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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
EUS-Guided Choledocho-duodenostomy Using Lumen Apposing Stent Versus ERCP With Covered Metallic Stents in Patients With Unresectable Malignant Distal Biliary Obstruction: A Multicenter Randomized Controlled Trial (DRA-MBO Trial)
Gastroenterology, Volume 165, No. 2, Year 2023
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Description
Background & Aims: Several studies have compared primary endoscopic ultrasound (EUS)-guided biliary drainage to endoscopic retrograde cholangiopancreatography (ERCP) with insertion of metal stents in unresectable malignant distal biliary obstruction (MDBO) and the results were conflicting. The aim of the current study was to compare the outcomes of the procedures in a large-scale study. Methods: This was a multicenter international randomized controlled study. Consecutive patients admitted for obstructive jaundice due to unresectable MDBO were recruited. Patients were randomly allocated to receive EUS-guided choledocho-duodenostomy (ECDS) or ERCP for drainage. The primary outcome was the 1-year stent patency rate. Other outcomes included technical success, clinical success, adverse events, time to stent dysfunction, reintervention rates, and overall survival. Results: Between January 2017 and February 2021, 155 patients were recruited (ECDS 79, ERCP 76). There were no significant differences in 1-year stent patency rates (ECDS 91.1% vs ERCP 88.1%, P = .52). The ECDS group had significantly higher technical success (ECDS 96.2% vs ERCP 76.3%, P < .001), whereas clinical success was similar (ECDS 93.7% vs ERCP 90.8%, P = .559). The median (interquartile range) procedural time was significantly shorter in the ECDS group (ECDS 10 [5.75–18] vs ERCP 25 [14–40] minutes, P < .001). The rate of 30-day adverse events (P = 1) and 30-day mortality (P = .53) were similar. Conclusion: Both procedures could be options for primary biliary drainage in unresectable MDBO. ECDS was associated with higher technical success and shorter procedural time then ERCP. Primary ECDS may be preferred when difficult ERCPs are anticipated. This study was registered to Clinicaltrials.gov NCT03000855. © 2023 AGA Institute
Authors & Co-Authors
Teoh, Anthony Yuen Bun
Hong Kong, Hong Kong
Chinese University of Hong Kong
Napoleón, Bertrand V.
France, Lyon
Hôpital Privé Jean Mermoz
Arcidiacono, Paolo Giorgio
Italy, Milan
Irccs Ospedale San Raffaele
Kongkam, Pradermchai
Thailand, Bangkok
Chulalongkorn University
Larghi, Alberto
Italy, Rome
Fondazione Policlinico Universitario Agostino Gemelli Irccs
van der Merwe, Schalk Willem
Belgium, Leuven
Ku Leuven
Saxena, Payal
Australia, Sydney
Royal Prince Alfred Hospital
Chan, Shannon Melissa
Hong Kong, Hong Kong
Chinese University of Hong Kong
Fumex, Fabien
France, Lyon
Hôpital Privé Jean Mermoz
Kaffes, Arthur John
Australia, Sydney
Royal Prince Alfred Hospital
Chiu, Philip Wai Yan
Hong Kong, Hong Kong
Chinese University of Hong Kong
Statistics
Citations: 12
Authors: 11
Affiliations: 11
Identifiers
Doi:
10.1053/j.gastro.2023.04.016
ISSN:
00165085
Research Areas
Cancer
Study Approach
Quantitative