percutaneous drainage because of general condition turned worse. CONCLUSIONS: Primary EUS-HES was safety and useful, especially for avoiding serious adverse events and reintervention.