EUS-guided biliary drainage in patients with distal malignant biliary obstruction requires fewer interventions and has a lower cost compared to ERCP biliary drainage

Introduction Endoscopic retrograde cholangiopancreatography (ERCP) biliary drainage is considered the reference standard in patients with biliary obstruction, but it is not free of complications. EUS-guided biliary drainage (EUS-BD) is considered an alternative in patients with failed ERCP; however, data are scarce as to whether EUS-BD could be considered a first option. Objective The aim of our study was to compare the need for reintervention and cost between ERCP biliary drainage vs. EUS-BD. Material and methods We conducted a retrospective and comparative study of patients with distal malignant biliary obstruction with biliary drainage with ERCP + plastic stent (ERCP-PS) vs.ERCP + metal stent (ERCP-MS) vs.EUS-BD. Results 124 patients were included, divided into three groups: ERCP-PS, 60 (48.3%) patients; ERCP-MS, 40 (32.2%) patients; and EUS-BD, 24 (19.3%) patients. The need for reinterventions (67 vs. 37 vs. 4%, respectively), the number of procedures [3 (1-10) vs.2 (1-7) vs. 1 (1-2)], and the costs (4550 +/- 3130 vs. 5555 +/- 3210 vs. 2375 +/- 1020 USD) were lower in the EUS-BD group. No differences in terms of complications were detected. Conclusion EUS-BD requires fewer reinterventions and has a lower cost compared to drainage by ERCP with metal or plastic stents.