TY - JOUR
T1 - Biliary drainage prior to pancreatoduodenectomy with endoscopic ultrasound-guided choledochoduodenostomy versus conventional ERCP
T2 - Propensity score-matched study and surgeon survey
AU - Fritzsche, Jeska A
AU - de Jong, Mike J P
AU - Bonsing, Bert A
AU - Busch, Olivier
AU - Daams, Freek
AU - Derksen, Wouter J M
AU - van Driel, Lydi
AU - Festen, Sebastiaan
AU - van Geenen, Erwin-Jan M
AU - Hoogwater, Frederik J H
AU - Inderson, Akin
AU - Kuiken, Sjoerd D
AU - Liem, Mike S L
AU - Lips, Daan J
AU - Nijkamp, Maarten W
AU - Van Santvoort, Hjalmar
AU - Siersema, Peter D
AU - Stommel, Martijn W J
AU - Venneman, Niels G
AU - Verdonk, Robert C
AU - Vleggaar, Frank P
AU - de Wilde, Roeland F
AU - Besselink, Marc G
AU - van Wanrooij, Roy L J
AU - Voermans, Rogier P
N1 - Publisher Copyright:
© 2025. The Author(s).
PY - 2025/7
Y1 - 2025/7
N2 - 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, in the absence of surgeon-reported outcomes, it is unknown whether EUS-CDS may hamper surgical exploration. This study assessed the impact of preoperative EUS-CDS on pancreatoduodenectomy. Method Consecutive patients who underwent pancreatoduodenectomy after preoperative biliary drainage were included in all eight centers performing EUS-CDS in the mandatory Dutch Pancreatic Cancer Audit (Jan 2020-Dec 2022). The 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 performing pancreatoduodenectomy after EUS-CDS completed a survey on surgical difficulty. Results 937 patients with pancreatoduodenectomy after preoperative biliary drainage were included (42 EUS-CDS, 895 endoscopic retrograde cholangiopancreatography [ERCP]). Major postoperative complications occurred in 8 patients (19.0%) in the EUS-CDS group and 292 (32.6%) in the ERCP group (relative risk [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 (13, 45%), slightly (9, 31%), clearly (5,17%), and severely (2, 7%) more complex because of 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.
AB - 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, in the absence of surgeon-reported outcomes, it is unknown whether EUS-CDS may hamper surgical exploration. This study assessed the impact of preoperative EUS-CDS on pancreatoduodenectomy. Method Consecutive patients who underwent pancreatoduodenectomy after preoperative biliary drainage were included in all eight centers performing EUS-CDS in the mandatory Dutch Pancreatic Cancer Audit (Jan 2020-Dec 2022). The 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 performing pancreatoduodenectomy after EUS-CDS completed a survey on surgical difficulty. Results 937 patients with pancreatoduodenectomy after preoperative biliary drainage were included (42 EUS-CDS, 895 endoscopic retrograde cholangiopancreatography [ERCP]). Major postoperative complications occurred in 8 patients (19.0%) in the EUS-CDS group and 292 (32.6%) in the ERCP group (relative risk [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 (13, 45%), slightly (9, 31%), clearly (5,17%), and severely (2, 7%) more complex because of 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.
UR - https://www.scopus.com/pages/publications/105005541948
U2 - 10.1055/a-2543-5672
DO - 10.1055/a-2543-5672
M3 - Article
C2 - 39978369
SN - 0013-726X
VL - 57
SP - 719
EP - 729
JO - Endoscopy
JF - Endoscopy
IS - 7
ER -