| Objective: For patients with malignant obstructive jaundice who cannot undergo radical surgery,conservative biliary drainage is needed to relieve clinical symptoms.Endoscopic Retrograde Cholangiopancreatography(ERCP)-guided biliary drainage is the accepted first-line drainage method.Endoscopic ultrasound guided biliary Drainage(EUS-BD)is a newly developed internal drainage technique and one of the options for the treatment of malignant obstructive jaundice.The aim of this study is to analyze and compare the jaundice reduction efficiency and complications of internal biliary drainage guided by ERCP and EUS for malignant biliary obstruction,and to explore the differences in efficacy and safety between EUS-BD,as an emerging medical technology,and ERCP.Methods: Clinical data of patients with malignant obstructive jaundice who underwent EUS-BD and ERCP-guided biliary stent implantation admitted to Shengjing Hospital of China Medical University from January 2014 to November 2022 were collected,and propensity score matching(PSM)was performed on the data.The technical success rate,jaundice reducing efficiency,postoperative short-term complication rate and postoperative hospitalization days between the two methods were retrospectively compared,and the risk factors of jaundice reducing efficiency were analyzed.Results: A total of 63 patients were collected,including 16 patients with bile duct cancer(25.4%),40 patients with pancreatic cancer(63.5%),5 patients with periampullary cancer(7.9%),and 2 patients with duodenal cancer(3.2%).There were 37 patients(58.7%)in the ERCP group,including 33 patients(89.2%)with metal stent and 4 patients(10.8%)with plastic stent.There were 26 cases(41.3%)in EUS group,including 9 cases(34.6%)of EUS-CDS,14 cases(53.9%)of EUS-HGS,and 3 cases(11.5%)of EUS-AG.(1)At baseline,TBIL(141.78±76.15vs264.53±113.05,P<0.001),ALT(253.70±194.07vs125.77±87.70,P=0.003),AST(187.46±141.71vs121.12±76.75,P=0.034)had significant difference.(2)The success rate of EUS was 96.2%(25/26)and that of ERCP was 100%,with no significant difference.(3)Among 37 patients in EUS group,jaundice was significantly decreased in 28 cases(75.7%),effective in 6 cases(16.2%),and ineffective in 3 cases(8.1%).Among 26 patients in EUS group,jaundice was significantly decreased in 14 cases(53.9%),effective in 9 cases(34.6%),and ineffective in 3 cases(11.5%).There was no significant difference in jaundice reducing efficiency between the groups(P=0.178).Postoperative short-term complications were observed in 6 patients(16.2%)in ERCP group and 4patients(15.4%)in EUS group.There was no significant difference in the incidence of postoperative short-term complications between the two groups(P=1.000).After PSM,there was a balanced cohort between the two groups,with 11 cases in ERCP group and11 cases in EUS group.There were no significant differences in the jaundice reducing efficiency(P=0.063)and the incidence of postoperative short-term complications(P=1.000)between the two groups.(4)Compared significant jaundice reduction group,effective jaundice reduction group with ineffective jaundice reduction group,there were no significant differences in gender,age,TBIL,ALT,AST,PT,ALB,Hb,Neu% and surgical methods.The variables of potential risk factors were included in the multivariate analysis and corrected.The operation method,ALT,AST,TBIL and ALB were not independent risk factors for jaundice reducing efficiency.(5)The mean postoperative hospitalization days in ERCP group and EUS group were4.24±1.57 days and 7.27±5.39 days,showing statistical difference(P=0.003).Conclusions: For patients with malignant obstructive jaundice,both ERCP-guided biliary stent implantation and EUS-BD are effective internal drainage methods for reducing jaundice,with similar technical success rate,jaundice reducing efficiency and postoperative short-term complication rate.The length of hospitalization days after biliary stent implantation guided by ERCP is shorter than that after EUS-BD. |
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