The study compared two methods of preoperative biliary drainage for patients undergoing pancreatoduodenectomy: endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) and conventional endoscopic retrograde cholangiopancreatography (ERCP). Preoperative biliary drainage is often necessary but can lead to complications that complicate surgery.
The study compared two methods of preoperative biliary drainage for patients undergoing pancreatoduodenectomy: endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) and conventional endoscopic retrograde cholangiopancreatography (ERCP). Preoperative biliary drainage is often necessary but can lead to complications that complicate surgery. EUS-CDS has been proposed as a safer alternative to ERCP, but its impact on surgical outcomes and complexity was unclear.
The study analyzed 937 patients across eight Dutch centers, with 42 undergoing EUS-CDS and 895 undergoing ERCP before surgery. Major postoperative complications occurred in 19% of EUS-CDS patients compared to 33% of ERCP patients, suggesting a trend toward fewer major complications with EUS-CDS (relative risk 0.50), although this difference was not statistically significant. Secondary outcomes, such as overall complications, bile leaks, and pancreatic fistulas, were similar between the two groups. Propensity score-matched analysis confirmed these findings, indicating no significant difference in postoperative risk between the techniques.
Surgeons reported that prior EUS-CDS rarely made surgery more challenging, with most finding it not (45%) or only slightly (31%) more difficult. Only 24% found it clearly or severely more complex.
Overall, EUS-CDS appears to be a safe and effective preoperative biliary drainage method, with no significant impact on postoperative complications or surgical complexity.
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