Experiencia inicial con derivación biliar mediante coledocoduodenostomía guiada por ultrasonido endoscópico en la obstrucción biliar maligna en un hospital de referencia en Colombia / Initial experience with endoscopic ultrasound-guided biliary drainage via choledochoduodenostomy (EUS-CDS) in malignant biliary obstruction in a reference hospital in Colombia

Resumen Introducción: en pacientes con obstrucción biliar distal maligna en quienes la derivación biliar mediante colangiopancreatografía retrógrada endoscópica (CPRE) no sea factible o sea fallida, el drenaje biliar guiado por ultrasonido endoscópico mediante coledocoduodenostomía es una opción terapéutica viable, de la que se describen altas tasas de éxito técnico y clínico con una baja morbimortalidad. Adicionalmente, este método podría ser superior en la mejora de la calidad de vida en comparación con el manejo percutáneo o quirúrgico. Objetivo: describir la experiencia inicial con el drenaje biliar guiado por ultrasonido endoscópico en pacientes con obstrucción biliar maligna en un centro de referencia. Métodos: es una serie de casos retrospectiva de 6 pacientes con obstrucción biliar maligna a quienes se les realizó inicialmente una CPRE que fue fallida, por lo cual se procedió a realizar coledocoduodenostomía guiada por ultrasonografía endoscópica. Se describieron las tasas de éxito técnico, éxito clínico, eventos adversos, tasas de disfunción y tiempo de supervivencia de los pacientes. Resultados: se analizaron 6 casos, predominó el sexo femenino, con un promedio de edad de 71,8 ± 19,8 años; las indicaciones fueron adenocarcinoma de páncreas, tumor periampular y colangiocarcinoma distal. Se observó un éxito técnico en el 100 % de los casos y éxito clínico en 83,3 % de los casos. No se registraron eventos adversos graves. En el seguimiento de los casos se observó una supervivencia del 66,7 % a los 30 días. Conclusión: la coledocoduodenostomía es una alternativa terapéutica viable, segura y efectiva en pacientes con obstrucción biliar maligna en quienes la CPRE fue fallida, con una alta tasa de éxito técnico y clínico.

Abstract Introduction: Patients with malignant biliary distal obstruction who cannot be treated with endoscopic retrograde cholangiopancreatography (ERCP) or who had a failed ERCP, can find alternative treatment in endoscopic ultrasound-guided biliary drainage via choledochoduodenostomy. EUS-CDS performs with high rates of technical and clinical success and with low rates of morbimortality. Moreover, this method could have the potential to improve the patient's quality of life, compared with percutaneous or surgical means. Objective: This study aims to describe the initial experience with endoscopic ultrasound-guided biliary drainage in patients with malignant biliary distal obstruction in a reference center. Methods: Retrospective case review of six patients with malignant biliary obstruction and prior ERCP-placed and failed. Endoscopic ultrasound-guided biliary drainage via choledochoduodenostomy was performed as an alternative method. Technical and clinical success rates, adverse event rates, dysfunction rates, and patient survival time were described. Results: 6 cases were analyzed with a higher proportion of female patients, with a mean age of 71,8 ± 19,8 years. The symptoms were related to pancreas adenocarcinoma, periampullary tumor, and distal cholangiocarcinoma. The procedure was technically successful in 100% of cases and clinically successful in 83% of cases. Serious adverse events were nor reported. After 30 days, a survival rate of 66,7 % was observed. Conclusion: Choledochoduodenostomy is a viable, safe, and effective method in patients with malignant biliary obstruction who had a failed ERCP, and it has high rates of technical and clinical success.

Comparison of the Effectiveness of Interventional Endoscopy in Bleeding Peptic Ulcer Disease according to the Timing of Endoscopy

BACKGROUND/AIMS: The optimal timing for interventional endoscopy in bleeding peptic ulcer disease is controversial. This study compared the outcomes between early endoscopy and delayed endoscopy in patients with bleeding peptic ulcer disease. METHODS: We conducted a prospective analysis of data from 90 patients with bleeding peptic ulcer disease who visited the emergency room between May 2006 and September 2007. Patients were categorized into two groups: the early-endoscopy group (admitted during the daytime or at night with prompt endoscopic management) and the delayed-endoscopy group (admitted at night or during weekends, with endoscopic management delayed until the next day). We compared the clinical outcomes of endoscopy between the two groups. RESULTS: There were 49 patients in the early-endoscopy group and 41 patients in the delayed-endoscopy group. Patient demographics, clinical characteristics, bleeding control modality, and Rockall score did not differ between the two groups. There were also no significant differences between the early- and delayed-endoscopy groups in the re-bleeding rate (3/49 vs 5/41, p=0.313), the duration of hospital stay (10.7 vs 9.3 days, p=0.437), and the total amount of blood transfused (3.4 vs 2.7 units, p=0.240). CONCLUSIONS: The effectiveness of interventional endoscopy for patients with bleeding peptic ulcer disease is not significantly affected by the timing of endoscopy.