Su1262 A FEASIBILITY AND SAFETY OF EUS-GUIDED HEPATICOESOPHAGOSTOMY AS A TRANSESOPHAGEAL EUS-BD

EUS-guided biliary drainage (EUS-BD) has been developed as an alternative biliary drainage after failed ERCP. Bile duct segment 3 (B3) (transgastric route) is a preferred drainage route over bile duct segment 2 (B2) in safety because B2 puncture via transesophageal route has been associated with severe adverse events such as mediastinitis or pneumomediastinum in some case reports. There has been no sufficient data of describing clinical performance of EUS guided transesophageal drainage. We puncture the bile duct segment 2 (B2), intraabdominal transesophageal route under crus of the diaphragm on EUS in performing B2 puncture EUS-BD. We conducted a retrospective analysis of efficacy and safety of EUS-HES (transesophageal route) in comparing with EUS-HGS (transgastric route). Patients who underwent EUS-BD from April 2015 to November 2019 were investigated retrospectively. Technical success rates were 100%[17/17] in the EUS-HES and 96.4%(81/84) in the EUS-HGS. The rate of puncture of B2 were significantly high in the EUS-HES compared with EUS-HGS (B2 88.2% [15/17] vs. B3 11.7%[2/17] in the EUS-HES, and B2 46[38/81]vs. B3 [42/81]vs B6[1/81], P=0.009). The incidence of severe procedural adverse events showed no statistical difference between the EUS-HES and the EUS-HGS (5.8% [1/17] in the EUS-HES vs. 4.9% [4/81] in the EUS-HGS, P=1). Severe procedural adverse event in EUS-HES was peritonitis due to leakage from fistula(n=1), and in HGS were bile leak(n=1) and bleeding(n=3). The median stent patency also showed no statistical difference between in EUS-HES, 113 days (range, 6 to 483 days) and in EUS-HGS, 116 days (range, 0 to 507 days) (P=0.116). EUS-HES showed technically feasible and similar duration of stent patency compared with HGS without severe mediastinal complications.