Background: Endoscopic ultrasound-guided biliary drainage (EUS-BD) is an emerging alternative technique for biliary drainage, which can provide potential benefits of internal drainage compared to percutaneuous transhepatic biliary drainage (PTBD). However, EUS-BD can be performed in only a small number of referral centers where there are endoscopic experts, and there are insufficient data comparing EUS-BD with PTBD. Also, there are no published data on patient preference for EUS-BD versus PTBD after failed endoscpic retrograde cholangiopancreatography (ERCP).
Methods: We enrolled 150 patients who were scheduled to undergo ERCP because of malignant biliary obstruction. Each patient received a booklet that described the techniques, benefits and complication rates of EUS-BD and PTBD. Then they were asked which method for biliary drainage they would prefer as an alternative procedure after failed ERCP, the reasons for their preference, their previous experience of endoscopic and other procedures, and how changes in the complication rate for EUS-BD would affect their preference.
Results: A total of 140 patients responded to the questionnaire (response rate 93.3%), and, of these, 105 patients (75.0 %) preferred EUS-BD (in EUS-BD-available center [40/44; 90.9%] and in EUS-BD-unavailable centers [65/96; 67.7%]). The advantages of EUS-BD were seen to be: 1) internal drainage (80.0%), 2) higher success rate and acceptable complication rate (15.2%), 3) a one-stage procedure (12.4%), and 4) other (4.8%). The most common reason for the choice of PTBD was its proven safety (68.6%). Previous experience of endoscopy, ERCP, or PTBD did not influence the choice of bile drainage technique. The preference for EUS-BD declined as its supposed complication rate increased (p<0.001). There were no significant differences in the preference for EUS-BD on the grounds of complication rate between centers in which EUS-BD was performed and those in which it was not performed (p=0.150).
Conclusions: After failed ERCP, EUS-BD is generally preferred over PTBD by patients in this survey. The fact that EUS-BD provides internal drainage appears to be the main reason for the preference. Most patients would prefer EUS-BD over PTBD if adverse events in EUS-BD were less frequent and comparable to PTBD.
Key word: Endoscopic ultrasound, Biliary drainage, Percutaneous transshepatic biliary drainage, Patient preference