Abstract
ABSTRACT
Background
Duodenal invasion is a risk factor for early recurrent biliary obstruction (RBO) due to the increased risk of duodenobiliary reflux. Transpapillary biliary drainage using anti‐reflux metal stents (ARMS) and endoscopic ultrasound‐guided hepaticogastrostomy (EUS‐HGS) are two different strategies for this condition.
Methods
We retrospectively reviewed unresectable pancreatic cancer (PC) patients with duodenal invasion who underwent either transpapillary biliary drainage using duckbill‐type ARMS (D‐ARMS) or EUS‐HGS for malignant distal biliary obstruction (MDBO). Technical and clinical success, causes of RBO, non‐RBO adverse events (AEs), time to RBO (TRBO), and endoscopic reintervention (ERI) were compared between groups.
Results
Forty‐four patients were included (D‐ARMS: 22, EUS‐HGS: 22). Technical and clinical success rates, and non‐RBO AE rates (9.1% vs. 36.4%,
p
= 0.069) were not significantly different between groups. Common causes of RBO were biliary debris/stones in the D‐ARMS group and hyperplasia in the EUS‐HGS group. Overall RBO rates (33.3% vs. 45.0%,
p
= 0.53), median TRBO (246 vs. 222 days,
p
= 0.98), and outcomes after ERI were comparable between groups.
Conclusions
Transpapillary biliary drainage using D‐ARMS may be a viable option in managing MDBO with duodenal invasion, especially for non‐high‐volume centers, when both procedures are technically feasible.