Duodenal Stenting Is Associated with Longer Biliary Patency in Endoscopic Ultrasound-Guided Biliary Drainage:...

Recently, EUS-guided biliary drainage (EUS-BD) has been widely used as the second biliary drainage method when endoscopic transpapillary drainage fails. A longer time to recurrent biliary obstruction (TRBO) is important for biliary stenting to avoid interfering with cancer treatment. However, the factors that influence the TRBO in EUS-BD are unknown. The aim of this study was to clarify the factors associated with the TRBO in EUS-BD.

All patients who underwent successful EUS-BD at Fukushima Medical University and Soma General Hospital were enrolled in this study. The factors associated with the TRBO were retrospectively analyzed (follow-up period: mean 215 ± standard deviation 214 days).

RBO was observed in 21/47 (44.7%) patients. According to the multivariate analyses, a duodenal stent before RBO was significantly associated with a longer TRBO (hazard ratio 0.34, 95% confidence interval 0.12-0.98; p = 0.045). The TRBO was also longer in patients with duodenal stents before RBO (p = 0.026) and in patients with braided biliary stents (p = 0.024). The TRBO became significantly longer according to the number of factors (p = 0.02).

Duodenal stents before RBO and braided biliary stents might be factors associated with a longer TRBO. Early duodenal stent insertion and braided biliary stent use might prevent food backflow, strongly dilate the biliary stricture, and lead to a longer TRBO.