Biliary drainage prior to pancreatoduodenectomy with Endoscopic Ultrasound-guided choledochoduodenostomy vs conventional Endoscopic Retrograde Cholangiopancreatography: a propensity score matched study and surgeon-survey.

• Tác giả: Marc G Besselink, Bert A Bonsing, Olivier Busch, Freek Daams, Mike J P de Jong, Roeland F de Wilde, Wouter J M Derksen, Sebastiaan Festen, Jeska A Fritzsche, Frederik J H Hoogwater, Akin Inderson, Sjoerd D Kuiken, Mike S L Liem, Daan J Lips, Maarten W Nijkamp, Peter D Siersema, Martijn W J Stommel, Lydi van Driel, Erwin-Jan M van Geenen, Hjalmar Van Santvoort, Roy L J van Wanrooij, Niels G Venneman, Robert C Verdonk, Frank P Vleggaar, Rogier P Voermans
• Ngôn ngữ: eng
• Ký hiệu phân loại: 635.955 Groupings by soil factors
• Thông tin xuất bản: Germany : Endoscopy , 2025
• Bộ sưu tập: NCBI
• ID: 691565

Tóm tắt

 Background Preoperative endoscopic biliary drainage may lead to complications (16%-24%), potentially hampering surgical exploration. Endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) may reduce drainage-related complications, however it is unknown whether EUS-CDS could in itself hamper surgical exploration as series with surgeon reported outcomes are lacking. Aim is to assess the impact of preoperative EUS-CDS on pancreatoduodenectomy. Method Consecutive patients who underwent pancreatoduodenectomy after preoperative biliary drainage were included in all eight centers that performed EUS-CDS in the mandatory Dutch Pancreatic Cancer Audit (Jan 2020-Dec 2022). Primary outcome was major postoperative complications. Secondary outcomes included bile leak grade B/C, postoperative pancreatic fistula (POPF) grade B/C, and overall postoperative complications. A propensity score matching (1:3) analysis was performed. Surgeons who performed a pancreatoduodenectomy after EUS-CDS were asked to complete a survey. Results Overall, 937 patients with pancreatoduodenectomy after preoperative biliary drainage were included (42 EUS-CDS, 895 ERCP). Major postoperative complications occurred in eight patients (19%) in the EUS-CDS group and 292 patients (33%) in the ERCP group (RR 0.50
  95%CI, 0.23-1.07). No significant differences were observed in overall complications (RR 0.95
  95%CI, 0.51-1.76), bile leak (RR 1.25
  95%CI, 0.31-4.98) or POPF (RR 0.62
  95%CI, 0.25-1.56). Results were similar after matching. The survey was completed for 29 pancreatoduodenectomies
  surgery was not (n=13, 45%), 'slightly' (n=8, 28%), 'clearly' (n=5, 17%) or 'severely' (n=2, 7%) more complex because of the EUS-CDS. Conclusion This early experience suggests that preoperative biliary drainage with EUS-CDS does not increase the rate of complications after pancreatoduodenectomy and only infrequently hampers surgical exploration.