Endoscopic ultrasound-guided choledochoduodenostomy vs. transpapillary stenting for distal XXXX .

@entity1 @entity253 @entity788
UNASSIGNED: Background and study aims: Endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) has gained popularity as an alternative to percutaneous biliary drainage for @entity1 in whom endoscopic retrograde cholangiopancreatography has failed. There are no previous studies comparing EUS-CDS with endoscopic transpapillary stenting (ETS) as first-line treatment for distal malignant obstruction. The aim of this study was to compare the clinical efficacy and safety of EUS-CDS and ETS as first-line treatment in @entity1 with distal malignant @entity253 . @entity1 and methods: A total of 82 @entity1 with distal malignant @entity253 underwent initial biliary drainage using self-expandable metal stents at a tertiary care university hospital. ETS was performed between June 2009 and May 2012, and EUS-CDS was performed between May 2012 and March 2014. Clinical success rates, adverse event rates, and reintervention rates were retrospectively evaluated for EUS-CDS and ETS. Results: A total of 26 @entity1 underwent EUS-CDS and 56 underwent ETS.Clinical success rates were equivalent between the groups (EUS-CDS 96.2%, ETS 98.2%; P=0.54). The mean procedure time was significantly shorter with EUS-CDS than with ETS (19.7 vs. 30.2 minutes; P<0.01). The rate of overall adverse events was not significantly different between the groups (EUS-CDS 26.9%, ETS 35.7%; P=0.46). Post-procedural @entity788 was only observed in the ETS group (0% vs. 16.1%; P=0.03). The reintervention rate at 1 year was 16.6% and 13.6% for EUS-CDS and ETS, respectively (P=0.50). Conclusions: EUS-CDS performed by expert endoscopists was associated with a short procedure time and no risk of @entity788 , and would therefore be feasible as a first-line treatment for @entity1 with distal malignant @entity253 .
