Safety of Endoscopic Ultrasound-guided choledocho-duodenostomy in patients with malignant obstruction and ascites

Aims To evaluate the safety of endoscopic ultrasound-guided choledocho-duodenostomy (EUS-CDS) in malignant biliary obstruction (MBO) and ascites in a restrospective study.

Methods Prospectively maintained records of patients with MBO and ascites were retrospectively reviewed. Forty-four patients required EUS-CDS due to failed ERCP (28 males, 16 females). Forty-three underwent EUS-CDS, while one underwent a choledocho-gastrostomy. The data were reviewed for immediate postoperative complications (abdominal pain, fever, increase in ascites, bile leak) and technical success (defined as successful stent deployment).

Results The most common lesions were pancreatic cancer (22), ampullary cancer (9), and duodenal cancer (5). Four had distal cholangiocarcinoma, two revealed malignant lymph nodal metastases causing MBO, and one each had gastric cancer and gall bladder cancer. Ten patients (22.7%) had ascites in the pre-procedure imaging (six had grade I ascites, and two had grade II and III ascites each). Technical success was achieved in all patients. Only two patients with ascites had bile leak, and one patient had fever responsive to antibiotics. In the group without ascites before the procedure, one had bile leak. The incidence of major adverse events was comparable across the two groups (p=0.53).

Conclusions We hereby present the data to prove that EUS-CDS is safe in patients with MBO and ascites. Previously, EUS-guided drainage is generally presumed to be contra-indicated in the presence of ascites [1]. EUS-hepaticogastrostomy has been shown to be safe in the presence of ascites [2]. Further larger studies are needed to evaluate the long-term safety data of EUS-guided drainage and the effect on the survival of these patients.

Publication History

Article published online:
15 April 2024

• References

• 1 Sundaram S, Dhir V.. EUS-guided biliary drainage for malignant hilar biliary obstruction: A concise review. Endosc Ultrasound 2021; 10 (03) 154-160
• 2 Yasuda T, Hara K, Mizuno N. et al. Safety of endoscopic ultrasound-guided hepatico-gastrostomy in patients with malignant biliary obstruction and ascites. Clin Endosc 2023