Factors Associated With Difficult Endoscopic Ultrasonography-guided Biliary Drainage

Area of Science:

• Gastroenterology
• Interventional Endoscopy

Background:

• Endoscopic ultrasound-guided biliary drainage (EUS-BD) is an alternative when ERCP is challenging.
• EUS-BD requires significant operator expertise.

Purpose of the Study:

• To identify factors associated with difficult EUS-BD procedures.
• To establish predictive criteria for EUS-BD difficulty.

Main Methods:

• Retrospective analysis of patients who underwent EUS-BD.
• Division of patients into 'easy' (≤60 min) and 'difficult' (>60 min) procedural time groups.
• Comparison of patient characteristics and procedural factors between groups.

Main Results:

• No significant differences in patient characteristics between groups.
• Punctured bile duct diameter was significantly different.
• Multivariate analysis identified bile duct diameter as the sole predictor of difficulty (OR 0.65, P=0.012).
• A cutoff diameter of 7.0 mm predicted difficult EUS-BD with high sensitivity (84.2%) and specificity (86.4%).

Conclusions:

• Nondilated bile ducts are predictive of difficult EUS-BD.
• A punctured bile duct diameter of 7.0 mm can guide beginners in selecting puncture sites for EUS-BD.